ESC 2022 Highlights Podcast

In this episode, Medicom’s correspondent covers 6 presentations from the European Society of Cardiology congress (ESC 2022), held in Barcelona, Spain, from 26-29 August 2022.
The topics discussed are:

1. Old dogs, new tricks: Acetazolamide plus loop diuretics improves decongestion 
   Adding acetazolamide, a carbonic anhydrase inhibitor that reduces renal proximal tubular sodium reabsorption, to loop diuretics in patients with acute decompensated heart failure with volume overload improved the rates of successful decongestion within 3 days, according to findings from the ADVOR trial. Because acetazolamide is inexpensive and clinics have >70 years of experience with this off-patent drug, it is anticipated that its wide adoption as a new standard-of-care will improve the speed and efficacy of decongestion, and will save millions of lives.
2. Polypill SECUREs win in secondary prevention in elderly
   The 3-drug fixed-dose ‘polypill’ containing aspirin, ramipril, and atorvastatin, prevents secondary cardiovascular events in people ≥65 years old who have previously had a myocardial infarction, reducing cardiovascular mortality by 33% in this vulnerable patient population.
3. First RCT evidence for use of AI in daily practice 
   In the first and only randomised-controlled trial of its kind, initial assessment of left ventricular ejection fraction (LVEF) by artificial intelligence (AI) was non-inferior and superior to initial sonographer assessment. After blinded review of initial LVEF assessment, cardiologists were less likely to substantially change their final report with initial AI assessment than sonographer assessment. Furthermore, AI-guided assessment took less time for cardiologists to overread, and was more consistent in test-retest modelling.
4. Fears regarding effect of neprilysin inhibition on cognition removed
   Initial results of the PERSPECTIVE trial demonstrated no evidence that neprilysin inhibition increased the risk of cognitive impairment, due to accumulation of amyloid-β in the brain, in patients with heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF). These data should set to rest concerns about increased cerebral amyloid-β deposition with sacubitril/valsartan related to neprilysin inhibition.
5. AXIOMATIC-SSP: Reducing risk of ischaemic stroke with factor Xia inhibition?
   Late-breaking findings from the phase 2, dose-ranging AXIOMATIC-SSP trial showed that, although dose response was not observed, a 30% relative risk reduction was demonstrated in symptomatic ischaemic strokes for patients randomised to milvexian arms compared with placebo in participants treated with dual antiplatelets. The milvexian safety signal was also encouraging: no fatal bleeding and no increase in symptomatic intracranial haemorrhage was reported.
6. Take hypertension medication anyTIME 
   The pragmatic randomised TIME trial, with over 5-year follow-up in >21,000 patients with high blood pressure, reported that taking antihypertensive medications in the morning or the evening provides identical protection against heart attack, stroke, or vascular death.

Enjoy listening!

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Posted on 15 September, 202222 February, 2024