Future Pulse Cardiology

Hosted by Thomas Nero MD FACC

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Latest episode

Dec 2024

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EN-US

About the show

Investigating Innovative Cardiovascular Research at the Intersection of Academic Theory and Clinical Practice. In these discussions we take a deep dive into the latest research and how it informs current practice. For a patient level discussion, please listen to PATIENT PULSE. Available on Apple Podcasts, Spotify, YouTube and most other services. Subscribe to have new podcasts sent directly to your player and please email us with any comments. We would love to hear from you.

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22 recent

December 26, 2024Episode 652 min

Inflammation and Cardio-Rheumatology with Dr Nehal Mehta

We would love to hear your thoughts on the episodes!Dr Thomas Nero discusses inflammation and the role of rheumatologic disorders on coronary artery disease with Dr Nehal Mehta, exploring how chronic inflammation serves as a cornerstone for various health issues, particularly in patients with conditions like psoriasis and serves as a model for investigating cardiovascular therapies. The discussion highlights the role of immune responses, the impact of lifestyle factors, and the importance of early diagnosis and risk assessment in managing cardiovascular health.Early ResearchDr Mehta's research began by observing obese patients with heart attacks despite few cardiovascular risk factors.He found adipose inflammation was driving obesity and insulin resistance.Psoriasis became a model for studying chronic inflammation's effects on cardiovascular health.Inflammation and Cardiovascular DiseaseAtherosclerosis requires both injury and lipids.Endothelial damage initiates inflammation in atherosclerosis.Neutrophils and myeloid cells play a critical role in the inflammatory process.Different inflammatory diseases have distinct cytokine profiles (e.g., psoriasis vs. lupus).Adipose Tissue and InflammationVisceral fat is metabolically active and a key site of inflammation.Psoriatic flares increase visceral fat volume and adipose tissue macrophages.Obese psoriasis patients have higher risks of cardiovascular events.Coronary Artery Disease in Inflammatory ConditionsCoronary inflammation can be detected by perivascular fat attenuation index (pFAI).Untreated psoriasis patients show progression from inflammation to plaque formation.Coronary artery calcium (CAC) scoring may underestimate disease in younger patients.Diagnostic ApproachesDr. Mehta recommends assessing blood pressure, body mass index, lipids, and glucose.Neutrophil-lymphocyte ratio (NLR) and GlycA are useful inflammatory markers.Imaging like carotid intima-media thickness and pFAI can help identify early vascular disease.Treatment StrategiesEarly statin initiation is recommended for psoriasis patients.Ongoing trials are exploring various anti-inflammatory agents (e.g., colchicine, IL-6 inhibitors).Future therapies may include oral IL-23 inhibitors and weight loss medications.Future Research DirectionsRetinal arteries as a model for studying vascular disease and lipid deposition.Exploring lipid accumulation in various tissues, including the central nervous system.Developing therapies to address lipid-driven processes in diseases of aging.The discussion emphasizes the complex interplay between inflammation, lipid metabolism, and cardiovascular disease, highlighting the need for personalized approaches and continued research in this field.

June 23, 2024Episode 545 min

Coronary Inflammation Imaging with FAI Score on CT angiography with Prof. Stefan Neubauer

We would love to hear your thoughts on the episodes!Prof. Stefan Neubauer and Dr. Thomas Nero discuss two recent papers on the utility of coronary inflammation imaging on CT coronary angiography with Fat Attenuation Index (FAI)FAI score. The ORFAN study demonstrated a 20 fold increased risk in CV event rates with low vs high FAI score and a 10 fold increased event rate in patients with elevated FAI score who have no coronary plaque. FAI score re-categorized 40% of patients in their follow-up studies.Prof. Neubauer is the head of the Division of Cardiovascular Medicine and Director of the Oxford Centre for Clinical Magnetic Resonance Research (OCMR) at the University of Oxford and Past President of the Society for Cardiovascular Magnetic Resonance (SCMR). We discussed two recently published landmark papers from his division:Kenneth Chan, Elizabeth Wahome , et al. Inflammatory risk and cardiovascular events in patients without obstructive coronary artery disease: the ORFAN multicentre, longitudinal cohort study. Lancet. 2024;403(10392):1823-1835. doi:10.1016/S0140-6736(24)00596-8Christopher J. Farina, Michael H. Davidson, Prediman K. Shah, Charles Stark, Wenqi Lu, Cheerag Shirodaria, Timothy Wright, Charalambos A. Antoniades, Jan Nilsson and Nehal N. Mehta (2024). Inhibition of oxidized low-density lipoprotein with orticumab inhibits coronary inflammation and reduces residual inflammatory risk in psoriasis: a pilot randomized, double-blind placebo-controlled trial. Cardiovascular Research, European Society of Cardiology, March 25, 2024.

February 29, 2024Episode 434 min

Trial Statistics, Trial Design and AI with Dr. C Michael Gibson

We would love to hear your thoughts on the episodes!Dr Gibson and Dr Nero discuss the oft maligned issue of medical statistics. Their discussion covers the pros and cons of traditional Cox proportional hazards regression models and Kaplan-Meier curves and newer techniques including win ratios. They then dip their toes into AI. A great overview by one of our leading clinical trialists.

February 19, 2024Episode 348 min

Deep Dive into Lp(a) with Dr Steven Nissen Part 2 of 2

We would love to hear your thoughts on the episodes!This episode is a deep dive into Lipoprotein a with Dr Steven Nissen from the Cleveland Clinic. He and Dr Nero discuss the genetics of Lp(a), its pathophysiology, current treatment strategies and research into lowering Lp(a) levels. This is a fascinating conversation that also discusses the role of coronary inflammation in the work of Dr. Paul Ridker as well as the role of CT angiography in future clinical trials.

February 13, 2024Episode 211 min

Lp(a): a basic clinical approach with Dr. Steven Nissen Part 1 of 2

We would love to hear your thoughts on the episodes!Dr Steven Nissen from the Cleveland Clinic discuses with Dr. Thomas Nero the basic clinical approach to Lp(a) with need for routine testing and a few simple case studies. In the second (longer podcast) they take a deep deep dive into Lp(a) genetic, pathophysiology and the current research trials.

February 1, 2024Episode 141 min

Coronary Artery Disease in the Endurance Athlete with Dr Aaron Baggish

We would love to hear your thoughts on the episodes!Dr Thomas Nero speaks with Dr Aaron Baggish about coronary artery disease in the endurance athlete (and non-athlete as well!) They discuss cardiovascular testing in Masters athletes including ETT, coronary calcium scoring and CT angiography as well as risk factor identification, inflammation, physical & emotional stress and ongoing research. Dr Baggish is a Professor of Sports Cardiology at Université de Lausanne and founder of the Cardiovascular Performance Program, Massachusetts General Hospital, Harvard Medical School. He has been team cardiologist for USA rowing, US Soccer, and the New England Patriots. He was the medical director for the Boston Marathon and is a consultant to the IADA, IOC and FIFA.

December 26, 2023Episode 748 min

Atrial Fibrillation and Clinical Trials with Dr John Mandrola

We would love to hear your thoughts on the episodes!Dr Mandrola discusses recent trail data with Dr. Thomas Nero including the results from Artesia, NOAH Afnet 6, Frail AF, Azalea and Oceanic-AF. They also discuss Left Atrial Appendage Occlusion and utility of wearable devices. Finally, a shout out to Dr. Andre Foy and his work on multi-morbidity and its role in clinical trial interpretation.

December 3, 2023Episode 624 min

Coronary Calcium Score and CT Coronary Angiography with Dr. Mathew Budoff

We would love to hear your thoughts on the episodes!Dr. Thomas Nero speaks with Dr. Mathew Budoff about Coronary Calcium Scoring, CT Coronary Angiography and cardiovascular outcomes. The discussion goes beyond basic risk factor enhancement, highlighting its role to help evaluate disease progression, power future clinical trials and determine efficacy of therapy. Along the way, they discuss coronary inflammation, perivascular adipose tissue imaging and fat attenuation index (FAI) as well as diving into the plaque stabilizing effects of EPA.

November 26, 2023Episode 534 min

Dr Elizabeth Ofili and The African American Heart Study

We would love to hear your thoughts on the episodes!Dr. Elizabeth Ofili discusses the African American Heart Study with Dr. Thomas Nero. They also discuss her work at the NIH and the African American Heart Failure Trial and the role of community based pragmatic clinical trials.

June 25, 2023Episode 430 min

Anticoagulation, Thombin Generation and Factor XI inhibition in ACS and Atrial Fibrillation with Dr C. Michael Gibson

We would love to hear your thoughts on the episodes!Dr. Thomas Nero discusses current therapy with Factor X inhibitors, the new research with Factor XI inhibition and specifically the enrolling Milvexian clinical trials with Dr. C Micahel Gibson. In addition they discuss, the addition of these medications along wiht anti-platelet therapy, Lp(a) and other interesting current and future research in cardiovascular disease.