Unequitable Heart Failure Therapy for Black, Hispanic and American-Indian Patients

Despite the high prevalence of heart failure among Black and Hispanic populations, patients of colour are frequently under-prescribed guideline-directed medical therapy (GDMT) and American-Indian populations are not well characterised. Clinical inertia, financial toxicity, underrepresentation in trials, non-trustworthy medical systems, bias and structural racism are contributing factors. There is an urgent need to develop evidence-based strategies to increase the uptake of GDMT for heart failure in patients of colour. Postulated strategies include prescribing all GDMT upon first encounter, aggressive outpatient uptitration of GDMT, intervening upon social determinants of health, addressing bias and racism through changing processes or policies that unfairly disadvantage patients of colour, engagement of stakeholders and implementation of national quality improvement programmes

Thyroidectomy in Mechanical Circulatory Support - A Salvage Treatment for Thyrotoxicosis-Induced Cardiogenic Shock: Case Series

Amiodarone is frequently used to treat arrhythmias in patients supported with left ventricular assist devices. Long term amiodarone use can cause hyperthyroidism ultimately leading to cardiomyopathy and sometimes thyrotoxicosis-induced cardiogenic shock (CS). We describe two cases of thyrotoxicosis-induced CS rescued by successful thyroidectomy under mechanical circulatory support (MCS) – one with a Heartmate III (Abbott Laboratories) and another supported with veno-arterial extracorporeal membrane oxygenation (V-A ECMO). In refractory CS, the initiation of V-A ECMO as a bridge to recovery is critical. In thyrotoxicosis-induced CS that is refractory to medical therapy requiring MCS, thyroidectomy is feasible, and a growing body of evidence suggests that it is safe

Myocarditis following COVID-19 vaccination in adolescents and adults: a cumulative experience of 2021

Clinical course and outcomes of myocarditis after COVID-19 vaccination remain variable. We retrospectively collected data on patients > 12 years old from 01/01/2021 to 12/30/2021 who received COVID-19 messenger RNA (mRNA) vaccination and were diagnosed with myocarditis within 60 days of vaccination. Myocarditis cases were based on case definitions by authors. We report on 238 patients of whom most were male (n = 208; 87.1%). The mean age was 27.4 ± 16 (range 12-80) years. Females presented at older ages (41.3 ± 21.5 years) than men 25.7 ± 14 years (p = 0.001). In patients > 20 years of age, the mean duration from vaccination to symptoms was 4.8 days ± 5.5 days, but in < 20, it was 3.0 ± 3.3 days (p = 0.04). Myocarditis occurred most commonly after the Pfizer-BioNTech mRNA vaccine (n = 183; 76.45) and after the second dose (n = 182; 80%). Symptoms started 3.95 ± 4.5 days after vaccination. The commonest symptom was chest pain (n = 221; 93%). Patients were treated with non-steroidal anti-inflammatory drugs (n = 105; 58.3%), colchicine (n = 38; 21.1%), or glucocorticoids (n = 23; 12.7%). About 30% of the patients had left ventricular ejection fraction but more than half recovered the on repeat imaging. Abnormal cardiac MRIs were common; 168 patients (96% of 175 patients that had MRI) had late gadolinium enhancement, while 120 patients (68.5%) had myocardial edema. Heart failure guideline-directed medical therapy use was common (n = 27; 15%). Eleven patients had cardiogenic shock; and 4 patients required mechanical circulatory support. Five patients (1.7%) died; of these, 3 patients had endomyocardial biopsy/autopsy-confirmed myocarditis. Most cases of COVID-19 vaccine myocarditis are mild. Females presented at older ages than men and duration from vaccination to symptoms was longer in patients > 20 years. Cardiogenic shock requiring mechanical circulatory support was seen and mortality was low. Future studies are needed to better evaluate risk factors, and long-term outcomes of COVID-19 mRNA vaccine myocarditis

Cardiomyopathy and heart failure secondary to anabolic-androgen steroid abuse

Bodybuilders often use anabolic-androgenic steroids to improve performance. We report a case of a 30-year-old male bodybuilder with anabolic-androgen steroid abuse while getting ready for a bodybuilding contest. He had New York Heart Association class IV heart failure, severe nonischemic dilated cardiomyopathy, new-onset atrial fibrillation, cardiogenic pulmonary edema, and acute respiratory distress requiring mechanical ventilation. After 6 months of heart failure guideline-directed medical therapy, cessation of anabolic steroids, and maintenance of sinus rhythm, his ejection fraction improved

Myocarditis following COVID-19 vaccination in adolescents and adults: a cumulative experience of 2021

Clinical course and outcomes of myocarditis after COVID-19 vaccination remain variable. We retrospectively collected data on patients > 12 years old from 01/01/2021 to 12/30/2021 who received COVID-19 messenger RNA (mRNA) vaccination and were diagnosed with myocarditis within 60 days of vaccination. Myocarditis cases were based on case definitions by authors. We report on 238 patients of whom most were male (n = 208; 87.1%). The mean age was 27.4 ± 16 (range 12-80) years. Females presented at older ages (41.3 ± 21.5 years) than men 25.7 ± 14 years (p = 0.001). In patients > 20 years of age, the mean duration from vaccination to symptoms was 4.8 days ± 5.5 days, but in < 20, it was 3.0 ± 3.3 days (p = 0.04). Myocarditis occurred most commonly after the Pfizer-BioNTech mRNA vaccine (n = 183; 76.45) and after the second dose (n = 182; 80%). Symptoms started 3.95 ± 4.5 days after vaccination. The commonest symptom was chest pain (n = 221; 93%). Patients were treated with non-steroidal anti-inflammatory drugs (n = 105; 58.3%), colchicine (n = 38; 21.1%), or glucocorticoids (n = 23; 12.7%). About 30% of the patients had left ventricular ejection fraction but more than half recovered the on repeat imaging. Abnormal cardiac MRIs were common; 168 patients (96% of 175 patients that had MRI) had late gadolinium enhancement, while 120 patients (68.5%) had myocardial edema. Heart failure guideline-directed medical therapy use was common (n = 27; 15%). Eleven patients had cardiogenic shock; and 4 patients required mechanical circulatory support. Five patients (1.7%) died; of these, 3 patients had endomyocardial biopsy/autopsy-confirmed myocarditis. Most cases of COVID-19 vaccine myocarditis are mild. Females presented at older ages than men and duration from vaccination to symptoms was longer in patients > 20 years. Cardiogenic shock requiring mechanical circulatory support was seen and mortality was low. Future studies are needed to better evaluate risk factors, and long-term outcomes of COVID-19 mRNA vaccine myocarditis

Serial Cardiac Troponin Measurements: A Prediction Tool for Heart Failure Risk in Black Patients?

Black adults are disproportionately affected by heart failure (HF), and incident HF rates are increasing in Black adults, who also have higher risks of hospitalization and age-adjusted mortality due to HF than White adults. These disparities in HF have, in part, been attributed to a higher prevalence of cardiovascular (CV) risk factors, inadequate treatment of HF and underuse of HF guideline-directed medical therapy. Understanding novel factors that may contribute to the heterogeneity of HF in Black individuals remains an unmet need. Tools that can be used for early detection of incident HF are potentially impactful because early detection can open the window for preventive or therapeutic strategies that reduce the risk of future clinical HF. Biomarkers, such as natriuretic peptides and high-sensitivity troponins, may represent emerging tools to better predict risk of incident HF in vulnerable populations at risk of cardiovascular disease (CVD) due to the reduced detection threshold of current assays. High-sensitivity cardiac troponins (hs-cTns) are specific and sensitive biomarkers of myocardial injury, whereas elevated natriuretic peptide levels in response to increased wall stretch due to volume or pressure overload are associated with increased risk of incident HF in adults

Addressing challenges faced by underrepresented biomedical investigators and efforts to address them: An NHLBI-PRIDE perspective

Junior investigators from groups underrepresented in the biomedical workforce confront challenges as they navigate the ranks of academic research careers. Biochemical research needs the participation of these researchers to adequately tackle critical research priorities such as cardiovascular health disparities and health inequities. We explore the inadequate representation of underrepresented minority investigators and the historical role of systemic racism in impacting their poor career progression. We highlight challenges these investigators face, and opportunities to address these barriers are identified. Ensuring adequate recruitment and promotion of underrepresented biomedical researchers fosters inclusive excellence and augments efforts to address health inequities. The Programs to Increase Diversity among Individuals Engaged in Health-Related Research (PRIDE), funded by the National Heart, Lung, and Blood Institute (NHLBI), is a pilot program by the National Institutes of Health (NIH) that aims to address these challenges yet, only a limited number of URM can be accepted to PRIDE programs. Hence the need for additional funding for more PRIDE or PRIDE-like programs. Here we aim to examine the challenges underrepresented minority biomedical investigators face and describe ongoing initiatives to increase URM in biomedical research using the NHLBI-PRIDE program as a focus point