Clinical Trials Arena lists five of the most popular tweets on cardiology in Q4 2021 based on data from GlobalData’s Pharmaceuticals Influencer Platform. The top tweets are based on total engagements (likes and retweets) received on tweets from more than 150 cardiology experts tracked by GlobalData’s Pharmaceuticals Influencer platform during the fourth quarter (Q4) of 2021.

1. Sunil V. Rao’s tweet on the use of intra-coronary imaging in contemporary clinical practice in the US

Sunil V. Rao, cardiologist at Duke University’s Duke Division of Cardiology, tweeted a study that examined the usage rates of intra-coronary imaging (ICI) in contemporary clinical practice in the US. ICI-guided intervention of percutaneous coronary intervention (PCI) or ICI-PCI can help in improving outcomes, however, the usage rate and real-world outcome rates of the technique in the US is currently unknown.

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Researchers conducted an instrumental variable (IV) analysis on more than 34,000 patients who underwent ICI-PCI between April 2018 and October 2020 to evaluate in-hospital mortality and other major adverse cardiovascular events (MACE). The analysis found that the rates of ICI-PCI were initially low at 2.36% although the rates increased gradually to 3.18%. Furthermore, patients who underwent ICI-PCI were found to have higher complexity lesions with severe calcification. The use of ICI-PCI was associated with lower risk of in-hospital mortality and MACE, the analysis concluded.

Username: Sunil V. Rao

Twitter handle: @SVRaoMD

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Likes: 118

Retweets: 38

2. Juan Lopez-Mattei’s tweet on the role of cardiovascular magnetic resonance in cancer patients

Juan Lopez-Mattei, MD, medical director of cardiac imaging at Lee Health System, shared findings of a study on the clinical impact of cardiovascular magnetic resonance (CMR) in cancer patients with supposed cardiomyopathy. The diagnosis and treatment of cardiomyopathy in cancer patients is essential as they are at increased risk of heart failure. CMR is one of the most effective methods for evaluation of patients with cardiomyopathy. The study reviewed data on a total of 110 patients who underwent CMR in a tertiary cancer centre.

Clinical impact of CMR on the evaluation of confirmed or suspected cases of cardiomyopathy was found in 62% of the patients, while changes in clinical diagnosis and management were observed in 51% and 37% of the patients, respectively. CMR was found to benefit patients diagnosed with multiple myeloma and those with a suspicion of infiltrative cardiomyopathy. It was also found to benefit patients who had higher left ventricular ejection fraction (LVEF) by echocardiography (echo), the study highlighted.

Username: Juan Lopez-Mattei

Twitter handle: @onco_cardiology

Likes: 102

Retweets: 36

3. Pradeep Natarajan’s tweet on stroke prevention in atrial fibrillation

Pradeep Natarajan, the director of preventive cardiology and the Paul and Phyllis Fireman endowed chair in vascular medicine at the Massachusetts General Hospital, shared an article on the need to rethink and re-trial the framework around stroke prevention in atrial fibrillation (AF). The article highlighted that risk stratification for stroke in individuals with AF is still primitive and one of the biggest risk assessment challenges in medicine.

The existing stroke prediction models in patients with AF are based on generalised risk scores such as CHA2DS2-VASc (congestive heart failure, hypertension, age 75 years or older, diabetes, stroke/transient ischemic attack, vascular disease (peripheral arterial disease, previous myocardial infarction, aortic atheroma), and sex category (female gender)). The CHA2DS2-VASc score was based on data from 1,000 untreated patients with only one year of follow-up and 25 events of AF.

Uncertainty persists in administering or withholding anti-coagulants to patients based on these scores, the article detailed.

A clinical trial in low-risk AF populations, therefore, will help in determining if strokes are caused by AF or whether individuals benefit from anticoagulation therapies, the article noted. A report by researchers in patients with AF who had cardiac implantable electronic devices, for example, found that multi-hour incidents of AF raised the chances of a stroke 3.7 times above baseline. Furthermore, the risk of stroke was highest within five days of AF, and then declined. The article also detailed how new wearable technologies can now identify AF, thereby reducing bleeding and other complications caused by anticoagulation consumption.

Username: Pradeep Natarajan

Twitter handle: @pnatarajanmd

Likes: 82

Retweets: 18

4. John Mandrola’s tweet on a study challenging the notion that myocardial infarction is a reliable surrogate for mortality

John Mandrola, a cardiac electrophysiologist at Baptist Health, shared a recent study by cardiologist David L Brown and his colleagues who challenged the assumption that cardiovascular therapies that lower myocardial infarction (MI) extend survival. MI was earlier assumed to result in cardiac injury, which led to heart failure and ventricular arrhythmias. Any treatment that lowered MI events, therefore, was considered effective in reducing death rates.

A recent study that included more than a million patients over a 40-year period, however, found that treatments to lower MI did not reduce deaths. Moreover, better therapies and tests have now made MI less reliable as an endpoint, according to the study. The other reasons for MI having failed as a reliable surrogate was multimorbidity and other competing causes of death, researchers claimed. As patients lived longer and with more comorbidities, ischemia was the least cause for their death, the study added.

Username: John Mandrola

Twitter handle: @drjohnm

Likes: 78

Retweets: 18

5. Dr. Deepak Bhatt’s tweet on removing the left atrial appendage at surgery

Dr. Deepak L. Bhatt, a professor of medicine at the Harvard Medical School, shared a study on removing the left atrial appendage (LAA) at surgery. The study stated that imaging and other studies suggested that more than 90% of thrombi in nonvascular atrial fibrillation (AF) are found in the LAA and are known to cause ischemic strokes. Removal of the LAA, therefore, can serve as an alternative or aide to systemic anticoagulation in order to provide a permanent preventative option for ischemic strokes.

The study also noted some of the drawbacks of LAA such as excess fluid retention attributable to atrial natriuretic peptide disruption, residual flow due to incomplete closure, and probable intrusion with the left circumflex artery.

Username: Dr. Deepak L. Bhatt

Twitter handle: @DLBHATTMD

Likes: 62 Retweets: 19