Welcome to the new Hypertrophic Cardiomyopathy (HCM) Knowledge Hub powered by CardioNerds. Each week we’ll deliver key insights and unique perspectives through podcasts, articles, infographics, videos, and more—all uniquely created by cardiologists to inform and educate.
117. The Braunwald Chronicles: Natural History of Aortic Stenosis, Beta-Blockers in Heart Failure &...
The VALOR-HCM Trial: Encouraging Findings for Patients with Obstructive HCM
In this insightful interview, Dr. Rawan Amir speaks with Dr. Milind Desai, director of the Center for Hypertrophic Cardiomyopathy and medical director of the Center of Aortic Diseases, Cleveland Clinic, about the phase III VALOR-HCM trial, which assessed mavacamten in adults with symptomatic obstructive hypertrophic cardiomyopathy.
The CardioNerds Discuss their Mission, their Partnership with DocWire News, and Future Plans
We sat down with Amit Goyal, MD, and Daniel Ambinder, MD, Cofounders of CardioNerds, who discussed the genesis of the platform, its mission, future plans, and, of course, the partnership with DocWire.
Hypertrophic Obstructive Cardiomyopathy
A middle-aged woman with hypertrophic cardiomyopathy now presents with progressive exertional shortness of breath. See how this plays out…
Pathophysiology of HCM vs. Treatment with Mavacamten
Many CCU patients have Swan-Ganz/PA catheters in place. They provide extremely valuable diagnostic and prognostic information and can be a critical tool for guiding management in critically ill patients. However, the sheer amount of data can sometimes be overwhelming. This infographic aims to help with learning the normal intracardiac pressures; utilization of these variables to derive important hemodynamic parameters; and understanding the diagnostic and/or prognostic significance of these parameters, including how to use them in clinical practice.
“PVR is the recommended parameter for differentiating subtypes of PH.”
Galiè N, McLaughlin VV, Rubin LJ, Simonneau G. An overview of the 6th World Symposium on Pulmonary Hypertension. Eur Respir J. 2019 Jan 24;53(1):1802148. doi: 10.1183/13993003.02148-2018. PMID: 30552088; PMCID: PMC6351332.
“PAPi ≤ 0.9 predicts RV failure and in-hospital mortality in inferior MI.”
Korabathina R, Heffernan KS, Paruchuri V, Patel AR, Mudd JO, Prutkin JM, Orr NM, Weintraub A, Kimmelstiel CD, Kapur NK. The pulmonary artery pulsatility index identifies severe right ventricular dysfunction in acute inferior myocardial infarction. Catheter Cardiovasc Interv. 2012 Oct 1;80(4):593-600. doi: 10.1002/ccd.23309. Epub 2012 Jan 10. PMID: 21954053.
“PAPi < 1.85 predicts RV failure in patients with LVADs.”
Morine KJ, Kiernan MS, Pham DT, Paruchuri V, Denofrio D, Kapur NK. Pulmonary Artery Pulsatility Index Is Associated With Right Ventricular Failure After Left Ventricular Assist Device Surgery. J Card Fail. 2016 Feb;22(2):110-6. doi: 10.1016/j.cardfail.2015.10.019. Epub 2015 Nov 10. PMID: 26564619.
“RA/PCWP > 0.54 predicted RV dysfunction in patients with LVADs.”
Soliman OII, Akin S, Muslem R, Boersma E, Manintveld OC, Krabatsch T, Gummert JF, de By TMMH, Bogers AJJC, Zijlstra F, Mohacsi P, Caliskan K; EUROMACS Investigators. Derivation and Validation of a Novel Right-Sided Heart Failure Model After Implantation of Continuous Flow Left Ventricular Assist Devices: The EUROMACS (European Registry for Patients with Mechanical Circulatory Support) Right-Sided Heart Failure Risk Score. Circulation. 2018 Feb 27;137(9):891-906. doi: 10.1161/CIRCULATIONAHA.117.030543. Epub 2017 Aug 27. PMID: 28847897.
“RA/PCWP >0.63 predicted RV dysfunction in patients with LVADs.”
Kormos RL, Teuteberg JJ, Pagani FD, Russell SD, John R, Miller LW, Massey T, Milano CA, Moazami N, Sundareswaran KS, Farrar DJ; HeartMate II Clinical Investigators. Right ventricular failure in patients with the HeartMate II continuous-flow left ventricular assist device: incidence, risk factors, and effect on outcomes. J Thorac Cardiovasc Surg. 2010 May;139(5):1316-24. doi: 10.1016/j.jtcvs.2009.11.020. Epub 2010 Feb 4. PMID: 20132950.
“CPO of <0.6 was the strongest independent hemodynamic correlate in the SHOCK trial registry for in-hospital mortality in patients with cardiogenic shock.”
Fincke R, Hochman JS, Lowe AM, Menon V, Slater JN, Webb JG, LeJemtel TH, Cotter G; SHOCK Investigators. Cardiac power is the strongest hemodynamic correlate of mortality in cardiogenic shock: a report from the SHOCK trial registry. J Am Coll Cardiol. 2004 Jul 21;44(2):340-8. doi: 10.1016/j.jacc.2004.03.060. PMID: 15261929.
“LV Transmural Filling Pressure.”
Borlaug BA, Reddy YNV. The Role of the Pericardium in Heart Failure: Implications for Pathophysiology and Treatment. JACC Heart Fail. 2019 Jul;7(7):574-585. doi: 10.1016/j.jchf.2019.03.021. PMID: 31248569; PMCID: PMC6601642.
“Studies have shown good correlation between TD and Direct Fick in severe TR and extremes of CO.”
Hoeper MM, Maier R, Tongers J, Niedermeyer J, Hohlfeld JM, Hamm M, Fabel H. Determination of cardiac output by the Fick method, thermodilution, and acetylene rebreathing in pulmonary hypertension. Am J Respir Crit Care Med. 1999 Aug;160(2):535-41. doi: 10.1164/ajrccm.160.2.9811062. PMID: 10430725.
“Central venous pressure (CVP) was shown as one of the predictors of SCAI profile and mortality in the Cardiogenic Shock Working Group registry.” Thayer KL, Zweck E, Ayouty M, Garan AR, Hernandez-Montfort J, Mahr C, Morine KJ, Newman S, Jorde L, Haywood JL, Harwani NM, Esposito ML, Davila CD, Wencker D, Sinha SS, Vorovich E, Abraham J, O’Neill W, Udelson J, Burkhoff D, Kapur NK. Invasive Hemodynamic Assessment and Classification of In-Hospital Mortality Risk Among Patients With Cardiogenic Shock. Circ Heart Fail. 2020 Sep;13(9):e007099. doi: 10.1161/CIRCHEARTFAILURE.120.007099. Epub 2020 Sep 9. PMID: 32900234.
Yung GL, Fedullo PF, Kinninger K, Johnson W, Channick RN. Comparison of impedance cardiography to direct Fick and thermodilution cardiac output determination in pulmonary arterial hypertension. Congest Heart Fail. 2004 Mar-Apr;10(2 Suppl 2):7-10. doi: 10.1111/j.1527-5299.2004.03406.x. PMID: 15073478.
“Central venous pressure (CVP) was shown as one of the predictors of SCAI profile and mortality in the Cardiogenic Shock Working Group registry.”
Thayer KL, Zweck E, Ayouty M, Garan AR, Hernandez-Montfort J, Mahr C, Morine KJ, Newman S, Jorde L, Haywood JL, Harwani NM, Esposito ML, Davila CD, Wencker D, Sinha SS, Vorovich E, Abraham J, O’Neill W, Udelson J, Burkhoff D, Kapur NK. Invasive Hemodynamic Assessment and Classification of In-Hospital Mortality Risk Among Patients With Cardiogenic Shock. Circ Heart Fail. 2020 Sep;13(9):e007099. doi: 10.1161/CIRCHEARTFAILURE.120.007099. Epub 2020 Sep 9. PMID: 32900234.
Eric L. Bonno, Michael C. Viray, Gregory R. Jackson, Brian A. Houston, Ryan J. Tedford; Modern Right Heart Catheterization: Beyond Simple Hemodynamics. Advances in Pulmonary Hypertension 1 January 2020; 19 (1): 6–15.
Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. Tenth edition. Philadelphia, PA: Elsevier/Saunders, 2015.
Anwaruddin S, Martin JM, Stephens JC, Askari AT. Cardiovascular Hemodynamics: An Introductory Guide: Humana Press; 2012
This schematics and figures chart details the cascade of cardiovascular events which can lead to the development of hypertrophic cardiomyopathy (HCM). It also delineates the typical clinical manifestations, EKG and Echo findings association with HCM, and depicts the “4 P’s of Prevention”; outlining how to reduce the risk of four serious complications correlated with HCM.
1. Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm. 2018;15(10):e73-e189.
2. Geske JB, Ommen SR, Gersh BJ. Hypertrophic Cardiomyopathy: Clinical Update. JACC Heart Fail. 2018;6(5):364-375.
3. Maron BJ. Clinical Course and Management of Hypertrophic Cardiomyopathy. N Engl J Med. 2018;379(20):1977.
4. Young L, Smedira NG, Tower-Rader A, Lever H, Desai MY. Hypertrophic cardiomyopathy: A complex disease. Cleve Clin J Med. 2018;85(5):399-411.
Meet The NERDS!
Amit Goyal, MD, Co-founder
Amit Goyal, MD MAS (@AmitGoyalMD) is an interventional cardiology fellow at the Cleveland Clinic.
With a passion for medical education, he co-founded CardioNerds. In this capacity, he designed the CardioNerds Academy, Healy Honor Roll, Narratives in Cardiology, Medical Journalism, and Scholarship programs.
He completed his medical school and obtained a Master’s Degree in Clinical Research at the University of California, San Diego and went on to enjoy internal medicine residency training in the Osler Program at Johns Hopkins University, where he served as the Assistant Chief of Service of the Barker Firm. As ACS he founded Osler Grand Rounds, an interactive mystery case discussion, and helped establish a novel morning report structure integrating bedside skills education. He
trained in general cardiology at the Cleveland Clinic where he remained for interventional cardiology fellowship. He has served as the Educational Editorial Fellow as member of the ACC FIT Editorial Board and Associate Editorial Team Lead for ACC.org’s Pericardial Section.
He relishes time with friends and family including with his wife Riddhi and three sons Dhruv, Aarav, and Atharv
Daniel Ambinder, MD, Co-founder
Daniel Ambinder, MD @Dr_DanMD is an interventional/structural cardiology fellow at the Johns Hopkins Hospital.
With a passion for medical education, he co-founded CardioNerds. In this capacity, he designed and maintains the CardioNerds website, helped established the CardioNerds Academy, Narratives in Cardiology, Medical Journalism, and Scholarship programs. He is an assistant social media editor for Circulation @circAHA and co-created and maintains @hopkinsheart.
He received his medical degree from the University of Maryland School of Medicine and completed residency in the Osler Program at Johns Hopkins Hospital where he also completed his general cardiology fellowship.
Clinical and research interests include resuscitation of cardiac arrest, mechanical circulatory support, coronary and structural heart disease.