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The 4th International Clinical Cardiovascular Genetics Conference

The 4th International Clinical Cardiovascular Genetics (ICCG) conference was held in Brisbane on May 11-13, 2022. As the first face-to-face meeting for the majority of the attendees, it was as much a social event and “family reunion” as it was an outstanding scientific conference exploring the latest in cardiovascular genetic advances and how these amazing developments have led to improved patient care.

Our two international guests, Dr Perry Elliott (UK) and Dr Bruce Gelb (USA), shared their knowledge in the fields of inherited cardiomyopathies and congenital heart diseases, and were accompanied by an exceptional national faculty of unmasked speakers, and a number of students presenting abstract talks and posters many for the first time at an international conference.

 Download the report in full here (pdf).

Prof Chris Semsarian, Scientific Program Chair

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Joint National Cardiovascular Implementation and Policy Roundtable

The Joint National CV Implementation and Policy Roundtable held in Canberra in March 2022 provided a unique opportunity to bring the community together to collectively take important steps to set a national CV Implementation & Policy agenda and action plan.

Prof Garry Jennings and Prof Julie Redfern, under the flagship of the ACvA Implementation and Policy, have joined forces with the Cardiac Society of Australia and New Zealand and the National Heart Foundation of Australia to start the national discussion to identify implementation and policy solutions for cardiovascular disease.

Over 60 participants from government, peak bodies, and individuals spanning clinicians, researchers, primary care, allied health, pharmacists, nurses, consumers and industry were in attendance and a draft report has been prepared for consultation and input take the first steps towards a National Implementation and Policy agenda and action plan.

Download the report here 

 

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Diagnostic Performance of CT-Derived Fractional Flow Reserve in Australian Patients Referred for Invasive Coronary Angiography

The first use of non-invasive fractional flow reserve-derived from CT coronary angiography (FFRct) in Australian patients is reported in our article, now published in Heart, Lung and Circulation [1]. This technology is currently TGA-approved in Australia, although not approved for use under Medicare.

Advances in CT coronary angiography currently offer the ability to assess both the anatomical and physiological aspects of coronary disease within the one scan. Non-invasive fractional flow reserve derived from CT coronary angiography (FFRct) is a technology first described in 2011 [2], pioneered by HeartFlow in the USA. Large multicentre global validation studies have since established its diagnostic performance and prognostic implications to be comparable with invasive fractional flow reserve. Across the US, Europe and Japan, and following regulatory approval, FFRct has evolved to become part ofmainstream clinical practice; in US (American Heart Association/American College of Cardiology) and UK (The National Institute for Health and Care Excellence [NICE] guidelines, FFRct is currently recommended for use in patients with stable recent onset chest pain.

How does FFRct work? Using the images of a routinely acquired CT coronary angiogram, a model of the coronary luminal tree is derived. Physiological assumptions are made regarding the viscosity of blood, as well as inlet and outlet flow and pressure, based on their observed relationship in accordance with vessel size and myocardial mass. These assumptions are then applied to the luminal model. Flow and pressure are derived using computational fluid dynamics across the entire coronary tree [3]. When compared with invasive fractional flow reserve, FFRct has high diagnostic performance. Importantly, it provides improved specificity for detection of vessel specific ischaemia compared with anatomical stenosis assessment using CT coronary angiography alone.

Our study included 109 patients who had undergone CT coronary angiography and invasive fractional flow reserve; the technology of FFRct was retrospectively applied. In this cohort of Australian patients, the diagnostic performance of FFRct was found to be comparable with the existing international literature, with demonstrated improvement in performance compared with CT coronary angiography alone for detection of vessel specific ischaemia.

[1]​Chua A, Ihdayhid AR, Linde J, Sorgaard M, Cameron JD, Seneviratne S, Ko BS. Diagnostic Performance of CT-derived Fractional Flow Reserve in Australian Patients Referred for Invasive Coronary Angiography. Heart Lung Circ 2022; Article in press https://www.heartlungcirc.org/article/S1443-9506(22)00115-9/fulltext

[2]​Koo BK, Erglis A, Doh JH, Daniels DV, Jegere S, Kim HS, et al. Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Results from the prospective multicenter DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study. J Am Coll Cardiol. 2011;58:1989-97.

[3]​Khav N, Ihdayhid AR, Ko B. CT-derived Fractional Flow Reserve (CT-FFR) in the Evaluation of Coronary Artery Disease. Heart Lung Circ 2020; 29: 1621-32.

Summary by co-author Brian Ko

Libby Admin Device Alerts

Medtronic Cobalt™ and Crome™ ICDs and CRT-Ds (May 2022)

May encounter a persistent “session-active” flag following the use of inductive telemetry, typically with CareLink Express. This will result in temporary suspension of some features until the flag is cleared:

ANZCDACC Hazard Alert May 2022

(Download as pdf)

Device:

Medtronic Cobalt™ and Crome™ Implantable Cardioverter Defibrillators (ICDs) and Cardiac Resynchronisation Therapy Defibrillators (CRT-Ds)

 TGA Reference: RC-2022-RN-00608-1

Read More
Libby Admin News Archive

CSANZ Research Scholarship Winners

Congratulations to the 2023 CSANZ Research Scholarship Winners

Dr Stephanie Rowe, cardiologist at the Baker Heart and Diabetes Institute, VIC.
The Project – Cardiac remodelling and exercise capacity: Clinical and genetic predictors of low exercise capacity and atrial fibrillation.
Synopsis:

The interaction between physical activity, our genome and cardiac structure is complex. Emerging evidence suggests functional capacity and cardiac size play a critical role in the development of heart failure and atrial fibrillation – both key causes of illness and health expenditure. Extremes of activity, from a sedentary lifestyle to endurance athletes, can impact heart structure and function and risk of arrhythmias. The sedentary end of the spectrum is associated with smaller stiffer hearts, poor exercise capacity and cardiovascular risk factors including type 2 diabetes and obesity. Through in-depth assessment of clinical, imaging and genetic factors that influence low exercise capacity and atrial fibrillation, this research project aims to identify novel and simple ways to detect people in this high risk population. Using the largest and most comprehensive cohort of cardiac, exercise and genetic metrics world-wide, we will also develop an understanding of the interaction between physical activity, cardiac structure and genetics by assessing how a person’s genetic signature impacts the heart’s ability to remodel in response to exercise.

Our aim is to identify and better understand clinical and genetic predictors of low exercise capacity and atrial fibrillation. Our hypothesis is that small cardiac size can be used to identify people with poor exercise capacity due to reduced cardiac reserve and that polygenic risk scores can predict those who are genetically primed to have low exercise capacity and atrial fibrillation.

Aim 1: Determine clinical and imaging markers which predict poor exercise capacity and atrial fibrillation.

Aim 2: Identify genetic traits associated with small hearts, poor exercise capacity and cardiac atrophy.

Aim 3: Assess the relationship between genes, physical activity, and heart structure and how they impact one another.

This project will generate highly clinically relevant knowledge with clear benefits to Australian clinical practice. Current health interventions are directed at those diagnosed with disease, but there is a crucial window of opportunity in preventing disease. By identifying markers predictive of exercise capacity, we will be able to identify individuals at greatest risk of heart failure and arrhythmias – both key causes of illness and health expenditure. By evaluating the relationship between our genome and exercise capacity we will identify to what extent the sedentary population may be genetically primed to be non-responders to exercise. The use of a cheap genetic test to anticipate response to therapy would be a considerable advance in individualized care. This research will lead to improvement in individualized risk assessments and early interventions to reduce population cardiac morbidity and mortality.

Dr Shaun Evans, Royal Adelaide Hospital, SA
Shaun’s Project : PREDICTive value of aggressive risk factor modification on the occurrence of major cardiovascular events in patients with embolic STROKE: PREDICT-STROKE
Synopsis:

PREDICT-STROKE is a randomised, multicentre trial to evaluate the potential benefits of aggressive risk factor modification versus standard of care to prevent major adverse cardiovascular events in patients with an embolic stroke or transient ischaemic attack.

Stroke is a major contributor to cardiovascular morbidity and mortality, resulting in lost quality of life, economic productivity, and health expense. Approximately one third of all strokes are attributable to atrial fibrillation, and a further third are cryptogenic (without known cause). Most cryptogenic strokes are subclassified as embolic stroke of undetermined source (ESUS). Approximately 3/10 patients with ESUS will be diagnosed with AF with prolonged monitoring.

Atrial cardiomyopathy is a relatively novel concept which encompasses pathological changes in the left atrium leading to the development of AF, or atrial thrombus and cardioembolism (potentially in the absence of AF). Multiple known factors influence atrial cardiomyopathy, and these include hypertension, obesity, diabetes, sleep apnoea and systemic inflammation.

We aim to test the hypothesis that aggressive management of these factors in a patient- specific fashion will prevent recurrent clinical and radiological embolic stroke.

The primary aim of the study is to investigate for patients with embolic stroke or transient ischaemic attack, whether the risk of major adverse cardiovascular events (including recurrent embolic stroke) can be modified by aggressive risk factor prevention.

For the diagnosis of atrial cardiomyopathy, invasive electroanatomical atrial mapping is known to demonstrate electrical atrial scar and regions of low voltage – the characteristic electrical changes of atrial cardiomyopathy. We aim to show that a multielectrode vest used to perform electrocardiographic imaging (ECGi) will correlate with invasive electroanatomical atrial mapping, predicting its extent and assist in stratifying risk of future atrial fibrillation.

We hypothesise that aggressive risk factor modification will reverse atrial cardiomyopathy, and that serial ECGi mapping will be able to demonstrate concordant longitudinal changes.

Systemic inflammation is closely related to the risk of developing AF, as shown by its relationship to multiple biomarkers of inflammation. We aim to investigate the relationship between these biomarkers and the extent of atrial cardiomyopathy as diagnosed by ECGi.

The primary potential benefit of this study is the identification of directed therapy for secondary prevention of embolic stroke of undetermined source. More generally, we expect a reduction in cardiovascular disease, which will provide individual patient benefit. With risk factor modification, we anticipate a group-level effect in weight reduction, blood pressure management and lifestyle improvement, which each have public health benefits for reduced incidence of atherosclerotic cardiovascular disease and improved mental health.

A clinically significant reduction in the primary endpoint of the study would translate to reduced hospitalisations, preserved quality of life, preserved cognitive function, freedom from physical disability and overall reduced healthcare expenditure.

Congratulations to the 2022 CSANZ Research Scholarship Winners

Rebecca Raeside, PhD Candidate, Research Officer at the University of Sydney
Rebecca’s Project: Health4Me Randomised Controlled Trial (RCT): primary prevention of cardiovascular disease among young people.
Synopsis:

The current picture of young peoples’ health in Australia is alarming with escalating health risks such as poor diet, physical inactivity, increased screen time and poor mental health becoming widely prevalent. These health risks can lead to chronic health problems such as heart disease in adulthood. Australia’s 3.3 million teenagers have little support to manage these health risks and accessible, engaging programs that support a healthy lifestyle are urgently needed. My innovative Health4Me program will strive to solve this problem. We know that text message healthy lifestyle programs in adults have improved health outcomes and resulted in positive behaviour change. Over the next 3 years, I will lead a research project that will develop and test an engaging healthy lifestyle program for teenagers using text messages, a method through which they communicate every day. I will work with teenagers to co-create the Health4Me program using an established process. I will test how effective Health4Me is in a randomised clinical trial (330 teenagers) and evaluate if the program improves physical and mental health outcomes, whether it is acceptable and engaging and if the program can be embedded into the Australian healthcare system. If it helps, it can be scaled up to deliver to teenagers throughout Australia to improve health outcomes.

Dr Thomas Meredith, Victor Chang Cardiac Research Institute, UNSW
Tom’s Project: Improving therapeutic decision making in aortic valve stenosis.
Synopsis:

Aortic stenosis is the most common heart valve disease. It is characterised by a complex interplay between the aortic valve and the heart muscle (ventricular) function, making diagnosis and treatment timing challenging. Although replacement of the aortic valve has improved the prognosis of this condition, the current recommendations for the timing of replacement are associated with a highly advanced disease state and oftentimes sub-clinical heart muscle dysfunction, which is not only likely irreversible, but also portends a worse prognosis. It is possible that there may be a significant advantage to aortic valve intervention prior to the end-stage disease state which currently forms the basis for guideline recommendations. In the proposed doctoral research, we aim to better predict the response to therapy in aortic stenosis and identify factors associated with a favourable response to aortic valve intervention, such that we can help individualise treatment for patients and improve survival.

Libby Admin News Archive

Be inspired by CSANZ Women in Cardiology…

In celebration of International Women’s Day last month, we are delighted to showcase women with diverse backgrounds and varied experiences spanning the professional cardiology spectrum in Australia and New Zealand.

Four Cardiac Society women share their career journeys, challenges and thoughts on diversity and inclusion…we hope you find their stories inspiring.

Dr Sarah Fairley, Consultant Interventional Cardiologist, NZ Incoming Chair, CSANZ NZ Interventional Working Group.

Dr Julee McDonagh, Registered Nurse and Lecturer, University of Newcastle School of Nursing and Midwifery.
Proud descendant of the Cabrogal Clan of the Dharug First Nations people.

Ms Katharine McBride, PhD Candidate at University of South Australia and Senior Implementation Project Officer at SAHMRI
2021 Indigenous Health Prize winner at the CSANZ ASM.
Ms Miriam Norman, Senior Cardiac Device Specialist, Royal Hobart Hospital.
On the Pulse
Read the full edition of the CSANZ On the Pulse here
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Temporary MBS item for use during thallium-201 (Tl-201) shortage

The new temporary Medicare Benefits Schedule (MBS) item for use during thallium-201 (Tl-201) supply disruptions was implemented on 1 April 2022.

Item 61644 is a direct substitute of item 61325 and enables the use of FDG PET in place of Tl-201 for cardiac viability testing when Tl-201 is unavailable.

The item will be available from 1 April 2022 until 30 September 2022. (See Factsheet Summary below):

Factsheet – substitute PET item for use during thallium-201 supply shortage.

Libby Admin News Archive

Upcoming MBS Item Changes

New and amended MBS items will be introduced in July and November, 2022 including:

  • low surgical risk TAVI (1 July)
  • transcatheter insertion of a dual-filter (multi-filter) CEP device (1 July)
  • remote options for cardiac ILRs (1 Nov)
  • surgical items (1 Nov)

See summary details here  MBS changes July and November 2022.pdf

Factsheets and a Quick Reference Guides will be made available shortly at: www.mbsonline.gov.au and under the Fact Sheets tab.

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