Researchers: Pacemakers help those with chemotherapy-induced heart disease
As the number of cancer patients living longer rises, so is the incidence of side-effect chemotherapy-induced cardiomyopathy (CHIC), or weakness of the heart muscle. In fact, anthracyclines and other drugs used to treat breast cancer and lymphomas tend to have a negative effect on the heart muscle and result in reduced heart function in about 9% of patients treated with them. Now, research has shown that treating CHIC with commercially available cardiac resynchronization therapy (CRT) delivered through a surgically implanted defibrillator or pacemaker can improve patient outcomes significantly. “Chemotherapies are systemic toxins,” said lead author Jagmeet Singh, associate chief of cardiology at Massachusetts General Hospital. “Patients take them to kill the cancer cells[,] but they can also affect different organs and tissues in the body.” While using CRT is “pretty standard therapy for conventional patients with reduced heart function and abnormal electrical activation within the heart,” Singh noted that he believes their use in former cancer patients has not been evaluated in a systematic way. “It’s an orphaned cohort of patients. Nobody knows who they ‘belong’ to – oncologists, cardiologists, internists?” Added to that, he said, CHIC is associated with decreased quality of life and poor clinical outcomes and is rarely treated aggressively. “There may be some unconscious physician bias because the prognosis isn’t good to start with,” he added. The study enrolled 30 patients between 2014 and 2018. Four of the patients had CRT pacemakers and 26 had CRT defibrillators implanted, and six months after surgery, the devices were found to increase left ventricular ejection fraction by a mean of 11 percentage points, a difference that is statistically significant and clinically meaningful. The article appeared Nov. 12, 2019, in JAMA.
Study points to low stroke, death rate with TCAR
Silk Road Medical Inc., a Sunnyvale, Calif.-based company focused on reducing the risk of stroke, reported the presentation of real-world data for the treatment of patients with carotid artery disease at risk for stroke at the VEITHsymposium. Mahmoud Malas, of the University of California, San Diego School of Medicine shared updated results for the ongoing TransCarotid Artery Revascularization (TCAR) Surveillance Project, which Is assessing TCAR to the surgical standard of care, carotid endarterectomy (CEA). “Our updated dataset now includes 6,526 matched patients. TCAR continues to show a low stroke and death rate equivalent to CEA with lower rates of myocardial infarction and cranial nerve injury. Additionally, TCAR patients experience shorter length of hospital stay, and are discharged home more often,” said Malas. The updated data came from patients evaluated between 2016 and 2019, with 8,104 patients receiving TCAR vs. 53,869 patients receiving CEA, with 6,526 patients in each group analyzed using propensity score matching. There were no statistical differences noted between TCAR and CEA for in-hospital stroke (TCAR, 1.4%; CEA, 1.2%, p=0.54) or in-hospital stroke and death (TCAR, 1.6%; CEA, 1.4%, p=0.57). In a separate risk adjusted analysis looking at patients with one-year follow-up, ipsilateral stroke or death at one year was lower in TCAR vs CEA (TCAR, 2.0%; CEA, 3.5%, p=.03).
Model looks to predict kidney injury following heart procedure
Researchers have developed a new mathematical model that can predict the risk of acute kidney injury (AKI) in those treated with percutaneous coronary intervention (PCI). These patients often are exposed to contrast agents, which can harm the kidneys. The tool aims to help doctors make better pre-procedure estimates of risk and provide more personalized estimates for how much contrast material can be used when inserting stents in blocked or narrowed blood vessels near the heart. “The previous models assumed that the exposure to contrast produced the same risk for everyone, but it is not one-size-fits-all. There are individual differences,” said Harlan Krumholz, cardiologist and director of the Yale Center for Outcomes Research and Evaluation. The researchers developed a machine learning model, a type of artificial intelligence, for estimating patients' risk of AKI prior to the heart procedure, while also accounting for the complexity of associations between contrast levels and AKI in different risk groups.
“We determined that their associations with the risk of kidney injury are quite complex. The range of contrast levels you're considering matters, and the baseline risk level for a particular patient matters, too,” said Chenxi Huang, an associate research scientist at Yale and first author of the study. The study describing the research appeared Nov. 22, 2019, in the journal JAMA Network Open.
VR helping stroke survivors
Researchers have created a virtual reality (VR) clinic that is intended to help stroke survivors attend their physical and occupational therapy sessions. Results from a proof-of-concept study suggest that the technology – and the social connection it facilitates – are effective at encouraging therapy participation. “Our goal was to create an online, [VR] platform that allows patients and therapists to interact in what is essentially real time,” said Derek Kamper, who is an associate professor in the joint department of biomedical engineering at North Carolina State University and the University of North Carolina at Chapel Hill. “Clients could also use the system to work on therapy exercises with loved ones who live far away.” The Virtual Environment for Rehabilitative Gaming Exercises (VERGE) is a software package that makes use of Kinect motion-sensor hardware to track the movement of patients and therapists. In a proof-of-concept study, researchers worked with 20 stroke survivors to evaluate the system. In the study, half of the participants spent two weeks using VERGE in single-user mode, while the other half used VERGE in multi-user mode – interacting with other people remotely. The groups then switched modes for an additional two weeks. It was determined that participants attended 99% of their therapy sessions when using VERGE in multi-user mode. Compliance was also good in single-user mode, with participants making 89% of their sessions. Their findings appeared Nov. 9, 2019, in the Archives of Physical Medicine and Rehabilitation.