“Heart Failure Minutes” (Episode 1) - The CAVIAR Trial скачать в хорошем качестве

“Heart Failure Minutes” (Episode 1) - The CAVIAR Trial

The CAVIAR Trial — PCSK9 Inhibition After Heart Transplantation HOST: Dr Milica Vukićević - Cardiologist, William Harvey Scholar at Brigham and Women’s Hospital Campus of the MGB Heart and Vascular Institute, Harvard Medical School. SPEAKER: Prof. Mandeep Mehra - the William Harvey Chair in Advanced Cardiovascular Medicine and is Executive Director of the Center for Advanced Heart Disease at Brigham and Women's Hospital and a Professor of Medicine at Harvard Medical School. The CAVIAR Trial (Fearon et al., Circulation 2025) presented at the American Heart Association meeting evaluated whether adding the PCSK9 inhibitor alirocumab to standard statin therapy early in the first year after heart transplantation could modify cardiac allograft vasculopathy (CAV). In this double-blind randomized study of 114 recipients on rosuvastatin, alirocumab achieved a remarkable over 50% LDL-C reduction (≈70 → 31 mg/dL) — but did not reduce plaque progression on serial IVUS imaging or improve coronary physiology (FFR, CFR, IMR) compared with placebo. No change in inflammatory indices (HS CRP) were noted. Does this mean that intensive lipid lowering should not be pursued after heart transplantation? A) Beyond Lipids: CAV may not be a purely lipid-driven process; inflammation, immune injury, and microcirculatory dysfunction likely dominate once LDL is below ~70 mg/dL, in the first year. B) The pathology of CAV: A bimodal disease, early after transplantation, the process is largely immunologically driven while in later years, traditional non-immune factors dominate. Intracoronary angioscopy studies have demonstrated the differences in plaque morphology supporting this fact (Mehra MR. Heterogeneity of cardiac allograft vasculopathy: clinical insights from coronary angioscopy. J Am Coll Cardiol. 1997;29:1339-44.) C)The Next Frontier: Instead of debunking the intensive lipid lowering hypothesis, we argue that it should be tested in the phase of CAV when lipid plaques dominate - A study of later intensification of lipid lowering (over 2 years) in concert with strategies that tackle other dysmetabolic substrates may define the next era of CAV prevention. Video Credits: This video was created and produced by Drs Milica Vukićević, Ameesh Isath and Mandeep Mehra along with Wendy Suero at the Brigham Campus of the MGB Heart and Vascular Institute.