Posted in bio ethics, Histroy of medicine, Medcal research, Medical education, Medical ethics, medical quotes, tagged ethics in medical research, ethics in medicine, greatest award in medicine, medical quote, nobel prize in medicine, publish or perish, what is success in scientific world on November 26, 2021|
What is the true success in a scientific career?
It is not the number of publications in journals or getting those big awards or memberships in prestigious scientific societies. True success is “something else,” says the Nobel Medical Laureate Dr Willam Kaelin
Great thoughts. Just wondering, what are those elements beyond our controls he was alluding to?
Video courtesy and thanks : http://www.nobel.org
Posted in Cardiology -Therapeutic dilemma, Cardiology -unresolved questions, Ethics in Medicine, fame study ffr, Fracional flow reserve, tagged ACC AHA ESC FAME TRIAL NEJM, evidence based medicine, FAME 3 TRIAL, multivessel pci, nejm on November 5, 2021|
News: Series of clinical trials fail to clear the ongoing confusion in the business of cardiac revascularization.FAME 3 is the new addition.
Caution: A non-academic journal review
There is no secret, about this cold war happening in an incognito mode for territorial rights between cardiologists and cardiac surgeons in glamorous cardiac suits for the past two decades. Of course, we keep believing this is a friendly fight in the overall interest of CAD patients. The ultimate winner should be the patient, not anyone else. Will that happen? Will anyone will allow that to happen? I am not sure.
The FAME3 is a stunning large study from 50 centers FFR guided multivessel PCI, that failed to dethrone CABG (or at least it wanted to sit along with it) I am not a seasoned statistician but definitely can’t understand the logic behind the methodology* and the choice of words in the conclusion from a paper published from a renowned journal.
(*I can recall an article about Non-inferiority trial from Lancet (Ref 1) )
FAME 3 aftermaths: A dizzy Interpretation
Before accepting the fact that, FFR guided PCI wasn’t able to show its superiority or to unable to prove its non-Inferiority, while CABG was clearly found to be non-inferior, (rather superior) to PCI, we should take into account an important caveat in the concept of FFR itself, which has at least half a dozen serious hyperemic and non-hyperemic flaws that demanded a more superior,non-hyperemic indices like iFR, RFR, qFR, etc.
Those of you who still believe PCI would be an undisputed modality in multivessel CAD should take up the challenge and disprove the superiority of CABG by doing the same FAME 3 subset with iFR and other stuff. (Eagerly waiting for the hypothetical iFAME 4 trial)
One more way to Interpret FAME 3: How can we accept FFR guided multivessel PCI as inferior, unless we have an FFR guided CABG (FAME 3 didn’t do this) to compare? Can you guess if only pre-CABG FFR was mandatory criteria, that would have excluded or included important grafts, what would have been the impact of CABG? This is a more dramatic suggestion, that will say sorry to FFR,( the old physiological friend,) and label it as a new villain.
Final message
Multivessel PCI still has a long way to go before trying to dethrone CABG. But, strictly scientific cardiologists need not worry much and they can continue to indulge multivessel PCI without FFR, which is no longer unscientific ! Thanks to FAME 3. I think one of the Important indirect consequences (?purpose) of FAME 3 would be, playing the end game for FFR.
Reference
Posted in acute coronary syndrome, Cardiology -unresolved questions, RIsk factors, wisdom in cardiology, tagged aha guidelines acc physical activity exertion, coronary risk factors, scd on November 4, 2021|
A young Indian superstar actor Punnet Rajkumar, suffered a sudden cardiac death last week during a workout at his gym. We don’t really know what happened, was it really a conventional heart attack ? or simply an exercise Induced arrhythmia or an isometric dissecting injury to the coronary arterial (or Aortic) wall. Only a postmortem would have thrown some light. (I am not sure what the ER room ECG showed though) He had excellent physical fitness and was following a good healthy lifestyle. One possibility is extreme physical exertion.
It is ironic, while a sedentary lifestyle is a chronic coronary risk factor, excessive physical activity in the background of emotional stress can be turn out to be an acute risk factor. (This is not to frighten all those young and energetic, it only conveys a simple message. Moderation is a must in any indulgences in life)
AHA has made an elaborate scientific statement on this Issue.
Meanwhile, the entire nation went into cardio-panic mode and TV media houses have become free cardiology consultation rooms. How many will realize sudden cardiac arrest and heart attacks can be totally two different entities. Further, who can teach the public, that endpoint of any life has to be cardiac arrest or a standstill. How unscientific does it sound when someone suggests a CT angiogram for all aged over 40 years ? Guess, who will enjoy whipping and sustaining such a frenzy.
Here is a precise article in Indian express that puts this episode into perspective.
The author is Dr. Ganesan Karthikeyan, professor of cardiology at AIIMS with a Global reputation.
Posted in Uncategorized, tagged ACC AHA ESC guidelines for cad stable angina, cardiology journal club, COURAGE BARI 2D ORBITA ISCHEIMIA, ISCHEMIA trial, Limitations of ISCHEMIA trial on November 2, 2021|
There are a whole lot of scientists trying to jailbreak and expose the limitations of the hugely popular ISCHEMIA trial which put the emergency breaks in the way we used to practice cardiology. Not everyone is happy. While few are ready to apply the brake, many continue to love the accelerator.
This study (Ref 1) talks about an important issue. How much of the CAD populations in the real world will match the ISCHEMIA trial population? It concludes it is just 32%. It suggests caution to the cardiologists to understand this trial from a proper perspective. Don’t give too much importance, lest we may end up with Inappropriate non-intervention.
Sounds too good?
But is it real?
The authors of ISCHEMIA have countered this claim. (Ref 2)If we include all mild and moderate symptom cohort Ischemia study population is very much relevant in the true world and, actually constitutes about 68 % .
Final message
Clinical trials are the greatest gift of science and EBM. But why is that …it never fails to confuse us at each and every step, while we accumulate tons and tons of evidence.
I wish someone do a mega four-limbed study on what really our patients are getting in the overall CAD care.
I could easily guess the winning theme of this hypothetical trial. (That’s not good news though) However, response 4 If practiced in the right spirits would have the maximum impact on global cardiovascular health in terms of both healing and saving.
Reference
Posted in Cardiology Illistrations, Cardiology Illustrations, Cardiology teaching websites, Cardiology-Echocardiography, cardiomyopathy, hocm hcm, hypertrophic cardiomyopathy, Uncategorized, tagged Alcohol septal ablation, ASE posters on hocm hcm, best illistration for hyocm hcm hypertrophic cardiomyopathy, how to do genetic screening for hcm hocm, lvot vs mr gradient in hocm, myosin titin sarcomere mutations hocm, premyectomy echo work up on November 1, 2021|
Check out these two posters* for are a quick reference on HOCM with current updated evidence. The first one details about Echo evaluation. The second one illustrates the genetic screening flow chart of the HOCM families.
Some of the queries, you will find the answers from these posters are,
1. How to recognize Intrinsic mitral valve defect by MR jet morphology?
2. How to cross-check the true LVOT gradient from MR jet?
3. When to do a provocative test to document the LVOT gradient?
4. What are the standard pre-myectomy measurements by Echo?
5. How to screen a family member of HCM? Pros and cons of Phenotypic vs Genotyping screening
*Reference
Thanks to the American Society of Echocardiography.
Dr.S.Venkatesan MD 