Fantastic (part 1 of several, hopefully) summary. Great idea to prominently feature your TWIC column. It’s been required weekly reading for me since circa 2012 when I stumbled across it on medscape.
I use dig now particularly in pts with HFrEF and AF. But in US and Canada (where digitoxin isn’t available) I’d wait for readout of the Decision trial you alluded to….which should hopefully occur within the next 6 months. I’m certainly guilty of needlessly abandoning dig for too long, due to Dig trial. But I’ve literally never used digitoxin, so I’d want some further reassurance of safety with digoxin in particular, esp in light of the somewhat fragile efficacy results.
I’ve embraced Reduce-AMI since publication. As an echo reader I’d submit that, while focussing on the precise EF numerical may be folly, we can in fact distinguish “low normal” vs “abnormal” systolic function. So I’ve refrained from using BB at post MI discharge in pts without abnormal LV fxn (unless there is an alternate BB indication, as you noted). Due to some differences in findings in the “mildly reduced” cohort (EF40-49), I may continue to discharge on BB in those pts…and factor in Abyss results after 1 year to discontinue their BB if there is no further abnormal remodelling (while abyss technically suggested you should continue BB long term, I agreed with your suggestion that it was driven by very soft endpoints that would not apply in a non-French environment).
As for primary prevention ICD in ischemics, I wonder how you reconcile current results in an enriched “mildly reduced LV fxn” cohort with the foundational studies which tested pts with EF<35. I think this result demands restraint for ICD use in the cohort with similar EF as in the study, but by itself I don’t think it changes the paradigm as thoroughly as Danish has for non-ischemics.
Thanks for your continued work. I learn something every time.
I really appreciate your reporting on these important cardiology meetings along with your insightful critical analysis of the studies presented! I will never forget my first ESC meeting in Nice in 1989. Your mention of the DIGIT-HF trial in your always stimulating This Week In Cardiology prompted me to share an update on my original Foxglove Equipoise article from 2015. It is very satisfying to see the resurrection of the cardiac glycosides, which have been in use for 250 years, in clinical practice.
Great to meet you in person, John. Our "debate" was a lot of fun, and Madrid was definitely a great venue for ESC. I look forward to coming back again!
Do any of your cardiology fraternity have experience with removing part of a Hickman Line removal from a heart valve in the upper chamber that has calcified. It could be lodged there at least 7 years. The blood flows out but also back in again. Fatigue on exertion is main complaint. Im not medical. Just looking to research any help we can get in Dublin, Ireland. Its for my nephew who was unwell with leukaemia a number of years back.
Shot in the dark I know but you're meeting the right people.
Fantastic (part 1 of several, hopefully) summary. Great idea to prominently feature your TWIC column. It’s been required weekly reading for me since circa 2012 when I stumbled across it on medscape.
I use dig now particularly in pts with HFrEF and AF. But in US and Canada (where digitoxin isn’t available) I’d wait for readout of the Decision trial you alluded to….which should hopefully occur within the next 6 months. I’m certainly guilty of needlessly abandoning dig for too long, due to Dig trial. But I’ve literally never used digitoxin, so I’d want some further reassurance of safety with digoxin in particular, esp in light of the somewhat fragile efficacy results.
I’ve embraced Reduce-AMI since publication. As an echo reader I’d submit that, while focussing on the precise EF numerical may be folly, we can in fact distinguish “low normal” vs “abnormal” systolic function. So I’ve refrained from using BB at post MI discharge in pts without abnormal LV fxn (unless there is an alternate BB indication, as you noted). Due to some differences in findings in the “mildly reduced” cohort (EF40-49), I may continue to discharge on BB in those pts…and factor in Abyss results after 1 year to discontinue their BB if there is no further abnormal remodelling (while abyss technically suggested you should continue BB long term, I agreed with your suggestion that it was driven by very soft endpoints that would not apply in a non-French environment).
As for primary prevention ICD in ischemics, I wonder how you reconcile current results in an enriched “mildly reduced LV fxn” cohort with the foundational studies which tested pts with EF<35. I think this result demands restraint for ICD use in the cohort with similar EF as in the study, but by itself I don’t think it changes the paradigm as thoroughly as Danish has for non-ischemics.
Thanks for your continued work. I learn something every time.
I really appreciate your reporting on these important cardiology meetings along with your insightful critical analysis of the studies presented! I will never forget my first ESC meeting in Nice in 1989. Your mention of the DIGIT-HF trial in your always stimulating This Week In Cardiology prompted me to share an update on my original Foxglove Equipoise article from 2015. It is very satisfying to see the resurrection of the cardiac glycosides, which have been in use for 250 years, in clinical practice.
Great to meet you in person, John. Our "debate" was a lot of fun, and Madrid was definitely a great venue for ESC. I look forward to coming back again!
Hi, thanks for they update.
Do any of your cardiology fraternity have experience with removing part of a Hickman Line removal from a heart valve in the upper chamber that has calcified. It could be lodged there at least 7 years. The blood flows out but also back in again. Fatigue on exertion is main complaint. Im not medical. Just looking to research any help we can get in Dublin, Ireland. Its for my nephew who was unwell with leukaemia a number of years back.
Shot in the dark I know but you're meeting the right people.
Many thanks,
Frances Craven.
Thanks. Have a good trip
Would be great to review AVIM therapy and the moderato / back beat trial. Seems like a promising development