EP 139: The Genetic Revolution in HCM: Mapping Family Risk to Targeted Treatment

In this fascinating episode of Parallax, Dr Ankur Kalra sits down with Dr Alexander Fanaroff, an interventional cardiologist, clinical trialist, and behavioral economist at the University of Pennsylvania. Dr Fanaroff brings a unique perspective to cardiovascular medicine, combining his expertise in interventional cardiology with cutting-edge insights from behavioral economics to transform how we approach patient care and clinical decision-making. Dr Fanaroff demystifies behavioral economics for the medical community, explaining how this field studies real-world decision-making beyond traditional economic models. He introduces key concepts like status quo bias, prospect theory, and the power of defaults in shaping both physician and patient behaviors. Through compelling examples, including Penn's successful intervention that increased 90-day statin prescriptions from 70% to 90% simply by changing EHR defaults, Dr Fanaroff demonstrates how small design changes can yield significant clinical improvements. Looking beyond individual interventions, Dr Fanaroff discusses how behavioral economics can address healthcare disparities by creating system-wide improvements that lift all patients while specifically targeting underserved communities. He envisions a future where AI identifies at-risk patients from routine imaging, and where interventional cardiologists focus not just on procedural excellence but on ensuring optimal long-term medical management through thoughtfully designed care systems. Questions and comments can be sent to "[email protected]" and may be answered by Ankur in the next episode. Host: @AnkurKalraMD and produced by: @RadcliffeCardio Parallax is Ranked in the Top 100 Health Science Podcasts (#48) by Million Podcasts.

In this essential episode of Parallax, Dr Ankur Kalra welcomes Dr Shelley Zieroth, Professor of Medicine, clinician-scientist, and advanced heart failure and transplant cardiologist in Winnipeg, Canada. As we mark the 10-year anniversary of the landmark EMPA-REG OUTCOME trial, Dr Zieroth provides a comprehensive update on how SGLT2 inhibitors have revolutionized cardiovascular care. Dr Zieroth takes us through the remarkable journey from the initial 2015 trial that transformed SGLT2 inhibitors from anti-diabetic agents into cardiovascular powerhouses, delivering highly significant reductions in cardiovascular death and heart failure hospitalization. She explores how these medications have become fundamental pillars of cardio-kidney-metabolic medicine, with evidence spanning the entire ejection fraction spectrum. Dr Zieroth discusses prescribing these agents in heart failure - including the straightforward 10-mg daily dosing, monitoring strategies, and crucial patient selection criteria. She shares insights from the recent EMPULSE trial on safe in-hospital initiation, addresses important considerations for diabetic patients, and highlights key contraindications like indwelling catheters that clinicians must recognize. Beyond the basics, Dr Kalra and Dr Zieroth examine the evolving role of SGLT2 inhibitors in valvular disease and diastolic dysfunction, tackle the ongoing reimbursement challenges across different healthcare systems, and discuss the critical importance of multidisciplinary collaboration in the cardio-kidney-metabolic space. They also look ahead to exciting combination therapies on the horizon that promise to further advance heart failure prevention and treatment. Questions and comments can be sent to "[email protected]" and may be answered by Ankur in the next episode. Host: @AnkurKalraMD and produced by: @RadcliffeCardio Parallax is Ranked in the Top 100 Health Science Podcasts (#48) by Million Podcasts.

In this compelling episode of Parallax, Dr Ankur Kalra sits down with Dr Anandita Kulkarni, preventive cardiologist at Baylor Scott and White Heart Hospital, for an eye-opening conversation about addressing cardiovascular disparities in South Asian populations through the innovative Dilwale registry. Dr Kulkarni tells the story of returning to her Texas community to serve South Asian patients and her determination to create meaningful change through data. What started as a local initiative grew into something much larger: a comprehensive registry of over 31,000 South Asian patients that's revealing critical insights about heart disease in this underserved population. Beyond the clinical data, this episode delves into the practical challenges of culturally informed preventive care. Dr Kulkarni shares insights on addressing barriers to physical activity within South Asian communities, helping patients navigate dietary changes while respecting cultural food traditions, and the delicate work of motivating lifestyle modifications in a population already facing higher cardiovascular risks. Her patient-centered approach demonstrates how combining population-level research with deep cultural understanding can fundamentally improve both individual outcomes and community health. Questions and comments can be sent to "[email protected]" and may be answered by Ankur in the next episode. Host: @AnkurKalraMD and produced by: @RadcliffeCardio Parallax is Ranked in the Top 100 Health Science Podcasts (#48) by Million Podcasts

In this essential episode of Parallax, Dr Ankur Kalra is joined by Dr Carolyn Ho, Professor of Medicine at Harvard Medical School and Medical Director of the Cardiovascular Genetics Program at Brigham and Women's Hospital, for a comprehensive discussion on how genetic testing is reshaping hypertrophic cardiomyopathy management. The conversation explores the VANISH HCM trial results, which showed that valsartan can slow disease progression in young, asymptomatic individuals with early sarcomeric HCM. Dr Ho discusses how this evidence influenced the 2024 HCM guidelines and created new opportunities for disease-modifying therapy before clinical symptoms appear. The episode also examines emerging gene-based therapeutics, from current adeno-associated virus approaches to future CRISPR technologies that could address the underlying genetic causes of HCM. Dr Ho addresses practical considerations for clinicians, including when to initiate genetic testing, how to manage family screening, and the promise of AI-assisted screening tools. The discussion highlights both current therapeutic options and the evolving landscape of precision medicine in inherited cardiovascular disease. Questions and comments can be sent to "[email protected]" and may be answered by Ankur in the next episode. Host: @AnkurKalraMD and produced by: @RadcliffeCardio Parallax is Ranked in the Top 100 Health Science Podcasts (#48) by Million Podcasts.

In this insightful episode of Parallax, Dr Ankur Kalra explores the emerging field of cardiac epigenetics with Dr Manuel Rosa-Garrido, assistant professor of medicine at the University of Alabama in Birmingham. Their conversation examines how the three-dimensional organization of DNA within the cell nucleus influences heart disease development beyond traditional genetic sequencing. Dr Rosa-Garrido shares his pioneering work using Hi-C technology to map genome structure, revealing that DNA arrangement plays a crucial role in cardiac pathology. The discussion covers key concepts including chromatin loops, topologically associating domains, and compartmentalization—explaining how these structures regulate gene expression and how their disruption contributes to cardiovascular disease. The episode explores practical implications for clinical practice, from early biomarker identification to potential CRISPR-based therapies that could target chromatin structure. Dr Rosa-Garrido outlines how this research could transform cardiovascular care within the next decade, offering new approaches to both inherited cardiomyopathies and environmentally-influenced conditions like atherosclerosis. Valuable insights for cardiologists interested in precision medicine and the evolving understanding of how genetic architecture influences cardiovascular risk and treatment strategies. Questions and comments can be sent to "[email protected]" and may be answered by Ankur in the next episode. Host: @AnkurKalraMD and produced by: @RadcliffeCardio Parallax is Ranked in the Top 100 Health Science Podcasts (#48) by Million Podcasts.

In this essential episode of Parallax, Dr Ankur Kalra is joined by Dr Michelle O'Donoghue, cardiologist at Brigham and Women's Hospital and co-author of the recently updated AHA/ACC acute coronary syndrome guidelines. Together, they explore the revolutionary changes reshaping ACS management in 2025. Dr O'Donoghue shares insights from the landmark guideline development process that unified non-ST elevation ACS and ST elevation MI recommendations into a single comprehensive document. The conversation covers game-changing updates including new risk stratification approaches, the shift toward selective invasive strategies, and the introduction of bivalirudin as an alternative anticoagulation option. The discussion highlights the groundbreaking "lower is better" approach to LDL management with new targets below 55 mg/dL, evolving antiplatelet therapy strategies, and the emerging role of ticagrelor monotherapy. Dr O'Donoghue also addresses future directions in cardiovascular care, from GLP-1 agonists to mechanical circulatory support devices, emphasizing how these guidelines represent a fundamental shift toward more personalized, evidence-based ACS management. Questions and comments can be sent to "[email protected]" and may be answered by Ankur in the next episode. Host: @AnkurKalraMD and produced by: @RadcliffeCardio Parallax is Ranked in the Top 100 Health Science Podcasts (#48) by Million Podcasts.

In this profound episode of Parallax, Dr Ankur Kalra welcomes Dr Pam Taub, Professor of Medicine and Director of Preventive Cardiology at UC San Diego, for an enlightening conversation about integrating spirituality, purpose, and scientific curiosity in cardiovascular practice. Dr Taub shares her unique philosophical foundation, shaped by exposure to diverse religions in South India. This experience fostered her belief that all faiths fundamentally center on being a good person and serving others. She explores how this spiritual perspective transforms medicine from a profession into a sacred calling, where patient interactions become profound privileges that fuel her desire to make meaningful impact beyond individual achievements. The episode highlights Dr Taub's groundbreaking work with POTS (Postural Orthostatic Tachycardia Syndrome), demonstrating how scientific curiosity serves as a spiritual path. Her research journey—from recognizing misdiagnosed conditions to conducting the first clinical trial for ivabradine in POTS—exemplifies how deeper questioning and evidence-based inquiry can transform patient lives on a broader scale. The episode also explores Dr Taub's research on time-restricted eating, connecting modern scientific evidence to fasting practices across many faiths. Questions and comments can be sent to "[email protected]" and may be answered by Ankur in the next episode. Host: @AnkurKalraMD and produced by: @RadcliffeCardio Parallax is Ranked in the Top 100 Health Science Podcasts (#48) by Million Podcasts.

In this insightful episode of Parallax, Dr Ankur Kalra is joined by Dr Leslie Saxon, a professor of medicine at Keck School of Medicine USC and executive director for the USC Center for Body Computing. Together, they explore the potential network data have in transforming healthcare delivery and patient survival. Beginning with the origin and aim of the USC Center for Body Computing, the episode dives into the benefits of a network of connected implantable devices to engage patients in their own care. Dr Saxon also shares her vision of overseeing "life care” as well as "sick care" by collecting data on the mind and body, providing insights into her work with professional athletes and the military to understand how the body functions as a system. The discussion later turns to the evolution of computing devices and how we are moving past the concept of "wearables" with AI-centric devices designed specifically for continuous health monitoring.

In this inspiring episode of Parallax, Dr Ankur Kalra engages with Dr Srihari S. Naidu, current President of the Society for Cardiovascular Angiography and Interventions (SCAI) and tenured professor at New York Medical College. Their conversation explores Dr Naidu's compelling journey from his formative years and family influences to his strategic vision for elevating interventional cardiology's national profile. Dr Naidu shares his innovative "LINK" philosophy—Leadership, Innovation, Networking, and Knowledge—which has guided his approach to medicine and leadership. The discussion delves into SCAI's remarkable growth in education, publications, and advocacy under his stewardship, while addressing the critical need to increase public understanding of interventional cardiologists' life-saving contributions to healthcare. The conversation offers valuable insights on career progression in medicine, exploring the delicate balance between knowledge and wisdom across different career stages. Dr Naidu provides thoughtful perspectives on the "sweet spot" of mid-career practice, the importance of cross-generational learning, and SCAI's commitment to fostering diversity by removing barriers for women and underrepresented groups in the field. Essential listening for cardiologists at all career stages, healthcare leaders, and those interested in the evolving landscape of interventional cardiology and its impact on patient care and public health. Buy the SCAI Cap here. (https://shop.scai.org/) Questions and comments can be sent to "[email protected]" and may be answered by Ankur in the next episode. Host: @AnkurKalraMD and produced by: @RadcliffeCardio Parallax is Ranked in the Top 100 Health Science Podcasts (#48) by Million Podcasts.

In this compelling episode of Parallax, Dr Ankur Kalra explores South Asian cardiovascular health with preventive cardiology experts, Dr Jaideep Patel from Johns Hopkins, and Dr Romit Bhattacharya from Massachusetts General Hospital. The conversation begins with both specialists sharing personal motivations behind their focus on South Asian heart health, from family losses to scientific curiosity about potential genetic and metabolic distinctions. They examine whether South Asians truly face different cardiovascular risks - discussing observations of earlier disease onset, unique lipid patterns, and metabolic dysfunction at lower BMIs - while emphasizing that fundamental prevention strategies remain effective across populations. The episode culminates with powerful closing insights on prevention as an investment—how small, consistent lifestyle modifications can prevent cardiovascular disease onset even in those with genetic predispositions, ultimately enabling fuller, more functional lives in later years. Questions and comments can be sent to "[email protected]" and may be answered by Ankur in the next episode. Host: @AnkurKalraMD and produced by: @RadcliffeCARDIO