Grand Rounds | 2022-2023

Putting Dogmas of Cardiology to the Test

John M. Mandrola, MD
Cardiology & Electrophysiology
Baptist Health

Overview:

While the field of cardiology has been exemplary in the generation of evidence, much of what we now accept as therapeutic fashion comes with weak evidentiary support. My goal is to use historical lessons as a means to render learners less susceptible to dogma and medical reversals.

Objectives:

At the conclusion of the activity a participant should be able to:

• Use seminal trials to guide current critical appraisal
• Resist the urge to accept practices with weak evidentiary support
• Use critical appraisal skills to reset prior beliefs about what does and does not benefit patients

Disclosures:

John Mandrola, MD has nothing to disclose relevant to the content of his presentation

The Planning Committee has nothing to disclose relevant to this program.

The THI CME Staff has nothing to disclose relevant to this program.

The Program Reviewers has nothing to disclose relevant to this program.

All relevant financial relationships have been mitigated.

Accreditation

Texas Heart Institute is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation

Texas Heart Institute designates this live activity for a maximum of 1.00 AMA PRA Category 1 Credits^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Takotsubo Cardiomyopathy: Can We Finally Clarify its Cause and Pathophysiology?

Paolo E. Angelini, MD
Interventional Cardiology
Texas Heart Institute

Overview:

Takotsubo cardiomyopathy (TTC) is a persistently confusing condition especially affecting women.

Its causes and most effective treatment are still unclear.  We have developed at Texas heart institute a novel theory based on endothelial dysfunction and coronary spasm.  We have substantial objective evidence now to claim that TTC can finally be reproduced in the Cath lab by acetylcholine testing of endothelial dysfunction and that intracoronary nitroglycerine can reliably abort the presentation.

Objectives:

At the conclusion of the activity a participant should be able to:

• Discuss the condition to establish the individual patient liability to Takotsubo is endothelial dysfunction. Acetylcholine testing can reproduce this entity during heart catheterization. Catecholamine surge can be a non-essential precipitating cause in predisposed patients.
• Discuss Nitroglycerine that can apparently abort Takotsubo if given early in its onset. Long term Calcium antagonists can apparently be successful in preventing relapsing.

Disclosures:

Paolo E. Angelini, MD has nothing to disclose relevant to this program.

The Planning Committee has nothing to disclose relevant to this program.

The THI CME Staff has nothing to disclose relevant to this program.

The Program Reviewers has nothing to disclose relevant to this program.

Accreditation

Texas Heart Institute is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation

Texas Heart Institute designates this live activity for a maximum of 1.00 AMA PRA Category 1 Credits^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Current Management of Acute Type B Aortic Dissection

Ourania Preventza, MD
Cardiothoracic Surgery
Baylor St Luke’s Medical Center

Overview:

We will discuss current management of acute Type B aortic dissection: Pros and cons of medical and surgical management

Objectives:

At the conclusion of the activity a participant should be able to:

• Review the latest advances and management of acute Type B aortic dissection
• Discuss the pros and cons of medical versus surgical treatment

Disclosures:

Ourania Preventza, MD is a consultant for W. L. Gore and Terumo.

The Planning Committee has nothing to disclose relevant to this program.

The THI CME Staff has nothing to disclose relevant to this program.

The Program Reviewers has nothing to disclose relevant to this program.

All relevant financial relationships have been mitigated.

Accreditation

Texas Heart Institute is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation

Texas Heart Institute designates this live activity for a maximum of 1.00 AMA PRA Category 1 Credits^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Overview:

We will review of worldwide outcomes of ECMO for COVID-19 and our institutional and TMC opportunities for collaboration with ECMO

Objectives:

At the conclusion of the activity a participant should be able to:

• Summarize indications and outcomes for ECMO in COVID-19 respiratory failure
• Demonstrate opportunities for collaborative during the COVID-19 pandemic
• Evaluate sustainable lessons from the COVID-19 ECMO experience

Disclosures:

Subhasis Chatterjee, MD is on advisory board for Edwards Lifesciences, La Jolla Pharmaceuticals, Baxter Pharmaceuticals, and Eagle Pharmaceuticals.

The Planning Committee has nothing to disclose relevant to this program.

The THI CME Staff has nothing to disclose relevant to this program.

The Program Reviewers has nothing to disclose relevant to this program.

All relevant financial relationships have been mitigated.

 Accreditation:

Texas Heart Institute is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation:

Texas Heart Institute designates this live activity for a maximum of 1.00 AMA PRA Category 1 Credits^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Carolyn Lam, MD, PhD

Professor, Duke-National University of Singapore
Senior Consultant, Department of Cardiology and Director of Women’s Heart Health
National Heart Centre Singapore

Overview:

This lecture traces the development of understanding HFpEF and its treatment over the years; and what are the current and future management of HFpEF.

Objectives:

At the conclusion of the activity a participant should be able to:

• Describe the evolution of nomenclature and mechanistic understanding of HFpEF
• Review treatment approaches that have and have not worked in HFpEF
• Explain recent developments and their implications for future management of HFpEF

 Disclosures:

Carolyn Lam, MD, PhD is a consultant or on the advisory board for Actelion, Alleviant Medical, Allysta Pharma, Amgen, AnaCardio AB, Applied Therapeutics, AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Cytokinetics, Darma Inc., EchoNous Inc, Eli Lilly, Impulse Dynamics, Intellia Therapeutics, Ionis Pharmaceutical, Janssen Research & Development LLC, Medscape/WebMD Global LLC, Merck, Novartis, Novo Nordisk, Prosciento Inc, Radcliffe Group Ltd., ReCor Medical, Roche Diagnostics, Sanofi, Siemens Healthcare Diagnostics and Us2.ai.  She receives research grant support for Bayer and Roche Diagnostics.  She is also co-founder and non-executive director forf US2.ai.

The Planning Committee has nothing to disclose relevant to this program.

The THI CME Staff has nothing to disclose relevant to this program.

The Program Reviewers has nothing to disclose relevant to this program.

All relevant financial relationships have been mitigated.

Accreditation

Texas Heart Institute is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation

Texas Heart Institute designates this live activity for a maximum of 1.00 AMA PRA Category 1 Credits^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Robert H. Lustig, MD, MSL

Emeritus Professor of Pediatrics in the Division of Endocrinology
and Member of the Institute for Health Policy Studies at UCSF
University of California, San Francisco

Overview:

Mountain Dew Mouth has been the scourge of dentists for decades. But there’s a new disease which affects even more people: Mountain Dew Liver. Non-alcoholic fatty liver disease (NAFLD) wasn’t even discovered until 1980; and now up to 40% of Americans suffer from it, and it is now the leading cause of liver transplantation. Especially children – 13% of autopsies in children show NAFLD; and 38% of obese children. This disease belies all our other chronic diseases, including diabetes, heart disease, and cancer. And it is due to our excessive sugar consumption.  Dietary sugar is composed of one molecule each of glucose and fructose. It is the fructose that is the primary driver of both diseases.

 Objectives:

At the conclusion of the activity a participant should be able to:

• Describe the effect of fluoride on cariogenesis, and its role as adjunct vs. primary prevention
• Review how subcellular energy overload drives insulin resistance
• Explain the differences and similarities between hepatic glucose vs. ethanol vs. fructose metabolism

Disclosures:

Robert H. Lustig, MD, MSL has nothing to disclose relevant to this program

The Planning Committee has nothing to disclose relevant to this program.

The THI CME Staff has nothing to disclose relevant to this program.

The Program Reviewers has nothing to disclose relevant to this program.

Accreditation

Texas Heart Institute is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation

Texas Heart Institute designates this live activity for a maximum of 1.00 AMA PRA Category 1 Credits^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Howard Rockman, MD, MSL

Edward S. Orgain Distinguished Professor of Cardiology in the School of Medicine, Professor of Medicine and Professor in Cell Biology at the Duke University School of Medicine

Overview:

A historical perspective of the discovery of the beta adrenergic receptor and mechanisms of GPCR signaling that has led to our current understanding of receptor signaling and how targeting GCPRs are used in the treatment of heart failure.

Objectives:

At the conclusion of the activity a participant should be able to:

• Recognize the mechanism of activation of G Protein-Coupled Receptors
• Indicate the therapeutic role of G- Protein-Coupled Receptors in heart failure
• Identify new concepts in G Protein-Coupled Receptor signaling

Disclosures:

Howard Rockman, MD, MSL has stock and is also a Scientific Co-Founder in Trevena Inc.

The Planning Committee has nothing to disclose relevant to this program.

The THI CME Staff has nothing to disclose relevant to this program.

The Program Reviewers has nothing to disclose relevant to this program.

Accreditation

Texas Heart Institute is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation

Texas Heart Institute designates this live activity for a maximum of 1.00 AMA PRA Category 1 Credits^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Jagmeet P Singh, MD, PHD

Physician Investigator (Cl) at the Cardiovascular Research Center, Mass General Research Institute, Professor of Medicine at Harvard Medical School and Founding Director, Resynchronization and Advanced Cardiac Therapeutics Program at Mass General

Overview:

This presentation will discuss advances in cardiac resynchronization therapies, neuromodulation and other newer technologies for patients with advanced heart failure. It will also cover the importance of individualizing care, as well as providing multidisciplinary care to the advanced heart failure patient.

Objectives:

At the conclusion of the activity a participant should be able to:

• Demonstrate the newer technologies in promoting cardiac resynchronization
• Describe the newer electrical therapies for the new narrow QRS patient
• Distinguish the importance of multidisciplinary care for the heart failure patient an implanted device

Disclosures:

Jagmeet P Singh, MD, PHD is a consultant for Abbott, Boston Scientific, Biotronik M, Sanofi, Rhythm Management Group, Microport, Medtronic, EBR, and Cardiologs

The Planning Committee has nothing to disclose relevant to this program.

The THI CME Staff has nothing to disclose relevant to this program.

The Program Reviewers has nothing to disclose relevant to this program.

Accreditation

Texas Heart Institute is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation

Texas Heart Institute designates this live activity for a maximum of 1.00 AMA PRA Category 1 Credits^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Tirone E. David

Professor of Surgery at the University of Toronto
Melanie Munk Chair of Cardiovascular Surgery at the Peter Munk Cardiac Centre 

Overview:  

What surgical intervention has done for arrhythmogenic mitral regurgitation 

Objectives:  

At the conclusion of the activity a participant should be able to:  

• Explain why rrhythmogenic mitral valve remains a serious and unresolved health problem 
• Assess available approaches to reduce the risk of sudden death in patients with arrhythmogenic mitral valve 
• Recognize Future directions on the identification and treatment of arrhythmogenic mitral valve. 

Disclosures: 

Tirone E. David, MD has nothing to disclose relevant to this program. 

The Planning Committee has nothing to disclose relevant to this program. 

The THI CME Staff has nothing to disclose relevant to this program. 

The Program Reviewers has nothing to disclose relevant to this program. 

Accreditation 

Texas Heart Institute is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.  

Credit Designation 

Texas Heart Institute designates this live activity for a maximum of 1.00 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity. 

Jihad A. Mustapha, MD

President & Chief Executive Officer, Director of Endovascular Interventions
Advanced Cardiovascular & Vascular Centers
Grand Rapids, MI

Overview:

Below the knee intervention options for best outcomes in CLI.

Objectives:

At the conclusion of the activity a participant should be able to:

• Summarize best diagnostic options for suspected CLI patients and importance of optimal medical therapy and ongoing surveillance in this patient population.
• Summarize treatment options for patients with CLI
• Determine treatment approach for patient presenting with CLI

Disclosures:

Jihad A. Mustapha, MD is a consultant for Bectin, Dickinson & Co (BD) and Angiodynamics; he is a Consultant/Researcher for Boston Scientific and Avinger

The Planning Committee has nothing to disclose relevant to this program.

The THI CME Staff has nothing to disclose relevant to this program.

The Program Reviewers has nothing to disclose relevant to this program.

Accreditation

Texas Heart Institute is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation

Texas Heart Institute designates this live activity for a maximum of 1.00 AMA PRA Category 1 Credits^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Da-Zhi Wang, PhD

Professor of Internal Medicine and of Molecular Pharmacology and Physiology in the College of Medicine at the University of South Florida
Director of the Center for Regenerative Medicine at USF
Director of the USF Heart Institute

Overview:

• Demonstrate genetic evidence to support the function of miRNAs in the heart
• Critique basic molecular mechanism of how miRNAs work
• Define how miRNAs and RBPs could become novel therapies for disease

Objectives:

At the conclusion of the activity a participant should be able to:

• Knowledge of heart function and disease
• Potential of novel therapeutic targets and strategies for heart disease
• Animal models to study heart function and regeneration

Disclosures:

Da-Zhi Wang, PHD has nothing to disclose relevant to this program.

The Planning Committee has nothing to disclose relevant to this program.

The THI CME Staff has nothing to disclose relevant to this program.

The Program Reviewers has nothing to disclose relevant to this program.

Accreditation

Texas Heart Institute is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation

Texas Heart Institute designates this live activity for a maximum of 1.00 AMA PRA Category 1 Credits^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

John Elrod, PhD

Director of the Cardiovascular Research Center in the Lewis Katz School of Medicine at Temple University

Overview:

We recently reported that glutaminolysis is essential for the epigenetic changes permissive to activation of the myofibroblast differentiation program and cardiac fibrosis. In fact, targeting these pathways is sufficient to reverse fibrosis in models of heart failure. These findings implicate metabolic remodeling as a critical feature of myofibroblast formation and persistence in the diseased heart. This presentation will highlight metabolite-dependent epigenetic signaling, new data implicating paracellular metabolic crosstalk as prominent mechanism in myofibroblast formation, and novel therapeutic targets in cardiac fibrosis and heart failure.

Objectives:

At the conclusion of the activity a participant should be able to:

• Differentiate the role of fibroblast fate in the cardiac fibrotic response.
• Define the molecular pathways underlying myofibroblast formation and persistence.
• Summarize the basic metabolic underpinnings of fibroblast ECM deposition and function in the failing heart.

Disclosures:

John Elrod, PhD is a Paid consultant and SRA unrelated to current work for Mitobridge Inc., an Astellas Company. He is also an Consultant on projects unrelated to current work for Janssen, J&J.

The Planning Committee has nothing to disclose relevant to this program.

The THI CME Staff has nothing to disclose relevant to this program.

The Program Reviewers has nothing to disclose relevant to this program.

Accreditation

Texas Heart Institute is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation

Texas Heart Institute designates this live activity for a maximum of 1.00 AMA PRA Category 1 Credits^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Darren K. McGuire, MD

Professor in the Department of Internal Medicine at UT Southwestern Medical Center
Director of the Parkland Hospital and Health System Outpatient Cardiology clinics.

Overview:

Review of the regulatory landscape for drugs for type 2 diabetes and how recent and ongoing cardiovascular trials have impacted clinical care for patients with type 2 diabetes.

Objectives:

At the conclusion of the activity a participant should be able to:

• To review the history of FDA regulation of drugs for type 2 diabetes
• To summarize available data from completed CV outcomes trials in patients with type 2 diabetes.
• To review contemporary specialty society recommendations and guidelines regarding the use of antihyperglycemic medications for cardiovascular and kidney disease risk mitigation

Disclosures:

Darren K. McGuire, MD, MHSc was an Honoraria for clinical trial leadership for Afimmune and Sanofi. He is currently an Honoraria for clinical trial leadership for Boehringer Ingelheim, Merck & Co, Pfizer, AstraZeneca, Novo Nordisk, Esperion, and Lilly US. Dr. McGuire was an Honoraria for consultancy for Merck & Co, Applied Therapeutics, Metavant, Sanofi, and Affimmune. He is still an Honoraria for consultancy for Lilly USA, Boehringer Ingelheim, Novo Nordisk, Bayer, GlaxoSmithKline, Lexicon, Altimmune, and Esperion. Dr. McGuire was an Honoraria for Expert Testimony for Kirkland & Ellis: for the benefit of Boehringer Ingelheim (2020); Teva Pharmaceuticals (2021)

The Planning Committee has nothing to disclose relevant to this program.

The THI CME Staff has nothing to disclose relevant to this program.

The Program Reviewers has nothing to disclose relevant to this program.

Accreditation

Texas Heart Institute is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation

Texas Heart Institute designates this live activity for a maximum of 1.00 AMA PRA Category 1 Credits^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Morton J Kern, MD

Professor of Medicine, University of California, Irvine School of Medicine

Chief of Medicine, VA Long Beach Health Care System

Overview:

Review the fundamentals of coronary pressure and flow

Address the invasive measurements of coronary physiology using sensor wires

Compare outcome studies using physiology to guide PCI

Objectives:

At the conclusion of the activity a participant should be able to:

• Identify the fundamentals of coronary blood flow
• Apply the invasive measurements of pressure and flow in the heart
• Appreciate the outcome data using physiology to guide PCI

Disclosures:

Morton J Kern, MD is speaker for Abiomed, Abbott Vascular, Acist, Opsens, Phillips Inc., and Cathworks.

The Planning Committee has nothing to disclose relevant to this program.

The THI CME Staff has nothing to disclose relevant to this program.

The Program Reviewers has nothing to disclose relevant to this program.

Accreditation

Texas Heart Institute is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation

Texas Heart Institute designates this live activity for a maximum of 1.00 AMA PRA Category 1 Credits^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.