March 30th, 2014
Ideas Lost, But Not Stolen
Seth Shay Martin, MD
Several Cardiology fellows who are attending ACC.14 in Washington, D.C. this week are blogging for CardioExchange. The fellows include Kumar Dharmarajan, Seth Martin, and Saurav Chatterjee. For more of our ACC.14 coverage of late-breaking clinical trials, interviews with the authors of the most important research, and blogs from our fellows on the most interesting presentations at the meeting, check out our ACC.14 Headquarters.
After experiencing a day of innovative science and healthy debate at ACC.14, I left the convention hall Saturday evening feeling inspired. Inspiration soon changed to surprise. Walking with an umbrella in my hand through the rainy D.C. weather, I saw my car from a distance and was shocked that it looked like I had left the right rear passenger-side window down. I never do that. Then, as I got closer, reality hit. My car had been broken into.
A favorite ESPN saying entered my mind – “C’mon man!” In retrospect, I should have moved some bags from the back seat into my trunk as I was leaving the car earlier, but I was running late and would have had to completely shift around my golf clubs and other items in my overcrowded trunk. I felt uncomfortable because it was a bustling street.
The police arrived via bicycle and informed me that auto theft is the most common crime in D.C. What valuables were in my book bag, they asked? I had lost some electronics. Then, as a police officer took notes, I realized what was most valuable to me could not be replaced: my paper journal articles with handwritten annotations. Although most of my work is digital, I still like printing articles and writing ideas on them.
This part of the story has a happy ending. A stranger interrupted and said that there was a bag a block away. My bag. Soaked in rain. Papers there! Though some material items were taken, one of my most valuable possessions – ideas – were only lost temporarily. Which made me realize their value. And for that, I feel blessed.
Here’s to hoping today brings plenty of new and creative ideas for us at ACC.14, and no police reports.
March 30th, 2014
Long-Term Follow-Up from MADIT-CRT: Guideline Implications
Arthur J. Moss, MD
CardioExchange’s John Ryan interviews Arthur J. Moss about his research group’s study of long-term survival for patients who received cardiac resynchronization therapy with a defibrillator (CRT-D) in the MADIT-CRT trial. The findings were presented at ACC.14 and published simultaneously in The New England Journal of Medicine.
THE STUDY
Seven-year follow-up in the MADIT-CRT trial was tracked, on an intention-to-treat basis, for all 1691 surviving participants and, subsequently, for 854 participants who were enrolled in post-trial registries. The cumulative all-cause mortality rate among patients with left bundle-branch block (LBBB) was significantly lower in the CRT-D group than in the defibrillator-alone group (18% vs. 29%). However, in patients without LBBB, CRT-D had no benefit and showed possible harm.
THE INTERVIEW
Ryan: Your results are very impressive. Will they compel us to change our practice and offer CRT-D to patients who have asymptomatic or mild congestive heart failure?
Moss: On the basis of data from our prior studies and publications (N Engl J Med 2010; 363:2385; MADIT-CRT), CRT-D is already approved for patients with asymptomatic or mild heart failure, a reduced LV ejection fraction, and a left bundle-branch block (LBBB) conduction disturbance. The current findings published in the NEJM strengthen the guideline indications, given the significant reduction in all-cause mortality during long-term (7-year) follow-up with CRT-D treatment in these patients.
Ryan: The 2013 heart failure guidelines list CRT as a class IIa recommendation for patients who have a “non-LBBB pattern with a QRS duration of >150 msec.” Given your findings, should this recommendation be revisited?
Moss: The 2013 heart failure guidelines should be revised because our original trial results from 2010 showed no benefit of CRT-D in reducing the incidence of heart failure in patients with a non-LBBB pattern even with a wide QRS duration >150 msec. Findings from our current trial show no evidence of mortality reduction during long-term follow-up.
Share your thoughts on Dr. Moss’ analysis of the long-term results from MADIT-CRT.
To view all of our coverage from the ACC meeting, go to our ACC.14 Headquarters page.
March 30th, 2014
MADIT-CRT Long-Term Follow-Up Shows Survival Benefit with CRT-D
Larry Husten, PHD
MADIT-CRT was an influential trial that showed a reduction in heart failure complications — but not mortality — when cardiac resynchronization therapy (CRT) was added to an implantable defibrillator in patients with mild heart failure who also had left bundle-branch block (LBBB). Patients in the trial were followed for 2.4 years, raising questions about the long-term effects of CRT. Now, a second look at 854 patients who participated in a follow-up study suggests that over the long term, CRT may save lives in this population.
Overall, there was a highly significant 41% reduction in death (P=0.001) associated with CRT therapy in the large subgroup of patients with LBBB. The mortality rate was different after 1 year and remained significant throughout follow-up. At 7 years, the mortality rate was 29% in the control group versus 18% in the CRT group. There was an even bigger difference in nonfatal heart failure events (P<0.001). The benefits were remarkably consistent across a broad range of subgroups.
However, the group of MADIT-CRT patients who did not have LBBB showed no reduction in either mortality or heart failure events associated with CRT. The authors wrote that this “lack of benefit of CRT in patients without left bundle-branch block was consistent, regardless of the QRS duration or ECG morphologic findings with respect to right bundle-branch block and an intraventricular conduction delay. Thus, at present, our data do not support early intervention with CRT in any subset of this population.”
In an accompanying editorial, Jeffrey Goldberger writes that the results should serve “as a strong impetus to pursue CRT in patients with mild heart failure with reduced ejection fraction and left bundle-branch block.”
Arthur Moss, responding in CardioExchange to a question from John Ryan, said the 2013 heart failure guidelines, which recommend CRT for non-LBBB patients with a QRS duration of >150 msec, needs to be revised.
To view all of our coverage from the ACC meeting, go to our ACC.14 Headquarters page.
March 30th, 2014
First TAVR Comparison Trial Favors Sapien XT Over CoreValve
Larry Husten, PHD
With two devices now approved for transcatheter aortic valve replacement (TAVR), the marketing battle has begun to win the hearts and minds of cardiologists. On Saturday at the ACC, Medtronic gained bragging rights showing the first mortality benefit for its CoreValve device. A similar improvement did not occur in the PARTNER trials with the Edwards Sapien device, but all the experts have warned against cross-trial comparisons. Now an actual randomized trial has emerged comparing the two platforms. The results favor the Sapien XT, but the size and scope of the trial mean that the discussion and debate will certainly continue.
CHOICE, presented at the American College of Cardiology meeting in Washington, DC, and published simultaneously in JAMA, was an investigator-initiated trial in which 241 patients with severe aortic stenosis were randomized to the Edwards Sapien XT or the Medtronic CoreValve at 5 centers in Germany. The primary endpoint was device success, defined as implantation of the device in the correct position with little or no regurgitation.
Device success was achieved in 95.9% of patients who received the balloon-expandable Sapien XT and in 77.5% of patients who received the self-expandable CoreValve (relative risk, 1.24; 95% CI, 1.12-1.37; P<0.001). The investigators attributed this difference to a significant reduction in more-than-mild aortic regurgitation (4.1% vs. 18.3%; RR, 0.23; 95% CI, 0.09-0.58; P<0 .001) and to a reduced need to implant more than 1 valve (0.8% vs. 5.8%; P=0.03) in the Sapien group.
There was no significant difference in cardiovascular mortality at 30 days, bleeding and vascular complications, or in a combined safety endpoint. But a new pacemaker was required less often in the Sapien group (17.3% vs. 37.6%; P=0.001). Improvement in symptoms and quality-of-life measures were more common in the Sapien group. The investigators speculated that the tighter seal of the balloon-expandable Sapien XT may account for some of the differences that emerged in the trial.
“This is a very dynamic field,” lead author Abdel-Wahab said. “We now have new valves coming out that will probably be even better, but we do not have enough data about them yet. These results can help to inform the design of future devices.”
In an accompanying editorial, E. Murat Tuzcu and Samir Kapadia take note of the advantages seen with the Sapien XT in the trial, including the primary endpoint of device success. They caution, however, that it “should not be interpreted as a surrogate for long-term outcomes such as death, stroke, and quality of life.”
For more of our ACC.14 coverage of late-breaking clinical trials, interviews with the authors of the most important research, and blogs from our fellows on the most interesting presentations at the meeting, check out our ACC.14 Headquarters.
March 29th, 2014
TAVR: Are You Impressed Now?
Ajay J Kirtane, MD, SM
CardioExchange’s Rick Lange and David Hillis ask interventionalist Ajay Kirtane for his perspective on the randomized trial comparing transcatheter aortic valve replacement (with the CoreValve device) and surgical aortic valve replacement. The data were presented at the 2014 ACC conference in Washington, DC, and published in The New England Journal of Medicine. Click here for CardioExchange’s news coverage of the trial.
BACKGROUND
In the CoreValve trial, researchers randomized 795 patients with severe aortic stenosis and a high estimated mortality risk for surgery to undergo surgical aortic valve replacement (SAVR) or transcatheter valve replacement (TAVR) with the Medtronic CoreValve self-expanding bioprosthesis. TAVR was associated with a significantly lower 1-year mortality rate than SAVR (14.2% vs. 19.1%; P=0.04).
By contrast, results from the Placement of Aortic Transcatheter Valves (PARTNER A) trial of the Edwards SAPIEN valve, involving 699 high-risk patients with severe aortic stenosis, transcatheter and surgical procedures for aortic valve replacement were associated with similar rates of survival at 1 year.
THE INTERVIEW
Lange and Hillis: Will the results of the CoreValve study change your threshold for recommending TAVR?
Kirtane: First, the CoreValve investigators should be commended for completing a second randomized trial of TAVR against SAVR. We know that for patients at the highest end of the risk spectrum, TAVR is the standard of care because it has superior outcomes compared with those of standard medical therapy (as demonstrated in the PARTNER B trial and the nonrandomized CoreValve study just published in JACC). In patients at high risk for SAVR, the PARTNER A trial demonstrated similar overall survival with TAVR and SAVR, with better quality-of-life outcomes for TAVR. Thus, most patients at high risk for SAVR currently undergo evaluation at valve centers for consideration of TAVR; for many, TAVR is the preferred approach.
The new randomized CoreValve study in NEJM confirms and extends the prior findings in a separate population of patients also deemed to be at high surgical risk, with a survival advantage for TAVR at both 30 days and 1 year. Even with results out to only 1 year, this trial further tilts the balance toward TAVR in high-risk patients.
Notably, though, a significant component of the morbidity and mortality in high-risk and “inoperable” patients with severe aortic stenosis is noncardiac. The high event rates in prior TAVR studies have related to comorbidities in many of the patients (in addition to their aortic stenosis). In patients deemed to be at high surgical risk, we have been willing to accept less-certain valve results over the long term (e.g., less in-vivo durability data, greater paravalvular leak) for the advantages of a minimally invasive approach that allows patients to actually survive the procedure. As TAVR gets extended to lower-risk populations, it is important to keep these long-term, valve-specific endpoints in mind, because conventional SAVR is an excellent procedure with proven durability over the long term. Indeed, lower-risk patients are expected to survive long enough for valve-specific endpoints to really matter.
Lange and Hillis: In high-risk patients with severe AS, is the survival benefit of TAVR in the CoreValve study, but the lack of benefit in the PARTNER study, due to a difference in the studies or the valves?
Kirtane: That’s the question everyone will be asking, isn’t it? These are obviously two different types of prostheses from two different companies: Medtronic’s CoreValve is a self-expanding supra-annular prosthesis with a larger longitudinal dimension; the Edwards Sapien valve used in PARTNER is a balloon-expandable valve deployed within the annulus itself. In addition, both devices are iterating with newer, potentially more advantageous designs that may soon be available. In the absence of a head-to-head comparison of the short- and long-term performance of these valves, it is really difficult to speculate about valve-specific differences, except theoretically. Even “apples-to-apples” comparisons across the study programs are challenging, with different clinical-events committees, echocardiographic core laboratories, and study sites. Even the analysis populations differed: PARTNER A primarily reported intent-to-treat analyses, including patients who did not receive SAVR or TAVR, whereas the CoreValve trial primarily reported as-treated analyses. That is one reason that the presentation of the results of the CHOICE trial (also a late-breaker at ACC.14) will be fascinating, representing the first head-to-head randomized trial of these two devices.
Although both the current CoreValve trial and the high-risk cohort of the PARTNER trial randomized patients at high surgical risk, the populations enrolled in these trials were likely very different, precluding fair cross-study comparisons. As an obvious example, PARTNER A included patients for whom the study PIs “concurred that the predicted risk of operative mortality was ≥15% and/or a STS score of ≥10.” In the CoreValve study, the STS score was calculated but not specifically included in the enrollment criteria, which only specified agreement that the “predicted risk of operative mortality is ≥15%.” As a result, the mean STS score (predicted 30-day mortality) in PARTNER A was 11.7%, whereas it was 7.4% in the CoreValve trial. Similarly, the logistic EuroSCORE in PARTNER A was nearly double that in the CoreValve trial, and the mortality rate in the surgical arm of PARTNER A was higher at both 30 days and especially at 1 year versus in the CoreValve trial (26.8% vs. 18.7%). Interestingly, the 30-day mortality rate in the surgical arm of both trials was approximately 40% lower than that correspondingly predicted by the STS algorithm.
Also consider the comparative stroke data across trials. The CoreValve study authors point out that – in contrast to PARTNER – CoreValve conferred no increased risk for stroke compared with SAVR. However, this may have been due to the unexpectedly higher risk for stroke rate in the surgical arm (6.2% at 30 days and 12.6% at 1 year). Given theoretical differences in stroke adjudication across studies, the 1-year rates of stroke in the TAVR arms of both trials are actually quite comparable (6.0% in PARTNER A, 8.8% in CoreValve).
The bottom line is that it will be very difficult to know what led to the observed differences between the two trials and devices. I view this as a “win” for TAVR as a whole.
Lange and Hillis: Given that we lack trials that directly compare TAVR valves, how will you choose which valve to use in an individual patient?
Kirtane: Another great question. A great deal ultimately depends on operator experience and familiarity, as well as specific sizing concerns and limitations. In the United States, the CoreValve is currently available for commercial use in a greater range of annular sizes than is the Sapien valve. For patients who cannot be treated with one device, the availability of another device that can facilitate TAVR is welcome. For patients who could be treated with either device, much of the decision will come down to operator experience and device familiarity. There are sites, like ours in the U.S., that will implant both devices (and even newer devices in clinical trials), but there are minimum volume requirements that are not necessarily transferrable across devices.
CoreValve also has one additional noteworthy advantage: the smaller size of access vessels required for deployment. The CoreValve has a lower-profile design that requires a smaller sheath size for deployment, so a greater number of patients are potentially eligible for transfemoral treatment with this device. In addition, provided that care is taken to exclude patients with arteries that are too small for even the CoreValve, one would expect the rates of vascular complications to be lower than with the commercially available Sapien valve (the newer Sapien XT valve studied in the PARTNER II trial is still not commercially available in the U.S.). In the CoreValve randomized trial, the rate of major vascular complications was only 5.9%, the lowest rate observed to date in major TAVR trials.
Share your reflections on the latest CoreValve study and Dr. Kirtane’s analysis of it.
To view all of our coverage from the ACC meeting, go to our ACC.14 Headquarters page.
March 29th, 2014
Negative Findings on Renal Denervation for Hypertension: Sweet SYMPLICITY?
Sandeep Mangalmurti, MD, JD
CardioExchange’s Rick Lange and David Hillis interview Deepak L. Bhatt, co-principal investigator of the SYMPLICITY HTN-3 trial, which was presented at the 2014 American College of Cardiology conference in Washington, DC, and published in The New England Journal of Medicine. For CardioExchange’s news coverage of the trial, click here.
BACKGROUND
Catheter-based radiofrequency denervation of the renal arteries is currently used to treat hypertension in more than 80 countries, largely on the basis of evidence from nonrandomized studies and unblinded randomized trials showing large reductions in blood pressure (BP) after renal denervation.
In the industry-funded SYMPLICITY HTN-3 trial, patients with resistant hypertension (≥160 mm Hg) were randomly assigned to undergo renal-artery denervation or only renal angiography (sham control), but the participants were unaware of their randomized assignment. At 6 months, the two groups did not differ significantly in reduction of office or 24-hour ambulatory systolic BP.
THE INTERVIEW
Lange and Hillis: What do you consider the most likely explanation for the discrepancy between the findings from SYMPLICITY HTN-3 and those from previous studies of renal denervation?
Bhatt: At least part of the difference is due to randomization, blinding, and use of a sham control. These are particularly difficult (and expensive) strategies in trials of procedures. However, they do remain important basic elements of rigorous trial design. The control arm had a significant reduction in blood pressure, and I think at a minimum, that amount should be subtracted from prior reports of the magnitude of blood pressure reduction with renal artery denervation. Why our reduction in blood pressure in the treatment arm was so much lower than previously reported remains unknown. It could be specific to the device we studied or it could be the way that the proctors instructed physicians to use the device in this trial. We are examining all these possibilities and hope in the coming months to provide some insight into whether there is a way forward – I remain cautiously optimistic.
Lange and Hillis: What does SYMPLICITY HTN-3 teach us about conducting interventional trials and the importance of blinding?
Bhatt: Unintentional, often well-meaning, bias tends to creep into non-blinded studies. This is less of an issue for a trial powered for “hard” endpoints, such as mortality. For a surrogate endpoint such as blood pressure, even though it is a powerful surrogate, a variety of different measurement biases can occur without blinding.
Lange and Hillis: Would you say that renal denervation for treating hypertension has now been blown out of the water?
Bhatt: I think it is premature to say that. Just as there has been exuberance about the procedure by understandably enthusiastic physicians hoping for a new treatment for a difficult patient subset, it would be extreme to pronounce the field dead on the basis of one trial with one device used in a certain way. The technology may work in other conditions, such as heart failure. Other devices, or even the device we studied used differently, might still have value in renal denervation. I would not say that the renal denervation story is ending, but really is just rebooting, hopefully in a more rigorous way. I think one key is to be certain that we really are effectively denervating with any catheter system before further clinical trials are performed. The procedure may not be as “simple” as we had assumed.
Lange and Hillis: Would you advise any patients with hypertension to undergo renal denervation? If so, whom?
Bhatt: No, I probably would not – at least not at the present time. It is conceivable that the procedure may still have value in patients dissimilar from the ones we enrolled. For example, nonadherent patients with out of control blood pressure were not (knowingly) included in our study, but these patients exist in real life and are a challenge to treat. Our negative study does not mean that the procedure would not work in that type of patient. On the other hand, we have raised the bar for evidence, and I don’t think it is sufficient for physicians to rely on anecdotal successes even in the patient type I described. So, bottom line, I think that further study should continue in renal denervation for resistant hypertension and other conditions, such as heart failure. Clinical use, however, should really wait until there are solid preclinical data followed by proper randomized data supporting performance of the procedure.
Share your thoughts on Dr. Bhatt’s analysis of the implications of the SYMPLICITY HTN-3 trial.
To view all of our coverage from the ACC meeting, go to our ACC.14 Headquarters page.
March 29th, 2014
Survival Advantage for TAVR Over Surgery in High-Risk Patients
Larry Husten, PHD
Transcatheter aortic valve replacement (TAVR), which has been slowly and cautiously entering the clinical arena, will probably get a big boost from a new trial showing a significant mortality advtange for TAVR over traditional surgery.
Results from the U.S. CoreValve High-Risk Study were presented at the American College of Cardiology in Washington, DC, and published simultaneously in The New England Journal of Medicine. In the trial, 795 patients with severe aortic stenosis who who were at high risk for surgery were randomized to surgical aortic valve replacement (SAVR) or TAVR with the Medtronic CoreValve device.
The headline news is the improved mortality with TAVR. In the as-treated analysis, at 1 year the rate of death was 14.2% in the TAVR group versus 19.1% in the SAVR group, a difference that was highly significant for noninferiority (P<0.001) and that reached significance for superiority (P=0.04). A similar pattern occurred in the intention-to-treat analysis: At 1 year, the rates of death were 13.9% for TAVR and 18.7% for SAVR (P<0.001 for non inferiority; P=0.04 for superiority).
However, for the important secondary endpoint of major adverse cardiovascular and cerebrovascular events at 30 days or discharge, TAVR did not meet the prespecified criteria for superiority (8.2% for TAVR vs. 10.9% for SAVR; P=0.10). At 30 days, the stroke rate was 4.9% in the TAVR group and 6.2% in the surgical group (P=0.46). At 1 year, the strokes were 8.8% and 12.6%, respectively (P=0.10).
More pacemakers were implanted in the TAVR group at 1 year (22.3% vs. 11.3% for SAVR), and the TAVR group had more major vascular complications. But bleeding complications occurred more frequently in the surgery group.
In an interview with Rick Lange and David Hillis for CardioExchange, Columbia University interventional cardiologist Ajay Kirtane said that the trial “further tilts the balance toward TAVR in high-risk patients.” He cautioned that it is impossible at this point to compare the CoreValve results with results from the Sapien device in the PARTNER trials. “In the absence of a head-to-head comparison of the short- and long-term performance of these valves, it is really difficult to speculate about valve-specific differences, except theoretically,” he said. “I view this as a ‘win’ for TAVR as a whole.”
For more of our ACC.14 coverage of late-breaking clinical trials, interviews with the authors of the most important research, and blogs from our fellows on the most interesting presentations at the meeting, check out our ACC.14 Headquarters.
March 29th, 2014
No Benefit Found in First Real Test of Renal Denervation
Larry Husten, PHD
SYMPLICITY HTN-3, the eagerly awaited first rigorous test of renal denervation, shows that the real effect of the novel blood-pressure-lowering technology is dramatically lower than earlier expectations, which had been fueled by data from previous uncontrolled trials. Results of SYMPLICITY HTN-3 were presented at the American College of Cardiology conference in Washington, DC, and published simultaneously in The New England Journal of Medicine.
The Medtronic-sponsored trial tested the effect of renal denervation in patients with resistant hypertension, defined as a sustained office systolic BP of at least 160 mm Hg confirmed by home BP and 24-hour ambulatory BP documentation of a systolic BP of at least 135 mm Hg. In all, 535 patients were randomized in a 2:1 ratio to either renal denervation or a sham procedure.
At 6 months, only a very small 2.39-mm-Hg difference was evident between the two groups in the change in office systolic BP since baseline. This difference — a drop of 14.13 mm Hg in the denervation group versus 11.74 mm Hg in the control group — did not reach statistical significance.
A similar pattern emerged with the secondary endpoint of ambulatory BP at 6 months, with only a 1.96-mm-Hg difference between the groups (a drop of 6.75 mm Hg in the denervation group vs. 4.79 mm Hg in the control group). No difference was found in the home BP measurements. The same results were observed when diastolic BP was examined.
There were 5 adverse events in the renal denervation group and 1 in the sham-procedure group.
The authors write, “These findings contradict the published clinical data regarding renal denervation, which showed larger reductions in blood pressure 6 months after denervation and, in the unblinded SYMPLICITY HTN-2 trial, no reduction of systolic blood pressure in control patients.”
The investigators also noted that despite the widespread hype, enough information was available to predict that the trial would not produce the large, dramatic reductions in BP that many experts had predicted: “A meta-analysis of antihypertensive- drug trials predicted that the change in office systolic blood pressure would be smaller than reported in two early renal-denervation trials… when a more rigorous study design was used to reduce bias. The current trial underscores the importance of conducting blinded trials with sham controls in the evaluation of new medical devices before their clinical adoption.”
The authors proposed a number of possible explanations for the discrepancy in the findings between their study and previous studies. They noted that some prior studies had not had a control arm and had compared the treatment effect to baseline observations, “leading to a false impression of treatment efficacy,” perhaps due at least in part to a regression to the mean. Without proper blinding and controls “both patients and assessors may be subject to bias in favor of a new treatment that is expected to have increased efficacy.” Given the results in the sham-treatment arm, it also seems likely that a placebo effect was interpreted as a treatment effect.
The study findings, the investigators wrote, have “important therapeutic implications for the design of trials of antihypertensive (and other) medications, devices, and strategies.”
In an accompanying editorial, Franz Messerli and Sripal Bangalore discuss the discrepancy between the earlier SYMPLICITY trials, which found systolic BP reductions as high as 32 mm Hg, and SYMPLICITY HTN-3. The earlier results were “unprecedented” and “continued to fan the flames of renal denervation.” Symplicity HTN-3, they write, “brings the renal-denervation train to a grinding halt.”
Click here to read an interview with Deepak L. Bhatt, co-principal investigator of SYMPLICITY HTN-3.
For more of our ACC.14 coverage of late-breaking clinical trials, interviews with the authors of the most important research, and blogs from our fellows on the most interesting presentations at the meeting, check out our ACC.14 Headquarters.
March 28th, 2014
Changing My Priorities for ACC.14
Kumar Dharmarajan, MD MBA
Several Cardiology fellows who are attending ACC.14 in Washington, D.C. this week are blogging for CardioExchange. The fellows include Kumar Dharmarajan, Seth Martin, and Saurav Chatterjee. For more of our ACC.14 coverage of late-breaking clinical trials, interviews with the authors of the most important research, and blogs from our fellows on the most interesting presentations at the meeting, check out our ACC.14 Headquarters.
I just reviewed the meeting itinerary on my way to D.C., and to my surprise, gravitated not towards the late breakers or quality of care and outcomes research-related sessions as I have in the past, but to talks sounding like textbook chapters or journal reviews: “Approaches to the Management of Pulmonary Hypertension”; “Prosthetic Valve Complications”; “Under-recognized and Challenging Cardiomyopathies”; “State of the Art for Secondary and Resistant Hypertension”; and so on.
No doubt initially confused, I now realize that with my time in fellowship rapidly dwindling, I have an increasing urge to consolidate my knowledge. I just had a baby girl and cannot help wondering, “Is this the career equivalent of nesting for my next life as a general cardiology attending?”
Are other graduating fellows feeling similarly?
March 28th, 2014
ACC.14 Headquarters
wpengine
CardioExchange is dedicated to bringing you the latest from ACC.14. Check out our coverage of the conference ─ and some of the great debates these posts have sparked ─ then tell us what you think!
News:
Analysis:
Follow our Fellows:
NEJM Journal Watch — Recent Cardiology Articles- Major and Intracranial Hemorrhage Risk with Direct Oral Anticoagulants vs. Aspirin
- Chlorthalidone vs. Hydrochlorothiazide for Hypertension: Renal Outcomes
- Estimating Heart Failure Risk in the U.S. Population with the PREVENT Calculator
- Atrial Fibrillation and Stable Coronary Artery Disease — What Is the Optimal Anticoagulation–Antiplatelet Regimen?
- β-Blockers After Myocardial Infarction