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Archive for the ‘Frontiers in Cardiology and Cardiovascular Disorders’ Category


First Surgical Robot Making Surgeon’s Life More Efficient

Reporter : Irina Robu, PhD

A team of microsurgeons and engineers, developed a high-precision robotic assistant called MUSA which is clinically and commercially available. The high precision robotic assistant is compatible with current operating techniques, workflow, instruments and other or instrument.   Microsure is a medical device company in The Netherlands founded by Eindhoven University of Technology and Maastricht University Medical Center in 2016. Microsure’s focus is to improve patients’ quality of life through developing robot systems for microsurgery.

The Microsure’s MUSA enhances surgical performance by stabilizing and scaling down the surgeon’s movements during complex microsurgical procedures on sub-millimeter scale. The surgical robot, allows lymphatic surgery on lymph vessels smaller than 0.3 mm in diameter. Microsure received the ISO 13485 certificate which assures that Microsure is adhering to the highest standards in quality management and regulatory compliance procedures to develop, manufacture, and test its products and services.

MUSA provides superhuman precision for microsurgeons, enabling new interventions that are currently impossible to perform by hand.

SOURCE

https://www.businesswire.com/news/home/20190607005175/en/

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New Neuromodulation Device to Treat Migraines

Reporter: Irina Robu, PhD

Theranica, Israeli startup is developing a non-invasive medical device that treats migraine pain through smartphone-controlled electric pulses unlike existing pharmaceutical solutions like triptans and ergotamine. The company recently received FDA De-novo clearance on Nerivio Migra, a class II medical device to treat acute migraine pain.

The non-invasive medical device, Nerivio Migra contains a bioelectric patch which is placed on the upper arm and a linked smartphone app which controls the electrical impulses and records data. The device’s electric pulses excite C-fiber nerves, generating an analgesic mechanism in the brain that lightens migraine pain.

In order to diminish the overuse of painkillers, the company developed the non-invasive device and tested it among acute migraine patients both two and 48 hours after treatment. Side effects from the device were mild and resolved within 24 hours.

Theranica’s product is lower in price than the existing alternatives and it is using existing smartphone technology. Their initial focus is on marketing to headache clinics as a start. And hoping to expand the indications for its device to the pediatric migraine population and finally use its platform to treat other idiopathic pain conditions like cluster headaches.

SOURCE

Israeli startup gets FDA nod for neuromodulation device to treat migraines

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@ClevelandClinic – Cardiac Consult: Catheter Ablation vs Antiarrhythmic Drug Therapy in Atrial Fibrillation: CABANA – What Did We Learn?

Reporter: Aviva Lev-Ari, PhD, RN

 

AUDIT PODCAST

https://my.clevelandclinic.org/podcasts/cardiac-consult/catheter-ablation-vs-antiarrhythmic-drug-therapy-in-atrial-fibrillation-cabana?_ga=2.88658141.711601484.1558922695-amp-RRJ7UwWd4zu5JL6IeLrcYA

 

The international CABANA trial (Catheter Ablation versus Arrhythmia Drug Therapy for Atrial Fibrillation) was the biggest buzz at the Heart Rhythm Society Scientific Sessions earlier this year, and it’s still making waves several months later.

Cleveland Clinic is among the 120 centers participating in the trial, and electrophysiologist Bruce Lindsay, MD, is the site’s principal investigator for the study. He recently sat down with Oussama Wazni, MD, Cleveland Clinic’s Section Head of Cardiac Electrophysiology and Pacing, to discuss the CABANA trial’s findings and implications. Below is an edited transcript of their conversation.

The problem was this: About 9 percent of the patients who were supposed to get ablations never did, and it’s not clear why. The reasons could have been financial issues or patients merely changing their mind or perhaps being too sick. If it was the latter reason, that would of course bias the results. But the problem is we don’t know.

On the other side, a substantial number of patients assigned to drug therapy — 27.5 percent — crossed over and received ablation. That rate of crossover was a bit higher than anticipated.

It’s difficult to use an intention-to-treat analysis when there’s a large crossover and a lot of people don’t get the treatment they were supposed to get. Nonetheless, the study design specified an intention-to-treat analysis, which found no significant differences between the groups in the composite primary end point or any of its components. There were, however, significant reductions in hospitalization for cardiovascular problems and in time to atrial fibrillation recurrence in the ablation group, and the latter finding is consistent with results from past studies.

Because of the large number of crossovers, there was much interest in the as-treated analysis, which was prespecified as a sensitivity analysis of the primary results.

  • This analysis showed a 3.9 percent absolute risk reduction — and
  • a 27 percent relative reduction — in the primary end point with ablation versus drug therapy.
  • That was a statistically significant effect, as was the 3.1 percent absolute reduction in all-cause death with ablation versus drug therapy.

SOURCE

https://consultqd.clevelandclinic.org/ablation-vs-medical-therapy-for-atrial-fibrillation-putting-cabana-in-perspective/?utm_campaign=qd%20tweets&utm_medium=social&utm_source=twitter&utm_content=180920%20ablation%20fibrillation&cvosrc=social%20network.twitter.qd%20tweets&cvo_creative=180920%20ablation%20fibrillation

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Clever experiment: GWAS of 500 time points in an EKG – The genetic makeup of the electrocardiogram

Reporter: Aviva Lev-Ari, PhD, RN

The genetic makeup of the electrocardiogram

Niek VerweijJan-Walter BenjaminsMichael P. MorleyYordi van de VegteAlexander TeumerTeresa TrenkwalderWibke ReinhardThomas P. CappolaPim van der Harst

Abstract

Since its original description in 1893 by Willem van Einthoven, the electrocardiogram (ECG) has been instrumental in the recognition of a wide array of cardiac disorders1,2. Although many electrocardiographic patterns have been well described, the underlying biology is incompletely understood. Genetic associations of particular features of the ECG have been identified by genome wide studies. This snapshot approach only provides fragmented information of the underlying genetic makeup of the ECG. Here, we follow the effects of individual genetic variants through the complete cardiac cycle the ECG represents. We found that genetic variants have unique morphological signatures not identified by previous analyses. By exploiting identified abberations of these morphological signatures, we show that novel genetic loci can be identified for cardiac disorders. Our results demonstrate how an integrated approach to analyse high-dimensional data can further our understanding of the ECG, adding to the earlier undertaken snapshot analyses of individual ECG components. We anticipate that our comprehensive resource will fuel in silico explorations of the biological mechanisms underlying cardiac traits and disorders represented on the ECG. For example, known disease causing variants can be used to identify novel morphological ECG signatures, which in turn can be utilized to prioritize genetic variants or genes for functional validation. Furthermore, the ECG plays a major role in the development of drugs, a genetic assessment of the entire ECG can drive such developments.

SOURCE

https://www.biorxiv.org/content/10.1101/648527v1

made available under a CC-BY-ND 4.0 International license.

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The role of PET/CT in diagnosing giant cell arteritis (GCA) and assessing the risk of ischemic events

 

Reporter: Aviva Lev-Ari, PhD, RN

 

 

May 20, 2019 — PET/CT images are offering evidence of a link between vascular patterns at the time of diagnosis for giant cell arteritis (GCA) and a patient’s risk of an ischemic event, Spanish researchers explained in a study published online on 12 May in the European Journal of Nuclear Medicine and Molecular Imaging.

The group found that patients with inflammation in vertebral arteries, which causes blood vessels to narrow, were five times more likely to develop ischemic symptoms. The information may be particularly helpful because GCA is difficult to diagnose in its early stages.

“Bearing in mind these results and our findings, we consider that the vertebral arteries should be carefully studied in patients with suspected GCA, not only to support the diagnosis but also to assess the risk of development of ischemic events,” wrote lead author Dr. Jaume Mestre-Torres and colleagues from Hospital Vall d’Hebron in Barcelona.

GCA’s challenges

Giant cell arteritis is an inflammatory disease that causes the large blood vessels to narrow and restrict blood flow. The affliction is typically seen in the temporal arteries and the aorta in adults older than 50. Currently, there is little information on how the disease develops, although there are indications that it may be linked to genetics.

The challenge for clinicians is that there are “no specific clinical symptoms that lead to the diagnosis of GCA, but headache and ischemic symptoms such as jaw claudication and transient visual loss or permanent visual loss may raise suspicion [of the disease],” the authors noted.

Results

In assessing visual loss, the team found no significant differences between patients with vertebral artery involvement and permanent visual loss (61.5%) and patients with vertebral artery issues and no permanent visual loss (58.8%) (p = 0.88). Interestingly, the presence of intrathoracic large-vessel vasculitis tended to protect against a patient’s likelihood of permanent visual loss.

In addition, “all patients with vertebral involvement but no aortic involvement showed ischemic manifestations at disease onset,” the researchers noted. “In contrast, none of the patients with aortic involvement but no vertebral hypermetabolism showed ischemic symptoms.”

SOURCE

https://www.auntminnieeurope.com/index.aspx?sec=sup&sub=mol&pag=dis&ItemID=617395

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Society for Cardiovascular Angiography and Interventions (SCAI) Released Classification Stages of Cardiogenic Shock

Reporter: Aviva Lev-Ari, PhD, RN
NEWS | CARDIOGENIC SHOCK | MAY 20, 2019

SCAI Releases New Consensus Document on Classification Stages of Cardiogenic Shock

New classification system endorsed by multiple societies was developed to describe five stages of shock

SCAI Releases New Consensus Document on Classification Stages of Cardiogenic Shock

Image courtesy of the Society for Cardiovascular Angiography and Interventions (SCAI).

May 20, 2019 – A newly released expert consensus statement proposes a classification schema for cardiogenic shock (CS) that will facilitate communication in both the clinical and research settings. The document was published online in the Society for Cardiovascular Angiography and Interventions (SCAI)’s Catheterization and Cardiovascular Interventions journal,1 and is endorsed by the American College of Cardiology, American Heart Association, the Society of Critical Care Medicine and the Society of Thoracic Surgeons.

Cardiogenic shock is a condition in which the heart, often abruptly, cannot pump enough blood to meet the body’s needs, according to the Mayo Clinic, most often accompanying larger heart attacks such as myocardial infarction (MI). Outcomes for patients with cardiogenic shock complicating MI have not significantly improved over the last 30 years despite the development of various percutaneous mechanical circulatory support technologies and the national standard of emergent angioplasty and stenting.

SCAI convened a multidisciplinary writing group comprised of leading experts in interventionaland advanced heart failure, non-invasive cardiology, emergency medicine, critical care and cardiac nursing to represent the team-based care of these patients. The writing group developed a new five-stage system that is defined by narrative patient descriptions, physical findings, and biochemical/hemodynamic markers, creating a new language that will facilitate rapid assessment, reassessment over time and communication between providers including hospital systems.

The new CS definition is intended to provide clinicians and researchers with a unified and standardized vocabulary that will translate across all settings. Additionally, the definition aims to facilitate recognition of risk for adverse outcomes and the potential benefit from various interventions and prognosis. The goal is to reduce mortality on both an individual and national scale.

“The main areas we may have failed in the fight to improve mortality in cardiogenic shock is, quite simply, not speaking the same language when describing these patients,” said Srihari S. Naidu, M.D., FSCAI, former SCAI Trustee and chair of the writing group. “Without that, we can’t even begin to understand these patients, how sick they are, what might work and what does not work. This is the most important first step, and it is important to use this classification system to reset our understanding of cardiogenic shock and restart the trials very much needed in this space.”

For more information: http://www.scai.org

Related Cardiogenic Shock Content

VIDEO: Cardiogenic Shock Case with Impella CP Support

VIDEO: Analysis of Outcomes for 15,259 U.S. Patients with AMICS Supported with the Impella Device

VIDEO: How to Reduce Cardiogenic Shock Mortality by 50 Percent

Reference

1. Baran D.A., Grines C.L., Bailey S., et al. SCAI clinical expert consensus statement on the classification of cardiogenic shock. Catheterization and Cardiovascular Interventions, May 19, 2019. https://doi.org/10.1002/ccd.28329

SOURCE

https://www.dicardiology.com/content/scai-releases-new-consensus-document-classification-stages-cardiogenic-shock?eid=333021707&bid=2450760

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The Promise of MicroRNA Therapy to Stimulates Uncontrolled Cardiac Repair in Animal Trials of Large Mammals

 

Reporter: Aviva Lev-Ari, PhD, RN

start quote

Here we show that expression of human microRNA-199a in infarcted pig hearts can stimulate cardiac repair. One month after myocardial infarction and delivery of this microRNA through an adeno-associated viral vector, treated animals showed marked improvements in both global and regional contractility, increased muscle mass and reduced scar size. These functional and morphological findings correlated with cardiomyocyte de-differentiation and proliferation. However, subsequent persistent and uncontrolled expression of the microRNA resulted in sudden arrhythmic death of most of the treated pigs. Such events were concurrent with myocardial infiltration of proliferating cells displaying a poorly differentiated myoblastic phenotype.

End quote

 

Abstract

Prompt coronary catheterization and revascularization have markedly improved the outcomes of myocardial infarction, but have also resulted in a growing number of surviving patients with permanent structural damage of the heart, which frequently leads to heart failure. There is an unmet clinical need for treatments for this condition1, particularly given the inability of cardiomyocytes to replicate and thereby regenerate the lost contractile tissue2. Here we show that expression of human microRNA-199a in infarcted pig hearts can stimulate cardiac repair. One month after myocardial infarction and delivery of this microRNA through an adeno-associated viral vector, treated animals showed marked improvements in both global and regional contractility, increased muscle mass and reduced scar size. These functional and morphological findings correlated with cardiomyocyte de-differentiation and proliferation. However, subsequent persistent and uncontrolled expression of the microRNA resulted in sudden arrhythmic death of most of the treated pigs. Such events were concurrent with myocardial infiltration of proliferating cells displaying a poorly differentiated myoblastic phenotype. These results show that achieving cardiac repair through the stimulation of endogenous cardiomyocyte proliferation is attainable in large mammals, however dosage of this therapy needs to be tightly controlled.

References

  1. 1.

    Roth, G. A. et al. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. J. Am. Coll. Cardiol70, 1–25 (2017).

  2. 2.

    Eschenhagen, T. et al. Cardiomyocyte regeneration: a consensus statement. Circulation 136, 680–686 (2017).

SOURCE

https://www.nature.com/articles/s41586-019-1191-6

 

ALTERNATIVE methods of Cardiac Repair were published in this Open Access Online Scientific Journal:

 

Stem Cells and Cardiac Repair: Content Curation & Scientific Reporting: Aviva Lev-Ari, PhD, RN

Curator: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2014/04/17/stem-cells-and-cardiac-repair-content-curation-scientific-reporting-aviva-lev-ari-phd-rn/

 

Arteriogenesis and Cardiac Repair: Two Biomaterials – Injectable Thymosin beta4 and Myocardial Matrix Hydrogel

Curator: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2013/02/27/arteriogenesis-and-cardiac-repair-two-biomaterials-injectable-thymosin-beta4-and-myocardial-matrix-hydrogel/

 

Human Embryonic-Derived Cardiac Progenitor Cells for Myocardial Repair

Reporter and Curator: Dr. Sudipta Saha, Ph.D.

https://pharmaceuticalintelligence.com/2012/08/01/human-embryonic-derived-cardiac-progenitor-cells-for-myocardial-repair/

 

 

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