Yogesh Reddy
@yreddyhf
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HF doc at Mayo Clinic, interested in HFpEF, PAH, valve hemodynamics
Minnesota, USA
Joined July 2016
RT @JCardFail: In our latest #JCFIgnite, @yreddyhf asks the❓are peak exercise performance measures really relevant in HFpEF trials? Rath…
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RT @hvanspall: Get your comfies on and join us at #THT2025 Tues Feb 11, 2025 for an exciting discussion on mechanisms & planned clinical tr…
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Mitral stenosis of the 2020s… learn how HFpEF can confound MS assessment through a large V wave from atrial noncompliance. @MayoClinicCV @CircHF
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Multi site and country collaboration made the rigorous validation possible. @RyanTedfordMD @MayoClinicCV @EchoLab_Gunma and many others
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@CMichaelGibson Qualitative analysis of individual trials based on whether there are enough events, and without p<0.05 thresholds to conclude if the Rx works or not. Meta analysis are just observational post hoc analyses with no alpha correction. misleading when rely on p<0.05 defines success.
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@djc795 @DrMarthaGulati Yes I don’t think there are easy fixes. The other unspoken problem is that for nontpx/VAD jobs, the rest of HF can be learned ‘on the job’ with a willingness to learn and some focussed training in fellowship. Most active practicing HF cardiologists learned this way in the past.
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@kaulcsmc @djc795 @gcfmd @AndrewFoy82 @drjohnm Yes, since non HF hosp is nonmodifiable by the Rx, you should have a 50-50 split in non HF hosp in the absence of biased adjudication (a non issue in a blinded trial). Noise from nonmodifiable nonHF hosp then requires massive trials - not a wise use of limited trial resources.
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@kaulcsmc @djc795 @gcfmd @AndrewFoy82 @drjohnm Those offsetting effects of therapy tend to be uncommon causes of hosp. So mathematically cannot result in true absence of all cause hosp reduction when HFH is clearly reduced in an unbiased, powered trial. In most cases, ‘absence’ of effect on all cause hosp is type 2 error.
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@kaulcsmc @gcfmd @AndrewFoy82 @drjohnm Absence of evidence. Not evidence of absence for benefit on all cause hosp in most HF trials.
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Multiple objective markers of HF and cardiorenal function improve with weight loss from tirzepatide in HFpEF.
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@drjohnm No one looks at one trial in isolation. Over the collective trial evidence, there is overwhelming evidence of efficacy to modify HF severity and risk. See larger number of events in SELECT (many with likely unrecognized HFpEF) with consistent effect on HFH
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RT @gcfmd: “When in doubt or unaware, measure.” Heart Failure With Preserved Ejection Fraction—A Role for Invasive Hemodynamics https://t.…
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