AHA FIT Newsletter

Nupoor Narula, MD, RPVI
Fellow, Cardiovascular Disease
NYP/Weill Cornell Medicine
President, AHA Cardiovascular Fellows Society of Greater New York

The American Heart Association (AHA) is an incredible resource for fellows-in- training (FIT), as we parse out our interests in the various avenues of cardiovascular medicine, pursue these aspirations, and navigate one of the most important transitions in our careers thus far, namely that from fellow to independent practitioner. During our fellowship, we have come to realize that support and mentorship from faculty and colleagues alike can have a profound influence on our career trajectory. The ability to connect with mentors and colleagues at the annual American Heart Association Scientific Sessions has extended and become more widely accessible through presence of affiliated state-level Societies. In our case, we’ve had the opportunity to conduct events through the AHA Cardiovascular Fellows Society of Greater New York. Founded by Dr. Valentin Fuster 30 years ago, the goal of the society is to build a sense of community amongst cardiology fellows, provide access to high impact educational programs, and encourage community service and outreach within our New York area.

Each year, the Society’s first educational event is Career Night, where we bring together early-, mid-, and senior-level colleagues in all cardiovascular medicine subspecialties so that FIT have a forum to ask job-associated questions and network with established Cardiology members and mentors in the greater New York area. This year, Career Night was preceded by a panel discussion with senior cardiology attendings, with a focus on “Creativity in Cardiology” and unique clinical, investigative, global health, leadership, and editorial paths which can be pursued within the field. Our second and third events during the year are Controversy Dinners, in which a case with a complex diagnostic or management dilemma is presented by a cardiology fellow and moderated by a Fellows Society Board Member. During this time, a group of experts debate and discuss the case in the presence of more than 100 FIT from different institutions. As an example, our first topic this year, chosen with Dr. Fuster’s guidance, focused on understanding the role, evaluation, and management of coronary microvascular disease. Through initiatives and gatherings such as these balanced throughout the year, the Society provides excellent educational and networking opportunities, and facilitates ongoing involvement in our local community and the AHA at large.

By Pina Patel, MD

The International Stroke Conference (ISC) 2020, held in February this year in Los Angeles, yielded some very exciting presentations in the realm of education, research, clinical trials & late breaking science. Below are key highlights from the conference.

Clinical trials recap

1. ISC celebrates milestone anniversaries for tPA and Endovascular Trials
   1. The 25th anniversary of the landmark NINDS alteplase (tPA) trial marks a breakthrough in the treatment of acute ischemic stroke. In 1995, the NINDS trial proved the efficacy and reasonable safety of tPA. Per pilot study analysis, the dose 0.9 mg/kg demonstrated the best efficacy, therefore, was chosen for the NINDS trial up to 3 hours from symptoms onset, which showed that patients in the treatment arm were 30% more likely to have minimal or no disability at 3 months with reasonable safety (symptomatic ICH 6.4%) for intra-cerebral. This trial changed the way we treat acute ischemic stroke and outcomes for patients. Today, tPA is the mainstay therapy for acute thrombolysis in eligible patients suffering from disabling stroke symptoms.
   2. The 5th anniversary of the endovascular trials marks the important contribution of neuro-intervention in the effective treatment of acute ischemic stroke due to large vessel occlusion. In 2015, four trials were published in NEJM which showed improved functional independence and decreased disability if patients were treated within about 7.3 hours from acute ischemic stroke onset. Since then, these trials were expanded and EVT remains one of the most effective treatments for acute ischemic stroke due to large vessel occlusion.
2. EXTEND IA TNK Part 2 recommends optimal dosing for Tenecteplase. The original EXTEND-IA TNK trial demonstrated that tenecteplase at 0.25 mg/kg improved reperfusion and clinical outcomes compared with alteplase. Given various reported doses used for treatment, Part 2 of this trial sought to clarify the optimal dosage of tenecteplase prior to endovascular thrombectomy (EVT) in patients with large vessel occlusion ischemic stroke. This randomized clinical trial including 300 adults demonstrated that both groups (0.25mg/kg vs 0.4mg/kg dose) achieved the same rate of reperfusion prior to EVT (19.3%) and that there was no difference in functional outcomes. Their findings suggest that the higher dose of tenecteplase does not confer an advantage over the lower dose, and therefore the investigators recommend 0.25 mg/kg be the standard dose for tenecteplase.
3. B-PROUD demonstrates that mobile stroke units (MSUs) improve clinical outcomes A Berlin research group presented premier evidence that MSUs not only accelerate care delivery for acute ischemic stroke, but also improve patients’ functional outcomes as well. This investigation is the first reported randomized trial showing improved outcomes for patients receiving prehospital treatment on an MSU compared with those receiving conventional care from EMS and emergency departments. The findings of improved functional outcomes may have been a result of quicker and more frequent use of tPA on the MSU from stroke onset, but also from providing earlier neurological assessment with continuous monitoring and management of complications in the prehospital setting.
4. Surgeons successfully treat brain aneurysms using a robot. Canadian researchers used a robot to treat brain aneurysms for the first time and their experience was presented as late breaking science. The group showed that using a robot to treat brain aneurysms is feasible and could allow for improved precision when placing stents, coils and other devices. The robotic system could eventually allow remote surgery, enabling surgeons to treat strokes from afar.
5. Wearable brain stimulation could safely improve motor function after stroke. According to preliminary late breaking science, a new, non-invasive wearable magnetic brain device that stimulates the brain to rewire itself is safe and could improve motor function in stroke patients. In the initial, randomized, double-blind, sham-controlled clinical trial of 30 chronic ischemic stroke survivors, the device transcranial, rotating, permanent magnet stimulator, or TRPMS, produced significant increases in physiological brain activity in areas near the injured brain, as measured by functional MRI. The researchers from Houston Methodist Hospital believe the study results are a signal of possible improved clinical motor function after magnetic brain stimulation for patients after stroke, which will need to be confirmed in a larger, multicenter trial.

Stroke Central

This year, the Stroke Central Programming included many educational and interactive sessions including tips on giving a scientific presentation and getting your article published, how to build upon your CV and negotiating your first job, creating a successful work-life balance in academic neurology and ways to network and engage with the Stroke community. A session on Stroke &; Women highlighted some of the presentations at ISC related to sex differences in stroke risk factors and stroke deaths, representation of women in acute stroke trials and women working in science and medicine.

We are pleased to announce that the 17th global Cardiovascular Clinical Trials Forum (CVCT) will be hosted virtually this year on December 3–7 2020.

The CVCT Forum strongly advocates for the evolution and growth of Young Investigators, giving the opportunity to network and to make connections with senior principal investigators. We passionately believe that what we offer for Young Investigators is exceptional.

Why? With the ratio of faculty/attendee at its highest as 1:3, young fellows have unprecedented networking opportunities with a unique mix of methodologists, designers of clinical trials, investigators, regulatory authorities, partner learned societies, patients, patient associations, cardiologists, epidemiologists, statisticians, major journal editors, scientific press, industry R&D & CRO’s and key decision makers for cardiovascular trials.

What else does the CVCT offer for young fellows?

• A scientifically rich program: delivered by the highest caliber faculty, that offers a genuine sharing experience
• Career Escalator: meet a mentor and discuss your career path
• Abstract contest: win a travel grant to attend the next CVCT forum!
• Papers & Publications: first author opportunities alongside senior faculty members as co-authors
• Industry training: fellowship programs
• Industry Internships: join a pharma study team

For more information please visit the official CVCT forum website: www.globalcvctforum.com
To register visit www.globalcvctforum.com/register and click 'Register'

The CVCT forum & AHA FIT will soon announce its collaboration to offer young fellows MORE!