Heartflow sees promise with PACIFIC

Redwood City, Calif-based Heartflow Inc. reported the publication of the PACIFIC substudy showing that the Heartflow FFRct Analysis demonstrates the highest diagnostic performance for detecting coronary artery disease (CAD) vs. other noninvasive tests. The offering is a personalized cardiac test that starts with a standard coronary computed tomography angiogram (CTA). The PACIFIC substudy included 208 patients undergoing a coronary CTA, SPECT, PET and three-vessel invasive fractional flow reserve (FFR) measurements. The Heartflow analyses were obtained using data from the coronary CTA images. On a per-vessel basis, Heartflow demonstrated significantly greater diagnostic performance vs. coronary CTA (0.83, p<0.001), SPECT (0.70, p<0.001) and PET (0.87, p<0.001). "These findings should give physicians confidence in the diagnostic performance of the Heartflow Analysis as it can identify disease that other noninvasive tests, such as SPECT, may overlook, and help better identify patients who require invasive treatment," said Campbell Rogers, Heartflow CMO. The publication, titled "Comparison of coronary computed tomography angiography, fractional flow reserve, and perfusion imaging for ischemia diagnosis," was published online by the Journal of the American College of Cardiology (JACC) Jan. 14, 2019, and was printed in the Jan. 22, 2019, issue of JACC.

Get to sleep

People who sleep less than six hours a night may be at increased risk of cardiovascular disease vs. those who sleep between seven and eight hours – that's according to a new study published in the Journal of the American College of Cardiology (JACC). One of the risks is increased atherosclerosis – plaque buildup in the arteries throughout the body. "Cardiovascular disease is a major global problem, and we are preventing and treating it using several approaches, including pharmaceuticals, physical activity and diet. But this study emphasizes we have to include sleep as one of the weapons we use to fight heart disease – a factor we are compromising every day," said senior study author José Ordovás, researcher at the Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC) in Madrid and director of nutrition and genomics at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University. "This is the first study to show that objectively measured sleep is independently associated with atherosclerosis throughout the body, not just in the heart." The new study included 3,974 bank employees in Spain from the PESA CNIC- Santander Study, led by JACC editor-in-chief Valentin Fuster, using imaging techniques to detect the prevalence and rate of progression of subclinical vascular lesions in a population with an average age of 46 years. All participants were without known heart disease, and two-thirds were men. All participants wore an actigraph, a small device that continuously measures activity or movement, for seven days to measure their sleep. They were divided into four groups: those who slept less than six hours, those who slept six to seven hours, those who slept seven to eight hours and those who slept more than eight hours. The participants underwent 3D heart ultrasound and cardiac CT scans to look for heart disease. The study found that when traditional risk factors for heart disease were considered, participants who slept less than six hours were 27 percent more likely to have atherosclerosis vs. those who slept seven to eight hours. Those who had a poor quality of sleep were 34 percent more likely to have atherosclerosis compared with those who had a good quality of sleep, which was defined by how often a person woke during the night, and the frequency of movements during the sleep which reflect the sleep phases. "It is important to realize that shorter sleep duration that is of good quality can overcome the detrimental effects of the shorter length," Fuster said. The study also suggested sleeping more than eight hours a night may be associated with an increase in atherosclerosis. While the number of participants who slept more than eight hours was small, women who slept more than eight hours a night had an increased risk of atherosclerosis. Alcohol and caffeine consumption were higher in participants with short and disrupted sleep, the study found. "Association of sleep duration and quality with subclinical atherosclerosis," appeared Jan. 22, 2019.

Heart failure culprit

University of Alberta scientists and their partners have pinpointed a hidden culprit that leads to dilated cardiomyopathy – a dangerous condition that accounts for 20 percent of all cases of heart failure – which opens the door to potential new treatments that could help counter the threat. The team identified PI3K alpha that binds to gelsolin – an enzyme that can destroy filaments that help make up the structure of the heart's cells – and suppresses it. The researchers, led by Gavin Oudit, a professor of cardiology at the U of A and director of the Heart Function Clinic at the Mazankowski Alberta Heart Institute, hypothesized that the molecule holds promise as a possible therapeutic target in terms of personalized medicine. The condition affects the heart's ability to pump blood because the left ventricle is enlarged and weakened. According to Oudit, the condition is caused by biomechanical stress, which activates the gelsolin enzyme. "You need some gelsolin, but when it gets out of control, it destroys things. The molecule chews up the filaments and you get really bad heart failure," said Oudit. "But we have also shown that when you suppress this molecule, you preserve your heart function. It's intact." There are currently no specific treatments for patients with heart failure. The same medications are used for all patients. "But if we can now identify patients that have problems with this type of remodeling (dilated cardiomyopathy), we can target them specifically," Oudit explained. The article "PI3Ka-regulated gelsolin activity is a critical determinant of cardiac cytoskeletal remodeling and heart disease," was published Dec. 19, 2018, in Nature Communications.