Tag: cardiology

Elite athletes with genetic heart disease can safely return to play with diagnosis and treatment, early study suggests | CNN

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CNN
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In a new study, most elite athletes with a diagnosed genetic heart disease did not experience serious or fatal symptoms of their condition, such as sudden cardiac death. The research suggests it can be “feasible” and “safe” for athletes to continue to participate in their sport.

Among a sample of 76 elite athletes with a genetic heart disease who had competed or are still competing in either Division I university or professional sports, 73 out of the 76 did not experience a cardiac event triggered by their disease during the study period, according to researchers behind a late-breaking clinical trial presented Monday at the American College of Cardiology’s Annual Scientific Session Together With the World Congress of Cardiology.

Among those elite athletes with a genetic heart disease, 40 of them – 52% – were asymptomatic, the study abstract finds.

Over the years, researchers have become more aware of alarming reports about elite athletes experiencing heart problems, or even suddenly collapsing during games.

“For athletes with genetic heart conditions, and I would add non-athletes, the tragedies occur when we don’t know of their condition,” said Dr. Michael Ackerman, a genetic cardiologist at Mayo Clinic in Rochester, Minnesota, who was a senior author of the new research. “When we know of their condition, and we assess the risk carefully and we treat it well, these athletes and non-athletes, they can expect to live and thrive despite their condition.”

The new research has not yet been published in a peer-reviewed journal, but the findings suggest that many athletes with a genetic heart disease can decide with their health care professionals on whether to continue competing in their sport and how to do so safely, instead of being automatically disqualified due to their health conditions.

“In sports, historically, we’ve been paternalistic and de-emphasize patient preference and risk tolerance, but we know that athletes come from all walks of life. They are intelligent and when there’s scientific uncertainty, their values should be incorporated in medical decision-making,” Dr. J. Sawalla Guseh, cardiologist at Massachusetts General Hospital, who was not involved in the new study, said during Monday’s scientific session.

“Shared decision-making when done well can have very favorable outcomes,” he said.

Elite basketball, hockey, soccer and football players, were among the 76 athletes included in the new study, conducted by researchers at Mayo Clinic and other institutions in the United States. They wrote in their study abstract that this is the first study to their knowledge describing the experience of athletes competing at the NCAA Division I level or in professional sports with a known genetic heart disease that puts them at risk of sudden cardiac death.

The athletes in the study were cleared for return-to-play at either a NCAA Division I school or at the professional level. They were studied over an average of seven years, and all had been diagnosed with a genetic heart disease in the past 20 years, being treated at either Mayo Clinic, Morristown Medical Center, Massachusetts General Hospital or Atrium Health Sports Cardiology Center.

“Only three of them had a breakthrough cardiac event, which means after they were diagnosed and treated, they were still having an event,” said Katherine Martinez, an undergraduate student at Loyola University in Baltimore, who helped conduct the research as an intern in the Mayo Clinic’s Windland Smith Rice Sudden Death Genomics Laboratory.

Fainting was the most common event, and one athlete received a shock with an implantable cardioverter defibrillator, or ICD. None of the athletes died.

“The majority of these athletes went on to continue their career with no events at all,” Martinez said. But most of the athletes in the study – 55 of them, or 72% – were initially disqualified from competing by their primary provider or institution after their diagnosis. Most ultimately opted to return to play with no restrictions after undergoing comprehensive clinical evaluations and talking with their doctors.

While each sports league has its own set of rules, historically, some people diagnosed with a genetic heart disease that puts them at an increased risk for sudden cardiac death have been restricted from competitive sports, the researchers wrote in their study abstract.

“Just because you were given this diagnosis, doesn’t mean that your life, your career, the future that you see for yourself is over, but taking a second opinion from an expert who knows what they’re doing and is comfortable with shared decision-making is the next step,” said Martinez, who worked on the new research alongside her father, Dr. Matthew Martinez, director of Atlantic Health System Sports Cardiology at Morristown Medical Center and an author of the new research.

Regarding the new study, “the take-home message is, if you have one of these findings, seek out an expert who’s going to help you identify a safe exercise plan for you and determine what level you can continue to safely participate in,” he said. “This is the next best step – the next evolution – of how we manage athletes with genetic heart disease.”

Leaving their sport due to a genetic heart disease can be “very destructive” for athletes who have devoted their lives to excelling in competitions, said Dr. Lior Jankelson, director of the Inherited Arrhythmia Program at NYU Langone Heart in New York, who was not involved in the new research.

Yet he added that these athletes still need to consult with their doctors and be watched closely because some genetic diseases could be more likely to cause a serious cardiac event than others.

The new study highlights that “the majority of athletes with genetic heart disease could probably – after careful, meticulous expert risk-stratification and care strategy – participate in sports,” Jankelson said. “But at the same time, this is exactly the reason why these patients should be cared only in high-expertise genetic cardiology clinics, because there are other conditions that are genetic, that could respond very adversely to sports, and have a much higher risk profile of developing an arrhythmia during intense activity.”

Separately, the NCAA Sports Science Institute notes on its website, “Though many student-athletes with heart conditions can live active lives and not experience health-related problems, sudden fatality from a heart condition remains the leading medical cause of death in college athletes.”

For athletes with a genetic heart disease, their symptoms and their family history of cardiac events should be considered when determining their risks, said Dr. Jayne Morgan, a cardiologist with Piedmont Healthcare in Atlanta, who was not involved in the new research.

“Certainly, there is concern with elite athletes competing and whether or not they are being screened appropriately,” Morgan said. But she added that the new research offers “some understanding” to the mental health implications for athletes with a genetic heart disease who may be required to step away from a competitive sport that they love.

“This study, I think, begins to go a long way in identifying that we may not need to pull the trigger so quickly and have athletes step away from something that they love,” Morgan said.

The new study is “timely” given the recent national attention on athletes and their risk of sudden cardiac death, Dr. Deepak Bhatt, director of Mount Sinai Heart in New York City, who was not involved in the research, said in an email.

“These are some of the best data showing that the risk of return to play may not be as high as we fear,” Bhatt said about the new research.

“Some caveats include that the majority of these athletes were not symptomatic and about a third had an implantable defibrillator,” he added. “Any decision to return to the athletic field should be made after a careful discussion of the potential risks, including ones that are hard to quantify. Input from experts in genetic cardiology and sports cardiology can be very helpful in these cases.”

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She flatlined three times, lost both legs and had a failing heart. Yet she told doctors she’s ‘the luckiest person on this planet’ | CNN

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CNN
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Her smile is bright, cheery, sometimes goofy and always contagious. But pictures can’t completely capture her upbeat, positive vibe. At 21, Claire Bridges has a mature spirit that amazes those who love her as well as the doctors who had to operate on her heart and remove both legs to save her life.

“She had a will to live, perseverance and a sort of twinkle in her eye — I tell all my patients that’s half the battle,” said Dr. Dean Arnaoutakis, a vascular surgeon at the University of South Florida Health in Tampa who amputated Bridges’ legs after complications from Covid-19.

“Most people would be despondent and feel like life had cheated them,” said Dr. Ismail El-Hamamsy, a professor of cardiovascular surgery at the Icahn School of Medicine at Mount Sinai in New York City, who operated on Bridges’ heart.

“But she told me, ‘I feel like I’m the luckiest person on this planet. I have my whole life ahead of me. I can have kids, a future, so many things to look forward to.’

“There was not once that I looked into her eyes that I didn’t feel her positiveness was true and genuine,” he said. “Claire’s story is one of just incredible resilience and positivity.”

Bridges left the hospital on her 21st birthday, more than two months after being admitted. Here she is with her brother Will.

In January 2022, Bridges was a 20-year-old model with her own apartment, a gaggle of friends and a part-time job as a bartender in St. Petersburg, Florida. She was a vegan and “exceptionally healthy,” according to her mother, Kimberly Smith.

When she caught Covid-19 that month, no one expected her be hospitalized. She was fully vaccinated and boosted.

But Bridges had been born with a common genetic heart defect: aortic valve stenosis, a mutation of the valve in the heart’s main artery, the aorta. Instead of having three cusps, or flaps, that let oxygen-rich blood flow from the heart into the aorta and to the rest of the body, people with aortic valve stenosis are often born with just two. The condition makes the heart work extremely hard to do its job, often causing breathlessness, dizziness and fatigue.

“I could work out and stuff, but I could never play sports,” she told CNN. “I couldn’t run. I couldn’t overexert myself.”

Her mom added, “We could really tell she began to learn her limits as she got older — she would get out of breath, stop and take a break.”

Before her surgeries, Bridges enjoyed roller-skating.

Whether due to her heart or another unknown reason, Covid-19 hit Bridges hard. Her health quickly spiraled out of control.

“Extreme fatigue, cold sweats — progressively every single day it would get harder to try to eat or drink anything,” she recalled. “Then one day my mom found me unresponsive and rushed me to the hospital. I flatlined three times that night.”

Bridges was put on dialysis, a ventilator and an exterior pump for her failing heart. She slipped into psychosis.

“I was thinking that everyone was trying to kill me, but I was holding on,” she said, adding that she then saw a bright light and her late grandfather.

“He was sitting on a bench, fishing, and he was wearing a baseball cap,” she said. “Then I saw my parents through a window. I don’t know if I actually did or if it was in my delusion, but I thought, ‘I can’t leave them like this.’ And my body just literally wouldn’t give up.”

While Bridges’ spirit battled on, doctors struggled to save her life. Her organs began to shut down, further weakening her frail heart. Blood wasn’t reaching her extremities, and tissues in both legs began to die.

Surgeons tried to save as much of her legs as possible. First, they opened tissue in both legs to reduce swelling, then amputated one ankle. Finally, there was no choice: Both legs had to be removed.

Doctors gathered around her bed to break the news.

“I remember looking up at them and saying, ‘Well, thank you for saving my life. And oh, can I have bionic legs?’ ” Bridges said.

“Everyone was totally shocked that she was taking it so well,” Smith recalled about her daughter. “But my entire family knew that if this tragedy had to happen to any of us, it would be Claire who would handle it the best. Upbeat and positive, that’s Claire.”

Bridges had a successful modeling career before she contracted Covid-19.

Losing her legs was only part of Bridges’ struggle back to health. “There were so many things that she could have died from while she was in the hospital,” Smith said.

Malnourished, Bridges was put on a feeding tube. She vomited, rupturing part of her small intestine, and “nearly bled out,” Smith said. To save her, doctors had to do an emergency transfusion — a dangerous procedure due to her weak heart.

“She almost died while getting the emergency transfusion because they had to pump the blood in so fast,” Smith said. “Then the next day she bled again, but they caught it in time.”

Bridges developed refeeding syndrome, a condition in which electrolytes, minerals and other vital fluids in a malnourished body are thrown out of balance when food is reintroduced, causing seizures, muscle and heart weakness, and a coma in some cases. Without quick treatment, it can lead to organ failure and death.

In another blow, her hair began to fall out, likely due to the loss of proper nutrition. Her family and friends came to her rescue.

“I knew that the only way to stop me from sobbing every time I pulled chunks of hair out of my head was to just get rid of it all,” Bridges said. “I told my brother Drew I was thinking about shaving my head, and without missing a beat, he immediately looked at me and said, ‘I’ll shave mine with you.’

“Then it snowballed into everyone telling me they would shave their heads, too,” Bridges said with a smile. “It was actually an extremely sweet, fun and freeing time — plus I’ve always wanted to shave my head, so I got to cross it off my bucket list!”

First row (from left): Luba Omelchenko, a friend, and Claire Bridges. Second row (from left): Andy Beaty, a friend; Jaye Scoggins, Beaty's mother; Anna Bridges-Brown, Claire's sister; and Kimberly Smith, Claire's mother. Third row: Kristen Graham, a friend who shaved everyone's heads.

Bridges credits her friends and family — along with members of the community who organized fundraisers or reached out on social media — for her upbeat attitude throughout the ordeal.

“I am very blessed to have such an amazing family and also friends and people in my community that are like family,” she said. “People I didn’t know, people that I haven’t spoken to since elementary school or high school were reaching out to me.

“Yes, I allowed myself to grieve, and there were dark days. But honestly, my friends and my family surrounded me with so much love that I never had a second to really think negatively about my legs or how I look now.”

Bridges’ heart presented another hurdle: Already frail before her prolonged illness, it was now severely damaged. She needed a new valve in her aorta, and soon.

“We always knew Claire would need an open-heart surgery at some point,” her mother said. “Doctors wanted her as old as possible before they replaced the valve because the older you are, the bigger you are, and there’s less chance of needing another operation soon after.”

Bridges with her modeling agent, Kira Alexander. Bridges lost nearly 70 pounds during her hospitalization.

Her doctors reached out to Mount Sinai’s El-Hamamsy, an expert in a more complicated form of aortic valve replacement called the Ross procedure.

“Anybody who has an anticipated life expectancy of 20 years or more is definitely a potential candidate for the Ross,” El-Hamamsy said, “and it’s a perfect solution for many young people like Claire.”

Unlike more traditional surgeries that replace the malfunctioning aortic valve with a mechanical or cadaver version, the Ross procedure uses the patient’s own pulmonary valve, which is “a mirror image of a normal aortic valve with three cusps,” El-Hamamsy said.

“It’s a living valve, and like any living thing, it’s adaptable,” the surgeon said. “It becomes like a new aortic valve and performs all the very sophisticated functions that a normal aortic valve would do.”

The pulmonary valve is then replaced with a donor from a cadaver, “where it matters a little less because the pressures and the stresses on the pulmonary side are much lower,” he said.

Bridges with Dr. Ismail El-Hamamsy, the surgeon who replaced the failed valve in her heart.

The use of a replacement part from the patient’s own body for the aortic valve also eliminates the need for lifelong use of blood thinners and the ongoing risk of major hemorrhaging or clotting and stroke, El-Hamamsy said. And because the new valve is stronger than the malfunctioning valve it replaces, patients aren’t as likely to need future surgeries.

“Ross is the only replacement operation for the aortic valve that allows patients to have a normal life expectancy,” he said, “and a completely normal quality of life with no restrictions, no modifications to their lifestyle and a very good durability of the operation.”

The Ross procedure is more technically challenging than inserting a tissue valve or a mechanical valve, “some of the simplest operations that we as cardiac surgeons would ever do,” El-Hamamsy said.

Because the operation takes a high level of technical skill, it’s only available in a few surgical facilities at this time.

“It requires dedicated surgeons who want to commit their practice to the Ross procedure and who have the technical skills and expertise to do that,” he added. “Patients need to know they should be undergoing the surgery in a Ross-certified facility.”

When El-Hamamsy first met Bridges in a video call last spring, he wasn’t sure he would be able to do the surgery. Only 127 pounds before she got sick, Bridges had lost nearly 70 pounds during her hospitalization.

“She was so emaciated. There was no way I could take her into the operating room the way she was,” El-Hamamsy said. “I never expected that she would recover so quickly and keep her amazingly positive mentality.”

Slowly, over many months, Bridges fought her way back to health. In rehab, she began to learn to walk with prosthetic lower limbs. As she got stronger, she has continued one of her favorite activities — rock climbing.

Bridges climbs a rock wall using prosthetic limbs.

“At six months, I could hardly recognize her — she had gained weight back, her skin had fully healed over at the amputation sites, and she was a completely different-appearing person to the malnourished and debilitated girl I had met in the hospital,” said Arnaoutakis, the vascular surgeon.

The heart operation was successfully done in December. Today, Bridges is in the middle of cardiac rehabilitation and looking forward to being fitted for prosthetic blades — J-shaped, carbon-fiber lower limbs that will allow her to run on a track for the first time in her life.

She’s also returned to modeling, proud to show the world how well she has survived.

Bridges has returned to modeling after her surgeries.

El-Hamamsy isn’t surprised. “I told her from the day I met her on that Zoom, ‘It will be such a privilege to look after you because you’ve inspired me. I’ve never met a young person with this level of maturity and outlook on life.’

“I still think of Claire every once in a while when I bump into difficulty with life or whatever. It’s a reminder that happiness and positivity is a choice. Claire made that choice.”

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Bempedoic acid improved heart health in patients who can’t tolerate statins, study finds | CNN

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CNN
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Bempedoic acid may be an alternative for people who need to lower their cholesterol but can’t or won’t take statins, according to a large study published Saturday in the New England Journal of Medicine.

Statins are the most commonly prescribed cholesterol-lowering drugs that help lower what’s known as the “bad” cholesterol, or low-density lipoprotein (LDL) cholesterol in the blood; more than 90% of adults who take a cholesterol-lowering medicine use a statin, according to the US Centers for Disease Control and Prevention.

Statins are considered safe and effective, but there are millions of people who cannot or will not take them. For some people it causes intense muscle pain. Past research has shown anywhere between 7% and 29% of patients who need to lower cholesterol do not tolerate statins, according Dr. Steven Nissen, a cardiologist and researcher at the Cleveland Clinic and co-author of the new study.

“I see heart patients that come in with terrible histories, multiple myocardial infarction, sometimes bypass surgery, many stents and they say, ‘Doctor, I’ve tried multiple statins, but whenever I take a statin, my muscles hurt, or they’re weak. I can’t walk upstairs. I just can’t tolerate these drugs,’ ” Nissen said. “We do need alternatives for these patients.”

Doctors have a few options, including ezetimibe and a monoclonal antibody called a proprotein convertase subtilisin/kexin type 9, or PCSK9 inhibitors for short.

Bempedoic acid, sold under the name Nexletol, was designed specifically to treat statin-intolerant patients. The FDA approved it for this purpose in 2020, but the effects of the drug on heart health had not been fully assessed until this large trial. The new study was funded in part by Esperion Therapeutics, the maker of Nexletol.

For the study, which was presented Saturday at the American College of Cardiology’s Annual Scientific Session with the World Congress of Cardiology, Nissen and his colleagues enrolled 13,970 patients from 32 countries.

All of the patients were statin intolerant, typically due to musculoskeletal adverse effects. Patients had to sign an agreement that they couldn’t tolerate statins “even though I know they would reduce my risk of a heart attack or stroke or death,” and providers signed a similar statement.

The patients were then randomized into two groups. One was treated with bempedoic acid, the other was given a placebo, which does nothing. Researchers then followed up with those patients for up to nearly five years. The number of men and women in the trial were mostly evenly divided, and most participants, some 91%, were White, and 17% were Hispanic or Latino.

The drug works in a similar way that statins do, by drawing cholesterol out of a waxy substance called plaque that can build up in the walls of the arteries and interfere with the blood flow to the heart. If there is too much plaque buildup, it can lead to a heart attack or stroke.

But bempedoic acid is only activated in the liver, unlike a statin, so it is unlikely to cause muscle aches, Nissen said.

In the trial, investigators found that bempedoic acid was well-tolerated and the percent reduction in the “bad” cholesterol was greater with bempedoic acid than placebo by 21.7%.

The risk of cardiovascular events – including death, stroke, heart attack and coronary revascularization, a procedure or surgery to improve blood flow to the heart – was 13% lower with bempedoic acid than with placebo over a median of 3.4 years.

“The drug worked in primary and secondary prevention patients – that is, patients that had had event and patients who were very high risk for a first event. There were a lot of diabetics. These were very high risk people,” Nissen said. “So the drug met its expectations and probably did a lot better than a lot of people thought it would do.”

In the group that took bempedoic acid, there were a few more cases of gout and gallstones, compared with people who took a placebo.

“The number is small, and weighing that against a heart attack, I think most people would say, ‘OK I’d rather have a little gout attack,’ ” Nissen said.

Bempedoic acid had no observed effect on mortality, but that may be because the observation period was too short to tell if it had that kind of impact. Earlier trials on statins showed the same; it was only after there were multiple studies on statins that scientists were able to show an impact on mortality.

Dr. Howard Weintraub, a cardiologist at NYU Langone Health who did not work on this study, said that while he knows some people will not consider a medication successful unless it reduces mortality, he thinks that is short-sighted.

“I think there’s more to doing medicine then counting body bags,” Weintraub said.”Preventing things that can be life changing, crippling, and certainly change your quality of life forever going forward, and your cost of doing things going forward, I think is a good thing.”

He was pleased to see the results of this trial, especially since the people in this study are often what he called “forgotten individuals” – the millions who could benefit from lowering their cholesterol, but can’t take statins.

“It’s not like their LDL was 180 or 190 or 230, their LDL was 139. This is about average in our country,” Weintraub said. He said often doctors will just tell those patients to watch their diet, but he thinks this suggests they would benefit from medication.

“Both groups primary and secondary prevention got benefit, which I think is impressive with the modest amount of LDL reduction,” Weintraub said.

There are some limitations to this trial. It was narrowly focused on patients with a known statin intolerance. Nissen said the trial was not designed to determine whether bempedoic acid could be an alternative to statins.

“Statins are the gold standard. They are the cornerstone. The purpose of this study was not to replace statins, but to allow an alternative therapy for people who simply cannot take them,” Nissen said.

Bempedoic acid is a much more expensive drug than a statin. There are generic versions of statins and some cost only a few dollars. Bempedoic acid, on the other hand, has no generic alternative and a 30-day supply can cost more than $400, according to GoodRx.

“I think what insurance companies need to recognize that even though this drug is going to cost more than statins, having a heart attack or a stroke or needing a stent is expensive. A 23% reduction in (myocardial infarctions) is a considerable reduction,” Weintraub said.

In an editorial in the New England Journal of Medicine that accompanied the study, Dr. John H. Alexander, who works in the division of cardiology at Duke Clinical Research Institute, Duke Health, Durham said that doctors should take these results into consideration when treating patients with high cholesterol who can’t take statins.

“The benefits of bempedoic acid are now clearer, and it is now our responsibility to translate this information into better primary and secondary prevention for more at-risk patients, who will, as a result, benefit from fewer cardiovascular events,” Alexander wrote.

Dr. Manesh Patel, a cardiologist and volunteer with the American Heart Association who was not a part of the study, said that providers are already prescribing bempedoic acid for some patients, but with this new research, he thinks they will quickly be used with more statin-intolerant patients.

“We continue to see that if we can lower your LDL significantly, we improve people’s cardiovascular health. And so we need as many different arrows in our quiver to try to get that done,” Patel said.

Heart disease is the No. 1 killer for men and women in the world. One person dies every 34 seconds in the US from cardiovascular disease, according to the CDC. About 697,000 people in the US died from heart disease in 2020 alone – about the same number as the population of Oklahoma City.

“Given the number of people that are eligible for statins, which are tens of millions of patients already, the number of people who cannot tolerate statins is in the millions,” Nissen said. “This is a big public health problem and I think we’ve come up with something that directly addresses this.”

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Stem cell therapy may reduce risk of heart attack and stroke in certain heart failure patients, study shows | CNN

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Cell therapy, involving adult stem cells from bone marrow, has been shown to reduce the risk of heart attack and stroke in severe heart failure patients, according to a new study.

A single administration of adult stem cells directly into an inflamed heart, through a catheter, could result in a long-term 58% reduced risk of heart attack or stroke among heart failure patients with reduced ejection fraction, meaning they have a weakened heart muscle, suggests the study, published Monday in the Journal of the American College of Cardiology.

The study is being called the largest clinical trial of cell therapy to date in patients with heart failure, a serious condition that occurs when the heart can’t pump enough blood to meet the body’s needs.

“We followed these patients during several years – three years – and what we found was that their hearts got stronger. We found a very significant reduction in heart attack and stroke, especially in the patient that we measured in their blood that they had more inflammation going on,” said the study’s lead author Dr. Emerson Perin, a practicing cardiologist and medical director at The Texas Heart Institute in Houston.

“That effect, it was there across everyone, but for the patient that had inflammation, it was even more significant,” Perin said. “And there also is evidence that we had a reduction in cardiovascular deaths.”

The therapy involves injecting mesenchymal precursor cells into the heart. These particular stem cells have anti-inflammatory properties, which could improve outcomes in heart failure patients since elevated inflammation is a hallmark feature of chronic heart failure.

More than 6 million adults in the United States have chronic heart failure, and most are treated with drugs that address the symptoms of the condition. The patients included in the new study were all taking medications for heart failure, and the new research suggests that cell therapy can be beneficial when used in conjunction with heart failure drugs.

“You can imagine, we keep everybody going and doing better with the medicine. And now we have a treatment that actually addresses the cause and quiets everything down. So, this line of investigation really has a great future and I can see that, with a confirmatory trial, we can bring this kind of treatment into the mainstream,” Perin said.

“We can treat heart failure differently,” he said. “We have a new weapon against heart failure and this study really opens the door and leads the way for us to be able to get there.”

The new study – sponsored by Australian biotechnology company Mesoblast – included 565 heart failure patients with a weakened heart muscle, ages 18 to 80. The patients were screened between 2014 and 2019 and randomly assigned to either receive the cell therapy or a placebo procedure at 51 study sites across North America.

The patients who received the cell therapy were delivered about 150 million stem cells to the heart through a catheter. The cells came from the bone marrow of three healthy young adult donors.

The researchers, from The Texas Heart Institute and other various institutions in the United States, Canada and Australia, then monitored each patient for heart-related events or life-threatening arrhythmias.

Compared with the patients who received a sham procedure, those treated with the stem cell therapy showed a small but statistically significant strengthening of the muscle of the heart’s left pumping chamber within a year.

The researchers also found that the cell therapy decreased the risk of heart attack or stroke by 58% overall.

“This is a long-term effect, lasting an average of 30 months. So that’s why we’re so excited about it,” Perin said.

Among patients with high inflammation in their bodies, the combined reduced risk of heart attack or stroke was even greater, at 75%, the researchers found.

“These cells directly address inflammation,” Perin said.

“They have little receptors for these inflammatory substances – some of them are called interleukins, and there’s other kinds,” he said. “When you put them into an inflamed heart, it activates the cells and the cells go, ‘Wow, we need to respond. This house is on fire. We need to put out the fire.’ And so they then secrete various anti-inflammatories.”

The researchers wrote in their study that their findings should be considered as “hypothesis generating,” in that they show this cell therapy concept could work, but clinical trials would be needed to specifically confirm the effects of these stem cells on heart attack, stroke and other events. It is still unclear for how long the effects of the stem cell therapy last beyond 30 months and whether patients will need more stem cell injections in the future.

Overall, there were no major differences between the adverse events reported among the patients who received the cell therapy compared with those in the control group, and the researchers reported no major safety concerns.

“We’ve made an enormous step to be able to harness the real power of adult stem cells to treating the heart,” Perin said. “This trial really is a signal of a new era.”

For more than a decade, scientists have been studying potential stem cell therapies for heart failure patients – but more research is needed to determine whether this treatment approach could reduce the amount of hospitalizations, urgent care events or complications among patients with heart failure.

The new study didn’t find that, said cardiologist Dr. Nieca Goldberg, medical director of Atria New York City and clinical associate professor of medicine at NYU Grossman School of Medicine, who was not involved in the latest study.

What the new study did find is that “there may be a population of people that could benefit from the stem cell therapy, particularly people who have inflammation,” Goldberg said.

“It’s actually an interesting therapy, an interesting thing to consider, once more research substantiates its benefit. Because in heart failure, there’s multiple things going on and, particularly for the inflammatory component, this could be an interesting treatment,” she said. “It might have some role in heart failure patients with inflammation.”

The therapy’s effects on heart attack or stroke risks “were positive,” Dr. Brett Victor, a cardiologist at the Cardiology Consultants of Philadelphia, who was not involved in the study, said in an email.

“Specifically, patients who received the stem cell therapy were less likely to have a heart attack or stroke over the next 2.5 years, especially among those who were found to have a high degree of systemic inflammation as measured by a laboratory test,” Victor said in the email, adding that this represents how heart failure has a significant inflammatory component.

Those “positive signals” likely will be evaluated more in subsequent studies, Victor said.

“Current therapies for heart failure including lifestyle modifications, a growing list of excellent medications, and device therapies will continue to be the standard of care for treatment in the near-term,” he said. “I suspect that this trial will continue to move the field forward in studying cardiac cell therapy as we continue to look for ways to not just treat, but actually find a cure for this disease.”

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Is your school equipped to save a life? Here’s how you’ll know | CNN

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CNN
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When 24-year-old Buffalo Bills safety Damar Hamlin collapsed on the field from cardiac arrest during the January 2 game against the Cincinnati Bengals, millions of people witnessed a remarkable resuscitation in real time on live television.

As a trauma neurosurgeon myself, I was in awe of the dozens of medical professionals – athletic trainers, doctors and EMTs – who put their years of training into action within seconds. The immediate recognition that this wasn’t a routine injury and the speedy administration of CPR and defibrillation saved his heart, his brain and his life. Six weeks later, we now hear Dr. Thomas Mayer, the medical director of the NFL Players Association, say “I guarantee you that Damar Hamlin will play professional football again.”

The rescue response was awesome to watch and reflected the remarkable resources and planning that go into every game played in the NFL. As a parent, though, I couldn’t help but wonder what would’ve happened if Hamlin faced this when he was still in high school. What if it would’ve happened to any of my three teenage kids at their school? Would they have been saved as well?

Sudden cardiac deaths are rare in young people, but you may be surprised to know that the US Centers for Disease Control and Prevention estimates that there are about 2,000 such deaths in people under the age of 25 every year.

While the overall number of cardiac arrests has stayed largely consistent, there is no question that school safety efforts – and cardiac arrest survival rates – have improved over the years. Florida was the first state to enact laws requiring automated external defibrillators, or AEDs, in schools in 1999, and there are now 20 states, along with the District of Columbia, with similar mandates, according to the American College of Cardiology. Even in most of the states with no requirement on the books, AEDs are available in the majority of schools.

Most venues with more than 200 people – large businesses, stadiums, casinos and concert halls – are required to have AEDs as well, but there has been a major focus on schools in recent decades, considering that about 20% of the US population is on school grounds at any one time. In the past quarter-century, we went from hardly any AEDs being present in schools to a remarkable awareness of the lifesaving potential they hold. That increased awareness and attention to defibrillators and CPR has directly resulted in more athletes surviving, says Dr. Jonathan Drezner, director of the University of Washington Medicine Center for Sports Cardiology and team physician for the Seattle Seahawks.

He points out that when he began investigating sudden cardiac arrest in young athletes in the early 2000s, survival rates hovered around 11%. A more recent study of young athletes from 2014 to 2018 found that survival rates have climbed to an average of 68%. That’s an improvement of more than 500% in less than two decades.

Still, we can and must do better, especially at the high school level. While there is increased awareness and availability of AEDs, none of that matters if the lifesaving device can’t be accessed within two to three minutes.

As part of a CNN investigation, we wanted a detailed understanding not just of AED availability in schools but of real-life accessibility. Speed matters when someone has suddenly dropped due to cardiac arrest. The best estimates are that every minute without defibrillation reduces survival by up to 10%.

That’s why Dr. Victoria Vetter, a cardiologist with the Cardiac Center at Children’s Hospital of Philadelphia, told us that “just having an AED is not sufficient.”

“You need to make sure that there is an accessible AED that is not locked in the nurse’s office or in some back office,” Vetter said.

The American Heart Association recommends that defibrillators be placed within a two- to three-minute walk. Unfortunately, even in schools that have diligently purchased devices – typically at a cost of $1,000 to $2,000 – too many of them are not readily accessible.

One small study of secondary public schools in Ohio and southeast Michigan found that in more than 70% of the 24 public schools surveyed, the devices simply couldn’t be reached in time. Another study of schools in Oregon found that people in just half of the schools surveyed could access the devices within four minutes of a field or arena. In Vermont, 81% of the state’s 74 schools had defibrillators near athletic fields or arenas; half of the time, the AEDs were kept in the main office, with the nurse or in the lobby.

As part of our investigation, we defined AED access as knowing where the AEDs are in case of emergency. But it is essential to make sure they are always fully charged and that drills are regularly run to ensure people know how to use them.

“We have fire drills in schools generally, every month. We have active shooter drills. But we do not in most schools have sudden cardiac arrest drills,” Vetter said.

Nationally, she said, just a handful of states require schools to practice cardiac emergency plans.

Many people have held up the NFL’s cardiac response as the gold standard: quick action and accessibility. Watching the remarkable 30-person team of professionals who saved Hamlin, many would argue that most high schools don’t have the resources to employ dozens of medical professionals.

But it doesn’t take an army to save a life.

“A single person can save a young athlete’s life if they promptly recognize cardiac arrest, call for help, start CPR and someone gets the AED,” said the Seahawks’ Drezner. “The treatment algorithm really is that simple.”

For many schools, that person would be an athletic trainer, the medical professional on the field.

And yet, in about a third of the nation’s high schools, there is no access to athletic trainers at all.

“You have to ask yourself: When those athletes get injured, who’s addressing those injuries? Who’s there to provide the emergency action plan in case something like this happens?” asked Kathy Dieringer, president of the National Athletic Trainers’ Association.

Drezner’s work has found that the survival rate from cardiac arrest for young athletes nearly doubled to over 80% when an athletic trainer was present or an AED was used. Part of the reason is that schools with athletic trainers were also the ones most likely to have emergency plans and AEDs. As things stand now, schools least likely to have athletic trainers are in urban or rural areas, and the schools most likely to have them are in the suburbs, areas that tend to have higher incomes.

“If I were a parent, I would ask those questions,” Dieringer said. “Where are the AEDs in my school? Are they accessible, and does someone know how to use them if they’re needed?”

Sudden cardiac arrest is a leading cause of death in young competitive athletes, with one study finding as many as one death every three days in youth sports.

One of those deaths was 16-year-old Matthew Mangine Jr., a soccer player at St. Henry District High School in Erlanger, Kentucky. In 2020, Matthew collapsed on the soccer field.

“There were five AEDs at the school that night, and one wasn’t brought to him,” his father, Matthew Mangine Sr., told the local news. “That night, his initial shock came from EMS. They arrived roughly 12 minutes after he was down.” Matthew died an hour later at the hospital.

John and Luann Ellsessar also know that pain well. They lost their 16-year-old son, Michael, on the football field when he went into cardiac arrest during a game in 2010. “There was no ambulance or AED on the field, and it took 15 minutes for the squad to arrive,” John told CNN. “If that ambulance is arriving 15 minutes later, he’s already 150% gone.” John recalls that the doctors at the hospital worked on Michael for 45 minutes before pronouncing him dead.

Many schools have AEDs on campus, but often, they're hard to find quickly.

Fortunately, this wasn’t the story for Peter Laake. In 2021, the star lacrosse player was already on the varsity team as a freshman at Loyola Blakefield in Towson, Maryland. Peter was hit on the left side in what was apparently a normal play, but what followed wasn’t normal at all. Peter told me he blacked out and collapsed on the field.

Jeremy Parr, the school’s athletic trainer, said he immediately went to Peter’s side and checked for a pulse.

“With no pulse, no breathing, we needed to get the AED and EMS activated as soon as possible,” Parr told me when I spoke with him recently.

CPR was started, and in Peter’s case, the AED data showed that his heart was beating again within two to three minutes.

Within three weeks, Peter was back on the field.

It’s an example of how things should work and could work in all schools.

Training in CPR for all staff, athletic and educational. Availability and accessibility of AEDs with regular drills to make sure execution is flawless. An emergency action plan that is posted and reviewed.

As a parent, you can and should ask about all of this yourself. After witnessing what happened to Hamlin, I did just that with the athletic department at my own children’s school.

In a world where we have many complicated problems, saving someone’s life is possible with the knowledge and resources we have right now. With a plan, it is easy. We often prioritize buses, fields and athletic equipment, but cardiac safety must also be at the top of the list.

As Parr told me, when the unthinkable happens, “every athlete deserves the chance to survive.”

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