This Week in Cardiology

ACC Recap #1: DanGer Shock (plus a sobering JAMA research letter on Impella use), REDUCE-AMI, PREVENT, and EMPACT-MI are the topics John Mandrola, MD, covers in this week?s podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. DanGer-Shock Trial

Impella CP Improves Survival in STEMI, Cardiogenic Shock https://www.medscape.com/viewarticle/impella-cp-improves-survival-stemi-cardiogenic-shock-2024a10006kz

Impella Saves Lives in Cardiogenic Shock, but Patient Selection Key https://www.medscape.com/viewarticle/1000659

Published DanGer Shock Study  https://www.nejm.org/doi/full/10.1056/NEJMoa2312572 JAMA Research letter https://jamanetwork.com/journals/jama/article-abstract/2817457

II. REDUCE-AMI Trial

New Data Question Beta-Blockers Post-MI With Preserved EF https://www.medscape.com/viewarticle/new-data-question-beta-blockers-post-mi-preserved-ef-2024a10006y8

Beta-Blockers Post-MI Past Their Expiration Date: REDUCE-AMI https://www.medscape.com/viewarticle/1000663

REDUCE-AMI paper https://www.nejm.org/doi/full/10.1056/NEJMoa2401479 Meta-analysis: Beta Blockers for MI https://doi.org/10.1016/j.amjmed.2014.05.032

III. PREVENT Trial

Preventive PCI for Vulnerable Plaques Reduces Cardiac Events

https://www.medscape.com/viewarticle/preventive-pci-vulnerable-plaques-reduces-cardiac-events-2024a10006tc

Preventive Coronary Stents: Not There Yet

https://www.medscape.com/viewarticle/preventive-coronary-stents-not-there-yet-2024a10006yr

PREVENT https://doi.org/10.1016/S0140-6736(24)00413-6

IV. EMPACT MI trial of Empagliflozin in the Post-MI setting

Empagliflozin Fails to Reduce Events After Acute MI

https://www.medscape.com/viewarticle/empagliflozin-fails-reduce-events-after-acute-mi-2024a10006kn

EMPACT-MI: Another SGLT2 Inhibitor Miss in Post-MI Care  https://www.medscape.com/viewarticle/1000684 EMPACT MI https://www.nejm.org/doi/10.1056/NEJMoa2314051 DAPA MI https://evidence.nejm.org/doi/full/10.1056/EVIDoa2300286 PARADISE MI https://www.nejm.org/doi/full/10.1056/NEJMoa2104508 Kaul thread https://x.com/kaulcsmc/status/1776611935842165029 Kaul paper https://www.ahajournals.org/doi/full/10.1161/circulationaha.116.022537

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Statins and diabetes, AAD in patients with heart disease, tricuspid valve interventions, and an ACC preview are the topics John Mandrola, MD, discusses in this week?s podcast.This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. Statins and Diabetes

Meta-analysis in Lancet-Diabetes https://doi.org/10.1016/S2213-8587(24)00040-8 Editorial https://doi.org/10.1016/S2213-8587(24)00059-7 NEJM Paper on Gene Variants and DM https://www.nejm.org/doi/full/10.1056/nejmoa1604304 JAMA Paper on Gene Variants and DM https://jamanetwork.com/journals/jama/fullarticle/2565289

II. Anti-arrhythmic Drugs in Patients With Serious Heart Disease

UPenn Paper on AADs for PVC Suppression https://doi.org/10.1016/j.jacep.2024.01.021 Three Questions for Evidence-Based Cardiac EP https://www.ahajournals.org/doi/full/10.1161/circoutcomes.110.957381 CAST trial https://www.nejm.org/doi/full/10.1056/NEJM199103213241201

III. Tricuspid Valve Interventions

FDA Clears TriClip for Tricuspid Regurgitation

https://www.medscape.com/viewarticle/fda-clears-triclip-tricuspid-regurgitation-2024a100068o

FDA Panel in Favor of TriClip for Tricuspid Regurgitation

https://www.medscape.com/viewarticle/fda-panel-favor-triclip-tricuspid-regurgitation-2024a100037n

Slides for Trisend II TRILUMINATE https://www.nejm.org/doi/full/10.1056/NEJMoa2300525

IV. ACC Preview

Mandrola's Three Trials to Look for at the 2024 American College of Cardiology Scientific Sessions

https://www.medscape.com/viewarticle/1000613

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Intermittent fasting, anticoagulation decisions, heterogenous treatment effects, frailty in HF, the importance of the ECG, and industry conflicts are the topics John Mandrola, MD, covers this week.

This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. Intermittent Fasting

No, Intermittent Fasting Won't Kill You

https://www.medscape.com/viewarticle/1000544

NEJM Paper on Time-Restricted Eating  https://www.nejm.org/doi/full/10.1056/NEJMoa2114833 JAMA TREAT Clinical Trial https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2771095

II. Stroke Prevention with OAC

Shah Meta analysis of Vitamin K Agonists in AF https://www.ahajournals.org/doi/abs/10.1161/CIRCOUTCOMES.123.010269

III. Heterogenous Treatment Effects in Trials

Pivotal CV Trials May Not Apply to Complex Patients

https://www.medscape.com/viewarticle/989129

Analysis of 8 Trials of Multimorbidity and Treatment Response https://doi.org/10.1016/j.amjmed.2024.01.028

IV. Frailty and HF

Circulation Outcomes: Multidomain Frailty and Mode of Death in HF  https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.123.010416

V. ECG in LBBB

JAMA Cardiology: Revised Definition of LBBB  https://jamanetwork.com/journals/jamacardiology/fullarticle/2816973

VI. Industry Payments to Doctors

JAMA: Payments to US Physicians by Specialty https://jamanetwork.com/journals/jama/fullarticle/2816900

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p>Obesity drugs as ASCVD-modifiers, HR monitors, when journals publish obvious facts, and effect scores and sorting out signals from RCTs are the topics John Mandrola, MD, covers in this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

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I. Denmark Notes

II. FDA approval of Semaglutide

FDA Approves Semaglutide for Cardiovascular Risk Reduction

https://www.medscape.com/viewarticle/fda-approves-semaglutide-cardiovascular-risk-reduction-2024a10004ix

Select Trial

III. PPG Monitor Accuracy

Research Letter https://doi.org/10.1016/j.jacc.2024.01.024

IV. AAD and Bradycardia

Anti-arrhythmic Drugs Linked to Bradycardia in Patients With AF

https://www.medscape.com/viewarticle/anti-arrhythmic-drugs-linked-bradycardia-patients-af-2024a10004vw

JACC paper on AAD Adverse Effects https://doi.org/10.1016/j.jacc.2024.01.013

V. Finding Signals in RCTs
 

JAMA paper on Treatment Effects of Oxygen Targets DANISH trial https://www.nejm.org/doi/full/10.1056/nejmoa1608029 LAFFLIN et al. Scoring System to Assess Generalizability of Trial Results https://doi.org/10.1177/2047487318815967

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Plastics and heart disease, MINT trial letters-to-the-editor and Bayes theorem, and Brugada syndrome are the topics John Mandrola, MD, discusses in this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. Plastics and Heart Disease

Plastic Particles in Carotid Plaques Linked to CV Events

https://www.medscape.com/viewarticle/plastic-particles-carotid-plaques-linked-cv-events-2024a10004ge

Plastics and ASCVD Study https://www.nejm.org/doi/full/10.1056/NEJMoa2309822 Review https://www.nejm.org/doi/full/10.1056/NEJMra2300476 Editorial https://www.nejm.org/doi/full/10.1056/NEJMe2400683

II. MINT trial LTE and Bayes Theorem

In MI With Anemia, Results May Favor Liberal Transfusion: MINT https://www.medscape.com/viewarticle/998376

The MINT Study https://www.nejm.org/doi/full/10.1056/NEJMoa2307983 Letter-to-the-Editor https://www.nejm.org/doi/full/10.1056/NEJMc2400982 Likelihood Ratio https://www.cebm.ox.ac.uk/resources/ebm-tools/likelihood-ratios

III. Brugada Syndrome

The EHJ paper: https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehae133/7623123

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The Western AF meeting, aspirin, cannabis use, LVEF in athletes, and shared decision making before ICD implantation are the topics John Mandrola, MD, discusses in this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

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I. ASA in Primary Prevention

Campbell Meta-analysis https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.065420 Swedish Observational study https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.117.028321 ASPREE https://www.nejm.org/doi/full/10.1056/NEJMoa1805819

II. Cannabis

Cannabis Use Tied to Increased Cardiovascular Risk

https://www.medscape.com/viewarticle/cannabis-use-tied-increased-cardiovascular-risk-2024a10003yr

It Sure Looks Like Cannabis Is Bad for the Heart, Doesn?t It?

https://www.medscape.com/viewarticle/1000250

Journal of the AHA Observational Study https://www.ahajournals.org/doi/full/10.1161/JAHA.123.030178

III. Low EF in Athletes

Reduced Ejection Fraction in Elite Endurance Athletes: Clinical and Genetic Overlap With Dilated Cardiomyopathy https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.063777

IV. ICDs and Shared Decision-Making

Association of a Medicare Mandate for Shared Decision-Making With Cardiac Device Utilization https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2815017

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Reading incidental CAC on chest CT scans, exercise benefits in women vs men, PCI with or without imaging, and trial non-reporting are the topics John Mandrola, MD, discusses in this week?s podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

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I. Incidental CAC on Chest CT

Incidental CAC Tweet When Does a Calcium Score Equate to Secondary Prevention?: Insights From the Multinational CONFIRM Registry https://doi.org/10.1016/j.jcmg.2023.03.008

II. Exercise

Health Gains of Exercise Greater in Women?

https://www.medscape.com/viewarticle/health-gains-exercise-greater-women-2024a10003fv

Sex Differences in Association of Physical Activity With All-Cause and Cardiovascular Mortality

III. PCI With or Without Imaging

Intravascular Imaging in PCI: Time for a Guideline Update?

https://www.medscape.com/viewarticle/995677 

Meta-analysis paper Lancet https://doi.org/10.1016/S0140-6736(23)02454-6 Imaging uptake paper https://doi.org/10.1093/eurheartj/ehad430

IV. Trial Non-reporting

The Ghost Research Haunting Nordic Medical Trials

https://www.medscape.com/viewarticle/ghost-research-haunting-nordic-medical-trials-2024a10003gz

Manuscript/preprint https://www.medrxiv.org/content/10.1101/2024.02.04.24301363v1#T10 Nissen (Rosiglitazone) https://www.nejm.org/doi/10.1056/NEJMoa072761

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An update in trial interpretation, CI, and P-values; percutaneous tricuspid Interventions; and news on HDL and humility in Medicine are the topics John Mandrola, MD, covers in this week?s podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

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I. Evidence of Absence Is not Absence of Evidence

Feb 09, 2024 This Week in Cardiology Podcast

https://www.medscape.com/viewarticle/1000101

ARCADIA Trial https://jamanetwork.com/journals/jama/fullarticle/2814933 FOURIER Trial https://www.nejm.org/doi/full/10.1056/nejmoa1615664 Sample Size Calculator https://clincalc.com/stats/samplesize.aspx

II. Tricuspid Valve Interventions

FDA OKs First Transcatheter Tricuspid Valve Replacement

https://www.medscape.com/viewarticle/fda-oks-first-transcatheter-tricuspid-valve-replacement-2024a10002dq

FDA Panel in Favor of TriClip for Tricuspid Regurgitation

https://www.medscape.com/viewarticle/fda-panel-favor-triclip-tricuspid-regurgitation-2024a100037n

Cardiothoracic Surgical Trials Network Study https://www.nejm.org/doi/full/10.1056/NEJMoa2115961 TRILUMINATE https://www.nejm.org/doi/full/10.1056/NEJMoa2300525 KAUL Tweet on ATTR Cardiomyopathy https://twitter.com/kaulcsmc/status/1753552603534016622?s=20 APOLLO B trial https://www.nejm.org/doi/full/10.1056/NEJMoa2300757 Al-Lamee Tweet on Sham Controls https://x.com/rallamee/status/1758236588570562736

III. HDL Cholesterol

Rationale paper ? AEGIS https://doi.org/10.1016/j.ahj.2020.10.052 Press Release AEGIS II https://www.prnewswire.com/news-releases/csl-announces-top-line-results-from-the-phase-3-aegis-ii-trial-evaluating-the-efficacy-and-safety-of-csl112-apolipoprotein-a-i-human-302059156.html

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Beta-blocker withdrawal in HFpEF, the ARCADIA trial, food as medicine, and bariatric surgery are the topics John Mandrola, MD, discusses in today?s podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

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I. HFpEF and Heart Rate

PRESERVE HF Substudy https://jamanetwork.com/journals/jamacardiology/fullarticle/2814596 PRESERVE HF Original https://doi.org/10.1016/j.jacc.2021.08.073

II. ARCADIA trial

ARCADIA Main Paper: Apixaban vs ASA https://jamanetwork.com/journals/jama/fullarticle/2814933 KAMEL?s AF and Stroke Paper 10.1161/STROKEAHA.115.012004 AVERROES Substudy -- 10.1016/S1474-4422(12)70017-0

III. Food as Medicine

Food-As-Medicine Trial results: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2812982 NPR Story https://www.npr.org/sections/thesalt/2017/05/08/526952657/fresh-food-by-prescription-this-health-care-firm-is-trimming-costs-and-waistline

IV. Bariatric Surgery

Weight Loss Surgery Yields Long-Term BP Control in Obesity

https://www.medscape.com/viewarticle/weight-loss-surgery-yields-long-term-bp-control-obesity-2024a10002le

Gateway RCT https://doi.org/10.1016/j.jacc.2023.11.032

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FDA approves PFA for AF ablation, flawed comparisons of TEER vs MV surgery and PCI vs CABG, and cardiologists struggling with board exams are the topics John Mandrola, MD, covers in this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

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I. PFA

FDA Okays Boston Scientific PFA System for Paroxysmal AF

https://www.medscape.com/viewarticle/fda-okays-boston-scientific-pfa-system-paroxysmal-af-2024a1000275

Pulsed-Field Ablation for AF: The Promise and the Reality

https://www.medscape.com/viewarticle/995675

ADVENT Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2307291 EU-PORIA Registry https://doi.org/10.1093/europace/euad185 Tomlinson/Mandrola Editorial https://www.jacc.org/doi/10.1016/j.jacc.2020.07.032

II. TEER vs MV Surgery

EHJ Paper https://doi.org/10.1093/eurheartj/ehae046

III. ISCHEMIA Post-Hoc Studies

JACC Post-Hoc ISCHEMIA Trialhttps://doi.org/10.1016/j.jacc.2023.11.002 Main ISCHEMIA paper https://www.nejm.org/doi/full/10.1056/nejmoa1915922 FAME 3 https://www.nejm.org/doi/full/10.1056/NEJMoa2112299

IV. Board Exams

More Cardiologists Failing the Boards, Why and How to Fix?

https://www.medscape.com/viewarticle/more-cardiologists-failing-boards-why-and-how-fix-2024a10001oi

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LAAO, more evidence that stable CAD is stable, CRT benefit over the long-term, and AF monitoring after stroke are the topics John Mandrola, MD, covers in this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

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I. LAAO

This Week in Cardiology Podcast, Dec 15, 2023 https://www.medscape.com/viewarticle/999282

European Heart Journal paper https://academic.oup.com/eurheartj/article/45/3/214/7471675 LAAOS 3 https://www.nejm.org/doi/full/10.1056/NEJMoa2101897

II. CAD after Transcatheter Aortic Valve Implantation

Cleveland Clinic Observational study https://doi.org/10.1093/eurheartj/ehae019 ACTIVATION trial  https://doi.org/10.1016/j.jcin.2021.06.041

III. Cardiac Resynchronization Therapy

Original RAFT 2010 https://www.nejm.org/doi/full/10.1056/nejmoa1009540 Long-term RAFT  https://www.nejm.org/doi/full/10.1056/NEJMoa2304542 Editorial https://www.nejm.org/doi/full/10.1056/NEJMe2312419

IV. AF Monitoring After Stroke

Japanese Observational Study https://www.ahajournals.org/doi/10.1161/JAHA.123.031508 ARTESIA https://www.nejm.org/doi/full/10.1056/NEJMoa2310234 NOAH https://www.nejm.org/doi/full/10.1056/NEJMoa2303062 LOOP substudy https://jamanetwork.com/journals/jamaneurology/fullarticle/2795865 CRYSTAL AF https://www.nejm.org/doi/full/10.1056/nejmoa1313600

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Listener feedback on antiplatelet therapy after PCI, bempedoic acid, off-Label PFO Closure, and palliative care are the topics John Mandrola, MD, discusses in this week's podcast.

This podcast is intended for healthcare professionals only.

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I. Listener Feedback on Antiplatelet Therapy After PCI

Long-term Clopidogrel Has Advantages After Coronary Stenting

https://www.medscape.com/viewarticle/long-term-clopidogrel-has-advantages-after-coronary-stenting-2024a10000c8

Host Exam Study;  Extended FU of Host-Exam https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.062770

II. Bempedoic Acid

This Week in Cardiology July 7, 2023 https://www.medscape.com/viewarticle/994089

NEJM: Bempedoic Acid and CV Outcomes JAMA: Primary Prevention Analysis https://jamanetwork.com/journals/jama/fullarticle/2806646 JAMA-Cardiology: Total Events Analysis https://jamanetwork.com/journals/jamacardiology/fullarticle/2813647/

III. Off-Label PFO Closure

Circulation Outcomes Paperhttps://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.123.010200

IV. Palliative Care

JAMA: Palliative Care Consultation

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GLP-1s and BaroStim Neo revisited, a new drug for transthyretin amyloid CM, clopidogrel vs ASA years after PCI and stent, and statins are the topics John Mandrola, MD, discusses in this week's podcast.

This podcast is intended for healthcare professionals only.

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I. GLP-1s and Obesity, BaroStim Neo Revisited

FDA Expands Label for CVRx Barostim System in HF https://www.medscape.com/viewarticle/fda-expands-label-cvrx-barostim-system-hf-2023a1000wsx

JAMA Cardiology Special Communication ? BDP https://jamanetwork.com/journals/jamacardiology/fullarticle/2810726

II. ATTR Cardiomyopathy

ATTRibute-CM NEJM paper https://www.nejm.org/doi/full/10.1056/NEJMoa2305434

Circulation Review of TTR https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.111.078915

ATTR-ACT (Tafadimis) https://www.nejm.org/doi/10.1056/NEJMoa1805689

III. Clopidogrel vs ASA Years After PCI

Long-term Clopidogrel Has Advantages After Coronary Stenting

https://www.medscape.com/viewarticle/long-term-clopidogrel-has-advantages-after-coronary-stenting-2024a10000c8

Stop DAPT Original Trial

STOP DAPT at 5 Years https://doi.org/10.1016/j.jacc.2023.10.013

Network Meta-analysis of P2Y12-I vs ASA https://doi.org/10.1016/j.jcin.2022.08.009

IV. Statin Use

Statin Use Remains Low for At-Risk Patients

https://www.medscape.com/viewarticle/999043

Annals of Internal Medicine Observational Study https://doi.org/10.7326/M23-1915

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Neuro-modulation in HF, private equity owned hospitals, HCM, SCD and ICD re-evaluated, and peer review are the topics John Mandrola, MD, discusses in this week?s podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

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I. Neuromodulation for HFrEF

FDA Expands Label for CVRx Barostim System in HF

https://www.medscape.com/viewarticle/fda-expands-label-cvrx-barostim-system-hf-2023a1000wsx

BeAT HF trial https://doi.org/10.1016/j.jacc.2020.05.015

II. Private Equity Takeover of US Hospitals

Hospital Adverse Events Rise After Private Equity Acquisition

https://www.medscape.com/viewarticle/hospital-adverse-events-rise-after-private-equity-2023a1000wya

Changes in Hospital Adverse Events and Patient Outcomes Associated With Private Equity Acquisition: https://jamanetwork.com/journals/jama/article-abstract/2813379

RSS audio: https://bi.medscape.com/pi/editorial/studio/audio/2024/core/999557.mp3

III. Hypertrophic Cardiomyopathy

Positive Topline Results for SEQUOIA-HCM Trial in OHCM

https://www.medscape.com/viewarticle/positive-topline-results-sequoia-hcm-trial-ohcm-2023a1000wu9

IV. The ICD gets a ReLook

Study to Examine Routine ICD Implantation Post Heart Attack

https://www.medscape.com/viewarticle/study-examine-routine-icd-implantation-post-heart-attack-2023a1000wmd

PROFID Site https://profid-project.eu/profid-ehra-trial/

Declining Risk of Sudden Death in Heart Failure https://www.nejm.org/doi/full/10.1056/NEJMoa1609758

V. Peer Review

Prevalence of Short Peer Reviews in 3 Leading General Medical Journals -- https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2812883

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FDA approves PFA, breakthrough in PAH, residual leaks after percutaneous LAAO, OAC in low to intermediate risk people are the topics John Mandrola, MD, discusses in this week?s podcast.

This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. FDA Approves PFA

FDA Approves First Pulsed Field Ablation System for AF https://www.medscape.com/viewarticle/fda-approves-first-pulsed-field-ablation-system-af-2023a1000vit

- PULSED AF https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.064329

- ADVENT Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2307291

- MANIFEST https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.064959

II. Pulmonary HTN

Positive Topline Data for Sotatercept in PAH: STELLAR

https://www.medscape.com/viewarticle/982407

- STELLAR https://www.nejm.org/doi/10.1056/NEJMoa2213558

- Editorial on STELLAR https://www.nejm.org/doi/full/10.1056/NEJMe2300324

III. Peri-Device Leaks

- Greek Meta-analysis https://doi.org/10.1093/eurheartj/ehad828

IV. Intermediate Risk AF ? Norwegian Study

- Stroke and bleeding risk in atrial fibrillation with CHA2DS2-VASC risk score of one: the Norwegian AFNOR study AFNOR Study https://doi.org/10.1093/eurheartj/ehad659

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Three aspects of the recent AF guideline documents and a possible new treatment of POTS are the topics John Mandrola, MD, discusses in this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I AF Guidelines

ACC/AHA Issue Updated Atrial Fibrillation Guideline

https://www.medscape.com/viewarticle/998956

- Guideline doc: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001193

- CASTLE AF https://www.nejm.org/doi/full/10.1056/nejmoa1707855

- Analysis of US Inpatient Sample https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/1471-2261-14-73

- RAFT AF https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057095

- Beta Blockers in AF https://pubmed.ncbi.nlm.nih.gov/25193873/

Section 2 AF Guidelines ? EARLY Rhythm Control Gets Emphasis

- STOP AF https://www.nejm.org/doi/full/10.1056/NEJMoa2029554

- EARLY AF https://www.nejm.org/doi/full/10.1056/nejmoa2029980

- EAST https://www.nejm.org/doi/full/10.1056/NEJMoa2019422

- Natural History of AF https://www.jacc.org/doi/abs/10.1016/j.jacc.2019.09.050

Section 3 AF Guidelines ? Dubious Upgrade of percutaneous LAAC

- PROTECT and PREVAIL Meta-analysis 5-year https://doi.org/10.1016/j.jacc.2017.10.021

- PINNACLE FLX https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.120.050117

II. Postural Orthostatic tachycardia Syndrome

Vagus Nerve Stimulation Promising In POTS

https://www.medscape.com/viewarticle/998913

- Stavrakis et al. Noninvasive VNS for POTS https://doi.org/10.1016/j.jacep.2023.10.015

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More from AHA including SGLT2 inhibitors, blood transfusion after MI; cracks in the armor of Factor XI inhibitors; and renal denervation are the topics John Mandrola, MD, covers in this week?s podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. DAPA MI

Potential Dapagliflozin Benefit Post-MI Is Not a 'Mandate'

https://www.medscape.com/s/viewarticle/998378

- NEJM Evidence: Dapagliflozin After MI https://evidence.nejm.org/doi/full/10.1056/EVIDoa2300286

II. Blood Transfusion Strategy Post MI

In MI With Anemia, Results May Favor Liberal Transfusion: MINT

https://www.medscape.com/viewarticle/998376

- MINT NEJM -- https://www.nejm.org/doi/full/10.1056/NEJMoa2307983

- REALITY https://jamanetwork.com/journals/jama/fullarticle/2776201

- PROTECTED TAVR - https://www.nejm.org/doi/full/10.1056/NEJMoa2204961

III. FACTOR XI

Impressive Bleeding Profile With Factor XI Inhibitor in AF: AZALEA

https://www.medscape.com/viewarticle/998418

Asundexian Phase 3 AF Study Halted for Lack of Efficacy

https://www.medscape.com/viewarticle/998665

- Abelacimab for VTE https://www.nejm.org/doi/full/10.1056/NEJMoa2105872

IV. Renal Denervation

FDA Panel Split on Efficacy of Spyral Renal Denervation

https://www.medscape.com/viewarticle/995800

FDA OKs Symplicity Renal Denervation System for Hypertension

https://www.medscape.com/viewarticle/998664

- SPYRAL HTN OFF MED  -- https://doi.org/10.1016/S0140-6736(20)30554-7

- SPRYAL HTN On Meds (Pilot Lancet 2018 ) https://doi.org/10.1016/S0140-6736(18)30951-6

- SPRYAL HTN ON Meds (Expansion Pilot) https://doi.org/10.1016/j.jacc.2023.08.045

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An AHA Recap: SELECT, ORBITA2, and ARTESIA are the trials John Mandrola, MD, reviews in this week's podcast.

This podcast is intended for healthcare professionals only.

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American Heart Association 2023 on theHeart.org | Medscape Cardiology

https://www.medscape.com/viewcollection/37277

I. SELECT Trial

Semaglutide 'A New Pathway' to CVD Risk Reduction: SELECT

https://www.medscape.com/viewarticle/998373

Positive Results From SELECT Begins a New Era in Cardiology

https://www.medscape.com/viewarticle/998217

Is It Time for Cardiologists to Treat Obesity?

https://www.medscape.com/viewarticle/998391

- SELECT trial https://www.nejm.org/doi/full/10.1056/NEJMoa2307563

- SUSTAIN 6 https://www.nejm.org/doi/full/10.1056/nejmoa1607141

II. ORBITA 2

Angioplasty Finally Proven Beneficial in Stable Angina: ORBITA-2

https://www.medscape.com/s/viewarticle/998375

ORBITA-2 Saves Interventional Cardiology and Challenges Current Guidance

https://www.medscape.com/viewarticle/998213

PCI, the Antianginal 'Pill': ORBITA-2 in Detail

https://www.medscape.com/viewarticle/997777

- ORBITA-2; NEJM https://www.nejm.org/doi/full/10.1056/NEJMoa2310610

- ORBITA 1 https://doi.org/10.1016/S0140-6736(17)32714-9

III. ARTESIA

Apixaban Cuts Stroke but Ups Bleeding in Subclinical AF: ARTESIA

https://www.medscape.com/viewarticle/998379

Sadly, ARTESIA Doesn't Answer a Common Question in Cardiology

https://www.medscape.com/viewarticle/998215

- NOAH https://www.nejm.org/doi/full/10.1056/NEJMoa2303062

- ARTESIA https://www.nejm.org/doi/10.1056/NEJMoa2310234

- AVERROES https://www.nejm.org/doi/full/10.1056/NEJMoa1007432

- McIntyre Meta-analysis https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.067512

- TRENDS https://www.ahajournals.org/doi/10.1161/circep.109.849638

- ASSERT https://doi.org/10.1093/eurheartj/ehx042

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Renal denervation, a potential deadly decision in the ED, GLP-1 agonists, and an AHA preview are the topics John Mandrola, MD, discusses in this week?s podcast.

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I. Renal Denervation

FDA OKs Paradise Renal Denervation System for Hypertension

https://www.medscape.com/viewarticle/998237

- Company Press Release https://www.recormedical.com/recor-medical-and-otsuka-medical-devices-announce-first-fda-approved-renal-denervation-system-for-the-treatment-of-hypertension/

- Six-month Meta-analysis of RDN Studies https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.123.066941

- March This Week in Cardiology with RDN Discussion https://www.medscape.com/viewarticle/989014

II. Potential Deadly Decisions in the ED

Even One Night in the ED Raises Risk for Death

https://www.medscape.com/viewarticle/998080

- JAMA Internal Medicine Study

III. Tirzepatide Approval

FDA Approves Tirzepatide for Treating Obesity

https://www.medscape.com/viewarticle/998225

- SURMOUNT 2 https://doi.org/10.1016/S0140-6736(23)01200-X

- SURMOUNT 1 https://www.nejm.org/doi/full/10.1056/NEJMoa2206038

IV. AHA Preview

Mandrola's Top Trials to Look for at AHA 2023

https://www.medscape.com/viewarticle/998123

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Tricuspid regurgitation therapy, two more left atrial appendage trials, and reflections on being too soft on medical science are the topics John Mandrola, MD, discusses in this week?s podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. Tricuspid Regurgitation

Trilogy TAVR Safe, Effective in Aortic Regurgitation

https://www.medscape.com/viewarticle/997782

The TRILUMINATE Transcatheter Tricuspid Repair Trial: Positive but No Benefit?

https://www.medscape.com/viewarticle/989105

Transcatheter Tricuspid Valve Repair Effective, Safe for Regurgitation: TRILUMINATE

https://www.medscape.com/s/viewarticle/989103

- TRILUMINATE NEJM https://www.nejm.org/doi/full/10.1056/NEJMoa2300525

II. LAA Occlusion

Different Strengths for LAA Closure Devices?

https://www.medscape.com/viewarticle/962893

- Swiss Apero ? Original paper https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057859

- Swiss Apero ? One-year https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.067599

Peri-device Leaks After Watchman https://pubmed.ncbi.nlm.nih.gov/35902169/

TAVR With Left Atrial Appendage Occlusion Non-inferior to TAVR Plus Medical Therapy https://www.medscape.com/viewarticle/997725

- WATCH TAVR Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.067312

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More on the Million Hearts RCT, ENRICH AF, TAVI vs SAVR, the Partner 3 and Evolut-low-risk trials, and myocardial viability are the topics John Mandrola, MD, covers in this week?s podcast.

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https://www.medscape.com/twic

I. Listener Feedback

Million Hearts

CMS 'Million Hearts' CVD Risk Reduction Model Works

https://www.medscape.com/viewarticle/997551

-  RCT JAMA -    https://jamanetwork.com/journals/jama/fullarticle/2810696

AC in ICH - ENRICH AF

Oral Anticoagulation in ICH Patients With AF: New Data https://www.medscape.com/viewarticle/997547

-  Lancet Neurology Meta-analysis https://doi.org/10.1016/S1474-4422(23)00315-0

-  ENRICH AF letter https://doi.org/10.1016/S0140-6736(23)02025-1

II.  TAVI vs SAVR

Low-Risk TAVR Studies: Divergent Long-Term Results 

https://www.medscape.com/viewarticle/997784

-  Partner 3 Main Results

-  Partner 3 ? Five Year

-  Original EVOLUT -LR https://www.nejm.org/doi/10.1056/NEJMoa1816885

-  EVOLUT 3-year https://doi.org/10.1016/j.jacc.2023.02.017

-  EVOLUT -LR 4-year https://doi.org/10.1016/j.jacc.2023.09.813

III. Myocardial Viability

Viability-Guided PCI Doubted in Stable Severe CAD: REVIVED-BCIS2

https://www.medscape.com/viewarticle/989101

-  Revived BCIS ? Original paper  https://www.nejm.org/doi/10.1056/NEJMoa2206606

-  JAMA Cardiology Viability paper https://jamanetwork.com/journals/jamacardiology/fullarticle/2810727

-  STICH Viability Paper - https://www.nejm.org/doi/full/10.1056/NEJMoa1100358

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Listener feedback, oral anticoagulation in patients with ICH, an example of statistical significance but not clinical significance, and statins and diabetes are the topics John Mandrola, MD, discusses in this week?s podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

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I. Listener Feedback

October 13, 2023 This Week in Cardiology Podcast   https://www.medscape.com/viewarticle/997281

-  European Heart Journal: IVI for PCI   https://doi.org/10.1093/eurheartj/ehad430

-  Elgendy Meta-analysis of Imaging in PCI:   https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.116.003700

-  ULTIMATE:   https://www.jacc.org/doi/10.1016/j.jacc.2018.09.013

-  ILUMEIN IV: https://www.nejm.org/doi/full/10.1056/NEJMoa2305861

-  OCTOBER:  https://www.nejm.org/doi/full/10.1056/NEJMoa2307770

-  Main STEP-HFpEF paper

-  Letter to the Editor on Lack of Obesity Paradox  https://doi.org/10.1016/j.amjcard.2019.04.037

II. Anticoagulation in ICH

Oral Anticoagulation in ICH Patients With AF: New Data   https://www.medscape.com/viewarticle/997547

-   Lancet Neuro   Meta-analysis https://doi.org/10.1016/S1474-4422(23)00315-0

-   ENRICH AF letter   https://doi.org/10.1016/S0140-6736(23)02025-1

III. Million Hearts

CMS 'Million Hearts' CVD Risk Reduction Model Works   https://www.medscape.com/viewarticle/997551

-   RCT JAMA

IV. Statin Choice and Diabetes

April 7, 2023 This Week in Cardiology Podcast

https://www.medscape.com/viewarticle/990542

-   LODESTAR Main Study

-   LODESTAR Substudy

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Three stories regarding GLP-1 agonists, imaging during PCI, and the power of sham controls in procedure trials are the topics John Mandrola, MD, covers in this week?s podcast.

This podcast is intended for healthcare professionals only.

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https://www.medscape.com/twic

I. FLOW Trial Positive

Novo Nordisk Stops Ozempic Kidney Trial After Early Signs of Success https://www.medscape.com/s/viewarticle/997237

-  FLOW Trial ? press release https://www.novonordisk.com/content/nncorp/global/en/news-and-media/news-and-ir-materials/news-details.html?id=166327

II. STEP HFpEF

Semaglutide Win in HFpEF With Obesity Regardless of Ejection Fraction: STEP-HFpEF

https://www.medscape.com/viewarticle/997185

The GLP-1 Agonist Semaglutide in HFpEF Cleared a Low Bar

https://www.medscape.com/viewarticle/995872

-  STEP HFpEF substudy

-   STEP HFpEF main paper

III. GLP-1 Agonist Adverse Effects

GLP-1 Agonists Linked to Higher Risk for Rare but Serious GI Complications

https://www.medscape.com/viewarticle/997128

-  GI Adverse Effects of GLP-1 Agonists  https://jamanetwork.com/journals/jama/fullarticle/2810542

IV. Imaging in PCI

Intravascular Imaging in PCI: Time for a Guideline Update?

https://www.medscape.com/viewarticle/995677

-  Intravascular imaging during percutaneous coronary intervention: temporal trends and clinical outcomes in the USA https://academic.oup.com/eurheartj/article/44/38/3845/7226277

-  HEART Review of Studies of Intracoronary Imaging During PCI  https://heart.bmj.com/content/107/9/755

V. The Power of Placebo (Sham) control

Hopeful Insights, No Overall HFpEF Gains From Splanchnic Nerve Ablation: REBALANCE-HF

https://www.medscape.com/viewarticle/997318

-  Transvenous Right GSN Ablationin HFpEF https://doi.org/10.1016/j.jchf.2022.05.009

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Coated vs uncoated ASA, a new trial in CAD, conflicts of interest, first AF in the hospital, and changing HTN scoring and CHADSVASC are the topics John Mandrola, MD, covers in this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. ASA

No Benefit of Enteric-Coated Aspirin vs Uncoated in CVD https://www.medscape.com/viewarticle/997119

-  JAMA Cardiology: Coated vs Uncoated ASA https://jamanetwork.com/journals/jamacardiology/fullarticle/2809795

-  ADAPTABLE https://www.nejm.org/doi/10.1056/NEJMoa2102137

II. RECHARGE

-  Revascularization Choices Among Under-Represented Groups Evaluation (The RECHARGE Program) https://www.pcori.org/research-results/2023/revascularization-choices-among-under-represented-groups-evaluation-recharge-program

-  Gaudino/Stone: Reconsidering Coronary Revascularization Trials

III. Conflicts of Interest

-  Financial Conflicts of Interest in Public Comments on Medicare National Coverage Determinations of Medical Devices  https://jamanetwork.com/journals/jama/fullarticle/2808721

IV. First AF in the Hospital

Decoding AFib Recurrence: PCPs' Role in Personalized Care https://www.medscape.com/viewarticle/997011

-  Annals of Internal Medicine: AF Recurrence https://doi.org/10.7326/M23-1411

V. Changing CHADSVASC Score

-  JAMA Network Open: HTN Guidelines and CHADSVASC Up-Scoring  https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2809933

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Reader feedback, leadless pacing, ABIM, SGLT2 inhibitors, peri-operative MI after cardiac surgery, and. AHA late-breakers are the topics John Mandrola, MD, covers in this week?s podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. Reader Feedback

Sep 22, 2023 This Week in Cardiology Podcast

https://www.medscape.com/viewarticle/996694

-   ODYSSEY OUTCOMES trial https://www.nejm.org/doi/full/10.1056/nejmoa1801174

-   FOURIER https://www.nejm.org/doi/full/10.1056/nejmoa1615664

II. Leadless Pacing

-   Leadless vs Transvenous Pacemaker Study https://doi.org/10.1093/europace/euad269

III. ABIM News

Heart Societies Ready to Split From ABIM Over Long-Standing MOC Disputes

https://www.medscape.com/viewarticle/996747

IV. SGLT2 inhibitors

Empagliflozin Gets FDA Nod for CKD Without T2D or HF

https://www.medscape.com/viewarticle/996873

-   EMPA-Kidney https://www.nejm.org/doi/full/10.1056/NEJMoa2204233

V. Peri-Op MI after Cardiac Surgery

Cardiac Troponin Predicts Mortality Post Surgery

https://www.medscape.com/viewarticle/996877

-   Austrian Perioperative MI study https://doi.org/10.1016/j.jacc.2023.07.011

-   Vision  https://www.nejm.org/doi/10.1056/NEJMoa2000803

VI. AHA Late Breakers

-   Link to Late-Breakers https://professional.heart.org/en/meetings/scientific-sessions/programming/late-breaking-science#late-breaking

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Coronary calcium, cardiac arrest survival, Factor XI drug findings, APCs and a potential new board certification in cardiology are the topics discussed by John Mandrola, MD in this week?s podcast.

This podcast is intended for healthcare professionals only.

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I Coronary Artery Calcium

-   CONFIRM Registry - https://doi.org/10.1016/j.jcmg.2023.03.008

-   CURE -- https://www.nejm.org/doi/full/10.1056/nejmoa010746

II Cardiac Arrest

Cardiac Arrest Centers No Benefit in OHCA Without STEMI

https://www.medscape.com/viewarticle/995885

-   Cycling coverage https://velo.outsideonline.com/road/road-racing/nathan-van-hooydonck-forced-to-end-to-racing-career-due-to-heart-condition/

-   ARREST https://doi.org/10.1016/S0140-6736(23)01351-X

-   SCD in Athletes Bob Harrington and Manesh Patel https://www.medscape.com/viewarticle/995575

III Factor XI

Trial Halted for Bleeding Reduction With Abelacimab vs Rivaroxaban in AF

https://www.medscape.com/viewarticle/996587

-   Press Release - https://anthostherapeutics.com/wp-content/uploads/2023/09/2023-09-18-Anthos-Press-Release-final.pdf

-   Abelacimab, a Factor XI Inhibitor, Prevents VTE With Low Bleeding Risk in Knee Replacement

-   NEJM proof-of-concept https://www.nejm.org/doi/full/10.1056/NEJMoa2105872

-   OCEANIC-AF https://classic.clinicaltrials.gov/ct2/show/NCT05643573

-   Will Factor XI Be the Goldilocks Anticoagulant Target? https://www.medscape.com/viewarticle/979634

IV APC Care

NPs and PAs Handling Increasingly More Primary Care Visits: New Studies https://www.medscape.com/viewarticle/996709

BMJ paper -- https://www.bmj.com/content/382/bmj-2022-073933

V Possible Cardiology Board Certification Changes

-   Heart Societies Ready to Split From ABIM Over MOC Disputes https://www.medscape.com/viewarticle/996747

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Reader feedback, imaging in the cath lab, AF ablation to relieve anxiety, and some possible help in hypertension are the topics John Mandrola, MD, discusses in this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. Reader Feedback

Sep 08, 2023 This Week in Cardiology Podcast   https://www.medscape.com/viewarticle/996233

First Clinical Trial of CTO Procedures Fails to Deliver   https://www.medscape.com/viewarticle/877405

-   DanGerShock trial https://pubmed.ncbi.nlm.nih.gov/31176289/

II. Imaging in the Cath Lab

Should Intravascular Imaging Be Almost Routine in PCI?    https://www.medscape.com/viewarticle/996375

-   ILUMIEN IV    https://www.nejm.org/doi/full/10.1056/NEJMoa2305861

-   OCTOBER    https://www.nejm.org/doi/full/10.1056/NEJMoa2307770

III. AF Ablation to Relieve Anxiety

-   REMEDIAL Trial   https://jamanetwork.com/journals/jama/fullarticle/2809419

-   Sohaib and Francis; Meta analysis of Symptomatic Response Effect of CRT Pacing    https://pubmed.ncbi.nlm.nih.gov/24259043/

IV. HTN

'New Dawn' for Aldosterone as Drug Target in Hypertension?    https://www.medscape.com/viewarticle/996316

-   TARGET HTN -    https://jamanetwork.com/journals/jama/fullarticle/2809625

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ESC Recap Part 2: ECLS-SHOCK, FIRE, MULTISTARS-AMI, HEART FID, and DANPACE II are the trials John Mandrola, MD, discusses in this week?s podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:  https://www.medscape.com/twic

I. Cardiogenic Shock

ECMO for Shock in Acute MI Won't Help, May Harm: ECLS-SHOCK  https://www.medscape.com/viewarticle/995882

-   ECLS-SHOCK trial  https://www.nejm.org/doi/full/10.1056/NEJMoa2307227

-   ECMO-CS trial  https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.062949

II. FIRE TRIAL

FIRE a Win for Physiology-Guided MI Complete Revascularization in Older Patients  https://www.medscape.com/viewarticle/995875

-   FIRE Trial  https://www.nejm.org/doi/full/10.1056/NEJMoa2300468

-   COMPLETE Trial  https://www.nejm.org/doi/full/10.1056/NEJMoa1907775

III. Immediate vs Staged Revascularization

Parity for Prompt vs Staged STEMI Complete Revascularization: MULTISTARS-AMI  https://www.medscape.com/viewarticle/995961

-   MULTISTARS AMI trial  https://www.nejm.org/doi/full/10.1056/NEJMoa2307823

-   Complete Revascularization Now Compulsory? MULTISTARS-AMI and FIRE in Context  https://www.medscape.com/viewarticle/995676

IV. Iron-Supplementation in Heart Failure

IV Iron Shows Only Modest Benefit in HF: HEART-FID  https://www.medscape.com/viewarticle/995874

-   HEART-FID   https://www.nejm.org/doi/full/10.1056/NEJMoa2304968

-   EHJ meta-analysis of Iron Supplementation   https://doi.org/10.1093/eurheartj/ehad586

V. AF Prevention with Pacing

Minimizing Atrial Pacing No Benefit in Sinus Node Disease: DANPACE II  https://www.medscape.com/viewarticle/996076

-   DANPACE II  https://doi.org/10.1093/eurheartj/ehad564

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ESC Wrap-up 1: Obesity, heart failure with preserved EF and reduced EF, AF, frailty, evidence translation, and catheter ablation are the topics John Mandrola, MD, discusses in this week?s podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. FRAIL AF

   -FRAIL-AF Study

   https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.066485

   -The Most Important Study From ESC: FRAIL-AF

   https://www.medscape.com/viewarticle/996063

II. STEP-HFpEF

Wegovy Scores HFpEF Benefits in People With Obesity

https://www.medscape.com/viewarticle/995844

GLP-1 Agonist Semaglutide in HFpEF Cleared Low Bar

https://www.medscape.com/viewarticle/995872

Semaglutide?s Big Step in HFpEF With Obesity: Investigator Inteview

https://www.medscape.com/viewarticle/995673

   -Semaglutide in Obese Patients With  HFpEF

   https://www.nejm.org/doi/full/10.1056/NEJMoa2306963

III. NOAH AFNET 6

Anticoagulation No Benefit in Presumed AF Detected by Cardiac Devices

https://www.medscape.com/viewarticle/995861

How Much AF Warrants Anticoagulation? NOAH-AFNET 6 Provides Clues

https://www.medscape.com/viewarticle/995871

   -NOAH AFNET-6 ? NEJM

   https://www.nejm.org/doi/full/10.1056/NEJMoa2303062

IV. ADVENT

Pulsed Field Ablation Challenges Conventional Devices in AF

https://www.medscape.com/viewarticle/995884

Pulsed Field Ablation Noninferior but Underwhelming in ADVENT

https://www.medscape.com/viewarticle/995898

   -PPFA vs Thermal Ablation for PAF

   https://www.nejm.org/doi/10.1056/NEJMoa2307291

V. BUDAPEST CRT

Impact of RV Pacing in Heart Failure, CRT Benefit Shown in BUDAPEST-CRT

https://www.medscape.com/viewarticle/996035

Supporting Evidence for a Common Practice: BUDAPEST CRT

https://www.medscape.com/viewarticle/995880

   -BUDAPEST CRT Study: European Heart Journal

   https://doi.org/10.1093/eurheartj/ehad591

VI. CASTLE HTx

Advanced HF No Obstacle to AF Ablation Success: CASTLE-HTx

https://www.medscape.com/viewarticle/995897

AF Ablation in End-Stage HF: Is CASTLE-HTx Too Good to Be True?

https://www.medscape.com/viewarticle/995974

   -CASTLE AF (2018)

   https://www.nejm.org/doi/full/10.1056/nejmoa1707855

   -CASTLE HTx

   https://www.nejm.org/doi/full/10.1056/NEJMoa2306037

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GLP-1 agonists in HFpEF, DOACs for subclinical AF, renal denervation, and the matter of remaining in the profession are the topics John Mandrola, MD, discusses in this week?s podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. Obesity and HFpEF

GLP-1 Agonists in HFpEF With Obesity: Are We There Yet? https://www.medscape.com/viewarticle/993980

Wegovy Scores HFpEF Benefits in People With Obesity https://www.medscape.com/viewarticle/995844

- Semaglutide in Obese Patients With HFpEF https://www.nejm.org/doi/full/10.1056/NEJMoa2306963

- Rationale/Protocol Paper https://doi.org/10.1016/j.jchf.2023.05.010

II. DOAC for Subclinical AF

- NOAH-AFNET 6 Rationale/Protocol https://doi.org/10.1016/j.ahj.2017.04.015

- NOAH-AFNET 6 Trial Results https://www.nejm.org/search?q=NOAH+AFNET

III. Renal Denervation

ReCor Renal Denervation System Safe, Effective: FDA Panel https://www.medscape.com/viewarticle/995741

FDA Panel Split on Efficacy of Spyral Renal Denervation https://www.medscape.com/viewarticle/995800

SPYRAL HTN-ON MED https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00455-X/fulltext

IV. Maintenance of Certification

As MOC Debate Heats Up, Cardiology Societies Weigh In https://www.medscape.com/viewarticle/moc-debate-heated-cardiology-societies-weigh-2023a1000jju

Features

Mandrola's 5 Things to Look for at the Upcoming ESC 2023

https://www.medscape.com/viewarticle/995614

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ICD generator change, less is more in VT management, co-morbidity in HF, and SGLT2i after AF ablation are the topics discussed by John Mandrola, MD, in this week?s podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. ICD Gen Change

- Patients? Perspectives Regarding Generator Exchanges of Implantable Cardioverter Defibrillators https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.122.009827

- DEFINITE https://www.nejm.org/doi/10.1056/nejmoa033088

- SCD-HeFT https://www.nejm.org/doi/full/10.1056/nejmoa043399

- DANISH https://www.nejm.org/doi/10.1056/NEJMoa1608029

- Poole and colleagues; 11-year follow-up of  SCD-HeFT https://doi.org/10.1016/j.jacc.2020.05.061

- Editorial ? Howell/Stecker https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.123.010266

II. VT Therapy

Crossed Wires: Ischemia Testing and Monomorphic VT Storm

https://www.medscape.com/viewarticle/995401

- Cleveland Clinic Study

  https://doi.org/10.1016/j.jacep.2023.04.030

III. Co-Morbidity in HF

- Hospital admissions in the last year of life of patients with heart failure

  https://doi.org/10.1093/ehjqcco/qcad047

- Four Horsemen of Apocalypse Lecture

  http://www.louisvillelectures.org/imblog/2017/10/5/whw8sf0m1k0wi6lm6kvjsx4nxzzjg5

IV. SGLT2i After Ablation for AF

SGLT2 Inhibitors Curb AF Post-Ablation Recurrences in Diabetes

  https://www.medscape.com/viewarticle/995415

- Observational Study ? Abu-Qaoud et al

  https://www.jacc.org/doi/full/10.1016/j.jacep.2023.06.008

- Meta-analysis SGLT2i and AF

  https://www.ahajournals.org/doi/full/10.1161/JAHA.121.022222

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Observational studies, another defense of digoxin, CTO-PCI, BP measurement, and a possible revolution in cardiovascular protection are the topics John Mandrola, MD, discusses in this week?s podcast.

This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. Observational Research

Yeh; Credibility in Observational  Research https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.064645

Hernan; Causal Language in Observational Research  https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2018.304337

Wang; RCT Duplicate Initiative https://jamanetwork.com/journals/jama/fullarticle/2804067

II. Defense of Digoxin

Brophy; Beta Blockers, Digoxin, or Both https://doi.org/10.1016/j.cjca.2023.06.009

Dorian editorial https://doi.org/10.1016/j.cjca.2023.07.013

Ziff Digoxin Meta-analysis https://www.bmj.com/content/351/bmj.h4451.long

DIG trial  https://www.nejm.org/doi/full/10.1056/nejm199702203360801

Davila Analysis of DIG Trial https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6801940/

Kotecha Meta-analysis of Beta Blockers https://pubmed.ncbi.nlm.nih.gov/25193873/

RATE-AF https://jamanetwork.com/journals/jama/fullarticle/2774407

III. CTO-PCI

PCI of Chronic Total Occlusions Improves Angina, Quality of Life in Trials https://www.medscape.com/viewarticle/994739

JAMA Network Open Meta-analysis

IV. BP Measurement

One Size Doesn?t Fit All in Blood Pressure Measurement https://www.medscape.com/viewarticle/995216

Ishigami Blood Pressure Measurement Comparison

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2807853

V. GLP-1 SELECT Trial

Semaglutide Cuts Cardiovascular Events in Landmark Trial

https://www.medscape.com/viewarticle/995270

SELECT Protocol Paper

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Listener feedback re observational studies, surgeons? dissent from recent guidelines, aspirin for primary prevention, and fish oil are the topics discussed by John Mandrola.MD in this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. Heart Surgeons Dissent

Surgical Groups Push Back Against New Revascularization Guidelines

https://www.medscape.com/viewarticle/966153

New Revascularization Guidelines: Key Points and Navigating Controversies

https://www.medscape.com/viewarticle/972014

- AHA Guidelines - https://doi.org/10.1161/CIR.0000000000001168

- AATS statement 2023 https://doi.org/10.1016/j.jtcvs.2023.03.001

- Yusef and colleagues 1994 Meta-analysis - https://doi.org/10.1016/S0140-6736(94)91963-1

- 10-year SYNTAXES https://doi.org/10.1016/S0140-6736(19)31997-X

- Surgeons? argument 2021 https://doi.org/10.1016/j.athoracsur.2021.12.003

- FAME 3 https://www.nejm.org/doi/full/10.1056/NEJMoa2112299

- Gaudino Meta-analysis of Medical Therapy vs CABG https://doi.org/10.1016/j.jtcvs.2022.06.003

- NOBLE https://doi.org/10.1016/S0140-6736(19)32972-1

- EXCEL 5 years https://www.nejm.org/doi/full/10.1056/nejmoa1909406

II. ASA for Primary Prevention

Daily Aspirin Challenged in Primary Stroke Prevention: ASPREE

https://www.medscape.com/viewarticle/994963

- ASPREE ? All-cause mortality

- ASPREE (MACE and Bleeding) https://www.nejm.org/doi/full/10.1056/NEJMoa1805819

- ASPREE (disability) https://www.nejm.org/doi/full/10.1056/NEJMoa1800722

- JAMA Network Open Subanalysis  https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2807630

III. Fish Oil

- OMEMI Substudy https://doi.org/10.1016/j.clnu.2023.07.002

- Gencer and colleagues Meta-analysis - https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.055654

- OMEMI Main Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.052209

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Antiarrhythmic drugs in patients with CAD, observational studies, GLP-1 agonists, and the subcutaneous ICD are the topics John Mandrola, MD, discusses in this week?s podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. AAD in Patients with CAD

- The Feasibility and Safety of Flecainide Use Among Patients With Varying Degrees of Coronary Disease

https://doi.org/10.1016/j.jacep.2022.12.021

- Three Questions for Evidence-Based Cardiac Electrophysiology

https://www.ahajournals.org/doi/full/10.1161/circoutcomes.110.957381

- The Cardiac Arrhythmia Suppression Trial (CAST) https://www.nejm.org/doi/full/10.1056/nejm198908103210608

II. GLP-1 Agonists

Tirzepatide Powers Weight Loss in Two More Pivotal Trials https://www.medscape.com/viewarticle/994889

Semaglutide Use Surges in US Adults With Type 2 Diabetes https://www.medscape.com/viewarticle/994873

- Tirzepatide Once Weekly for the Treatment of Obesity

https://www.nejm.org/doi/full/10.1056/NEJMoa2206038

- Tirzepatide once weekly for the treatment of obesity in people with type 2 diabetes (SURMOUNT-2): a double-blind, randomised, multicentre, placebo-controlled, phase 3 trial

https://doi.org/10.1016/S0140-6736(23)01200-X

III. S-ICD

S-ICD Shows Virtues, Limits in 'Real World' Postmarket Study https://www.medscape.com/viewarticle/994851

- Postapproval Study of a Subcutaneous Implantable Cardioverter-Defibrillator System https://doi.org/10.1016/j.jacc.2023.05.034

- Subcutaneous or Transvenous Defibrillator Therapy https://www.nejm.org/doi/full/10.1056/NEJMoa1915932

- Letter to the Editor  https://www.nejm.org/doi/full/10.1056/NEJMc2034917

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Listener feedback, conduction system pacing, eating fish vs fish pills, exercise, and an RCT for diet are the topics discussed by John Mandrola,.MD, in this week?s podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. Listener Feedback Monitor HF and AHA

Jun 02, 2023 This Week in Cardiology Podcast

https://www.medscape.com/viewarticle/992678

- Link to the ACC Email -- https://www.acc.org/Latest-in-Cardiology/Clinical-Trials/2023/07/18/17/21/monitor-hf

- Tweet From Anthony Pearson

https://twitter.com/skepcard/status/1681288604990189574

II. Conduction System Pacing

- Clinical Outcomes in Conduction System Pacing Compared to Right Ventricular Pacing in Bradycardia https://doi.org/10.1016/j.jacep.2022.10.016

- Hormone Therapy To Prevent Disease and Prolong Life in Postmenopausal Women https://www.acpjournals.org/doi/abs/10.7326/0003-4819-117-12-1016

III. Fish Oil

Omega-3s and AF: No Added Risk From Eating Fish but High-Dose Supplement Questions Persist https://www.medscape.com/viewarticle/994559

- Omega-3 Fatty Acid Biomarkers and Incident Atrial Fibrillation

https://www.jacc.org/doi/full/10.1016/j.jacc.2023.05.024

- Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia https://www.nejm.org/doi/full/10.1056/nejmoa1812792

- Effect of Long-Term Marine ?-3 Fatty Acids Supplementation on the Risk of Atrial Fibrillation in Randomized Controlled Trials of Cardiovascular Outcomes: A Systematic Review and Meta-Analysis https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.055654

IV. Exercise

Even Exercise by 'Weekend Warriors' Can Cut CV Risk

https://www.medscape.com/viewarticle/994617

- Accelerometer-Derived ?Weekend Warrior? Physical Activity and Incident Cardiovascular Disease https://jamanetwork.com/journals/jama/article-abstract/2807286

V. Diet

Cognitive Benefit of Highly Touted MIND Diet Questioned

https://www.medscape.com/viewarticle/994550

- Trial of the MIND Diet for Prevention of Cognitive Decline in Older Persons

https://www.nejm.org/doi/full/10.1056/NEJMoa2302368

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https://www.medscape.com/author/bob-harrington

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Carotid stents, the paclitaxel story now closed, inclisiran, DOAC failures, and primary vs secondary prevention are the topics John Mandrola, MD, covers in this week?s podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. Carotid Stenting CMS Proposal

Expanded Coverage of Carotid Stenting in CMS Draft Proposal

https://www.medscape.com/viewarticle/994315

No Added Benefit From Revascularization in Low-Risk CAS

https://www.medscape.com/viewarticle/992524

- Percutaneous Transluminal Angioplasty (PTA) of the Carotid Artery Concurrent with Stenting https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=Y&NCAId=311

- Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy

https://doi.org/10.1016/S0140-6736(21)01910-3

- SPACE-2 https://journals.sagepub.com/doi/10.1177/1747493019833017

- Rationale, Design, and Implementation of Intensive Risk Factor Treatment in the CREST2 Trial 10.1161/STROKEAHA.120.030730

II. Paclitaxel

FDA: No Excess Mortality Risk From Paclitaxel Stents, Balloons for Peripheral Intervention https://www.medscape.com/viewarticle/994253

- FDA Statement https://www.fda.gov/medical-devices/letters-health-care-providers/update-paclitaxel-coated-devices-treat-peripheral-arterial-disease-unlikely-increase-risk-mortality?utm_medium=email&utm_source=govdelivery#_FDA_Actions

III. Inclisiran

FDA Expands Inclisiran Statin-Adjunct Indication to Include Primary Prevention https://www.medscape.com/viewarticle/994185

- ORION 10-11 Two Phase 3 Trials of Inclisiran in Patients with Elevated LDL Cholesterol https://www.nejm.org/doi/10.1056/NEJMoa1912387

- Effect of inclisiran on lipids in primary prevention: the ORION-11 trial

https://doi.org/10.1093/eurheartj/ehac615

- Inclisiran and cardiovascular events: a patient-level analysis of phase III trials https://pubmed.ncbi.nlm.nih.gov/36331326/

IV. DOAC Failure

Association of Alternative Anticoagulation Strategies and Outcomes in Patients With Ischemic Stroke While Taking a Direct Oral Anticoagulant

https://doi.org/10.1212/WNL.0000000000207422

V. Primary or Secondary Prevention

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European HTN Guidelines, vitamin D, bempedoic acid, and leadless pacing, with some critical appraisal techniques thrown in, are the topics John Mandrola, MD, tackles in this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. European Hypertension Guidelines

New ESH Hypertension Guidelines Aim for Simplified Message

https://www.medscape.com/viewarticle/993913

- 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH)

https://pubmed.ncbi.nlm.nih.gov/37345492/

II. Vitamin D

CV Benefit From Vitamin-D Caps Hinted in Huge D-Health Trial

https://www.medscape.com/viewarticle/993996

- Vitamin D supplementation and major cardiovascular events: D-Health randomised controlled trial

https://www.bmj.com/content/381/bmj-2023-075230

- Vitamin D Supplementation and Cardiovascular Disease Risks in More Than 83?000 Individuals in 21 Randomized Clinical Trials

https://jamanetwork.com/journals/jamacardiology/fullarticle/2735646

III. Bempedoic Acid

'Striking' Benefit of Lipid Lowering in Primary Prevention

https://www.medscape.com/viewarticle/993666

- Bempedoic Acid for Primary Prevention of Cardiovascular Events in Statin-Intolerant Patients

https://jamanetwork.com/journals/jama/fullarticle/2806646

- Bempedoic Acid for High-Risk Primary Prevention of Cardiovascular Disease

https://jamanetwork.com/journals/jama/fullarticle/2806647

- Bempedoic Acid and Cardiovascular Outcomes in Statin-Intolerant Patients

https://www.nejm.org/doi/full/10.1056/NEJMoa2215024

IV. Leadless Pacing

FDA Approves First Leadless Dual-Chamber Pacing System

https://www.medscape.com/viewarticle/994033

- A Dual-Chamber Leadless Pacemaker

https://www.nejm.org/doi/full/10.1056/NEJMoa2300080

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Starting HF meds during hospitalization for HF, Impella, testosterone, and colchicine are the topics John Mandrola, MD, discusses in this week?s podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. Starting HF Meds During Hospitalization for HF

Starting Indicated Heart Failure Meds In-Hospital: Progress, Opportunities https://www.medscape.com/viewarticle/993539

- Opportunities and Achievement of Medication Initiation Among Inpatients With Heart Failure With Reduced Ejection Fraction https://www.jacc.org/doi/full/10.1016/j.jchf.2023.04.015

II. Impella

- Comparative Effectiveness of Percutaneous Microaxial Left Ventricular Assist Device vs Intra-Aortic Balloon Pump or No Mechanical Circulatory Support in Patients With Cardiogenic Shock

https://jamanetwork.com/journals/jamacardiology/fullarticle/2806562

- Evidence Generation for Novel Cardiovascular Devices?Putting the Horse Back in Front of the Cart

https://jamanetwork.com/journals/jamacardiology/fullarticle/2806565

III. Testosterone

Big Trial Reassures on Heart Safety of Testosterone in Men

https://www.medscape.com/viewarticle/993322

- Cardiovascular Safety of Testosterone-Replacement Therapy

https://www.nejm.org/doi/full/10.1056/NEJMoa2215025

IV. Colchicine for CV Disease

Low-Dose Colchicine Approved for CVD: Now What?

https://www.medscape.com/viewarticle/993578

- Efficacy and Safety of Low-Dose Colchicine after Myocardial Infarction

https://www.nejm.org/doi/full/10.1056/nejmoa1912388

- Colchicine in Patients with Chronic Coronary Disease

https://www.nejm.org/doi/full/10.1056/nejmoa2021372

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AF screening, BNP, a new SGLT2 inhibitor, a sky-is-blue study, and the UK Mini Mitral surgical trial are discussed in this week's podcast

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I AF Screening

- Effects of Atrial Fibrillation Screening According to N-Terminal Pro-B-Type Natriuretic Peptide: A Secondary Analysis of the Randomized LOOP Study https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.064361

- Implantable loop recorder detection of atrial fibrillation to prevent stroke (The LOOP Study): a randomised controlled trial https://doi.org/10.1016/S0140-6736(21)01698-6

- Natural History of Subclinical Atrial Fibrillation Detected by Implanted Loop Recorders https://www.jacc.org/doi/full/10.1016/j.jacc.2019.09.050

- Prevalence and Prognostic Significance of Bradyarrhythmias in Patients Screened for Atrial Fibrillation vs Usual Care https://jamanetwork.com/journals/jamacardiology/fullarticle/2801362

- Stepwise mass screening for atrial fibrillation using N-terminal pro b-type natriuretic peptide: the STROKESTOP II study design https://doi.org/10.1093/europace/euw319

- Current misconception 3: that subgroup-specific trial mortality results often provide a good basis for individualising patient care https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068511/

II Frailty and GDMT of HFrEF

Frailty Linked to Lower Use of Guideline Treatments in HFrEF

https://www.medscape.com/viewarticle/993218

- Physical Frailty and Use of Guideline?Recommended Drugs in Patients With Heart Failure and Reduced Ejection Fraction https://www.ahajournals.org/doi/10.1161/JAHA.122.026844

III Sotagliflozin

FDA Approves New Drug, Sotagliflozin, for Heart Failure

https://www.medscape.com/viewarticle/992518

- Sotagliflozin in Patients with Diabetes and Chronic Kidney Disease

https://www.nejm.org/doi/full/10.1056/NEJMoa2030186

- Sotagliflozin in Patients with Diabetes and Recent Worsening Heart Failure

https://www.nejm.org/doi/full/10.1056/NEJMoa2030183

IV Mini-Mitral

Support for Minimally Invasive Mitral Valve Repair: Mini Mitral Published

https://www.medscape.com/viewarticle/993191

- Minithoracotomy vs Conventional Sternotomy for Mitral Valve Repair

https://jamanetwork.com/journals/jama/article-abstract/2805908

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Impella, digital health, low-value processes, are tricuspid valve interventions with pacing leads are the topics Dr. John Mandrola, MD, discusses in this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. Impella Class I Recall

FDA Class I Recall for Some Abiomed Impella Heart Pumps

https://www.medscape.com/viewarticle/992845

- A Prospective, Randomized Clinical Trial of Hemodynamic Support With Impella 2.5 Versus Intra-Aortic Balloon Pump in Patients Undergoing High-Risk Percutaneous Coronary Intervention

https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.112.098194

- Percutaneous Mechanical Circulatory Support Versus Intra-Aortic Balloon Pump in Cardiogenic Shock After Acute Myocardial Infarction

https://doi.org/10.1016/j.jacc.2016.10.022

https://www.sciencedirect.com/science/article/pii/S0735109716367675?via%3Dihub

- The Evolving Landscape of Impella Use in the United States Among Patients Undergoing Percutaneous Coronary Intervention With Mechanical Circulatory Support

https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.119.044007

- Association of Use of an Intravascular Microaxial Left Ventricular Assist Device vs Intra-aortic Balloon Pump With In-Hospital Mortality and Major Bleeding Among Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock

https://jamanetwork.com/journals/jama/fullarticle/2761003

- Danish Cardiogenic Shock Trial (DanShock)

https://clinicaltrials.gov/ct2/show/NCT01633502

II. Wearable Devices

- Use of Wearable Devices in Individuals With or at Risk for Cardiovascular Disease in the US, 2019 to 2020 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2805753 doi:10.1001/jamanetworkopen.2023.16634

- Implantable loop recorder detection of atrial fibrillation to prevent stroke (The LOOP Study): a randomised controlled trial

https://doi.org/10.1016/S0140-6736(21)01698-6

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01698-6/fulltext

- Prevalence and Prognostic Significance of Bradyarrhythmias in Patients Screened for Atrial Fibrillation vs Usual Care

https://jamanetwork.com/journals/jamacardiology/fullarticle/2801362

III. The Cost of Quality Measures

- The Volume and Cost of Quality Metric Reporting

https://jamanetwork.com/journals/jama/fullarticle/2805705

- Goodhart's law

https://en.wikipedia.org/wiki/Goodhart%27s_law

IV. Tricuspid Valve Interventions and Pacing Leads

Leadless Dual-Chamber Pacemaker Clears Early Safety, Performance Hurdles

https://www.medscape.com/viewarticle/992464

- Transcatheter Tricuspid Valve Replacement With the EVOQUE System: 1-Year Outcomes of a Multicenter, First-in-Human Experience

https://www.jacc.org/doi/10.1016/j.jcin.2022.01.280

- Effects of Implantable Cardioverter-Defibrillator Leads on the Tricuspid Valve and Right Ventricle: A Randomized Comparison of Transvenous versus Subcutaneous Leads

https://eppro01.ativ.me/src/EventPilot/php/express/web/planner.php?id=HRS23&utm_source=heartrhythm&utm_medium=nav-button&utm_campaign=hr23-webtracking

- Management and Outcomes of Transvenous Pacing Leads in Patients Undergoing Transcatheter Tricuspid Valve Replacement

https://www.jacc.org/doi/10.1016/j.jcin.2020.04.054

- TRILUMINATE trial -- Transcatheter Repair for Patients with Tricuspid Regurgitation

https://www.nejm.org/doi/full/10.1056/NEJMoa2300525

https://www.nejm.org/doi/full/10.1056/NEJMoa2300525

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https://www.medscape.com/author/bob-harrington

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Listener feedback on the most important study in a decade, MONITOR-HF, a flawed paper and analysis, and the tension between pathos and logos are the topics John Mandrola, MD discusses in this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. Listener Feedback

Earlier Anticoagulation Safe in Stroke With AF: ELAN

https://www.medscape.com/viewarticle/992411

- Early versus Later Anticoagulation for Stroke with Atrial Fibrillation

https://www.nejm.org/doi/full/10.1056/NEJMoa2303048

- Fibrinolysis or Primary PCI in ST-Segment Elevation Myocardial Infarction

https://www.nejm.org/doi/full/10.1056/nejmoa1301092

II. Monitor HF

CardioMEMS Boosts QoL, Curbs HF Hospitalizations: MONITOR-HF

https://www.medscape.com/viewarticle/992333

- Remote haemodynamic monitoring of pulmonary artery pressures in patients with chronic heart failure (MONITOR-HF): a randomised clinical trial

https://doi.org/10.1016/S0140-6736(23)00923-6

- Remote pulmonary artery pressure monitoring in heart failure care: part of the new normal?

https://doi.org/10.1016/S0140-6736(23)01010-3

- Sowell?s A Conflict of Visions

https://en.wikipedia.org/wiki/A_Conflict_of_Visions

III. Intensive BP Treatment in Older Patients ? Pathos vs Logos

- Clinical Outcomes of Intensive Inpatient Blood Pressure Management in Hospitalized Older

Adultshttps://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2805021

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An HRS meeting recap, Impella failure, sacubitril/valsartan, the purpose of trials, and a major breakthrough in evidence generation are the topics discussed by John Mandrola, MD in this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit: https://www.medscape.com/twic

I. HRS Meeting Recap

II. Impella in VT ablation

- First-in-human Experience with Impella 5.0/5.5 for High-Risk Patients with Advanced Heart Failure Undergoing VT Ablationhttps://www.jacc.org/doi/10.1016/j.jacc.2023.05.012

III. Sacubitril/Valsartan

ARNI Bests ARB to Reduce NT-proBNP in Stabilized Preserved-EF HF

https://www.medscape.com/viewarticle/992461

- Angiotensin-Neprilysin Inhibition in Patients With Mildly Reduced or Preserved Ejection Fraction and Worsening Heart Failure

https://www.jacc.org/doi/10.1016/j.jacc.2023.04.019

- Angiotensin?Neprilysin Inhibition in Heart Failure with Preserved Ejection Fraction

https://www.nejm.org/doi/full/10.1056/nejmoa1908655

- Sacubitril/valsartan in heart failure with mildly reduced or preserved ejection fraction: a pre-specified participant-level pooled analysis of PARAGLIDE-HF and PARAGON-HF

https://doi.org/10.1093/eurheartj/ehad344

- Bogdan Tweet

https://twitter.com/bogdienache/status/1660356776204595201?s=20

IV. Big Change in Reporting of Medical Evidence ? Elan Trial

- Early versus Later Anticoagulation for Stroke with Atrial Fibrillationhttps://www.nejm.org/doi/full/10.1056/NEJMoa2303048

- Early versus Late initiation of direct oral Anticoagulants in post-ischaemic stroke patients with atrial fibrillatioN (ELAN): Protocol for an international, multicentre, randomised-controlled, two-arm, open, assessor-blinded trial https://doi.org/10.1177/23969873221106043

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When to use an ICD, risk stratification for HCM, blending EP and structural cardiology to improve care in post-TAVI patients, and hsTroponins are the topics John Mandrola, MD, discusses in this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. ICD in Patients with NICM

Simple Risk Score Predicts VT in Nonischemic Cardiomyopathy

https://www.medscape.com/viewarticle/992018

- Declining Risk of Sudden Death in Heart Failure    https://www.nejm.org/doi/full/10.1056/NEJMoa1609758

- Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure    https://www.nejm.org/doi/full/10.1056/NEJMoa1608029

- Reduction in mortality from implantable cardioverter-defibrillators in non-ischaemic cardiomyopathy patients is dependent on the presence of left ventricular scar https://doi.org/10.1093/eurheartj/ehy437

- RCT of Implantable Defibrillators in Patients With Non Ischemic Cardiomyopathy, Scar and Severe Systolic Heart Failure (BRITISH)   https://clinicaltrials.gov/ct2/show/NCT05568069

II. Risk Stratification in HCM

- Changing Risk Stratification in Hypertrophic Cardiomyopathy? https://www.medscape.com/viewarticle/992014

- NOAH?AFNET 6 trial terminates ahead of time (NOAH AFNET 6 trial)   https://dzhk.de/en/news/latest-news/article/noah-afnet-6-trial-terminates-ahead-of-time-noah-afnet-6-trial/

III. Blending EP and Structural to Improve TAVI Care

- Impact of Right Ventricular Pacing in Patients With TAVR Undergoing Permanent Pacemaker Implantation   https://www.jacc.org/doi/full/10.1016/j.jcin.2023.02.003

IV. Troponins

- Age-Specific Cut-Offs Needed for Cardiac Troponin Tests? https://www.medscape.com/viewarticle/992167

- Myocardial Injury Thresholds for 4 High-Sensitivity Troponin Assays in U.S. Adults https://www.jacc.org/doi/full/10.1016/j.jacc.2023.03.403

- What Is a Normal Troponin Anyway? https://www.jacc.org/doi/10.1016/j.jacc.2023.03.404

- Updating Our Thinking on Troponin Use and Interpretation    https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2777967

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Two new papers on left atrial appendage occlusion, the promise of DNA, statins in the elderly, and SGLT2 inhibitors are the topics John Mandrola, MD, discusses in this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. Listener Feedback

- When to Start a Statin Is a Preference-Sensitive Decision

https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.117.029808

II. Left Atrial Appendage Closure

LAA Closure Outcomes Improve With CCTA: Swiss-Apero Subanalysis

https://www.medscape.com/viewarticle/991623

- Impact of Preprocedural Computed Tomography on Left Atrial Appendage Closure Success: A Swiss-Apero Trial Subanalysis https://doi.org/10.1016/j.jcin.2023.02.027

- Outcomes of percutaneous left atrial appendage occlusion device implantation in atrial fibrillation patients based on underlying stroke risk https://doi.org/10.1093/europace/euad049

III. Polygenic Risk Scores

- Predictive Accuracy of a Polygenic Risk Score Compared With a Clinical Risk Score for Incident Coronary Heart Disease https://jamanetwork.com/journals/jama/fullarticle/2761086

- Cardiovascular Disease Risk Assessment Using Traditional Risk Factors and Polygenic Risk Scores in the Million Veteran Program https://jamanetwork.com/journals/jamacardiology/article-abstract/2804439

- Validity of polygenic risk scores: are we measuring what we think we are? https://doi.org/10.1093/hmg/ddz205

IV. Statins in Older Patients

High Cholesterol in Seniors: Use Statins for Primary Prevention?

https://www.medscape.com/viewarticle/991801

V. SGLT2 Inhibitors

FDA Expands Use of Dapagliflozin to Broader Range of HF

https://www.medscape.com/viewarticle/991736

- Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction

https://www.nejm.org/doi/full/10.1056/NEJMoa2206286

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https://www.medscape.com/author/bob-harrington

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Beta-blockers post MI, public perception of statins, trust in the medical profession, BMI, and TAVI are the topics John Mandrola, MD, covers in this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit: https://www.medscape.com/twic

I. Post-MI Beta Blockers

Long-term Beta-Blockers Not Needed After MI with Preserved Systolic Function? https://www.medscape.com/viewarticle/991542

- Association of beta-blockers beyond 1 year after myocardial infarction and cardiovascular outcomes https://heart.bmj.com/content/early/2023/04/16/heartjnl-2022-322115

- Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure

https://www.nejm.org/doi/full/10.1056/nejmoa1608029

II. Statin Perceptions

Statin Misinformation on Social Media Flagged by AI

https://www.medscape.com/viewarticle/991585

- Artificial Intelligence?Enabled Analysis of Statin-Related Topics and Sentiments on Social Media

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2803988

III. BMI

BMI Is a Flawed Measure of Obesity. What Are Alternatives?

https://www.medscape.com/viewarticle/991210

IV. TAVI Access

Better Access to Transcatheter Aortic Valve Replacement Associated With Improved Outcomes

https://www.medscape.com/viewarticle/991573

- Regional Differences in Outcomes for Patients Undergoing Transcatheter Aortic Valve Replacement in New York State and Ontario https://doi.org/10.1016/j.cjca.2023.01.025

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https://www.medscape.com/author/bob-harrington

Questions or feedback, please contact: [email protected]

Two studies of cardiac device infections, observational studies, RCTs, and our ways of knowing in Medicine are the topics discussed by John Mandrola, MD in this week?s podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit: https://www.medscape.com/twic

I. Cardiac Device Infection

Mortality Climbs When CIED Infections Are 'Delayed' After Implant

https://www.medscape.com/viewarticle/990692

- Association of the Timing and Extent of Cardiac Implantable Electronic Device Infections With Mortality

https://jamanetwork.com/journals/jamacardiology/fullarticle/2803627

- Low Utilization of Lead Extraction Among Patients With Infective Endocarditis and Implanted Cardiac Electronic Devices https://www.jacc.org/doi/full/10.1016/j.jacc.2023.02.042

- Cardiac Implantable Electronic Devices and Infective Endocarditis: A Call to Arms...? https://www.jacc.org/doi/full/10.1016/j.jacc.2023.02.043

II. Can RCTs be Emulated with Real World Evidence?

- Emulation of Randomized Clinical Trials With Nonrandomized Database Analyses https://jamanetwork.com/journals/jama/fullarticle/2804067

- Randomized Trials vs Real-world Evidence https://jamanetwork.com/journals/jama/fullarticle/2804092

- Reanalyses of Randomized Clinical Trial Data

https://jamanetwork.com/journals/jama/fullarticle/1902230

III. Multi-Morbidity Effects in Trials

Pivotal CV Trials May Not Apply to Complex Patients

https://www.medscape.com/viewarticle/989129

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John Mandrola, MD discusses early vs delayed AF ablation, a report on a devastating complication of AF ablation, and a potential crosswind for a major therapeutic fashion in electrophysiology.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit: https://www.medscape.com/twic

I Early Vs Delayed Ablation

- Impact of Early Versus Delayed Atrial Fibrillation Catheter Ablation on Atrial Arrhythmia Recurrences

https://doi.org/10.1093/eurheartj/ehad247

- Diagnosis-to-Ablation Time and Recurrence of Atrial Fibrillation Following Catheter Ablation

https://www.ahajournals.org/doi/full/10.1161/CIRCEP.119.008128

- Cryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation

https://www.nejm.org/doi/full/10.1056/nejmoa2029980

- Progression of Atrial Fibrillation after Cryoablation or Drug Therapy

https://www.nejm.org/doi/full/10.1056/NEJMoa2212540

II Atrial-Esophageal Fistula

CT and Surgery Best Diagnose and Manage Esophageal Fistula

https://www.medscape.com/viewarticle/990933

- A worldwide survey on incidence, management and prognosis of oesophageal fistula formation following atrial fibrillation catheter ablation: The POTTER-AF study https://doi.org/10.1093/eurheartj/ehad250

- Oesophageal Probe Evaluation in Radiofrequency Ablation of Atrial Fibrillation (OPERA): results from a prospective randomized trial https://doi.org/10.1093/europace/euaa209

- Temperature monitoring and temperature-driven irrigated radiofrequency energy titration do not prevent thermally induced esophageal lesions in pulmonary vein isolation: A randomized study controlled by esophagoscopy before and after catheter ablation https://doi.org/10.1016/j.hrthm.2021.02.003

III High-Power Short-Duration Ablation

Short, High-Power Ablation on Par With Standard AF Ablation

https://www.medscape.com/viewarticle/972087

- Power-Fast Trial

https://clinicaltrials.gov/ct2/show/NCT04153747

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SCAI consensus document on LAAC, semaglutide/tirzepatide disruption, NSAIDs, and interventional echocardiography are the topics discussed by John Mandrola, MD, on this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. SCAI Consensus Document

New Update on Left Atrial Appendage Closure Recommendations

https://www.medscape.com/viewarticle/990507

- SCAI/HRS Expert Consensus Statement on Transcatheter Left Atrial Appendage Closure

https://doi.org/10.1016/j.jscai.2022.100577

- Transcatheter Left Atrial Appendage Closure Comes of Age

https://doi.org/10.1016/j.jscai.2023.100592

- EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion ? an update https://doi.org/10.1093/europace/euz258

II. Semaglutide and Tirzepatide Disruption

Tirzepatide Powers 'Unprecedented' Weight Loss in Obesity Trial

https://www.medscape.com/viewarticle/975061

- Obesity Management in Primary Care

https://reference.medscape.com/recap/982874

- The $76 Billion Diet Industry Asks: What to Do About Ozempic?

https://www.wsj.com/amp/articles/ozempic-wegovy-mounjaro-weight-loss-industry-89419ecb

III. NSAIDs and HF

NSAID Use in Diabetes May Worsen Risk for First HF Hospitalization

https://www.medscape.com/viewarticle/990642

- Heart Failure Following Anti-Inflammatory Medications in Patients With Type 2 Diabetes Mellitus

https://doi.org/10.1016/j.jacc.2023.02.027

IV. Interventional Echocardiography

New ASE Guideline on Interventional Echocardiography Training

https://www.medscape.com/viewarticle/990520

- Recommendations for Special Competency in Echocardiographic Guidance of Structural Heart Disease Interventions: From the American Society of Echocardiography

https://doi.org/10.1016/j.echo.2023.01.014

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Chat GPT, a relatively unknown therapy for HFpEF, and two fun studies on statins and secondary prevention are the topics John Mandrola, MD, discusses in this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit: https://www.medscape.com/twic

I. Artificial Intelligence and CHAT GPT

Can ChatGPT Replace Diabetes Educators? Perhaps Not Yet

https://www.medscape.com/viewarticle/990381

- Potential and Pitfalls of ChatGPT and Natural-Language Artificial Intelligence Models for Diabetes Education

https://doi.org/10.2337/dc23-0197

II. Exercise and HFpEF

AHA, ACC Advocate Supervised Exercise Training in HFpEF

https://www.medscape.com/viewarticle/990351

- Supervised Exercise Training for Chronic Heart Failure With Preserved Ejection Fraction: A Scientific Statement From the American Heart Association and American College of Cardiology

https://doi.org/10.1016/j.jacc.2023.02.012

III. Statins and Muscles

Statins Don't Worsen Muscle Injury From Moderately Intense Exercise

https://www.medscape.com/viewarticle/990473

- Prolonged Moderate-Intensity Exercise Does Not Increase Muscle Injury Markers in Symptomatic or Asymptomatic Statin Users https://doi.org/10.1016/j.jacc.2023.01.043

IV. Statins in Secondary Prevention

Treat to LDL Target or High-Intensity Statin for All With Clinical CAD: LODESTAR

https://www.medscape.com/viewarticle/989884

- Treat-to-Target or High-Intensity Statin in Patients With Coronary Artery Disease

https://jamanetwork.com/journals/jama/article-abstract/2802214

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Diets, coronary artery calcium, statins, basic CAD knowledge, and AF ablation are the topics John Mandrola, MD, discusses in this week?s podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit: https://www.medscape.com/twic

I. Diet

Some Diets Better Than Others for Heart Protection https://www.medscape.com/viewarticle/990305

- Comparison of seven popular structured dietary programmes and risk of mortality and major cardiovascular events in patients at increased cardiovascular risk: systematic review and network meta-analysis https://doi.org/10.1136/bmj-2022-072003

Plant-Based Diets Not Always Healthy; Quality Is Key https://www.medscape.com/viewarticle/990178

- Association of Healthful Plant-based Diet Adherence With Risk of Mortality and Major Chronic Diseases Among Adults in the UK https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2802814

II. CAC and Statins

- Using the Coronary Artery Calcium Score to Guide Statin Therapy https://www.ahajournals.org/doi/full/10.1161/CIRCOUTCOMES.113.000799

III. Subclinical Atherosclerosis

Subclinical CAD by CT Predicts MI Risk, With or Without Stenoses https://www.medscape.com/viewarticle/990254

- Subclinical Coronary Atherosclerosis and Risk for Myocardial Infarction in a Danish Cohort

A Prospective Observational Cohort Study 0799 https://www.acpjournals.org/doi/10.7326/M22-3027

- A Prospective Natural-History Study of Coronary Atherosclerosis https://www.nejm.org/doi/10.1056/NEJMoa1002358?url_ver=Z39.88-2003

IV. AF ablation

- Standard vs Augmented Ablation of Paroxysmal Atrial Fibrillation for Reduction of Atrial Fibrillation RecurrenceThe AWARE Randomized Clinical Trial https://jamanetwork.com/journals/jamacardiology/fullarticle/2802860

- Effect of Catheter Ablation Using Pulmonary Vein Isolation With vs Without Posterior Left Atrial Wall Isolation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial FibrillationThe CAPLA Randomized Clinical Trial https://jamanetwork.com/journals/jama/article-abstract/2800186

- Approaches to Catheter Ablation for Persistent Atrial Fibrillation https://www.nejm.org/doi/full/10.1056/NEJMoa1408288

You may also like:

Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine. https://www.medscape.com/features/public/machine

The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington

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