This Week in Cardiology

MRAs in HF with renal dysfunction, coronary autoregulation, the hubris of US doctors, NSTEMI in older patients, survival after STEMI, and new leaders at JACC are discussed by John Mandrola, MD.

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

• Combined analysis (Matsumoto)

II Coronary artery autoregulation with increasing stenosis

• NEJM Paper https://www.nejm.org/doi/full/10.1056/NEJMc2402216

III RECOVER IV Trial

• Gregg Stone, MD Tweet https://x.com/GreggWStone/status/1803583552354742416
• DANGER-Shock Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2312572
• Impella Saves Lives in Cardiogenic Shock, but Patient Selection Key https://www.medscape.com/viewarticle/1000659

IV NSTEMI Elderly

• Main Paper
• Datamethods https://discourse.datamethods.org/t/random-vs-fixed-effects-meta-analysis/7361
• O’Fee Paper https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2785560

V MI Survival

Danish Paper https://doi.org/10.1016/j.jacc.2024.04.025

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Listener feedback, statin eligibility and Yogi Berra, evidence-based medicine and heterogenous treatment effects, and MRAs in HF 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

• ASPIRE AF https://classic.clinicaltrials.gov/ct2/show/NCT03968393
• Butala paper: Stroke After TAVR With and Without EPD https://www.ahajournals.org/doi/abs/10.1161/CIRCINTERVENTIONS.123.013697
• PROTECTED TAVR
• Heuts meta-analysis: EPD During TAVR https://heart.bmj.com/content/110/11/757

II. Statin Eligibility

• JAMA-IM: Data Analytic Choices and Predicting Vascular Events https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2819821
• Zeraatker Specification Analysis Paper https://doi.org/10.1016/j.jclinepi.2024.111278
• PCE https://www.mdcalc.com/calc/3398/ascvd-atherosclerotic-cardiovascular-disease-2013-risk-calculator-aha-acc

III. Heterogenous Treatment Effect

• Weisberg and Dailey-Higgs
• DANISH

IV. Heart Failure and MRAs 

• RALES https://www.nejm.org/doi/full/10.1056/NEJM199909023411001
• EMPHASIS https://www.nejm.org/doi/full/10.1056/NEJMoa1009492
• Combined analysis (Matsumoto)

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Cannabis and CV outcomes, post-CABG AF, embolic protection devices, emulation of randomization, and a preview heterogenous treatment effects 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:

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I. Cannabis

It Sure Looks Like Cannabis Is Bad for the Heart, Doesn't It?

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

Cannabis Use Tied to Increased Cardiovascular Risk

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

Medical Cannabis for Chronic Pain Tied to Arrhythmia Risk

https://www.medscape.com/viewarticle/medical-cannabis-chronic-pain-tied-arrhythmia-risk-2024a10000sc

• Cannabis for Chronic Pain and CV Safety https://doi.org/10.1093/eurheartj/ehad834
• Editorial  https://academic.oup.com/eurheartj/article/45/6/485/7500073
• Response to Letter  https://doi.org/10.1093/eurheartj/ehae314
• UCLA paper https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2819559
• Lifetime Cannabis Use and Mortality https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2819635

II. Post Cardiac Surgery AF

• Meta-analysis https://doi.org/10.1093/eurheartj/ehae267

III. Embolic Protection devices

Clear Stroke Benefit Eludes Embolic Protection: PROTECTED TAVR

https://www.medscape.com/viewarticle/980978

• Embolic Protection and Stroke Prevention With TAVR https://www.ahajournals.org/doi/abs/10.1161/CIRCINTERVENTIONS.123.013697
• PROTECTED TAVR https://www.nejm.org/doi/full/10.1056/NEJMoa2204961

IV. Preview of HTE

Paper https://doi.org/10.1016/j.ahj.2024.04.020

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The FLOW trial of semaglutide, the DANCAVAS CV screening trial, non-invasive tests for chest pain, and conflicts of interest on social media are the topics John Mandrola, MD, discusses this week.

This podcast is intended for healthcare professionals only.

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I. Semaglutide for CKD

Semaglutide Significantly Improves Chronic Kidney Disease

https://www.medscape.com/viewarticle/semaglutide-significantly-improves-chronic-kidney-disease-2024a10009w9

• FLOW Trial

II. CV Screening

Judicious CVD Screening May Work in Men: DANCAVAS

https://www.medscape.com/viewarticle/980153

• DANCAVAS 6-Year Outcomes https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004403
• DANCAVAS Main Trial NEJM https://www.nejm.org/doi/full/10.1056/NEJMoa2208681

III. Non-invasive Cardiac Testing in Chest Pain

• Circulation Outcomes Paper https://www.ahajournals.org/doi/abs/10.1161/CIRCOUTCOMES.123.010457
• Scot Heart https://www.nejm.org/doi/full/10.1056/NEJMoa1805971

IV. COI and Social Media

• JAMA letter https://jamanetwork.com/journals/jama/fullarticle/2816900

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Clues in SCAF, a DOAC antidote trial, another negative lytic trial in stroke, JAMA changes to observational studies, and BP in stroke care 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. ARTESIA Substudy

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

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

• ARTESIA Substudy
• NOAH https://www.nejm.org/doi/full/10.1056/NEJMoa2303062
• ARTESIA https://www.nejm.org/doi/10.1056/NEJMoa2310234

II. DOAC Reversal

• ANNEXA-1 Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2313040

III. Lytic Therapy in Acute Stroke

Thrombolysis Offers No Benefit for Mild Stroke

https://www.medscape.com/viewarticle/iv-thrombolysis-offers-no-benefit-mild-stroke-2024a10009p7

• TEMPO-2 Trial https://doi.org/10.1016/S0140-6736(24)00921-8
• The Case Against Thrombolytic Therapy in Stroke

IV. Observational Research

• JAMA Special Communication https://jamanetwork.com/journals/jama/fullarticle/2818746
• JAMA editors note https://jamanetwork.com/journals/jama/fullarticle/2818747

V. Aggressive BP Control in Stroke

Guidelines on Rapid BP Reduction in Acute Ischemic Stroke Challenged

https://www.medscape.com/viewarticle/guidelines-rapid-bp-reduction-acute-ischemic-stroke-2024a10009pe

• TRUTH Trial  https://doi.org/10.1016/S1474-4422(24)00177-7

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An Impella update, another TAVI vs SAVR trial, two studies on angina and PCI, another null substudy from REVIVED-BCIS, and semaglutide 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. Impella Update

• CHRIP BCIS 3 https://classic.clinicaltrials.gov/ct2/show/NCT05003817
• Danger-Shock Podcast https://www.medscape.com/viewarticle/1000675

II. TAVI vs SAVR

• Notion 2 Trial EHJ https://doi.org/10.1093/eurheartj/ehae331
• DEDICATE-DZHK6

III. Angina and PCI

• Orbita 2 Sub-analysis
• Orbita Star https://www.jacc.org/doi/10.1016/j.jacc.2024.04.001

IV. Complete Revascularization

• Main REVIVED trial https://www.nejm.org/doi/full/10.1056/NEJMoa2206606
• JACC Substudy https://www.jacc.org/doi/10.1016/j.jacc.2024.04.043

V. Semaglutide

Semaglutide CV Benefits Irrespective of Weight Loss: 4-Year SELECT Data

https://www.medscape.com/viewarticle/semaglutide-cv-benefits-irrespective-weight-loss-4-year-2024a100095z

• Nature Med substudy https://www.nature.com/articles/s41591-024-02996-7
• SELECT Main paper https://www.nejm.org/doi/full/10.1056/NEJMoa2307563

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Inclisiran, sodium-channel blocker safety, analytic flexibility, the work-up of patients with HF, and BP in older patients 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. Inclisiran Update

• ORION 4 https://classic.clinicaltrials.gov/ct2/show/NCT03705234

II. Sodium-Channel AADs

• UPenn Paper https://doi.org/10.1016/j.jacep.2024.01.021
• Three Questions Editorial https://www.ahajournals.org/doi/full/10.1161/circoutcomes.110.957381
• EAST Post-hoc Review https://doi.org/10.1093/europace/euae121

III. Analytic Flexibility  

Is Red Meat Healthy? Multiverse Analysis Has Lessons Beyond Meat

https://www.medscape.com/viewarticle/red-meat-healthy-multiverse-analysis-has-lessons-beyond-meat-2024a10008qv

• Specification Curve Analysis of Red Meat Data https://doi.org/10.1016/j.jclinepi.2024.111278

IV. The Work-up of Patients With HF

• Durstenfeld and colleagues, UCSF https://www.ahajournals.org/doi/abs/10.1161/CIRCOUTCOMES.123.010800
• REVIVED BCIS2 https://www.nejm.org/doi/full/10.1056/NEJMoa2206606

V. BP Therapy in Older Patients

• Haring and colleagues; Women’s Health  Initiative BP Study https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.067302
• SPRINT Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1511939

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The DEDICATE trial of TAVR vs SAVR, more on renal denervation, inclisiran, and marketing disguised as science 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. TAVR vs SAVR

TAVI Comparable With SAVR in Lower-Risk Aortic Stenosis

https://www.medscape.com/viewarticle/tavi-comparable-savr-lower-risk-aortic-stenosis-2024a100074o?form=fpf

• DEDICATE https://www.nejm.org/doi/full/10.1056/NEJMoa2400685
• Partner 3 https://www.nejm.org/doi/full/10.1056/NEJMoa1814052
• Evolut Low Risk https://www.nejm.org/doi/full/10.1056/NEJMoa1816885
• Barili meta-analysis https://doi.org/10.1093/ejcts/ezab516

II. Renal Denervation

Alcohol-Mediated Renal Denervation Promising in Hypertension

https://www.medscape.com/viewarticle/alcohol-mediated-renal-denervation-promising-hypertension-2024a10007eg

• TARGET 1 https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.069291

III. Inclisiran

Earlier Inclisiran Gives Better Long-Term LDL Reductions

https://www.medscape.com/viewarticle/earlier-inclisiran-gives-better-long-term-ldl-reductions-2024a10007d6

• VICTORIAN INITIATE Trial https://www.jacc.org/doi/10.1016/j.jacc.2024.03.382

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A listener defends colored boxes in guidelines; mysteries of non-culprit coronary lesions during PCI, and of AF ablation; and surrogate markers 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. Mystery of What to Do in the Cath Lab after Fixing the Culprit Lesion – The FULL REVASC Trial

Complete Revascularization Not Superior to Culprit-Only PCI After MI

https://www.medscape.com/viewarticle/complete-revascularization-not-superior-culprit-only-pci-2024a10007ik

• FULL REVASC Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2314149
• FIRE Trial https://www.nejm.org/doi/10.1056/NEJMoa2300468
• COMPLETE Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1907775
• Cohen Tweet on FULL REVASC https://x.com/djc795/status/1781361606238085532

II. AF Ablation Mysteries

New Expert Consensus on Ablation Strategies for AF

https://www.medscape.com/viewarticle/new-expert-consensus-ablation-strategies-af-2024a1000851

• Bern Study of Remapping https://doi.org/10.1016/j.jacep.2024.02.026
• Natural History of SCAF https://doi.org/10.1016/j.jacc.2019.09.050
• Liverpool Study: Thermal PV Isolation in Persistent AF https://doi.org/10.1016/j.hrthm.2024.04.061

III. Surrogate Markers

• JAMA: Surrugate Markers and Clinical Outcomes https://jamanetwork.com/journals/jama/fullarticle/2817850
• BP Surrogate Meta-analysis https://doi.org/10.1016/S0140-6736(21)00590-0
• JAMA: Nonfatal MI as Surrogate for Mortality https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2785560

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ACC Part 2: The TACT2 trial of chelation, inter-atrial shunts for HF, and triglyceride lowering; plus diltiazem and Factor Xa anticoagulants 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:

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I. TACT 2

Chelation Therapy Provides No Benefit Post-MI

https://www.medscape.com/viewarticle/chelation-therapy-provides-no-benefit-post-mi-2024a10006l5

Chelation Therapy and CV Risk: Why TACT2 Showed No Benefit https://www.medscape.com/viewarticle/chelation-therapy-and-cv-risk-why-tact2-showed-no-benefit-2024a1000761?src=

• JAMA TACT 1 paper https://jamanetwork.com/journals/jama/fullarticle/1672238
• Diabetes Subgroup paper https://pubmed.ncbi.nlm.nih.gov/24254885/
• A New Look at P-values https://evidence.nejm.org/doi/abs/10.1056/EVIDoa2300003
• PARAGON HF https://www.nejm.org/doi/full/10.1056/NEJMoa1908655

II. Interatrial Shunts for HF

No Net HF Benefit for Interarterial Shunt Device

https://www.medscape.com/viewarticle/no-net-hf-benefit-interarterial-shunt-device-2024a10006kk

• REDUCE LAP HF II https://doi.org/10.1016/S0140-6736(22)00016-2

III. Triglyceride Lowering

Early Olezarsen Results Show 50% Reduction in Triglycerides

https://www.medscape.com/viewarticle/early-olezarsen-results-show-50-reduction-triglycerides-2024a10006oz

Is It Time to Stop Treating High Triglycerides?

https://www.medscape.com/viewarticle/990126

• NEJM https://www.nejm.org/doi/full/10.1056/NEJMoa2402309

Substantial Triglyceride Reduction With Plozasiran

https://www.medscape.com/viewarticle/substantial-triglyceride-reduction-plozasiran-2024a10006wf?icd=login_success_email_match_norm

• JAMA Cardiology https://jamanetwork.com/journals/jamacardiology/article-abstract/2817469

IV. Diltiazem and Factor Xa inhibitors

• JAMA Vanderbilt University Paper https://jamanetwork.com/journals/jama/fullarticle/2817546

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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.

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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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The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington

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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:

https://www.medscape.com/twic

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:

https://www.medscape.com/twic

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:

https://www.medscape.com/twic

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:

https://www.medscape.com/twic

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.

To read a partial transcript or to comment, visit:

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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.

To read a partial transcript or to comment, visit:

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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:

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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:

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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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Questions or feedback, please contact [email protected]

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.

To read a partial transcript or to comment, visit:

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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.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

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.

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 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.

To read a partial transcript or to comment, visit:

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.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

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

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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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Questions or feedback, please contact [email protected]

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

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

Questions or feedback, please contact

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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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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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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

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Questions or feedback, please contact [email protected]

Exercise, sudden cardiac death in sports, new TAVI data, behavioral psychology, EHR doing good things, maybe, and coffee 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. Fitness and Longevity

Even Small Changes in Fitness Tied to Lower Mortality Risk https://www.medscape.com/viewarticle/989906

- Changes in Cardiorespiratory Fitness and Survival in Patients With or Without Cardiovascular Disease https://www.jacc.org/doi/full/10.1016/j.jacc.2023.01.027

II. SCD in Sports

Sports-Related Sudden Cardiac Arrest 'Extremely' Rare in Women https://www.medscape.com/viewarticle/990025

- Incidence of Cardiac Arrest During Sports Among Women in the European Union https://www.jacc.org/doi/full/10.1016/j.jacc.2023.01.015

- Sex-Related Differences in Sports-Related Sudden Cardiac Death Should Be Reflected in Guideline Screening Recommendations∗   https://www.jacc.org/doi/full/10.1016/j.jacc.2023.01.014

- Association between physical activity and risk of incident arrhythmias in 402 406 individuals: evidence from the UK Biobank cohort https://doi.org/10.1093/eurheartj/ehz897

III. EVOLUT Three Year Data

Encouraging 3-Year Data for TAVR in Low-Risk Patients: EVOLUT

https://www.medscape.com/viewarticle/989144

- Three-Year Outcomes After Transcatheter or Surgical Aortic Valve Replacement in Low-Risk Patients with Aortic Stenosis https://www.jacc.org/doi/10.1016/j.jacc.2023.02.017

- Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients

https://www.nejm.org/doi/full/10.1056/nejmoa1816885

- Outcomes 2 Years After Transcatheter Aortic Valve Replacement in Patients at Low Surgical Risk https://www.jacc.org/doi/10.1016/j.jacc.2020.12.052

IV. Behavioral Psychology

NUDGE-FLU: Electronic 'Nudges' Boost Flu Shot Uptake in Seniors https://www.medscape.com/viewarticle/989108

- The Effect of Electronic Nudges on Influenza Vaccination Rate in Older Adults With Cardiovascular Disease: a Prespecified Analysis of the NUDGE-FLU Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.064270

- Influenza Vaccination After Myocardial Infarction: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.121.057042

EHR Alerts Boosted MRA Prescribing in HFrEF: BETTER CARE-HF https://www.medscape.com/viewarticle/989110

- Cluster-Randomized Trial Comparing Ambulatory Decision Support Tools to Improve Heart Failure Care https://doi.org/10.1016/j.jacc.2023.02.005

- The Effect of Spironolactone on Morbidity and Mortality in Patients with Severe Heart Failure https://www.nejm.org/doi/full/10.1056/nejm199909023411001

V. Coffee

- Acute Effects of Coffee Consumption on Health among Ambulatory Adults https://www.nejm.org/doi/full/10.1056/NEJMoa2204737

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Questions or feedback, please contact [email protected]

ACC Recap No. 2: Pacing in HFpEF, Oral PCSK9 inhibitor, PAH, soft thinking on adherence, and so called metabolically healthy obese are 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. Pacing in HFpEF

No Exercise Boost From Pacemaker in HFpEF With Impaired HR Response: RAPID-HF https://www.medscape.com/viewarticle/989681

- Rate-Adaptive Atrial Pacing for Heart Failure With Preserved Ejection FractionThe RAPID-HF Randomized Clinical Trial https://jamanetwork.com/journals/jama/article-abstract/2802147

- Accelerated Pacing a Possible Strategy for Preserved-EF Heart Failure? https://www.medscape.com/viewarticle/987815

- Could a Breakthrough in Heart Failure With Preserved Ejection Fraction Just Take a Change of Pace? - https://www.medscape.com/viewarticle/988088

- Effect of Personalized Accelerated Pacing on Quality of Life, Physical Activity, and Atrial Fibrillation in Patients With Preclinical and Overt Heart Failure With Preserved Ejection Fraction: The myPACE Randomized Clinical Trial https://jamanetwork.com/journals/jamacardiology/fullarticle/2801001

- Effect of β-Blocker Withdrawal on Functional Capacity in Heart Failure and Preserved Ejection Fraction https://doi.org/10.1016/j.jacc.2021.08.073

II Oral PCSK9i

Oral PCSK9 Inhibitor Shows Encouraging LDL Lowering https://www.medscape.com/viewarticle/989655

- Efficacy and safety of the oral PCSK9 inhibitor MK-0616: a phase 2b randomized controlled trial https://www.jacc.org/doi/10.1016/j.jacc.2023.02.018

III PAH

'Unheard of' PAH Improvement With Novel Drug: STELLAR https://www.medscape.com/viewarticle/989612

- Phase 3 Trial of Sotatercept for Treatment of Pulmonary Arterial Hypertension https://www.nejm.org/doi/full/10.1056/NEJMoa2213558

IV Medical Adherence

Waiving Co-Pays for CV Meds as Adherence Incentive Doesn't Cut Clinical Risk: ACCESS Trial https://www.medscape.com/viewarticle/989474

- Eliminating Medication Copayments for Low-income Older Adults at High Cardiovascular Risk: A Randomized Controlled Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.064188

- Medicaid Expansion: Good First Step, but No Panacea for CV Care https://www.medscape.com/viewarticle/975141

- Health Care Access and Management of Cardiovascular Risk Factors Among Working-Age Adults With Low Income by State Medicaid Expansion Status https://jamanetwork.com/journals/jamacardiology/article-abstract/2793120

- Rand Link https://www.rand.org/pubs/reports/R3055.html

- The Oregon Health Insurance Experiment https://www.healthaffairs.org/do/10.1377/hpb20150716.236899/full/

- Effect of Health Insurance in India: A Randomized Controlled Trial https://www.nber.org/papers/w29576

- Full Coverage for Preventive Medications after Myocardial Infarction https://www.nejm.org/doi/full/10.1056/nejmsa1107913

- Effect of Medication Co-payment Vouchers on P2Y12 Inhibitor Use and Major Adverse Cardiovascular Events Among Patients With Myocardial InfarctionThe ARTEMIS Randomized Clinical Trial https://jamanetwork.com/journals/jama/fullarticle/2720024

- Coronary CT Angiography and 5-Year Risk of Myocardial Infarction https://www.nejm.org/doi/full/10.1056/NEJMoa1805971

IV Metabolically Healthy Obese

'Metabolically Healthy Obesity' Rising, but Still Uncommon https://www.medscape.com/viewarticle/989398

- Trends in the Prevalence of Metabolically Healthy Obesity Among US Adults, 1999-2018 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2802164

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Questions or feedback, please contact [email protected]

ACC Recap Part 1: Sports, bempedoic acid NASCARs, tricuspid regurgitation, and more on revascularization of stable CAD. 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. Sports Cardiology

Even Vigorous Exercise Appears Safe for Patients With Hypertrophic Cardiomyopathy: LIVE-HCM https://www.medscape.com/viewarticle/989351

- Lifelong endurance exercise and its relation with coronary atherosclerosis https://doi.org/10.1093/eurheartj/ehad152

- Increased average longevity among the "Tour de France" cyclists https://pubmed.ncbi.nlm.nih.gov/21618162/

II. Clear Outcomes

Bempedoic Acid Cuts CV Events in Statin-Intolerant Patients: CLEAR Outcomes

https://www.medscape.com/viewarticle/989100

- Bempedoic Acid and Cardiovascular Outcomes in Statin-Intolerant Patients https://www.nejm.org/doi/full/10.1056/NEJMoa2215024

- Bodgan Enache Tweet https://twitter.com/bogdienache/status/1632143539965509632?s=20

III. TRILUMINATE Trial

Transcatheter Tricuspid Valve Repair Effective, Safe for Regurgitation: TRILUMINATE https://www.medscape.com/viewarticle/989103

- Transcatheter Repair for Patients with Tricuspid Regurgitation https://www.nejm.org/doi/full/10.1056/NEJMoa2300525

- New Treatment Could Help Fix the Heart’s ‘Forgotten Valve.’ https://www.nytimes.com/2023/03/04/health/tricuspid-valve-clip-leakage.html

- Rasha Al-Lamee Tweet https://twitter.com/rallamee/status/1632295242685612033?s=20

IV. REVIVED-BCIS

Viability-Guided PCI Doubted in Stable Severe CAD: REVIVED-BCIS2 https://www.medscape.com/viewarticle/989101

- Percutaneous Revascularization for Ischemic Left Ventricular Dysfunction https://www.nejm.org/doi/full/10.1056/NEJMoa2206606

Features:

CLEAR Positives and Cautions With Bempedoic Acid for Statin Intolerance https://www.medscape.com/viewarticle/989098

The TRILUMINATE Transcatheter Tricuspid Repair Trial: Positive but No Benefit? https://www.medscape.com/viewarticle/989105

Three Surprising Studies on Exercise Restriction and an Exercise Sweet Spot https://www.medscape.com/viewarticle/989417

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

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Renal denervation, AF ablation, omecamtiv mecarbil, and an ACC Preview 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. AF Ablation

- Initial Findings From the National Cardiovascular Data Registry of Atrial Fibrillation Ablation Procedures https://www.jacc.org/doi/10.1016/j.jacc.2022.11.060

II. Renal Denervation

Consistent BP Cut With Renal Denervation: More on RADIANCE https://www.medscape.com/viewarticle/989006

- Endovascular Ultrasound Renal Denervation to Treat HypertensionThe RADIANCE II Randomized Clinical Trial https://jamanetwork.com/journals/jama/fullarticle/2801849

- Patient-Level Pooled Analysis of Ultrasound Renal Denervation in the Sham-Controlled RADIANCE II, RADIANCE-HTN SOLO, and RADIANCE-HTN TRIO Trials https://jamanetwork.com/journals/jamacardiology/fullarticle/2802098

- Is There a Role for Renal Denervation in the Treatment of Hypertension? https://jamanetwork.com/journals/jamacardiology/fullarticle/2802099

III. Omecamtiv Mecarbil

FDA Declines Approval for Omecamtiv Mecarbil in HFrEF https://www.medscape.com/viewarticle/988948

IV. ACC Preview

ACC Scientific Session Returns Live, Virtually to New Orleans https://www.medscape.com/viewarticle/988803

- ‘Faith Healing’ and ‘Subtraction Anxiety’ in Unblinded Trials of Procedures https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.118.004665

Features

Mandrola's 5 Things to Look for at ACC 23 https://www.medscape.com/viewarticle/988808

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

Questions or feedback, please contact [email protected]

Reporting on potential fraud in medicine, AF, stroke, a possible new cholesterol-lowering drug, and the tone of debate in 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. Potential Fraud in Medicine

Inside the Big Business of Clogged Arteries https://www.medscape.com/viewarticle/988448

II. AF Screening and Stroke

STROKE AF at 3 Years: High AF Rate After Atherosclerotic Stroke https://www.medscape.com/viewarticle/988076

Severity and Etiology of Incident Stroke in Patients Screened for Atrial Fibrillation vs Usual Care and the Impact of Prior Stroke https://jamanetwork.com/journals/jamaneurology/fullarticle/2795865

III. Bempedoic Acid

New Studies Give Bempedoic Acid a Bump as Lipid-Lowering Agent https://www.medscape.com/viewarticle/911100

- Rationale and design of the CLEAR-outcomes trial: Evaluating the effect of bempedoic acid on cardiovascular events in patients with statin intolerance https://doi.org/10.1016/j.ahj.2020.10.060

- Safety and Efficacy of Bempedoic Acid to Reduce LDL Cholesterol https://www.nejm.org/doi/full/10.1056/NEJMoa1803917

- Effect of Bempedoic Acid vs Placebo Added to Maximally Tolerated Statins on Low-Density Lipoprotein Cholesterol in Patients at High Risk for Cardiovascular Disease https://jamanetwork.com/journals/jama/fullarticle/2754792

- N-of-1 Trial of a Statin, Placebo, or No Treatment to Assess Side Effects https://www.nejm.org/doi/full/10.1056/NEJMc2031173

- Side Effect Patterns in a Crossover Trial of Statin, Placebo, and No Treatment https://www.jacc.org/doi/10.1016/j.jacc.2021.07.022

IV. The Technique of Critical Appraisal

Why Evidence-Based Medicine Enthusiasts Could Use a Lesson in Persuasion https://www.medscape.com/viewarticle/988227

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Questions or feedback, please contact [email protected]

Bradyarrhythmia during AF screening, thrombolysis in stroke, NP vs MD care, and the most biased paper this year — on LAAO — 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. Screening with ILR

- Ade Adamson Tweet https://twitter.com/AdeAdamson/status/1625878856820482048?s=20

- The Rapid Rise in Cutaneous Melanoma Diagnoses

https://www.nejm.org/doi/full/10.1056/NEJMsb2019760

- Loop Trial 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

II. Thrombolysis in Mild Stroke

Thrombolysis Not Necessary in Mild Nondisabling Stroke: ARAMIS

https://www.medscape.com/viewarticle/988381

- PRISMS Trial https://jamanetwork.com/journals/jama/fullarticle/2687354

- Risk of selection bias assessment in the NINDS rt-PA stroke study https://pubmed.ncbi.nlm.nih.gov/35705913/

- Tissue Plasminogen Activator for Acute Ischemic Stroke https://www.nejm.org/doi/full/10.1056/NEJM199512143332401

- Effects of alteplase for acute stroke; Hacke et al meta-analysis https://journals.sagepub.com/doi/10.1177/1747493017744464

- Methodological survey of missing outcome data in an alteplase for ischemic stroke meta-analysis

https://onlinelibrary.wiley.com/doi/full/10.1111/ane.13656

- ECASS; Thrombolysis with Alteplase 3 to 4.5 Hours after Acute Ischemic Stroke https://www.nejm.org/doi/full/10.1056/nejmoa0804656

- Thrombolysis with alteplase 3-4.5 hours after acute ischaemic stroke: trial reanalysis adjusted for baseline imbalances https://pubmed.ncbi.nlm.nih.gov/32430395/

III. NP vs MD Care

This Doc Still Supports NP/PA Led Care ... With Caveats https://www.medscape.com/viewarticle/967073

- The Productivity of Professions: Evidence from the Emergency Department https://www.nber.org/papers/w30608

- Independent Nurse Practitioners and Physician Assistants: A Doc's View https://www.medscape.com/viewarticle/924047

IV. LAAO vs OAC

- Comparative Effectiveness of Left Atrial Appendage Occlusio Versus Oral Anticoagulation by Sex

https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.062765

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

Questions or feedback, please contact [email protected]

Drug and non-drug therapies for HFpEF, the search for AF, and exercise as medicine 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. SGLT2 Inhibitors in HFpEF

Dapagliflozin Gets Expanded Heart Failure Indication in Europe https://www.medscape.com/viewarticle/988034

• Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction https://www.nejm.org/doi/full/10.1056/NEJMoa2206286

II. HFpEF and Heart Rate

Accelerated Pacing a Possible Strategy for Preserved-EF Heart Failure? https://www.medscape.com/viewarticle/987815

III. Stroke and AF

STROKE AF at 3 Years: High AF Rate After Atherosclerotic Stroke https://www.medscape.com/viewarticle/988076

• Effect of Long-term Continuous Cardiac Monitoring vs Usual Care on Detection of Atrial Fibrillation in Patients With Stroke Attributed to Large- or Small-Vessel Disease https://jamanetwork.com/journals/jama/fullarticle/2780490
• Cryptogenic Stroke and Underlying Atrial Fibrillation https://www.nejm.org/doi/full/10.1056/nejmoa1313600
• Duration of device-detected subclinical atrial fibrillation and occurrence of stroke in ASSERT https://pubmed.ncbi.nlm.nih.gov/28329139/
• Left Atrial Appendage Occlusion during Cardiac Surgery to Prevent Stroke https://www.nejm.org/doi/full/10.1056/NEJMoa2101897

IV. Exercise as Medicine

Trending Clinical Topic: Exercise Prescription https://reference.medscape.com/viewarticle/985373

• Effect of Moderate and Vigorous Aerobic Exercise on Incident Diabetes in Adults With Obesityhttps://pubmed.ncbi.nlm.nih.gov/36716009/

Features

Could a Breakthrough in Heart Failure With Preserved Ejection Fraction Just Take a Change of Pace? https://www.medscape.com/viewarticle/988088

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Questions or feedback, please contact [email protected]

A possible major breakthrough in thinking about diastolic dysfunction and HFpEF, MRI scanning and cardiac devices, and AF and dementia 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. New Thinking in HFpEF

Accelerated Pacing a Possible Strategy for Preserved-EF Heart Failure? https://www.medscape.com/viewarticle/987815

- Effect of Personalized Accelerated Pacing on Quality of Life, Physical Activity, and Atrial Fibrillation in Patients With Preclinical and Overt Heart Failure With Preserved Ejection Fraction: The myPACE Randomized Clinical Trial https://jamanetwork.com/journals/jamacardiology/fullarticle/2801001

- Effect of β-Blocker Withdrawal on Functional Capacity in Heart Failure and Preserved Ejection Fraction https://doi.org/10.1016/j.jacc.2021.08.073

- A Targeted Treatment Opportunity for HFpEF: Taking Advantage of Diastolic Tone https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.056412

- Lenient versus Strict Rate Control in Patients with Atrial Fibrillation https://www.nejm.org/doi/full/10.1056/nejmoa1001337

II. MRI and ICD Function

Legacy ICDs Exposed to MRI Still Shock, Pace as Needed https://www.medscape.com/viewarticle/987729

- Implantable Defibrillator System Shock Function, Mortality, and Cause of Death After Magnetic Resonance Imaging https://doi.org/10.7326/M22-2653

- 2017 HRS expert consensus statement on magnetic resonance imaging and radiation exposure in patients with cardiovascular implantable electronic devices https://pubmed.ncbi.nlm.nih.gov/28502708/

III. AF and Dementia

Atrial Fibrillation and Dementia: What Do We Know?

https://www.medscape.com/viewarticle/985900

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

Questions or feedback, please contact [email protected]

Exercise for AF, drugs have more than one effect, AI bots and the future of medicine, and the good and bad news about prognosis in HF 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 and Exercise

• Aerobic Exercise Can Reduce AF Frequency, Severity: ACTIVE-AF https://www.medscape.com/viewarticle/957322
• An Exercise and Physical Activity Program in Patients With Atrial Fibrillation: The ACTIVE-AF Randomized Controlled Trial https://www.jacc.org/doi/full/10.1016/j.jacep.2022.12.002
• Early Rhythm-Control Therapy in Patients with Atrial Fibrillation https://www.nejm.org/doi/full/10.1056/NEJMoa2019422

II. GLP-1 Inhibitors and Retinopathy

• Eye Check Important Before Starting Semaglutide for Diabetes https://www.medscape.com/viewarticle/987418
• Glucagon-like peptide 1-receptor agonists and A1c: Good for the heart but less so for the eyes? https://doi.org/10.1016/j.dsx.2022.102696

III. AI Bot Passes USMLEs

• AI Bot ChatGPT Passes US Medical Licensing Exams Without Cramming – Unlike Students https://www.medscape.com/viewarticle/987549
• Performance of ChatGPT on USMLE: Potential for AI-Assisted Medical 2 Education Using Large Language Models https://www.medrxiv.org/content/10.1101/2022.12.19.22283643v2.full.pdf
• Tyler Cowen Comments -- GPT and my own career trajectory https://marginalrevolution.com/marginalrevolution/2023/01/gpt-and-my-own-career-trajectory.html

IV. HF Prognosis

• Temporal trends in the incidence of malignancy in heart failure: a nationwide Danish study https://doi.org/10.1093/eurheartj/ehac797

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Questions or feedback, please contact [email protected]

The loop diuretic duels, adverse events during hospital admissions, BP accuracy, and, again, left main revascularization strategies (again) are the topics John Mandrola 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. TRANSFORM HF

Clarity on Torsemide vs Furosemide in HF: TRANSFORM-HF Published https://www.medscape.com/viewarticle/987128

• Effect of Torsemide vs Furosemide After Discharge on All-Cause Mortality in Patients Hospitalized With Heart Failure https://jamanetwork.com/journals/jama/fullarticle/2800428

• RANSFORM-HF—Can We Close the Loop on Diuretics in Heart Failure? https://jamanetwork.com/journals/jama/fullarticle/2800445

II. Adverse Events in the Hospital

Adverse Events Reported in One Quarter of Inpatient Admissions https://www.medscape.com/viewarticle/987091

• The Safety of Inpatient Health Care https://www.nejm.org/doi/full/10.1056/NEJMsa2206117

III. BP Accuracy

Experts Demand Validation of Automatic Blood Pressure Devices

https://www.medscape.com/viewarticle/987032

IV. Left Main Coronary Artery Disease

Real-World Examination of Revascularization Strategies for Left Main Coronary Disease in Ontario, Canada

https://doi.org/10.1016/j.jcin.2022.10.016

Management of Left Main Coronary Artery Disease in Nonemergent Settings: The Heart of Multidisciplinary Teamwork https://doi.org/10.1016/j.jcin.2022.11.024

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Questions or feedback, please contact [email protected]

FOURIER authors’ response, a possible practice-changing paper in electrophysiology, and the ATLAS and CAPLA trials 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. FOURIER Authors Respond

Recount of FOURIER Data Finds Higher Mortality With Evolocumab; Trialists Push Back https://www.medscape.com/viewarticle/986634

• Restoring mortality data in the FOURIER cardiovascular outcomes trial of evolocumab in patients with cardiovascular disease: a reanalysis based on regulatory data https://bmjopen.bmj.com/content/12/12/e060172
• Letter to the Editor RE: "Restoring mortality data in the FOURIER cardiovascular outcomes trial of evolocumab in patients with cardiovascular disease: a reanalysis based on regulatory data". BMJ Open https://bmjopen.bmj.com/content/12/12/e060172.responses#letter-to-the-editor-re-restoring-mortality-data-in-the-fourier-cardiovascular-outcomes-trial-of-evolocumab-in-patients-with-cardiovascular-disease-a-reanalysis-based-on-regulatory-data-bmj-open-2022123060172
• Risk of selection bias assessment in the NINDS rt-PA stroke study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9202115/
• Methodological survey of missing outcome data in an alteplase for ischemic stroke meta-analysis https://doi.org/10.1111/ane.13656

II. A Potential Practice-Changing Paper in Cardiac Pacing

Novel 'Cure' May Avert Lead Extraction in CIED Pocket Infections https://www.medscape.com/viewarticle/986762

• Regional Antibiotic Delivery for Implanted Cardiovascular Electronic Device Infections https://doi.org/10.1016/j.jacc.2022.10.022
• Treatment of Localized Implantable Cardiac Device Pocket Infections https://doi.org/10.1016/j.jacc.2022.11.018

III. ATLAS Trial

• Perioperative Safety and Early Patient and Device Outcomes Among Subcutaneous Versus Transvenous Implantable Cardioverter Defibrillator Implantations https://doi.org/10.7326/M22-1566
• Subcutaneous or Transvenous Defibrillator Therapy https://www.nejm.org/doi/full/10.1056/NEJMoa1915932
• Subcutaneous or Transvenous Defibrillator Therapy https://www.nejm.org/doi/10.1056/NEJMc2034917

IV. CAPLA Published

CAPLA Shows Limits of Further Ablation Post PVI in Persistent AF https://www.medscape.com/viewarticle/986901

• 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 Fibrillation https://jamanetwork.com/journals/jama/fullarticle/2800186
• Catheter Ablation for Persistent Atrial Fibrillation https://jamanetwork.com/journals/jama/fullarticle/2800200

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

Questions or feedback, please contact

[email protected]

Damar Hamlin, obesity and semaglutide, Open Data and PCSK9 inhibitors, and TAVI vs SAVR trials 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. Damar Hamlin

Five Thoughts on the Damar Hamlin Collapse

https://www.medscape.com/viewarticle/986550

II. Semaglutide and Obesity in Adolescents

FDA Approves Wegovy (Semaglutide) for Obesity in Teens 12 and Up

https://www.medscape.com/viewarticle/986403

• Once-Weekly Semaglutide in Adolescents with Obesity https://www.nejm.org/doi/full/10.1056/NEJMoa2208601

III. Open Data and PCSK9 inhibitors

Evolocumab Added to Statins Cuts CV Events in FOURIER Trial

https://www.medscape.com/viewarticle/877348

• Restoring mortality data in the FOURIER cardiovascular outcomes trial of evolocumab in patients with cardiovascular disease: a reanalysis based on regulatory data

https://bmjopen.bmj.com/content/12/12/e060172

• Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease

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

• PCSK9 deficiency rewires heart metabolism and drives heart failure with preserved ejection fraction https://pubmed.ncbi.nlm.nih.gov/34252181/

• Bendary Tweet https://twitter.com/DrBendary/status/1609849852979986432?s=20&t=FDDhGIofS_HQ4jxf8aHwBA

IV. Open Data and TAVI vs SAVR Trials

Risk of Bias in Randomized Clinical Trials Comparing Transcatheter and Surgical Aortic Valve Replacement https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2799937

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Questions or feedback, please contact [email protected]

The top ten stories of the year plus a few honorary mentions. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic

I Annual Wrap Ups on Medscape

- Mandrola’s Top 10 Cardiology Stories of 2022 https://www.medscape.com/viewarticle/985607

- 2022 in Review Through a Cardiology Lens https://www.medscape.com/viewarticle/984505

- Top Cardiology Trials of 2022 https://www.medscape.com/viewarticle/985647

II REVIVED BCIS2

- Percutaneous Revascularization for Ischemic Left Ventricular Dysfunction https://www.nejm.org/doi/full/10.1056/nejmoa2206606

- PCI Fails in Stable Disease Again: REVIVED-BCIS https://www.medscape.com/viewarticle/979862

- PCI Fails to Beat OMT in Ischemic Cardiomyopathy: REVIVED-BCIS2 https://www.medscape.com/viewarticle/979853

III GUIDE HF

- Haemodynamic-guided management of heart failure (GUIDE-HF): a randomised controlled trial https://doi.org/10.1016/S0140-6736(21)01754-2

- CardioMEMS Remote HF Monitoring: Resist the Spin and FOMO https://www.medscape.com/viewarticle/970278

- GUIDE-HF: CardioMEMS-Guided Meds Fall Short in Mild to Moderate Heart Failure https://www.medscape.com/viewarticle/957390

IV DECAAF II

- Effect of MRI-Guided Fibrosis Ablation vs Conventional Catheter Ablation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial Fibrillation The DECAAF II Randomized Clinical Trial https://jamanetwork.com/journals/jama/fullarticle/2793452

- DECAAF II: AF, Fibrosis Ablation Technique Falls Short, but Signs of Hope https://www.medscape.com/viewarticle/957469

V DANCAVAS

- Five-Year Outcomes of the Danish Cardiovascular Screening (DANCAVAS) Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2208681

- DANCAVAS Misses Primary Endpoint but Hints at Benefit from Comprehensive CV Screening https://www.medscape.com/viewarticle/979854

- Judicious CVD Screening May Work in Men: DANCAVAS https://www.medscape.com/viewarticle/980153

- DANCAVAS: Might Cardiovascular Screening Extend Men's Lives? https://www.medscape.com/viewarticle/979632

VI SODIUM HF

- Reduction of dietary sodium to less than 100 mmol in heart failure (SODIUM-HF): an international, open-label, randomised, controlled trial https://doi.org/10.1016/S0140-6736(22)00369-5

- Low-Sodium Diet Did Not Cut Clinical Events in Heart Failure Trial https://www.medscape.com/viewarticle/971482

- Sodium Restriction in Heart Failure: Another Dogma Felled by Randomization https://www.medscape.com/viewarticle/971697

- SODIUM-HF Simplifies Message to Patients on Diet https://www.medscape.com/viewarticle/971547

VII STRONG-HF

- Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised, trial https://doi.org/10.1016/S0140-6736(22)02076-1

- Rapidly, Fully Optimize HF Meds After Hospital Discharge: STRONG-HF https://www.medscape.com/viewarticle/983870

- STRONG HF: More Beats Less After Discharge for Heart Failure https://www.medscape.com/viewarticle/983698

VIII Health Insurance Access

- Health Care Access and Management of Cardiovascular Risk Factors Among Working-Age Adults With Low Income by State Medicaid Expansion Status https://doi.org/10.1001/jamacardio.2022.1282

- Medicaid Expansion: Good First Step, but No Panacea for CV Care https://www.medscape.com/viewarticle/975141

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Questions or feedback, please contact [email protected]

BP control over the long term, omecamtiv mecarbil, incentives and Goodhart’s law, and open science 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. Long-Term BP Control

- Final SPRINT Data Confirm Lower BP Is Better https://www.medscape.com/viewarticle/951572

- Longer-Term All-Cause and Cardiovascular Mortality With Intensive Blood Pressure Control https://jamanetwork.com/journals/jamacardiology/fullarticle/2797064

- Let's Not SPRINT to Judgment About New Blood Pressure Goals https://www.acpjournals.org/doi/full/10.7326/M15-3123

- Should We SPRINT Toward New Blood Pressure Goals or Let the Dust Settle? https://doi.org/10.1016/j.amjmed.2016.04.022

II. Omecamtiv Mecarbil

- FDA Panel Votes No on Omecamtiv Mecarbil for Heart Failure https://www.medscape.com/viewarticle/985593

- Omecamtiv Mecarbil Fails to Improve Exercise Capacity in HFrEF https://www.medscape.com/viewarticle/978355

- Cardiac Myosin Activation with Omecamtiv Mecarbil in Systolic Heart Failure https://www.nejm.org/doi/full/10.1056/NEJMoa2025797

- Effect of Omecamtiv Mecarbil on Exercise Capacity in Chronic Heart Failure With Reduced Ejection Fraction https://jamanetwork.com/journals/jama/fullarticle/2794362

- Effects of omecamtiv mecarbil in heart failure with reduced ejection fraction according to blood pressure: the GALACTIC-HF trial https://doi.org/10.1093/eurheartj/ehac293

III. Measuring Quality of Care

- MIPS Quality Scores Don't Reflect Quality of Care: Study https://www.medscape.com/viewarticle/985396

- Association Between Individual Primary Care Physician Merit-based Incentive Payment System Score and Measures of Process and Patient Outcomes https://jamanetwork.com/journals/jama/article-abstract/2799153

- Pay for Performance When Slogans Overtake Science in Health Policy https://jamanetwork.com/journals/jama/fullarticle/2799177

- Goodhart's law https://en.wikipedia.org/wiki/Goodhart%27s_law

IV. Open Science

- Radial Artery Outlasts SVG as Second CABG Conduit, Cuts 5-Year Clinical Risk https://www.medscape.com/viewarticle/896122

- Many Analysts, One Data Set: Making Transparent How Variations in Analytic Choices Affect Results https://doi.org/10.1177/2515245917747646

- Radial artery versus saphenous vein versus right internal thoracic artery for coronary artery bypass grafting https://academic.oup.com/ejcts/article/62/1/ezac345/6604735?login=false

- Do all roads lead to Rome? Critical reassessment of the individual patient meta-analysis on bypass grafts by Gaudino et al. https://doi.org/10.1093/ejcts/ezac564

- Editorial: Radial artery versus saphenous vein versus right internal thoracic artery for coronary artery bypass grafting: Different conduits or different trials? https://doi.org/10.1093/ejcts/ezac562

Features

- Mandrola’s Top 10 Cardiology Stories of 2022 https://www.medscape.com/viewarticle/985607

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Questions or feedback, please contact [email protected]

Nudges, statins, AI, less-is-more in the ICU, myocarditis, exercise as medicine, and December in the hospital 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. Nudges and Statin Prescribing

EHR Alerts to Both Doc and Patient May Boost Statin Prescribing

https://www.medscape.com/viewarticle/984944

Effect of Nudges to Clinicians, Patients, or Both to Increase Statin Prescribing

https://jamanetwork.com/journals/jamacardiology/article-abstract/2798971

Association of the Hospital Readmissions Reduction Program With Mortality Among Medicare Beneficiaries Hospitalized for Heart Failure, Acute Myocardial Infarction, and Pneumonia

https://jamanetwork.com/journals/jama/fullarticle/2719307

Lack of Efficacy of a Salience Nudge for Substituting Selection of Lower-Calorie for Higher-Calorie Milk in the Work Place https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4488787/

II. AI and Chest X-Ray

Single Chest X-Ray Could Predict 10-Year CVD Risk

https://www.medscape.com/viewarticle/984910

III. BOX Trial

Shorter Fever Prevention Duration Effective After Cardiac Arrest

https://www.medscape.com/viewarticle/984852

Duration of Device-Based Fever Prevention after Cardiac Arrest

https://www.nejm.org/doi/10.1056/NEJMoa2212528

Oxygen Targets in Comatose Survivors of Cardiac Arrest

https://www.nejm.org/doi/full/10.1056/NEJMoa2208686

Blood-Pressure Targets in Comatose Survivors of Cardiac Arrest

https://www.nejm.org/doi/full/10.1056/NEJMoa2208687

Lower or Higher Oxygenation Targets for Acute Hypoxemic Respiratory Failure

https://www.nejm.org/doi/full/10.1056/NEJMoa2032510

IV. Myocarditis

Mortality Higher in Myocarditis After Virus Than After COVID Vax

https://www.medscape.com/viewarticle/985045

Autopsy-based histopathological characterization of myocarditis after anti-SARS-CoV-2-vaccination

https://link.springer.com/article/10.1007/s00392-022-02129-5#Tab2

Myopericarditis After COVID-19 mRNA Vaccination Among Adolescents and Young Adults

https://jamanetwork.com/journals/jamapediatrics/fullarticle/2798866

Prognosis of Myocarditis Developing After mRNA COVID-19 Vaccination Compared With Viral Myocarditis

https://www.jacc.org/doi/full/10.1016/j.jacc.2022.09.049

V. Exercise as Medicine

Just 8 Minutes of Exercise a Day Is All You Need

https://www.medscape.com/viewarticle/984684

Vigorous physical activity, incident heart disease, and cancer: how little is enough? https://doi.org/10.1093/eurheartj/ehac572

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

Questions or feedback, please contact [email protected]

John M Mandrola, MD

SGLT2 inhibitors, publishing choices, second and third order effects of interventions, decision support, and patient selection for preventive procedures 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. EMPA Kidney

- EMPA-Kidney Seals SGLT2 Inhibitors as 'Foundational' for CKD https://www.medscape.com/viewarticle/984439

- EMPA-Kidney Moves the Needle for SGLT2 Inhibitors in Kidney Disease https://www.medscape.com/viewarticle/983521

- Empagliflozin in Patients with Chronic Kidney Disease https://www.nejm.org/doi/pdf/10.1056/NEJMoa2204233

- Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy https://www.nejm.org/doi/10.1056/NEJMoa1811744

- Dapagliflozin in Patients with Chronic Kidney Disease https://www.nejm.org/doi/full/10.1056/NEJMoa2024816

- Impact of diabetes on the effects of sodium glucose co-transporter-2 inhibitors on kidney outcomes: collaborative meta-analysis of large placebo-controlled trials https://doi.org/10.1016/S0140-6736(22)02074-8

II. Publishing Choices

- Motorcycle Rallies Linked to Spike in Organ Transplants https://www.medscape.com/viewarticle/984623

- Organ Donation and Transplants During Major US Motorcycle Rallies https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2798550

III. Second and Third Order Effects

- Heart Disease Deaths Spiked During COVID After 10-Year Decline https://www.medscape.com/viewarticle/984605

IV. Decision Support

- Patient App Aids Decisions on Anticoagulants: ENHANCE-AF https://www.medscape.com/viewarticle/984253

- A Randomized Clinical Trial to Evaluate an Atrial Fibrillation Stroke Prevention Shared Decision‐Making Pathway https://www.ahajournals.org/doi/10.1161/JAHA.122.028562

V. Percutaneous Left Atrial Appendage Closure

- Consider Life Expectancy When Referring for LAA Closure? https://www.medscape.com/viewarticle/981117

- Transcatheter Left Atrial Appendage Occlusion: A Multi-Center Real Life Experience https://www.mdpi.com/2077-0383/11/23/6944

- Incidence and Predictors of Early Death in Patients Undergoing Percutaneous Left Atrial Appendage Closure https://www.jacc.org/doi/full/10.1016/j.jacep.2022.06.012

- Indications for Left Atrial Appendage Occlusion in the United States and Associated In-Hospital Outcomes: Results From the NCDR LAAO Registry https://www.ahajournals.org/doi/full/10.1161/CIRCOUTCOMES.121.008418

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Questions or feedback, please contact [email protected]

AHA 2022, Part 2: IRONMAN, ECMO-CS, CTS-AMI, and PROGRESSIVE AF are the trials John Mandrola, MD, reviews 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. Pushback on PROMINENT

Zimerman Thread: https://twitter.com/AndreZimerman/status/1593019800036708353

II. IRONMAN

IRONMAN Galvanizes Case for IV Iron Repletion in Heart Failure

https://www.medscape.com/viewarticle/984030

Is Iron Replacement in Heart Failure Worth the Trouble?

https://www.medscape.com/viewarticle/983622

- Intravenous ferric derisomaltose in patients with heart failure and iron deficiency in the UK (IRONMAN): an investigator-initiated, prospective, randomised, open-label, blinded-endpoint trial https://doi.org/10.1016/S0140-6736(22)02083-9

III. ECMO-CS

Avoid Routine Early ECMO in Severe Cardiogenic Shock: ECMO-CS

https://www.medscape.com/viewarticle/983618

- Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock: Results of the ECMO-CS Randomized Clinical Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.062949

- Venoarterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock and Cardiac Arrest https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.118.004905

IV. CTS-AMI

Chinese Herbal Medicine May Offer Benefits in STEMI: CTS-AMI

https://www.medscape.com/viewarticle/983619

V. PROGRESSIVE AF

First-Line AF Ablation Cuts Risk of Progression vs Drug Therapy

https://www.medscape.com/viewarticle/983882

Role of Ablation Type and Risk Factors in Paroxysmal AF: PROGRESSIVE-AF Interview https://www.medscape.com/viewarticle/983474

- 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/10.1056/NEJMoa2212540

- Natural History of Subclinical Atrial Fibrillation Detected by Implanted Loop Recorders

https://pubmed.ncbi.nlm.nih.gov/31779791/

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

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[email protected]

AHA 2022 Part 1: ISCHEMIA-EXTEND, STRONG-HF, chlorthalidone vs HCTZ, experts vs practitioners; torsemide vs furosemide; and TG lowering are 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. AHA Meta-comments

II. ISCHEMIA-Extended

- ISCHEMIA-EXTEND: Conservative Stable CAD Management Holds Up https://www.medscape.com/viewarticle/983657

- Survival After Invasive or Conservative Management of Stable Coronary Disease https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.062714

III. STRONG-HF

- Rapidly, Fully Optimize HF Meds After Hospital Discharge: STRONG-HF https://www.medscape.com/viewarticle/983870

- STRONG HF: More Beats Less After Discharge for Heart Failure https://www.medscape.com/viewarticle/983698

- Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised, trial https://doi.org/10.1016/S0140-6736(22)02076-1

IV. DCP

- Diuretic Agents Equal to Prevent CV Events in Hypertension: DCP https://www.medscape.com/viewarticle/983608

- HCTZ vs Chlorthalidone -- A Win for Practicing Doctors and Science https://www.medscape.com/viewarticle/983614

V. TRANSFORM HF

- No Survival Advantage for Either Torsemide or Furosemide in HF: TRANSFORM-HF https://www.medscape.com/viewarticle/983611

VI. PROMINENT

- Triglyceride Lowering Fails to Show CV Benefit in Large Fibrate Trial https://www.medscape.com/viewarticle/983610

- Triglyceride Lowering with Pemafibrate to Reduce Cardiovascular Risk https://www.nejm.org/doi/full/10.1056/NEJMoa2210645

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Questions or feedback, please contact [email protected]

AF conversion in the ED, HRT, a shining example of evidence-based medicine and less-is-more, multimorbidity, and what’s coming at AHA 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. AF Conversion

- IV Potassium and Magnesium an Acute Treatment for AF? https://www.medscape.com/viewarticle/983137

- Association of Intravenous Potassium and Magnesium Administration With Spontaneous Conversion of Atrial Fibrillation and Atrial Flutter in the Emergency Department https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2797474

II. HRT

- USPSTF Doesn't Change Postmenopausal Hormone Recommendations https://www.medscape.com/viewarticle/983349

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

- Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal WomenPrincipal Results From the Women's Health Initiative Randomized Controlled Trial https://jamanetwork.com/journals/jama/fullarticle/195120

- Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal PersonsUS Preventive Services Task Force Recommendation Statement https://jamanetwork.com/journals/jama/fullarticle/2797867

- Menopausal Hormone Therapy for Prevention of Chronic Conditions https://jamanetwork.com/journals/jama/fullarticle/2797897

III. BP Targets After Stroke Intervention

- Intensive BP Lowering Harmful in Acute Ischemic Stroke: ENCHANTED2/MT https://www.medscape.com/viewarticle/983176

- Intensive blood pressure control after endovascular thrombectomy for acute ischaemic stroke (ENCHANTED2/MT): a multicentre, open-label, blinded-endpoint, randomised controlled trial https://doi.org/10.1016/S0140-6736(22)01882-7

IV. Multimorbidity

- ACC Issues Guidance on Integrating ASCVD and Multimorbidity Care https://www.medscape.com/viewarticle/983123

- 2022 ACC Expert Consensus Decision Pathway for Integrating Atherosclerotic Cardiovascular Disease and Multimorbidity Treatment: A Framework for Pragmatic, Patient-Centered Care: A Report of the American College of Cardiology Solution Set Oversight Committee https://www.jacc.org/doi/10.1016/j.jacc.2022.08.754

V. AHA Preview

- AHA 2022 to Recapture In-Person Vibe but Preserve Global Reach https://www.medscape.com/viewarticle/983315

- Mandrola's Top 5 Picks From AHA 2022 Previewed https://www.medscape.com/viewarticle/983237

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Questions or feedback, please contact [email protected]

ERASE AF follow-up, recreational drugs and AF, etripamil, misuse of science, and diabetes as a cardiovascular risk factor 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. Follow-up on ERASE AF

II. Recreational Drugs

Four Commonly Abused Drugs Linked With Atrial Fibrillation

https://www.medscape.com/viewarticle/983052

III. Etripamil

RAPID: Positive Data for Etripamil Nasal Spray in Paroxysmal SVT

https://www.medscape.com/viewarticle/982787

- Milestone Pharmaceuticals Announces Positive Results from Phase 3 RAPID Clinical Trial of Etripamil Nasal Spray in Patients with Paroxysmal Supraventricular Tachycardia https://investors.milestonepharma.com/news-releases/news-release-details/milestone-pharmaceuticals-announces-positive-results-phase-3

IV. Misuse of Science

When Bad Actors Hijack Good Research

https://www.medscape.com/viewarticle/982936

- Level and Prevalence of Spin in Published Cardiovascular Randomized Clinical Trial Reports With Statistically Nonsignificant Primary Outcomes: A Systematic Review https://pubmed.ncbi.nlm.nih.gov/31050775/

V. Diabetes as a Risk Factor

Diabetes Becoming Less Potent Risk Factor for CVD Events

https://www.medscape.com/viewarticle/982801

- Trends in the Association Between Diabetes and Cardiovascular Events, 1994-2019 https://jamanetwork.com/journals/jama/fullarticle/2797494

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

Questions or feedback, please contact

[email protected]

The ERASE AF ablation trial, left bundle pacing, finerenone, and perceptions of cardiology 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 Ablation

- Low-Voltage Myocardium-Guided Ablation Trial of Persistent Atrial Fibrillation https://evidence.nejm.org/doi/10.1056/EVIDoa2200141

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

- Effect of MRI-Guided Fibrosis Ablation vs Conventional Catheter Ablation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial Fibrillation https://jamanetwork.com/journals/jama/fullarticle/2793452

- Circumferential Pulmonary Vein Isolation Plus Low-Voltage Area Modification in Persistent Atrial Fibrillation: The STABLE-SR-II Trial https://www.jacc.org/doi/full/10.1016/j.jacep.2022.03.012

- Effect of Catheter Ablation With Vein of Marshall Ethanol Infusion vs Catheter Ablation Alone on Persistent Atrial Fibrillation https://jamanetwork.com/journals/jama/fullarticle/2772281

- Hybrid Convergent Procedure for the Treatment of Persistent and Long-Standing Persistent Atrial Fibrillation https://www.ahajournals.org/doi/full/10.1161/CIRCEP.120.009288

II. Left Bundle Branch Area Pacing

- FDA OKs Medtronic Lead for Left Bundle Branch Pacing https://www.medscape.com/viewarticle/982577

- Left bundle branch area pacing outcomes: the multicentre European MELOS study https://academic.oup.com/eurheartj/article/43/40/4161/6671019

- Randomized Trial of Left Bundle Branch vs Biventricular Pacing for Cardiac Resynchronization Therapy https://www.jacc.org/doi/full/10.1016/j.jacc.2022.07.019

- Early sudden distal conductor fracture of a stylet-driven lead implanted for left bundle branch area pacing https://doi.org/10.1016/j.hrcr.2022.10.004

- Repositioning and extraction of stylet-driven pacing leads with extendable helix used for left bundle branch area pacing https://pubmed.ncbi.nlm.nih.gov/33825263/

- Safety and Procedural Success of Left Atrial Appendage Exclusion With the Lariat Device https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2289126

III. Finerenone

- Finerenone Benefits T2D Across Spectrum of Renal Function https://www.medscape.com/viewarticle/982626

- Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes https://www.nejm.org/doi/10.1056/NEJMoa2110956

- Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis https://academic.oup.com/eurheartj/article/43/6/474/6433104

- Finerenone and Heart Failure Outcomes by Kidney Function/Albuminuria in Chronic Kidney Disease and Diabetes https://www.jacc.org/doi/10.1016/j.jchf.2022.07.013

IV. Perceptions of Cardiology

- IM Residents Rate Cardiology Low on Work-Life Balance https://www.medscape.com/viewarticle/982578

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Questions or feedback, please contact [email protected]

Chest pain evaluation in the ED, peer review, the NordICC trial, and a surgeon lost too early 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. Chest Pain Consensus Pathway

- ACC Issues Guidance on ED Evaluation of Acute Chest Pain https://www.medscape.com/viewarticle/982302

- 2022 ACC Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain in the Emergency Department: A Report of the American College of Cardiology Solution Set Oversight Committee https://www.jacc.org/doi/10.1016/j.jacc.2022.08.750

- 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines https://www.ahajournals.org/doi/10.1161/CIR.0000000000001030#d20522356e1

II. Peer Review

- Big Name Researchers May Get Special Treatment, Limiting New Science https://www.medscape.com/viewarticle/982193

- Nobel and Novice: Author Prominence Affects Peer Review https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4190976

- Editorial peer review for improving the quality of reports of biomedical studies https://www.cochrane.org/MR000016/METHOD_editorial-peer-review-for-improving-the-quality-of-reports-of-biomedical-studies

III. NordICC

- Colonoscopy Lowers CRC Risk and Death, but Not by Much: NordICC https://www.medscape.com/viewarticle/982143

- Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death https://www.nejm.org/doi/full/10.1056/NEJMoa2208375

- The arrogance of preventive medicine https://www.ncbi.nlm.nih.gov/pmc/articles/PMC117852/

- Five-Year Outcomes of the Danish Cardiovascular Screening (DANCAVAS) Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2208681

IV. Domenico Pagano

- Surgeon Domenico Pagano Has Died, EACTS Announces https://www.medscape.com/viewarticle/982351

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

Questions or feedback, please contact [email protected]

Post-PCI antiplatelet therapy, palliative care in patients with HF, Watchman information on hospital websites, and HCM in athletes 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-Stent Antiplatelet Therapy

SMART-CHOICE 3-Year Results Support Dropping Aspirin After PCI

https://www.medscape.com/viewarticle/981741

• Long-term Effects of P2Y12 Inhibitor Monotherapy After Percutaneous Coronary Intervention https://jamanetwork.com/journals/jamacardiology/fullarticle/2796902
• The Smart(est) Choice for Dual Antiplatelet Therapy is a Patient-Directed One https://jamanetwork.com/journals/jamacardiology/fullarticle/2796904
• Effect of P2Y12 Inhibitor Monotherapy vs Dual Antiplatelet Therapy on Cardiovascular Events in Patients Undergoing Percutaneous Coronary Intervention https://jamanetwork.com/journals/jama/fullarticle/2736564

II. Palliative Care in HF

Home-Based Palliative Care Improves Heart Failure Outcomes https://www.medscape.com/viewarticle/981715

• Regional collaborative home-based palliative care and health care outcomes among adults with heart failure https://doi.org/10.1503/cmaj.220784

III. Watchman Info on Hospital Websites

Concern Over US Hospital Patient Information on LAA Closure https://www.medscape.com/viewarticle/981961

• Analysis of Patient-Focused Information About Left Atrial Appendage Occlusion on US Hospital Web Pages https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2797102

IV. HCM and Exercise in Athletes

Athletes With Mild HCM Can Likely Continue Competitive Sports https://www.medscape.com/viewarticle/981782

• Impact of Exercise on Outcomes and Phenotypic Expression in Athletes With Nonobstructive Hypertrophic Cardiomyopathy https://www.jacc.org/doi/full/10.1016/j.jacc.2022.08.715
• A novel clinical risk prediction model for sudden cardiac death in hypertrophic cardiomyopathy (HCM risk-SCD) https://pubmed.ncbi.nlm.nih.gov/24126876/

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https://www.medscape.com/features/public/machine

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

Questions or feedback, please contact

[email protected]

Pulmonary embolism, coffee, when DOACs don’t work, lipoprotein (a), and the marginal benefits of current CV therapy 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. Pulmonary Embolism

- Positive Data on Thrombectomy Catheter That Avoids Thrombolytics in Acute PE https://www.medscape.com/viewarticle/981322

- Acute Outcomes for the Full US Cohort of the FLASH Mechanical Thrombectomy Registry in Pulmonary Embolism https://eurointervention.pcronline.com/article/acute-outcomes-for-the-full-us-cohort-of-the-flash-mechanical-thrombectomy-registry-in-pulmonary-embolism

- PEERLESS Study https://clinicaltrials.gov/ct2/show/NCT05111613

- Ultrasound-facilitated, Catheter-directed, Thrombolysis in Intermediate-high Risk Pulmonary Embolism (HI-PEITHO) https://clinicaltrials.gov/ct2/show/NCT04790370

- A Prospective, Single-Arm, Multicenter Trial of Catheter-Directed Mechanical Thrombectomy for Intermediate-Risk Acute Pulmonary Embolism: The FLARE Study https://doi.org/10.1016/j.jcin.2018.12.022

II. Coffee Again

- Coffee Linked to Reduced Cardiovascular Disease and Mortality https://www.medscape.com/viewarticle/981518

Enough With the Coffee Research and Other Distractions https://www.medscape.com/viewarticle/883709

- The impact of coffee subtypes on incident cardiovascular disease, arrhythmias, and mortality: long-term outcomes from the UK Biobank https://doi.org/10.1093/eurjpc/zwac189

III. DOAC and Mechanical Valves

- PROACT Xa Trial of Apixaban With On-X Heart Valve Stopped https://www.medscape.com/viewarticle/981644

- Artivion Follows Recommendation to Stop PROACT Xa Clinical Trial https://investors.artivion.com/news-releases/news-release-details/artivion-follows-recommendation-stop-proact-xa-clinical-trial

- PROACT Xa - A Trial to Determine if Participants With an On-X Aortic Valve Can be Maintained Safely on Apixaban https://clinicaltrials.gov/ct2/show/NCT04142658

- Dabigatran versus Warfarin in Patients with Mechanical Heart Valves https://www.nejm.org/doi/full/10.1056/nejmoa1300615

IV. Lipoprotein(a)

- Aspirin Primary Prevention Benefit in Those With Raised Lp(a)? https://www.medscape.com/viewarticle/981602

- Aspirin for Primary Prevention of Cardiovascular Events in Relation to Lipoprotein(a) Genotypes https://www.jacc.org/doi/full/10.1016/j.jacc.2022.07.027

- A Randomized Trial of Low-Dose Aspirin in the Primary Prevention of Cardiovascular Disease in Women https://www.nejm.org/doi/full/10.1056/nejmoa050613

- Effect of Aspirin on Disability-free Survival in the Healthy Elderly https://www.nejm.org/doi/full/10.1056/NEJMoa1800722

- Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly https://www.nejm.org/doi/full/10.1056/NEJMoa1805819

- Effect of Aspirin on All-Cause Mortality in the Healthy Elderly https://www.nejm.org/doi/full/10.1056/NEJMoa1803955

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

Questions or feedback, please contact: [email protected]

In this week’s podcast, John Mandrola, MD, discusses the PROTECTED TAVR trial, renal denervation, left atrial appendage closure and deprescribing aspirin.

This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic

I Cerebral Embolic Protection After TAVI

- Clear Stroke Benefit Eludes Embolic Protection: PROTECTED TAVR https://www.medscape.com/viewarticle/980978

- Cerebral Embolic Protection during Transcatheter Aortic-Valve Replacement https://www.nejm.org/doi/10.1056/NEJMoa2204961

- Protection Against Cerebral Embolism During Transcatheter Aortic Valve Replacement https://doi.org/10.1016/j.jacc.2016.10.023

- Angiotensin–Neprilysin Inhibition in Heart Failure with Preserved Ejection Fraction https://www.nejm.org/doi/full/10.1056/NEJMoa1908655

- Five-Year Outcomes of the Danish Cardiovascular Screening (DANCAVAS) Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2208681

- Randomised Trial Of Intravenous Streptokinase, Oral Aspirin, Both, Or Neither Among 17 187 Cases Of Suspected Acute Myocardial Infarction: Isis-2 https://doi.org/10.1016/S0140-6736(88)92833-4

II Renal Denervation

- Legacy of Neutral Renal Denervation Trial Recast by Long-term Outcomes: SYMPLICITY HTN-3 https://www.medscape.com/viewarticle/981062

- Long-term outcomes after catheter-based renal artery denervation for resistant hypertension: final follow-up of the randomised SYMPLICITY HTN-3 Trial https://doi.org/10.1016/S0140-6736(22)01787-1

- A systematic review, meta-analysis, and meta regression of the sham controlled renal denervation randomized controlled trials https://doi.org/10.1016/j.tcm.2022.05.009

- Legacy of Neutral Renal Denervation Trial Recast by Long-term Outcomes: SYMPLICITY HTN-3 https://www.medscape.com/viewarticle/981062

- A Controlled Trial of Renal Denervation for Resistant Hypertension https://www.nejm.org/doi/10.1056/NEJMoa1402670

III Percutaneous Left Atrial Appendage Occlusion (LAAO)

- Amulet, Watchman 2.5 LAAO Outcomes Neck and Neck at 3 Years https://www.medscape.com/viewarticle/981199

- Consider Life Expectancy When Referring for LAA Closure? https://www.medscape.com/viewarticle/981117

- Incidence and Predictors of Early Death in Patients Undergoing Percutaneous Left Atrial Appendage Closure https://www.jacc.org/doi/full/10.1016/j.jacep.2022.06.012

IV Deprescribing Aspirin

- Deprescribing Aspirin for Warfarin Patients May Reduce Bleeding https://www.medscape.com/viewarticle/981243

- Assessment of an Intervention to Reduce Aspirin Prescribing for Patients Receiving Warfarin for Anticoagulation https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2796492

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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

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Questions or feedback, please contact [email protected]

The safety of very low LDL-C, the win-ratio analytic method, sacubitril/valsartan, SGLT2 inhibitors, and percutaneous left atrial appendage closure 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 PCSK9I

Evolocumab Benefits Accrue With Longer Follow-up: FOURIER OLE https://www.medscape.com/viewarticle/979950

- Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease https://www.nejm.org/doi/full/10.1056/nejmoa1615664

- Long-Term Evolocumab in Patients with Established Atherosclerotic Cardiovascular Disease https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.061620

II Analytic Methods and Re-Analysis of Old Trials

- PARADISE-MI Results Obscured As Post Hoc Analysis Finds Flaws https://www.medscape.com/viewarticle/980776

- Angiotensin Receptor–Neprilysin Inhibition in Acute Myocardial Infarction https://www.nejm.org/doi/10.1056/NEJMoa2104508

- Impact of Sacubitril/Valsartan Versus Ramipril on Total Heart Failure Events in the PARADISE-MI Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057429

- The Year’s Most Important Study Adds to Uncertainty in Science https://www.medscape.com/viewarticle/904286

III SGLT2i Post MI

- Early Signal of Benefit for Empagliflozin in Acute MI: EMMY https://www.medscape.com/viewarticle/980180

- Empagliflozin in acute myocardial infarction: the EMMY trial https://doi.org/10.1093/eurheartj/ehac494

IV Percutaneous Left Atrial Appendage Closure

- Incidence and Predictors of Early Death in Patients Undergoing Percutaneous Left Atrial Appendage Closure https://www.jacc.org/doi/10.1016/j.jacep.2022.06.012

- Cost‐Effectiveness of Left Atrial Appendage Closure for Stroke Reduction in Atrial Fibrillation: Analysis of Pooled, 5‐Year, Long‐Term Data https://www.ahajournals.org/doi/10.1161/JAHA.118.011577

- Baseline Comorbidities And Bleeding Events Of Patients Undergoing Percutaneous Left Atrial Appendage Occlusion Among Medicare Beneficiaries https://www.jacc.org/doi/10.1016/S0735-1097%2822%2901158-5

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Questions or feedback, please contact [email protected]

A potential new anticoagulant, surveillance stress testing, a trial misinterpretation, an old diuretic, and AI in cardiology 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. Factor XI inhibitors

- Factor XIa Inhibitor After MI, Stroke Encouraging in Early Phase 2 Studies https://www.medscape.com/viewarticle/979942

- AXIOMATIC-SSP: Cautious Optimism on Factor XI Inhibitor in Stroke https://www.medscape.com/viewarticle/979860

II. Surveillance Stress Testing

- No Benefit of Routine Stress Test POST-PCI in High-Risk Patients https://www.medscape.com/viewarticle/979866

- Routine Functional Testing or Standard Care in High-Risk Patients after PCI https://www.nejm.org/doi/full/10.1056/NEJMoa2208335

III. New Diuretic for Acute Heart Failure

- Vintage Drug Atop IV Loop Diuretics Boosts Decongestion in ADHF: ADVOR https://www.medscape.com/viewarticle/979851

- Acetazolamide in Acute Decompensated Heart Failure with Volume Overload https://www.nejm.org/doi/full/10.1056/NEJMoa2203094

IV. AI in Cardiology

- In Blinded Trial, Artificial Intelligence Beats Sonographers for Echo Accuracy https://www.medscape.com/viewarticle/979857

- Video-based AI for beat-to-beat assessment of cardiac function https://www.nature.com/articles/s41586-020-2145-8

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Questions or feedback, please contact [email protected]

A second ESC review covering REVIVED, the DANCAVAS CV screening trial, DELIVER on dapagliflozin in HF with mildly reduced EF, and the INVICTUS trial of rivaroxaban in rheumatic heart disease. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic

I REVIVED BCIS

- PCI Fails to Beat OMT in Ischemic Cardiomyopathy: REVIVED-BCIS2 https://www.medscape.com/viewarticle/979853

- Percutaneous Revascularization for Ischemic Left Ventricular Dysfunction https://www.nejm.org/doi/full/10.1056/NEJMoa2206606

- Coronary-Artery Bypass Surgery in Patients with Left Ventricular Dysfunction https://www.nejm.org/doi/full/10.1056/nejmoa1100356

II DANCAVAS

- DANCAVAS Misses Primary Endpoint but Hints at Benefit from Comprehensive CV Screening https://www.medscape.com/viewarticle/979854

- Five-Year Outcomes of the Danish Cardiovascular Screening (DANCAVAS) Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2208681

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

III DELIVER Trial

- Dapagliflozin's HFpEF Benefit Recasts Heart Failure Treatment: DELIVER https://www.medscape.com/viewarticle/979855

- Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction https://www.nejm.org/doi/full/10.1056/NEJMoa2206286

- Empagliflozin in Heart Failure with a Preserved Ejection Fraction https://www.nejm.org/doi/full/10.1056/NEJMoa2107038

- SGLT-2 inhibitors in patients with heart failure: a comprehensive meta-analysis of five randomised controlled trials https://doi.org/10.1016/S0140-6736(22)01429-5

IV Rheumatic Heart Disease

- Rivaroxaban Outmatched by VKAs for AF in Rheumatic Heart Disease https://www.medscape.com/viewarticle/979861

- Rivaroxaban in Rheumatic Heart Disease–Associated Atrial Fibrillation https://www.nejm.org/doi/full/10.1056/NEJMoa2209051

- Rivaroxaban in Patients with Atrial Fibrillation and a Bioprosthetic Mitral Valve https://www.nejm.org/doi/full/10.1056/NEJMoa2029603

- Outcomes of Direct Oral Anticoagulants in Patients With Mitral Stenosis https://www.jacc.org/doi/full/10.1016/j.jacc.2018.12.047

Features:

- Do SGLT2 Inhibitors DELIVER in All Patients With Heart Failure? https://www.medscape.com/viewarticle/979852

- PCI Fails in Stable Disease Again: REVIVED-BCIS https://www.medscape.com/viewarticle/979862

- DANCAVAS: Might Cardiovascular Screening Extend Men's Lives? https://www.medscape.com/viewarticle/979632

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

Questions or feedback, please contact [email protected]

Early rhythm control in AF, treating coronary artery disease before transcatheter aortic valve implantation, and an ESC 2022 preview 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. Early Rhythm Control

- Early AF Rhythm-Control Advantage Climbs With Comorbidity Burden: EAST-AFNET4 https://www.medscape.com/viewarticle/979627

- Early Rhythm Control in Patients With Atrial Fibrillation and High Comorbidity Burden https://www.ahajournals.org/doi/suppl/10.1161/CIRCULATIONAHA.122.060274

Early Rhythm-Control Therapy in Patients with Atrial Fibrillation https://www.nejm.org/doi/full/10.1056/NEJMoa2019422

II. CAD and Aortic Stenosis

- No Survival Gains Seen From Pre-TAVR PCI of Complex CAD https://www.medscape.com/viewarticle/979408

- The Effect of Coronary Lesion Complexity and Preprocedural Revascularization on 5-Year Outcomes After TAVR https://doi.org/10.1016/j.jcin.2022.06.019

- Transcatheter Aortic Valve Implantation With or Without Percutaneous Coronary Artery Revascularization Strategy: A Systematic Review and Meta‐Analysis https://www.ahajournals.org/doi/10.1161/JAHA.117.005960

- ACTIVATION (PercutAneous Coronary inTervention prIor to transcatheter aortic Valve implantaTION): A Randomized Clinical Trial https://www.jacc.org/doi/full/10.1016/j.jcin.2021.06.041

III. ESC Trials

- Mandrola Previews His Top 5 Trials From ESC 2022 https://www.medscape.com/viewarticle/979560

TIME

- Bedtime dosing of antihypertensive medications: systematic review and consensus statement: International Society of Hypertension position paper endorsed by World Hypertension League and European Society of Hypertension https://pubmed.ncbi.nlm.nih.gov/35983870/

- Empirical Evaluation of Very Large Treatment Effects of Medical Interventions https://jamanetwork.com/journals/jama/fullarticle/1386610

SECURE

- Polypill Strategy in Secondary Cardiovascular Prevention http://www.nejm.org/doi/full/10.1056/NEJMoa2208275

The obesity paradox in AF and paradoxes in general, digital health gets whacked again, and direct-to-consumer ads 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. Collider Bias and the Obesity Paradox

- 'Obesity Paradox' in Atrial Fibrillation Challenged as Mortality Climbs With BMI https://www.medscape.com/viewarticle/979150

- Association of body mass index with outcomes in patients with newly diagnosed atrial fibrillation: GARFIELD-AF https://openheart.bmj.com/content/9/2/e002038

- Collider bias https://catalogofbias.org/biases/collider-bias/

- Pediatric obesity appears to lower the risk of diabetes if selection bias is ignored https://pubmed.ncbi.nlm.nih.gov/29374028/

- Effect of Caloric Restriction or Aerobic Exercise Training on Peak Oxygen Consumption and Quality of Life in Obese Older Patients With Heart Failure With Preserved Ejection Fraction: A Randomized Clinical Trial https://jamanetwork.com/journals/jama/fullarticle/2480484

II. Digital Health

- Blood Pressure Smartphone App Fails to Beat Standard Self-Monitoring https://www.medscape.com/viewarticle/979341

- Effectiveness of Standard vs Enhanced Self-measurement of Blood Pressure Paired With a Connected Smartphone Application https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2794971

III. Direct-to-Consumer Ads

- Does DTC Heart Drug Advertising Discourage Lifestyle Changes? https://www.medscape.com/viewarticle/979404

- Association of Direct-to-Consumer Advertising of Prescription Drugs With Consumer Health-Related Intentions and Beliefs Among Individuals at Risk of Cardiovascular Disease https://jamanetwork.com/journals/jama-health-forum/fullarticle/2794995

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Questions or feedback, please contact [email protected]

AF screening; sodium, potassium, BP, and CV outcomes; drug prices; and cardio-respiratory fitness 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. AF Screening

- Using Wearable Devices to Detect AF Is 'Cost Effective' https://www.medscape.com/viewarticle/978861

- Cost-effectiveness of Screening for Atrial Fibrillation Using Wearable Devices https://jamanetwork.com/journals/jama-health-forum/fullarticle/2794835

- Screening for Atrial Fibrillation in Asymptomatic Older Adults https://www.nejm.org/doi/full/10.1056/NEJMclde2203726

II. Salt Substitutes

- More Evidence Salt Substitutes Lower Risk of CVD and Death https://www.medscape.com/viewarticle/978999

- Effects of salt substitutes on clinical outcomes: a systematic review and meta-analysis https://heart.bmj.com/content/early/2022/07/21/heartjnl-2022-321332

- Effect of Salt Substitution on Cardiovascular Events and Death https://www.nejm.org/doi/10.1056/NEJMoa2105675

- Settling the controversy of salt substitutes and stroke: sodium reduction or potassium increase? https://doi.org/10.1093/eurheartj/ehac160

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

- Fractional Flow Reserve versus Angiography for Guiding Percutaneous Coronary Intervention https://www.nejm.org/doi/full/10.1056/nejmoa0807611

III. Drug Prices

- House Could Soon Give Biden Win on Medicare Drug Negotiations, Insulin Costs https://www.medscape.com/viewarticle/978988

IV. Fitness is Under-rated

- Cardiorespiratory Fitness Key to Longevity for All? https://www.medscape.com/viewarticle/978854

- Cardiorespiratory Fitness and Mortality Risk Across the Spectra of Age, Race, and Sex https://www.jacc.org/doi/full/10.1016/j.jacc.2022.05.031

- Cardiorespiratory fitness, obesity and left atrial function in patients with atrial fibrillation https://doi.org/10.1016/j.ijcha.2022.101083

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Questions or feedback, please contact [email protected]

Hyperkalemia in heart failure, CV health in America, primary prevention ICDs, and a debate about posters at medical meetings 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. Hyperkalemia in Heart Failure

- DIAMOND: Adding Patiromer Helps Optimize HF Meds, Foils Hyperkalemia https://www.medscape.com/viewarticle/971616

- Patiromer for the management of hyperkalemia in heart failure with reduced ejection fraction: the DIAMOND trial https://doi.org/10.1093/eurheartj/ehac401

- Potassium Binders for Patients With Heart Failure? The Real Enlightenment of the DIAMOND Trial https://doi.org/10.1093/eurheartj/ehac399

- The Effect of Spironolactone on Morbidity and Mortality in Patients with Severe Heart Failure https://www.nejm.org/doi/full/10.1056/nejm199909023411001

- Eplerenone in Patients with Systolic Heart Failure and Mild Symptoms https://www.nejm.org/doi/full/10.1056/nejmoa1009492

- Evaluation of the efficacy and safety of RLY5016, a polymeric potassium binder, in a double-blind, placebo-controlled study in patients with chronic heart failure (the PEARL-HF) trial https://pubmed.ncbi.nlm.nih.gov/21208974/

II. CV Health in America

- ‘Staggering’ CVD Rise Projected in US, Especially in Minorities https://www.medscape.com/viewarticle/978366

- Cardiovascular Disease Projections in the United States Based on the 2020 Census Estimates https://www.jacc.org/doi/10.1016/j.jacc.2022.05.033

III. Primary Prevention ICDs in Modern Era

- Do ICDs Still ‘Work’ in Primary Prevention Given Today’s Recommended HF Meds? https://www.medscape.com/viewarticle/978254

- Guideline-Directed Medical Therapy and the Risk of Death in Primary Prevention Defibrillator Recipients https://doi.org/10.1016/j.jacep.2022.05.001

- 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

IV. Medical Meetings and Posters

- As Digital Posters Take Over, Traditionalists Push Back https://www.medscape.com/viewarticle/978384

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Questions or feedback, please contact [email protected]

A big new HF and EP trial, doctors and probability, LV assist devices in cardiogenic shock, vitamin D, and exercise in PAD 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. Left vs Left RCT

Taking Cardiac Pacing From Boring to Super-Cool https://www.medscape.com/viewarticle/973615

Conduction-System Pacing Shines vs BiV Pacing for CRT in Early Studies https://www.medscape.com/viewarticle/974173

• Baylor led research awarded $31 Million for Resynchronization Therapy in Patients with Heart Failure https://www.bcm.edu/news/baylor-led-research-awarded-31-million-for-resynchronization-therapy-in-patients-with-heart-failure

II. Probability and Conjunction Fallacy

Is What You Call Probable...Impossible?

https://www.medscape.com/viewarticle/976451

• Analysis of Physicians’ Probability Estimates of a Medical Outcome Based on a Sequence of Events

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2793624

III. LV Assist Devices

Impella Pump for MI With Cardiogenic Shock Again Fares Poorly vs IABP in Study

https://www.medscape.com/viewarticle/977994

• Clinical Outcomes and Cost Associated With an Intravascular Microaxial Left Ventricular Assist Device vs Intra-aortic Balloon Pump in Patients Presenting With Acute Myocardial Infarction Complicated by Cardiogenic Shock

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2794390

• Intravascular Microaxial Left Ventricular Assist Device for Acute Myocardial Infarction With Cardiogenic Shock—A Call for Evidence of Benefit https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2794394

• Intra-aortic Balloon Pump Therapy for Acute Myocardial InfarctionA Meta-analysis https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2210888

IV. Vitamin D

Vitamin D Supplements Do Not Lower Risk of Fractures

https://www.medscape.com/viewarticle/978108

Why Is Vitamin D Hype So Impervious to Evidence? https://www.medscape.com/viewarticle/968682

• Supplemental Vitamin D and Incident Fractures in Midlife and Older Adults

https://www.nejm.org/doi/full/10.1056/NEJMoa2202106

V. Peripheral Artery Disease

For Patients With Peripheral Artery Disease, Pain Can Be Gain

https://www.medscape.com/viewarticle/978053

• Effects of Walking Exercise at a Pace With Versus Without Ischemic Leg Symptoms on Functional Performance Measures in People With Lower Extremity Peripheral Artery Disease: The LITE Randomized Clinical Trial

https://www.ahajournals.org/doi/10.1161/JAHA.121.025063

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

Questions or feedback, please contact mailto:[email protected]

Therapeutic fashion and conduction system pacing, early rhythm control in AF, statins in CKD, and salt intake in HF 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 – Therapeutic Fashion and Conduction System Pacing

- Medical Necessity vs Therapeutic Fashion: How Evidence-Based Is Your Field of Medicine? https://www.medscape.com/viewarticle/977358

- Conduction System Pacing Noninferior to Biventricular Pacing for HF With Wide QRS https://www.medscape.com/viewarticle/971740

- His Corrective Pacing or Biventricular Pacing for Cardiac Resynchronization in Heart Failure https://www.jacc.org/doi/full/10.1016/j.jacc.2019.04.026

II – Early Rhythm Control

- Benefit of Early Rhythm Control Questioned in Newly Diagnosed Atrial Fibrillation https://www.medscape.com/viewarticle/977584

- Presenting Pattern of Atrial Fibrillation and Outcomes of Early Rhythm Control Therapy https://doi.org/10.1016/j.jacc.2022.04.058

- Early Rhythm-Control Therapy in Patients with Atrial Fibrillation https://www.nejm.org/doi/full/10.1056/NEJMoa2019422

III – Statins and CKD

- Rosuvastatin Again Linked With Risks to Kidneys https://www.medscape.com/viewarticle/977646

- Association of Rosuvastatin Use with Risk of Hematuria and Proteinuria https://doi.org/10.1681/ASN.2022020135

- Atorvastatin in Patients with Type 2 Diabetes Mellitus Undergoing Hemodialysis https://www.nejm.org/doi/10.1056/NEJMoa043545

- Rosuvastatin and Cardiovascular Events in Patients Undergoing Hemodialysis https://www.nejm.org/doi/full/10.1056/nejmoa0810177

IV – Sodium and HF

- Overly Tight Sodium Restriction May Worsen HFpEF Outcomes https://www.medscape.com/viewarticle/977441

- Salt restriction and risk of adverse outcomes in heart failure with preserved ejection fraction https://heart.bmj.com/content/early/2022/06/07/heartjnl-2022-321167

- Spironolactone for Heart Failure with Preserved Ejection Fraction https://www.nejm.org/doi/full/10.1056/nejmoa1313731

- Reduction of dietary sodium to less than 100 mmol in heart failure (SODIUM-HF): an international, open-label, randomised, controlled trial https://doi.org/10.1016/S0140-6736(22)00369-5

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Questions or feedback, please contact [email protected]

The LIFE study, multimorbidity and evidence translation, cardiac arrest and therapeutic fashion, diabetes and cardiology, and EP cuts 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 – LIFE Study and Substudy

- LIFE: ARNI Does Not Best Valsartan in Advanced Heart Failure https://www.medscape.com/viewarticle/952681

- Tolerability of Sacubitril/Valsartan in Patients With Advanced Heart Failure: Analysis of the LIFE Trial Run-In https://www.jacc.org/doi/10.1016/j.jchf.2022.04.013

- Effect of Treatment With Sacubitril/Valsartan in Patients With Advanced Heart Failure and Reduced Ejection FractionA Randomized Clinical Trial https://jamanetwork.com/journals/jamacardiology/fullarticle/2785700

II – Early Angiography and Therapeutic Fashion

- Emergency Angiography for Cardiac Arrest Without ST Elevation? https://www.medscape.com/viewarticle/975434

- Emergency vs Delayed Coronary Angiogram in Survivors of Out-of-Hospital Cardiac ArrestResults of the Randomized, Multicentric EMERGE Trial https://jamanetwork.com/journals/jamacardiology/article-abstract/2793310

- Immediate Coronary Angiography in Survivors of Out-of-Hospital Cardiac Arrest https://www.nejm.org/doi/full/10.1056/NEJM199706053362302

- Coronary Angiography after Cardiac Arrest without ST-Segment Elevation https://www.nejm.org/doi/10.1056/NEJMoa1816897

- Randomized Pilot Clinical Trial of Early Coronary Angiography Versus No Early Coronary Angiography After Cardiac Arrest Without ST-Segment Elevation https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.049569

- Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation https://www.nejm.org/doi/10.1056/NEJMoa2101909

- Most healthcare interventions tested in Cochrane Reviews are not effective according to high quality evidence: a systematic review and meta-analysis https://www.jclinepi.com/article/S0895-4356(22)00100-7/fulltext

III – Diabetes and Cardiology

- Medicare Advantage Tied to Less Use of Pricey Diabetes Drugs https://www.medscape.com/viewarticle/977181

- Diabetes Care Among Older Adults Enrolled in Medicare Advantage Versus Traditional Medicare Fee-For-Service Plans: The Diabetes Collaborative Registry https://doi.org/10.2337/dc21-1178

IV – EP Cuts

- EP Ablation Rate Changes in 2022 Physician Fee Schedule https://www.acc.org/Latest-in-Cardiology/Articles/2021/11/18/01/44/EP-Ablation-Rate-Changes-in-2022-Physician-Fee-Schedule

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Questions or feedback, please contact [email protected]

On this week’s podcast, John Mandrola, MD discusses fish oil, America’s heart health, pharmacists and prescribing and statins This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic

I - Fish Oil

- New Biomarker Data Add to Concerns Over REDUCE-IT Trial https://www.medscape.com/viewarticle/976490

- Effects of Randomized Treatment With Icosapent Ethyl and a Mineral Oil Comparator on Interleukin-1β, Interleukin-6, C-Reactive Protein, Oxidized Low-Density Lipoprotein Cholesterol, Homocysteine, Lipoprotein(a), and Lipoprotein-Associated Phospholipase A2: A REDUCE-IT Biomarker Substudy https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.059410

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

- Effect of High-Dose Omega-3 Fatty Acids vs Corn Oil on Major Adverse Cardiovascular Events in Patients at High Cardiovascular RiskThe STRENGTH Randomized Clinical Trial https://jamanetwork.com/journals/jama/fullarticle/2773120

- Effect of icosapent ethyl on progression of coronary atherosclerosis in patients with elevated triglycerides on statin therapy: final results of the EVAPORATE trial https://academic.oup.com/eurheartj/article/41/40/3925/5898836

II - US Heart Health

- New AHA Checklist: Only 1 in 5 Adults Have Optimal Heart Health https://www.medscape.com/viewarticle/976519

- Life’s Essential 8: Updating and Enhancing the American Heart Association’s Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association https://www.ahajournals.org/doi/10.1161/CIR.0000000000001078

- Status of Cardiovascular Health in US Adults and Children Using the American Heart Association's New "Life's Essential 8" Metrics: Prevalence Estimates from the National Health and Nutrition Examination Survey (NHANES), 2013-2018 https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.060911

III - Pharmacist Prescribing

- Paxlovid Is Here: A Pharmacist's Prescribing Pearls https://www.medscape.com/viewarticle/973260

- Coronavirus (COVID-19) Update: FDA Authorizes Pharmacists to Prescribe Paxlovid with Certain Limitations https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-pharmacists-prescribe-paxlovid-certain-limitations

IV - Statin Eligibility

- New European Guidelines ‘Drastically’ Reduce Statin Eligibility https://www.medscape.com/viewarticle/976715

- Statin Eligibility for Primary Prevention of Cardiovascular Disease According to 2021 European Prevention Guidelines Compared With Other International Guidelines https://jamanetwork.com/journals/jamacardiology/article-abstract/2793729

- Time to Revisit Using 10-Year Risk to Guide Statin Therapy https://jamanetwork.com/journals/jamacardiology/article-abstract/2793732

- Mendelian randomization studies: using naturally randomized genetic data to fill evidence gaps https://doi.org/10.1097/mol.0000000000000247

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Questions or feedback, please contact [email protected]

A non-significant but wonderful trial in AF, smoking and HF, vitamins, and pre-op risk screening 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 – DECAAF II Trial

DECAAF II: AF, Fibrosis Ablation Technique Falls Short, but Signs of Hope

https://www.medscape.com/viewarticle/957469

• Effect of MRI-Guided Fibrosis Ablation vs Conventional Catheter Ablation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial Fibrillation https://jamanetwork.com/journals/jama/article-abstract/2793452

• Association of Atrial Tissue Fibrosis Identified by Delayed Enhancement MRI and Atrial Fibrillation Catheter Ablation

https://jamanetwork.com/journals/jama/fullarticle/1820433

II – Smoking and HF

Cigarettes Linked to HF With Preserved or Reduced EF https://www.medscape.com/viewarticle/976066?src=

• Cigarette Smoking, Cessation, and Risk of Heart Failure With Preserved and Reduced Ejection Fraction https://www.jacc.org/doi/full/10.1016/j.jacc.2022.03.377

III – Vitamins

Evidence Still Lacking That Vitamins Prevent CVD, Cancer: USPSTF https://www.medscape.com/viewarticle/975965

• Vitamin, Mineral, and Multivitamin Supplementation to Prevent Cardiovascular Disease and Cancer: US Preventive Services Task Force Recommendation Statement https://jamanetwork.com/journals/jama/fullarticle/2793446

IV – Pre-Op Risk

Add Atrial Fibrillation to Pre-Noncardiac Surgery Risk Evaluation: New Support

https://www.medscape.com/viewarticle/975926

• Preoperative Atrial Fibrillation and Cardiovascular Outcomes After Noncardiac Surgery

https://doi.org/10.1016/j.jacc.2022.04.021

• Patterns and Determinants of Low-Value Preoperative Testing in Michigan

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2779744

• Coronary-Artery Revascularization before Elective Major Vascular Surgery

https://www.nejm.org/doi/full/10.1056/nejmoa041905

• Stress testing before abdominal aortic aneurysm repair does not lead to a reduction in perioperative cardiac events https://doi.org/10.1016/j.jvs.2021.02.032

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

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[email protected]

Statin Intolerance, external validity of trials, contrast shortage, and expansion of cardiology into diabetes and nephrology 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 - Statin Intolerance

- New National Lipid Association Statement on Statin Intolerance https://www.medscape.com/viewarticle/975674

- What proportion of symptomatic side effects in patients taking statins are genuinely caused by the drug? Systematic review of randomized placebo-controlled trials to aid individual patient choice. https://academic.oup.com/eurjpc/article/21/4/464/5926070

- Unblinded and Blinded N-of-1 Trials Versus Usual Care: A Randomized Controlled Trial to Increase Statin Uptake in Primary Care. https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.120.007793

- Role of Blinding in N-of-1 Trials https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.122.008914

- N-of-1 Trial of a Statin, Placebo, or No Treatment to Assess Side Effects https://www.nejm.org/doi/full/10.1056/NEJMc2031173

II - External Validity

- Is Paxlovid, the Covid Pill, Reaching Those Who Most Need It? The Government Won't Say https://www.medscape.com/viewarticle/973906

- Oral Nirmatrelvir for High-Risk, Nonhospitalized Adults with Covid-19 https://www.nejm.org/doi/full/10.1056/NEJMoa2118542

- PFE Press Release on EPIC SR https://www.pfizer.com/news/press-release/press-release-detail/pfizer-reports-additional-data-paxlovidtm-supporting

III - Contrast Shortage

- Global Contrast Media Shortage Blamed on COVID Lockdown in China https://www.medscape.com/viewarticle/973810

IV - Cardiology Expands

- Experts Elevate New Drugs for Diabetic Kidney Disease https://www.medscape.com/viewarticle/975724

- SGLT2 Inhibitors Cut AFib Risk in Real-Word Analysis https://www.medscape.com/viewarticle/975542

- Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes https://www.nejm.org/doi/full/10.1056/NEJMoa2025845

- Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes https://www.nejm.org/doi/full/10.1056/nejmoa2110956

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

Questions or feedback, please contact [email protected]

More ISCHEMIA controversy, health Insurance and CV outcomes, testosterone, and flawed observational studies 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 – More Ischemia Controversy

- Data Concerns Mount Despite ISCHEMIA Substudy Correction https://www.medscape.com/viewarticle/974974

- ISCHEMIA Substudy Data Just Don't Add Up, Cardiac Surgeons Say https://www.medscape.com/viewarticle/974107

- Initial Invasive or Conservative Strategy for Stable Coronary Disease https://www.nejm.org/doi/full/10.1056/nejmoa1915922

- Outcomes in the ISCHEMIA Trial Based on Coronary Artery Disease and Ischemia Severity https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.049755

- Link to Bakaeen and Sabik Second letter (agree to terms to download the letter): https://protect-us.mimecast.com/s/nfDdCwp5G6HLjLO9GHV9Cnm?domain=wetransfer.com

II – Health Insurance and CV outcomes

- Medicaid Expansion: Good First Step, but No Panacea for CV Care https://www.medscape.com/viewarticle/975141

- Health Care Access and Management of Cardiovascular Risk Factors Among Working-Age Adults With Low Income by State Medicaid Expansion Status https://jamanetwork.com/journals/jamacardiology/article-abstract/2793120

- Rand Link https://www.rand.org/pubs/reports/R3055.html

- The Oregon Health Insurance Experiment https://www.healthaffairs.org/do/10.1377/hpb20150716.236899/full/

- Effect of Health Insurance in India: A Randomized Controlled Trial https://www.nber.org/papers/w29576

III – Testosterone

- Jury Still Out on Cardiovascular Safety of Testosterone https://www.medscape.com/viewarticle/975273

- Adverse cardiovascular events and mortality in men during testosterone treatment: an individual patient and aggregate data meta-analysis https://doi.org/10.1016/S2666-7568(22)00096-4

- Adverse events associated with testosterone administration. https://www.nejm.org/doi/full/10.1056/NEJMoa1000485

IV – Voting and Mortality

- Blue Counties Enjoy Dramatic Mortality Edge https://www.medscape.com/viewarticle/975217

- Political environment and mortality rates in the United States, 2001-19: population based cross sectional analysis https://www.bmj.com/content/377/bmj-2021-069308

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

Questions or feedback, please contact [email protected]

Devices for HF, Twitter for disseminating science, HDL levels, and dubious post-hoc studies 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 – Interatrial Shunts for HF

- Interatrial Shunt in HF Hints at Heart Structural, Functional Benefits https://www.medscape.com/viewarticle/974776

- Atrial shunt device for heart failure with preserved and mildly reduced ejection fraction (REDUCE LAP-HF II): a randomised, multicentre, blinded, sham-controlled trial https://doi.org/10.1016/S0140-6736(22)00016-2

- Reducing Lung CongestIon Symptoms in Advanced Heart Failure (RELIEVE-HF) https://clinicaltrials.gov/ct2/show/NCT03499236

II – Twitter for Science Communication

- Twitter Promotion Boosts Visibility, Citation for CV Research https://www.medscape.com/viewarticle/974653

- Twitter promotion is associated with higher citation rates of cardiovascular articles: the ESC Journals Randomized Study https://doi.org/10.1093/eurheartj/ehac150

- A Randomized Trial of Social Media From Circulation https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.114.013509

III – HDL Level

- Very High HDL-C: Too Much of a Good Thing? https://www.medscape.com/viewarticle/974651

- Association Between High-Density Lipoprotein Cholesterol Levels and Adverse Cardiovascular Outcomes in High-risk Populations https://jamanetwork.com/journals/jamacardiology/article-abstract/2792282

- Rare variant in scavenger receptor BI raises HDL cholesterol and increases risk of coronary heart disease https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4889017/

IV – Dubious Sub-Studies: Omecamtiv Mecarbil

- Myosin Inhibitor May Benefit Data-Deprived Patients With Heart Failure and Low Blood Pressure https://www.medscape.com/viewarticle/974960

- Cardiac Myosin Activation with Omecamtiv Mecarbil in Systolic Heart Failure https://www.nejm.org/doi/full/10.1056/NEJMoa2025797

- METEORIC-HF: Omecamtiv Mecarbil Does Not Improve Exercise Capacity in HFrEF Patients https://www.acc.org/Latest-in-Cardiology/Articles/2022/04/02/13/22/Sun-945am-METEORIC-HF-acc-2022

- Effects of Omecamtiv mecarbil in heart failure with reduced ejection fraction according to blood pressure: the GALACTIC-HF trial https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehac293/6590348

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Questions or feedback, please contact

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Ischemia vs anatomic testing for CAD, UK-TAVI trial, TAVI for AR? and post-PCI anti-thrombotics 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 – Ischemic vs Anatomic Evaluation for CAD

- ISCHEMIA Substudy Data Just Don't Add Up, Cardiac Surgeons Say https://www.medscape.com/viewarticle/974107

- Outcomes in the ISCHEMIA Trial Based on Coronary Artery Disease and Ischemia Severity https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.120.049755

- Initial Invasive or Conservative Strategy for Stable Coronary Disease https://www.nejm.org/doi/full/10.1056/nejmoa1915922

- Forget Ischemia: It’s All About the Plaque https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.054102

- Optimal Medical Therapy With or Without Percutaneous Coronary Intervention to Reduce Ischemic Burden https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.107.743963

- Baseline stress myocardial perfusion imaging results and outcomes in patients with stable ischemic heart disease randomized to optimal medical therapy with or without percutaneous coronary intervention https://doi.org/10.1016/j.ahj.2012.05.018

- Outcomes of Anatomical versus Functional Testing for Coronary Artery Disease https://www.nejm.org/doi/full/10.1056/nejmoa1415516

- Coronary CT Angiography and 5-Year Risk of Myocardial Infarction https://www.nejm.org/doi/full/10.1056/NEJMoa1805971

- Five Reasons I Don't Believe an Imaging Test Improves Outcomes https://www.medscape.com/viewarticle/901204

II – UK-TAVI Trial

- UK TAVI: Similar Outcomes to Surgery in Real World https://www.medscape.com/viewarticle/927729

- Effect of Transcatheter Aortic Valve Implantation vs Surgical Aortic Valve Replacement on All-Cause Mortality in Patients With Aortic Stenosis https://jamanetwork.com/journals/jama/fullarticle/2792251

III – TAVI for AI?

- JenaValve Trilogy Takes Another Step Forward in Severe AR https://www.medscape.com/viewarticle/974304

IV – Post PCI DAPT

- One-Month DAPT Enough for Complex PCI if Bleeding Risk High https://www.medscape.com/viewarticle/974224

- Duration of Antiplatelet Therapy After Complex Percutaneous Coronary Intervention In Patients at High Bleeding Risk: a MASTER DAPT trial sub-analysis https://doi.org/10.1093/eurheartj/ehac284

- Dual Antiplatelet Therapy after PCI in Patients at High Bleeding Risk https://www.nejm.org/doi/full/10.1056/NEJMoa2108749

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

Questions or feedback, please contact

[email protected]

Obstructive hypertrophic cardiomyopathy and mavacamten, SGLT2 inhibitors, the triple whammy, espresso, and clinician burnout are the topics John Mandrola, MD, covers in today’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 – Mavacamten

- FDA Clears Mavacamten (Camzyos) for Obstructive Hypertrophic Cardiomyopathy https://www.medscape.com/viewarticle/972945

- Mavacamten for treatment of symptomatic obstructive hypertrophic cardiomyopathy (EXPLORER-HCM): a randomised, double-blind, placebo-controlled, phase 3 trial https://doi.org/10.1016/S0140-6736(20)31792-X

- FDA approves new drug to improve heart function in adults with rare heart condition https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-new-drug-improve-heart-function-adults-rare-heart-condition

II – Dapagliflozin in HFpEF

- Positive Topline Results for Dapagliflozin in HFpEF: DELIVER https://www.medscape.com/viewarticle/973490

- Empagliflozin in Heart Failure with a Preserved Ejection Fraction https://www.nejm.org/doi/full/10.1056/NEJMoa2107038

III – Triple Whammy for AKI

- Mixing BP Meds With NSAID May Be 'Triple Whammy' for Kidneys https://www.medscape.com/viewarticle/973885

IV – Espresso

- Espresso Coffee Associated With Increased Total Cholesterol https://www.medscape.com/viewarticle/973819

- Association between espresso coffee and serum total cholesterol: the Tromsø Study 2015–2016 https://openheart.bmj.com/content/9/1/e001946

- Is everything we eat associated with cancer? A systematic cookbook review https://pubmed.ncbi.nlm.nih.gov/23193004/

- Enough With the Coffee Research and Other Distractions https://www.medscape.com/viewarticle/883709

V – Clinician Burnout

- Administrative Hassle Hacks: Strategies to Curb Physician Stress https://www.medscape.com/viewarticle/973597

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Questions or feedback, please contact [email protected]

HRS meeting presentations: conduction system pacing, AF in the ED, a possible new treatment for vagal bradycardia, and women in EP 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 – HRS Comments

II – Conduction System Pacing

Conduction System Disease Recast as Preventive Therapy Target

https://www.medscape.com/viewarticle/973488

• Rescue Left Bundle Branch Area Pacing in Coronary Venous Lead Failure or Non-response to Biventricular Pacing: Results From International LBBAP Collaborative Study Group

https://doi.org/10.1016/j.hrthm.2022.04.024

• Clinical Outcomes Of Conduction System Pacing Compared To Biventricular Pacing In Patients Requiring Cardiac Resynchronization Therapy

https://doi.org/10.1016/j.hrthm.2022.04.023

III – Emergency Triage of AF

Early Arrhythmia-Specialist Consult, Ordered in the ER, a Boon to AF Outcomes: ER2EP Study

https://www.medscape.com/viewarticle/973250

• ClinicalTrials.gov Reference

https://clinicaltrials.gov/ct2/show/NCT04476524

• George Bernard Shaw Reference:

https://jamanetwork.com/journals/jama/fullarticle/2623628

IV – Cardioneural Ablation

Can Ablation Abolish Vasovagal Syncope? Early Series Promising

https://www.medscape.com/viewarticle/973346

V – Women in EP

Why Are Numbers of Women, Minorities So Low in Cardiac EP?

https://www.medscape.com/viewarticle/972968

• Temporal and geographical trends in women operators of electrophysiology procedures in the United States

https://doi.org/10.1016/j.hrthm.2022.02.015

• Quantification of Female and Underrepresented Minority Applicants to Clinical Cardiac Electrophysiology Fellowship

https://www.jacc.org/doi/full/10.1016/j.jacep.2022.04.001

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

Questions or feedback, please contact [email protected]

Aspirin for primary prevention, time-restricted feeding, renal denervation, and a potential new obesity drug 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 for Primary Prevention:

- USPSTF Final Recommendation on Aspirin for Primary CV Prevention https://www.medscape.com/viewarticle/972761

- Aspirin Use to Prevent Cardiovascular Disease: US Preventive Services Task Force Recommendation Statement https://jamanetwork.com/journals/jama/fullarticle/2791399

- Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly https://www.nejm.org/doi/10.1056/NEJMoa1805819

- Effect of Aspirin on All-Cause Mortality in the Healthy Elderly https://www.nejm.org/doi/full/10.1056/NEJMoa1803955

II – Time Restricted Feeding

- Is There a Benefit to Fasting Plus Calorie Counting? https://www.medscape.com/viewarticle/972579

- Calorie Restriction with or without Time-Restricted Eating in Weight Loss https://www.nejm.org/doi/full/10.1056/NEJMoa2114833

- Effects of Time-Restricted Eating on Weight Loss and Other Metabolic Parameters in Women and Men With Overweight and Obesity. The TREAT Randomized Clinical Trial https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2771095

III – Renal Denervation

- Renal Denervation BP Benefits Remain at 3 Years: SPYRAL HTN-ON https://www.medscape.com/viewarticle/971883

- Long-term efficacy and safety of renal denervation in the presence of antihypertensive drugs (SPYRAL HTN-ON MED): a randomised, sham-controlled trial https://doi.org/10.1016/S0140-6736(22)00455-X

IV – Tirzepatide for Obesity

- Tirzepatide Excites in Obesity Now Too, Says Lilly https://www.medscape.com/viewarticle/972936

- Lilly's tirzepatide delivered up to 22.5% weight loss in adults with obesity or overweight in SURMOUNT-1 https://www.prnewswire.com/news-releases/lillys-tirzepatide-delivered-up-to-22-5-weight-loss-in-adults-with-obesity-or-overweight-in-surmount-1--301534871.html

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Questions or feedback, please contact [email protected]

Critiques of last week’s comments on VT ablation and a review of EHRA presentations, including new ways to ablate atrial myocardium and pace the ventricle, are 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 – VT ablation

- VT Ablation After First ICD Shock Boosts Survival: PARTITA https://www.medscape.com/viewarticle/971969

- Does Timing of Ventricular Tachycardia Ablation Affect Prognosis in Patients With an Implantable Cardioverter Defibrillator? Results From the Multicenter Randomized PARTITA Trial https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.122.059598

- Substrate Ablation vs Antiarrhythmic Drug Therapy for Symptomatic Ventricular Tachycardia https://www.jacc.org/doi/10.1016/j.jacc.2022.01.050

- Ventricular Tachycardia Ablation versus Escalation of Antiarrhythmic Drugs https://www.nejm.org/doi/full/10.1056/NEJMoa1513614

II – Pulsed-Field Ablation

- Pulsed Field Ablation Treats AF With Few Complications https://www.medscape.com/viewarticle/972147

- Pulsed Field Ablation for Persistent Atrial Fibrillation (PersAFOne): Hope or Hype? https://www.jacc.org/doi/10.1016/j.jacc.2020.07.032

III – High-Power Short Duration Ablation

- Short, High-Power Ablation on Par With Standard AF Ablation https://www.medscape.com/viewarticle/972087

IV – LBB-Area Pacing

- MELOS: LBB Area Pacing Promising for Bradyarrhythmias, HF https://www.medscape.com/viewarticle/972270

Also of interest...

- Conduction System Pacing Noninferior to Biventricular Pacing for HF With Wide QRS https://www.medscape.com/viewarticle/971740

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Questions or feedback, please contact [email protected]

ACC Recap, Part 2: VT ablation, HF care, three-vessel disease, and patiromer 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 – VT ablation

VT Ablation After First ICD Shock Boosts Survival: PARTITA

https://www.medscape.com/viewarticle/971969

• Does Timing of Ventricular Tachycardia Ablation Affect Prognosis in Patients With an Implantable Cardioverter Defibrillator? Results From the Multicenter Randomized PARTITA Trial https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.122.059598

• Substrate Ablation vs Antiarrhythmic Drug Therapy for Symptomatic Ventricular Tachycardia https://www.jacc.org/doi/10.1016/j.jacc.2022.01.050

• Ventricular Tachycardia Ablation versus Escalation of Antiarrhythmic Drugs https://www.nejm.org/doi/full/10.1056/NEJMoa1513614

II – HF Care

Alerts Improve Prescribing of HF Quadruple Therapy: PROMPT-HF https://www.medscape.com/viewarticle/972079

• Electronic Alerts to Improve Heart Failure Therapy in Outpatient Practice: A Cluster Randomized Trial https://www.jacc.org/doi/10.1016/j.jacc.2022.03.338

• Reassessing Quality Assessment — The Flawed System for Fixing a Flawed System https://www.nejm.org/doi/full/10.1056/NEJMms2200976

III – Three-Vessel Disease

FAME 3 Subanalysis Adds Twist to Negative Primary Results

https://www.medscape.com/viewarticle/971495

• Fractional Flow Reserve–Guided PCI as Compared with Coronary Bypass Surgery https://www.nejm.org/doi/10.1056/NEJMoa2112299

• Quality of Life After Fractional Flow Reserve-Guided PCI Compared with Coronary Bypass Surgery https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.122.060049

IV – Treating Drug Side Effects with More Drugs

DIAMOND: Adding Patiromer Helps Optimize HF Meds, Foils Hyperkalemia https://www.medscape.com/viewarticle/971616

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

Questions or feedback, please contact

[email protected]

ACC Recap: John Mandrola, MD, provides part 1 of an ACC recap 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 – HTN in Pregnancy

- Hypertension Control During Pregnancy Validated in Large Trial https://www.medscape.com/viewarticle/971486

- Treatment for Mild Chronic Hypertension during Pregnancy https://www.nejm.org/doi/full/10.1056/NEJMoa2201295

II – Prevention of Bleeding in Non-Cardiac Surgery

- POISE-3 Backs Wider Use of Tranexamic Acid in Noncardiac Surgery https://www.medscape.com/viewarticle/971483

- Tranexamic Acid in Patients Undergoing Noncardiac Surgery https://www.nejm.org/doi/full/10.1056/NEJMoa2201171

III – HCM

- VALOR-HCM: Novel Drug May Delay, Avert Invasive Therapy in OHCM https://www.medscape.com/viewarticle/971484

IV – Left Atrial Appendage Occlusion

- Small Leaks After LAAO Linked to Thromboembolism, Bleeding https://www.medscape.com/viewarticle/971709

V – Low Sodium Diet for HF

- Low-Sodium Diet Did Not Cut Clinical Events in Heart Failure Trial https://www.medscape.com/viewarticle/971482

- Reduction of dietary sodium to less than 100 mmol in heart failure (SODIUM-HF): an international, open-label, randomised, controlled trial https://doi.org/10.1016/S0140-6736(22)00369-5

VI – Flu Vaccine and Heart Failure

- Flu Vaccines Cut Seasonal Death in Patients With Heart Failure https://www.medscape.com/viewarticle/971619

VII – New Anticoagulant?

- Less Bleeding With Factor XI Inhibitor Anticoagulant? PACIFIC-AF https://www.medscape.com/viewarticle/971702

Features:

- Sodium Restriction in Heart Failure: Another Dogma Felled by Randomization https://www.medscape.com/viewarticle/971697

- Percutaneous Left Atrial Appendage Occlusion: ACC Data Challenge Promise vs Reality https://www.medscape.com/viewarticle/971512

- Mavacamten in Hypertrophic Cardiomyopathy: Reasons for Both Optimism and Caution https://www.medscape.com/viewarticle/971485

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Questions or feedback, please contact: [email protected]

Coronary CTA, semaglutide, coronary artery calcium, exercise, and an ACC and EHRA preview 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 – Coronary CTA Feedback

- Coronary Computed Tomography Angiography vs Functional Stress Testing for Patients With Suspected Coronary Artery Disease https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2655243

II – Semaglutide

- FDA Okays Semaglutide Higher Dose, 2 mg/Week, for Type 2 Diabetes https://www.medscape.com/viewarticle/971156

- Efficacy and safety of once-weekly semaglutide 2·0 mg versus 1·0 mg in patients with type 2 diabetes (SUSTAIN FORTE): a double-blind, randomised, phase 3B trial https://doi.org/10.1016/S2213-8587(21)00174-1

- Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes https://www.nejm.org/doi/full/10.1056/NEJMoa1607141

- Once-Weekly Semaglutide in Adults with Overweight or Obesity https://www.nejm.org/doi/full/10.1056/NEJMoa2032183

III – CAC and SCD

- Calcium Scores Predict Sudden-Death Risk in Preclinical CAD in Large Cohort Study https://www.medscape.com/viewarticle/971056

- Coronary Artery Calcium for Risk Stratification of Sudden Cardiac Death: The Coronary Artery Calcium Consortium https://www.jacc.org/doi/10.1016/j.jcmg.2022.02.011

IV – Exercise and COVID-19

- More Exercise Linked to Lower Chance of Severe COVID-19: Study https://www.medscape.com/viewarticle/949468

- Small steps, strong shield: directly measured, moderate physical activity in 65 361 adults is associated with significant protective effects from severe COVID-19 outcomes http://dx.doi.org/10.1136/bjsports-2021-105159

V – ACC Preview

- Hybrid ACC.22 Resurrects the Live Scientific Session https://www.medscape.com/viewarticle/971083

- Mandrola Previews the 2022 American College of Cardiology Scientific Sessions https://www.medscape.com/viewarticle/971084

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AF ablation vs rate control in HF, TAVI vs SAVR, atherosclerosis, and surrogate endpoints in observational studies 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 ablation vs Rate Control

RAFT-AF, Despite Itself, Hints at Advantage for Ablation Rhythm Control in Heart Failure With AF https://www.medscape.com/viewarticle/951326

• Randomized Ablation-Based Rhythm-Control Versus Rate-Control Trial in Patients with Heart Failure and Atrial Fibrillation: Results from the RAFT-AF trial https://www.ahajournals.org/doi/suppl/10.1161/CIRCULATIONAHA.121.057095

• Catheter Ablation for Atrial Fibrillation with Heart Failure

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

• Lenient versus Strict Rate Control in Patients with Atrial Fibrillation https://www.nejm.org/doi/full/10.1056/nejmoa1001337

II – TAVI vs SAVR

Surgery Groups Push Back on VARC-3 Valve Trial Definitions https://www.medscape.com/viewarticle/970753

• Joint Surgical Associations (EACTS, LACES, ASCVTS, AATS, and STS) Position Statement Regarding the VARC-3 Definitions for Aortic Valve Clinical Research https://doi.org/10.1093/ejcts/ezac110

III – Atherosclerosis

Medical Management Best for Atherosclerotic Stroke: New AAN Guidance

https://www.medscape.com/viewarticle/970886

• Stroke Prevention in Symptomatic Large Artery Intracranial Atherosclerosis Practice Advisory https://n.neurology.org/content/98/12/486

IV – ECHO parameters with Rhythm Control

Global Gains in Heart Function From Early AF Rhythm Control

https://www.medscape.com/viewarticle/970329

• Restoring Sinus Rhythm Reverses Cardiac Remodeling and Reduces Valvular Regurgitation in Patients With Atrial Fibrillation https://doi.org/10.1016/j.jacc.2021.12.029

• Effects of Atrial Fibrillation and Sinus Rhythm on Cardiac Remodeling and Valvular Regurgitation https://doi.org/10.1016/j.jacc.2021.12.028

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

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[email protected]

AF screening, CTA, stroke prevention and broken observational studies, and medical writing 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 Screening

- Handheld ECGs Ease A-Fib Screening in the Very Elderly https://www.medscape.com/viewarticle/969846

- Screening for Atrial Fibrillation in Older Adults at Primary Care Visits: the VITAL-AF Randomized Controlled Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057014

II - CTA

- DISCHARGE: CTA Shows Safety Edge vs Cath in Intermediate-Risk Stable Chest Pain https://www.medscape.com/viewarticle/969732

- CT or Invasive Coronary Angiography in Stable Chest Pain https://www.nejm.org/doi/full/10.1056/NEJMoa2200963

III - Stroke Prevention post TAVI

- Silver Lining Emerges for Embolic Protection in Post-TAVR Stroke https://www.medscape.com/viewarticle/969992

- Cerebral Embolic Protection and Stroke-Related Mortality Following Transcatheter Aortic Valve Replacement https://www.jacc.org/doi/full/10.1016/j.jcin.2022.01.007

- Safety and efficacy of cerebral protection devices in transcatheter aortic valve replacement: A clinical end-points meta-analysis https://pubmed.ncbi.nlm.nih.gov/29550047/

- Cerebral Embolic Protection and Outcomes of Transcatheter Aortic Valve Replacement: Results From the Transcatheter Valve Therapy Registry https://pubmed.ncbi.nlm.nih.gov/33619968/

IV - Medical Writing

- Writing Program Asks Physicians to Explore Their Experiences https://www.medscape.com/viewarticle/969973

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Questions or feedback, please contact [email protected]

An update to CardioMEMs post, ARBs and cancer, troponins, empagliflozin, and low-value care 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 – Invasive Monitoring for HF

- FDA Expands Eligibility for CardioMEMS Heart Failure System https://www.medscape.com/viewarticle/969004

- Haemodynamic-guided management of heart failure (GUIDE-HF): a randomised controlled trial https://doi.org/10.1016/S0140-6736(21)01754-2

II – ARBs and Cancer

- ARBs and Cancer Risk: New Meta-Analysis Raises Questions Again https://www.medscape.com/viewarticle/969510

- Risk of cancer with angiotensin-receptor blockers increases with increasing cumulative exposure: Meta-regression analysis of randomized trials https://doi.org/10.1371/journal.pone.0263461

- Marciniak Meta-analysis in FDA Medical Review 206316Orig1Orig2s000 https://rb.gy/myhlvy

III – Troponins and Cardiac Surgery

- What Troponin Level Indicates Injury After Cardiac Surgery? https://www.medscape.com/viewarticle/969617?src=

- High-Sensitivity Troponin I after Cardiac Surgery and 30-Day Mortality https://www.nejm.org/doi/full/10.1056/NEJMoa2000803

- Five-Year Outcomes after PCI or CABG for Left Main Coronary Disease https://www.nejm.org/doi/full/10.1056/nejmoa1909406

IV – Empagliflozin in HFpEF

- FDA Okays Empagliflozin for HF Regardless of Ejection Fraction https://www.medscape.com/viewarticle/969118

- Empagliflozin in Heart Failure with a Preserved Ejection Fraction https://www.nejm.org/doi/full/10.1056/NEJMoa2107038

- Angiotensin-Neprilysin Inhibition in Heart Failure with Preserved Ejection Fraction https://www.nejm.org/doi/full/10.1056/NEJMoa1908655

V – Low-Value Care

- AHA Targets 'Low-Value' Heart Care in New Scientific Statement https://www.medscape.com/viewarticle/969107

- Strategies to Reduce Low-Value Cardiovascular Care: A Scientific Statement From the American Heart Association https://www.ahajournals.org/doi/abs/10.1161/HCQ.0000000000000105

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Questions or feedback, please contact [email protected]

FDA approval of CardioMEMS, statins, VT storm, and fish oil and AF are the topics covered 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 - Invasive Monitoring for HF

- FDA Expands Eligibility for CardioMEMS Heart Failure System https://www.medscape.com/viewarticle/969004

- Haemodynamic-guided management of heart failure (GUIDE-HF): a randomised controlled trial https://doi.org/10.1016/S0140-6736(21)01754-2

- Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial https://doi.org/10.1016/S0140-6736(11)60101-3

II - Statin Use in Primary Prevention

- USPSTF Tweaks Primary Prevention Statin Recommendations in New Draft Guidance https://www.medscape.com/viewarticle/968963

- Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: Preventive Medication https://www.uspreventiveservicestaskforce.org/uspstf/document/draft-evidence-review/statin-use-primary-prevention-cardiovascular-disease-adults

- The Case Against Coronary Artery Calcium Scoring for Cardiovascular Disease Risk Assessment https://www.aafp.org/afp/2019/1215/p734.html

III - VT-Storm

- Transcutaneous Magnetic Stimulation Promising Against VT Storm https://www.medscape.com/viewarticle/968955

- Effect of Transcutaneous Magnetic Stimulation in Patients With Ventricular Tachycardia Storm https://jamanetwork.com/journals/jamacardiology/fullarticle/2788915

IV - Fish Oil and AF risk

- Fish Oil Supplements May Increase the Risk for Atrial Fibrillation: What Does This Mean? https://www.medscape.com/viewarticle/967159

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Questions or feedback, please contact [email protected]

Spinal cord stimulation to prevent post-cardiac surgery AF, statin intolerance, heart failure with preserved ejection fraction, and Vitamin D are 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 Post-Cardiac Surgery AF

Spinal Cord Stimulation May Cut AF After Cardiac Surgery

https://www.medscape.com/viewarticle/968478

• Autonomic Neuromodulation for Atrial Fibrillation Following Cardiac Surgery: JACC Review Topic of the Week https://www.jacc.org/doi/10.1016/j.jacc.2021.12.010

• Temporary Spinal Cord Stimulation to Prevent Postcardiac Surgery Atrial Fibrillation: 30-Day Safety and Efficacy Outcomes https://www.jacc.org/doi/10.1016/j.jacc.2021.08.078

II – Statin Intolerance

Statin Intolerance 'Overestimated and Overdiagnosed' https://www.medscape.com/viewarticle/968627

• Prevalence of statin intolerance: a meta-analysis https://doi.org/10.1093/eurheartj/ehac015

III – HFpEF

Risk in Preserved-EF HF Varies With Normal vs High Natriuretic Peptides https://www.medscape.com/viewarticle/968748

• Heart failure with preserved ejection fraction in patients with normal natriuretic peptide levels is associated with increased morbidity and mortality https://doi.org/10.1093/eurheartj/ehab911

• Universal definition and classification of heart failure: a report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure: Endorsed by the Canadian Heart Failure Society, Heart Failure Association of India, Cardiac Society of Australia and New Zealand, and Chinese Heart Failure Association https://pubmed.ncbi.nlm.nih.gov/33605000/

Features:

Why Is Vitamin D Hype So Impervious to Evidence? https://www.medscape.com/viewarticle/968682

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

Questions or feedback, please contact: [email protected]

LDL equations, stroke interventions, post-PCI antiplatelets, the transitive function and network meta-analysis, and lipoprotein(a) 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 - LDL-C Equations:

- Standard LDL Equations Yield Discordant Results https://www.medscape.com/viewarticle/968112

- Discordance Between Standard Equations for Determination of LDL Cholesterol in Patients With Atherosclerosis https://www.jacc.org/doi/10.1016/j.jacc.2021.11.042

- LDL-C Estimation: The Perils of Living With Imperfection https://www.jacc.org/doi/10.1016/j.jacc.2021.12.005

II - Acute Stroke Care

- Endovascular Therapy Benefits Stroke With Larger Ischemic Core? https://www.medscape.com/viewarticle/968203

- Endovascular Therapy for Acute Stroke with a Large Ischemic Region https://www.nejm.org/doi/full/10.1056/NEJMoa2118191

III - Post PCI Antiplatelet Regimens

- Study Parses Out Merits of Short DAPT, De-escalation in ACS https://www.medscape.com/viewarticle/968050

- Short Duration of DAPT Versus De-Escalation After Percutaneous Coronary Intervention for Acute Coronary Syndromes https://www.jacc.org/doi/10.1016/j.jcin.2021.11.028

IV - Lipoprotein (a)

- Positive Topline Results for siRNA in Raised Lipoprotein(a) https://www.medscape.com/viewarticle/968278

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Questions or feedback, please contact [email protected]

Interatrial shunt therapy, the power of the RCT, chronic stress, anxiety and cardiometabolic risk, and TAVR, are the topics covered 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 - Interatrial Shunt

- Interatrial Shunt Falters in Preserved, Mid-Range LVEF Heart Failure: REDUCE LAP-HF 2 https://www.medscape.com/viewarticle/967792

- Atrial shunt device for heart failure with preserved and mildly reduced ejection fraction (REDUCE LAP-HF II): a randomised, multicentre, blinded, sham-controlled trial https://doi.org/10.1016/S0140-6736(22)00016-2

II - Chronic Stress

- Chronic Stress Accelerates Aging: Epigenetic Evidence https://www.medscape.com/viewarticle/967828

- Psychological and biological resilience modulates the effects of stress on epigenetic aging https://www.nature.com/articles/s41398-021-01735-7

- DNA methylation GrimAge strongly predicts lifespan and healthspan https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6366976/

III – Anxiety, Neuroticism, and CardioMetabolic Risk Factors

- Anxiety in Men Tied to Risk Factors for CVD, Diabetes https://www.medscape.com/viewarticle/967811

- Neuroticism, Worry, and Cardiometabolic Risk Trajectories: Findings From a 40‐Year Study of Men https://www.ahajournals.org/doi/full/10.1161/JAHA.121.022006

IV - TAVR Implant Success

- VARC-3 TAVR Technical Failure Definition 'Highly Clinically Relevant https://www.medscape.com/viewarticle/967717

- Validation of the Valve Academic Research Consortium 3 Technical Success Definition in Patients Undergoing TAVR https://www.jacc.org/doi/full/10.1016/j.jcin.2021.11.013

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Questions or feedback, please contact [email protected]

AF Screening, alcohol, sports-related sudden death, non-MD-led healthcare, and CPR 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 Screening

- USPSTF Says Evidence Still Lacking for AF Screening in Asymptomatic Patients https://www.medscape.com/viewarticle/967275

- Screening for Atrial Fibrillation US Preventive Services Task Force Recommendation Statement https://jamanetwork.com/journals/jama/fullarticle/2788340

- Screening for Atrial Fibrillation—New Devices, Same Challenges https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2788475

- 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

II - Vaccine Induced Myocarditis

- Hong Kong, US, Israeli Data Illuminate COVID Vaccine Myocarditis https://www.medscape.com/viewarticle/967355

III - Alcohol and Heart

- No Amount of Alcohol Safe for the Heart: WHF https://www.medscape.com/viewarticle/967124

IV - Sports Related Sudden Cardiac Arrest

- Survival Improving in Sports-Related Sudden Cardiac Arrest https://www.medscape.com/viewarticle/967061

- Evolution of Incidence, Management, and Outcomes Over Time in Sports-Related Sudden Cardiac Arrest https://www.jacc.org/doi/full/10.1016/j.jacc.2021.11.011

V - Non MD vs MD-led Care

- This Doc Still Supports NP/PA Led Care ... With Caveats https://www.medscape.com/viewarticle/967073

VI - CPR

- Should We Always Offer CPR? https://www.medscape.com/viewarticle/966886

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Questions or feedback, please contact [email protected]

Olive oil, breastfeeding and CV health, informed consent during stroke, and controversy regarding revascularization guidelines 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 – Olive Oil

- Olive Oil Intake Tied to Reduced Mortality https://www.medscape.com/viewarticle/966366

- Consumption of Olive Oil and Risk of Total and Cause-Specific Mortality Among U.S. Adults https://www.jacc.org/doi/full/10.1016/j.jacc.2021.10.041

- Can Small Amounts of Olive Oil Keep the Death Away? https://www.jacc.org/doi/10.1016/j.jacc.2021.11.006

II – Breastfeeding and CV Maternal Health

- Breastfeeding Linked to Lower CVD Risk in Later Life https://www.medscape.com/viewarticle/966767

- Breastfeeding Is Associated With a Reduced Maternal Cardiovascular Risk: Systematic Review and Meta‐Analysis Involving Data From 8 Studies and 1 192 700 Parous Women https://www.ahajournals.org/doi/10.1161/JAHA.121.022746

- Meta-analysis: pitfalls and hints https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3868184/

III – Informed Consent

- New Guidance on Consent in Acute Ischemic Stroke https://www.medscape.com/viewarticle/966889

- Consent Issues in the Management of Acute Ischemic Stroke https://n.neurology.org/content/98/2/73

- The Case Against Thrombolytic Therapy in Stroke https://www.medscape.com/viewarticle/895159

- tPA in Stroke: 'The Facts Are Clear' https://www.medscape.com/viewarticle/895370

IV – Controversy in Revascularization Guidelines

- 'Incomprehensible' CABG Recommendation Raises Concerns https://www.medscape.com/viewarticle/966819

- Surgical Groups Push Back Against New Revascularization Guidelines https://www.medscape.com/viewarticle/966153

- Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration https://doi.org/10.1016/S0140-6736(94)91963-1

- Ten-Year Follow-Up Survival of the Medicine, Angioplasty, or Surgery Study (MASS II) https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.109.911669

- What constitutes an appropriate empirical trial of antianginal therapy in patients with stable angina before referral for revascularisation? https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02045-6/fulltext

- Initial Invasive or Conservative Strategy for Stable Coronary Disease https://www.nejm.org/doi/full/10.1056/nejmoa1915922

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Questions or feedback, please contact [email protected]

Xeno-transplantation, weight loss drugs, DOAC coverage, vitamin D, LAAC and frailty, and recalled LVADs are the topics John Mandrola, MD, discusses in this week’s podcast. To read a partial transcript or to comment, visit: https://www.medscape.com/twic

I – Xenotransplantation

- Pig Heart Successfully Transplanted to Man https://www.medscape.com/viewarticle/966367

- What Does a Pig-to-Human Heart Transplant Mean for Medicine? https://www.medscape.com/viewarticle/966488

II – Weight Loss Drugs

- Wegovy Tops Sibling Saxenda for Weight Loss https://www.medscape.com/viewarticle/966376

- Effect of Weekly Subcutaneous Semaglutide vs Daily Liraglutide on Body Weight in Adults With Overweight or Obesity Without Diabetes https://jamanetwork.com/journals/jama/article-abstract/2787907

III – DOAC Coverage

- CVS Caremark Formulary Change Freezes Out Apixaban https://www.medscape.com/viewarticle/966588

IV – Vitamin D

- More Vitamin D Not Better for Reducing Cancer or CVD Incidence https://www.medscape.com/viewarticle/966333

- The D-Health Trial: a randomised controlled trial of the effect of vitamin D on mortality https://doi.org/10.1016/S2213-8587(21)00345-4

- Vitamin D supplementation and prevention of cardiovascular disease and cancer in the Finnish Vitamin D Trial—a randomized controlled trial https://doi.org/10.1093/ajcn/nqab419

- Association between vitamin D supplementation and mortality: systematic review and meta-analysis https://www.bmj.com/content/366/bmj.l4673

V – LAAC and Frailty

- Frailty in patients undergoing percutaneous left atrial appendage closure https://doi.org/10.1016/j.hrthm.2022.01.007

- Net Clinical Benefit of Left Atrial Appendage Closure Versus Warfarin in Patients With Atrial Fibrillation: A Pooled Analysis of the Randomized PROTECT-AF and PREVAIL Studies https://pubmed.ncbi.nlm.nih.gov/31752643/

VI – LVAD recall

- A High-Risk Medical Device Didn't Meet Federal Standards. The Government Paid Millions for More. https://www.medscape.com/viewarticle/966255

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Questions or feedback, please contact [email protected]

This podcast is intended for US health professionals only.

Causes of sudden death, inclisiran, DOAC choices, and alcohol and VT/VF are the topics discussed by John Mandrola, MD, in this week’s podcast.

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

I – Causes of Sudden Death

- Cardiac Device Interrogation After Death 'Richly Informative' https://www.medscape.com/viewarticle/965730

- Postmortem Interrogation of Cardiac Implantable Electronic Devices: A 15-Year Experience https://www.jacc.org/doi/full/10.1016/j.jacep.2021.10.011

- Sudden Death in Patients With Cardiac Implantable Electronic Devices https://pubmed.ncbi.nlm.nih.gov/26098676/

- Cardiac Implantable Electronic Device Interrogation at Forensic Autopsy https://www.ahajournals.org/doi/full/10.1161/circulationaha.117.032367

II – Inclisiran

- FDA Approves First-in-Class Inclisiran to Lower LDL-C https://www.medscape.com/viewarticle/965464

- ORION: Inclisiran Phase 3 Trials Published https://www.medscape.com/viewarticle/927107

- Meta-Analysis of Inclisiran for the Treatment of Hypercholesterolemia https://pubmed.ncbi.nlm.nih.gov/32892993/

- Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease https://www.nejm.org/doi/full/10.1056/nejmoa1615664

- Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome https://www.nejm.org/doi/10.1056/NEJMoa1801174

III – DOAC Choice

- Apixaban: The 'Anticoagulant of Choice' for AF https://www.medscape.com/viewarticle/965390

- Association of Rivaroxaban vs Apixaban With Major Ischemic or Hemorrhagic Events in Patients With Atrial Fibrillation https://jamanetwork.com/journals/jama/fullarticle/2787319

IV – Alcohol and VT/VF and SCD

- Some Good News on Alcohol and 'Holiday Heart Syndrome' https://www.medscape.com/viewarticle/965498

- Alcohol consumption and risk of ventricular arrhythmias and sudden cardiac death: An observational study of 408,712 individuals https://www.heartrhythmjournal.com/article/S1547-5271(21)02215-3/fulltext

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Questions or feedback, please contact [email protected]

PFO closure, trans-mitral procedures, yoga as therapy, and a year-end-review are the topics John Mandrola, MD, covers in this week’s podcast. To read a partial transcript or to comment, visit: https://www.medscape.com/twic

I – PFO Closure

- Heterogeneity of Treatment Effects in an Analysis of Pooled Individual Patient Data From Randomized Trials of Device Closure of Patent Foramen Ovale After Stroke https://jamanetwork.com/journals/jama/fullarticle/2787115

- Patent Foramen Ovale Closure—Harnessing Clinical Trial Evidence to Inform Individualized Treatment Decisions https://jamanetwork.com/journals/jama/fullarticle/2787132

- Personalized evidence based medicine: predictive approaches to heterogeneous treatment effects https://pubmed.ncbi.nlm.nih.gov/30530757/

- Lord’s Paradox by Stephen Senn https://www.linkedin.com/pulse/cause-concern-stephen-senn/

II – Trans-Mitral Procedures

- Transcatheter Mitral Valve Procedures Up Tenfold Since 2014 https://www.medscape.com/viewarticle/964657

- Transcatheter Mitral Valve Therapy in the United States: A Report From the STS-ACC TVT Registry https://www.jacc.org/doi/full/10.1016/j.jacc.2021.07.058

- Percutaneous Repair or Surgery for Mitral Regurgitation https://www.nejm.org/doi/full/10.1056/nejmoa1009355

- Transcatheter Mitral-Valve Repair in Patients with Heart Failure https://www.nejm.org/doi/full/10.1056/NEJMoa1806640

- Percutaneous Repair or Medical Treatment for Secondary Mitral Regurgitation https://www.nejm.org/doi/full/10.1056/NEJMoa1805374

III – Yoga for Vasovagal Syncope

- Yoga Effective Adjunct Therapy in Recurrent Vasovagal Syncope https://www.medscape.com/viewarticle/964644

- Effect of Yoga on Clinical Outcomes and Quality of Life in Patients With Vasovagal Syncope (LIVE-Yoga) https://www.jacc.org/doi/full/10.1016/j.jacep.2021.09.007

- Effect of Yoga on Arrhythmia Burden, Anxiety, Depression, and Quality of Life in Paroxysmal Atrial Fibrillation: The YOGA My Heart Study https://www.jacc.org/doi/full/10.1016/j.jacc.2012.11.060

- Effects of yoga in patients with paroxysmal atrial fibrillation - a randomized controlled study https://pubmed.ncbi.nlm.nih.gov/26976659/

IV – Top Ten of 2021

- Mandrola's Top 10 Cardiology Stories of 2021 https://www.medscape.com/viewarticle/964818

- Top Cardiology Trials of 2021 https://www.medscape.com/viewarticle/963475

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Questions or feedback, please contact [email protected]

AF triggers, rising BP during the pandemic, long COVID, cardiac arrest care, and social media are the topics John Mandrola, MD discusses in this week’s podcast. To read a partial transcript or to comment, visit: https://www.medscape.com/twic

I – AF Triggers

- Alcoholic Drinks Stand Out in Novel Trial Exploring AF Triggers https://www.medscape.com/viewarticle/962911

- Individualized Studies of Triggers of Paroxysmal Atrial Fibrillation https://jamanetwork.com/journals/jamacardiology/article-abstract/2786196

II – BP Increase During the Pandemic

- Blood Pressure Control Worsened During COVID Pandemic https://www.medscape.com/viewarticle/964329

- Rise in Blood Pressure Observed Among US Adults During the COVID-19 Pandemic https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057075

III – DOAC after VTE

- Apixaban Outmatches Rivaroxaban for VTE in Study https://www.medscape.com/viewarticle/964301

- Risk for Recurrent Venous Thromboembolism and Bleeding With Apixaban Compared With Rivaroxaban: An Analysis of Real-World Data https://www.acpjournals.org/doi/full/10.7326/M21-0717

- Ticagrelor or Prasugrel in Patients with Acute Coronary Syndromes https://www.nejm.org/doi/full/10.1056/NEJMoa1908973

IV – Long Covid

- In Long COVID, CPET Finds Abnormalities Other Tests Don't https://www.medscape.com/viewarticle/964250

- Use of Cardiopulmonary Stress Testing for Patients With Unexplained Dyspnea Post–Coronavirus Disease https://doi.org/10.1016/j.jchf.2021.10.002

V – Cardiac Arrest Care

- Calcium Does Not Benefit Patients in Cardiac Arrest https://www.medscape.com/viewarticle/964059

- Effect of Intravenous or Intraosseous Calcium vs Saline on Return of Spontaneous Circulation in Adults With Out-of-Hospital Cardiac Arrest https://jamanetwork.com/journals/jama/fullarticle/2786819

VI – Social Media

- Online Reviews Most Important Factor in Choosing a Doctor: Survey https://www.medscape.com/viewarticle/964264

Features:

- Booze Out, Coffee Okay to Outsmart Atrial Fibrillation? https://www.medscape.com/viewarticle/961993

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Questions or feedback, please contact [email protected]

The AMAZE trial of left atrial appendage isolation, non-statin oral lipid lowering drugs, EHR alerts, non-MD care, and obesity are the topics John Mandrola, MD, discusses in this week’s podcast. To read a partial transcript or to comment, visit: https://www.medscape.com/twic

I – aMAZE Trial

- No Advantage Shown for LAA Ligation as Adjunct to Pulmonary Vein Isolation https://www.medscape.com/viewarticle/962954

- Safety and Procedural Success of Left Atrial Appendage Exclusion With the Lariat Device https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2289126

- Left Atrial Appendage Isolation in Patients With Longstanding Persistent AF Undergoing Catheter Ablation: BELIEF Trial https://pubmed.ncbi.nl m.nih.gov/27788847/

II – Non-Statin Lipid Lowering

- Obicetrapib: CETP Inhibitor Impresses in LDL Lowering https://www.medscape.com/viewarticle/963611

- Daily Oral PCSK9 Inhibitor Encouraging in Phase 1 Trials https://www.medscape.com/viewarticle/963550

III – EHR Alerts and Prognosis

- EHR Alerts Have No Impact on Inpatient HF Treatment or Outcomes https://www.medscape.com/viewarticle/963002

- REVeAL-HF: Design and Rationale of a Pragmatic Randomized Controlled Trial Embedded Within Routine Clinical Practice https://www.jacc.org/doi/full/10.1016/j.jchf.2021.03.006

IV – Non-MD Care Models

- Remote Non-Physician Care Helps BP, LDL Control https://www.medscape.com/viewarticle/963783

- A Remotely Delivered Hypertension and Lipid Program in 10,000 Patients Across a Diverse Health Care Network https://www.abstractsonline.com/pp8/?_ga=2.141042993.2042594723.1635046736-1021258137.1633710264#!/9349/presentation/18153

V – Obesity in the Young

- Obesity Rates Soar in Early Adulthood in the US https://www.medscape.com/viewarticle/963511

- Trends in Obesity Prevalence Among Adults Aged 18 Through 25 Years, 1976-2018 https://jamanetwork.com/journals/jama/article-abstract/2786516

Features

- Doubting the BELIEF Trial on LAA Isolation https://www.medscape.com/viewarticle/850822

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Questions or feedback, please contact [email protected]

In AHA 2021 Part 1, John Mandrola, MD, reports on selected sessions from the virtual American Heart Association meeting.

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

I - AVATAR

- Early SAVR Tops Watchful Waiting in Severe, Asymptomatic Aortic Stenosis: AVATAR https://www.medscape.com/viewarticle/962904

- Aortic Valve ReplAcemenT versus Conservative Treatment in Asymptomatic SeveRe Aortic Stenosis: The AVATAR Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057639

- Early Surgery or Conservative Care for Asymptomatic Aortic Stenosis https://www.nejm.org/doi/full/10.1056/NEJMoa1912846

II - TCV Repair

- Concomitant Tricuspid-Mitral Surgery Beneficial but With a Tradeoff https://www.medscape.com/viewarticle/962899

- Concomitant Tricuspid Repair in Patients with Degenerative Mitral Regurgitation https://www.nejm.org/doi/full/10.1056/NEJMoa2115961

III - PALACS

- Procedure Reduces Postop AF After Cardiac Surgery: PALACS https://www.medscape.com/viewarticle/962907

- Posterior left pericardiotomy for the prevention of atrial fibrillation after cardiac surgery: an adaptive, single-centre, single-blind, randomised, controlled trial https://doi.org/10.1016/S0140-6736(21)02490-9

IV - Left Main CAD

- Left-Main PCI, CABG Mortality Similar; Choice Remains Complex https://www.medscape.com/viewarticle/963198

- Percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass grafting in left main coronary artery disease: an individual patient data meta-analysis https://doi.org/10.1016/S0140-6736(21)02334-5

Features:

- Questions Remain on Tricuspid Repair at Time of Mitral Surgery https://www.medscape.com/viewarticle/962902

- Despite Positive Trials, Early Surgery in Asymptomatic AS Should Wait https://www.medscape.com/viewarticle/962926

- Can New Meta-analysis of PCI vs CABG for Left Main CAD Settle the Debate? https://www.medscape.com/viewarticle/963295

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Questions or feedback, please contact [email protected]

Left atrial appendage closure vs DOACs, TAVR vs SAVR, renal denervation, and an AHA 2021 preview are the topics John Mandrola, MD, discusses in this week’s podcast. To read a partial transcript or to comment, visit: https://www.medscape.com/twic

I - LAAC

- PRAGUE-17: LAA Closure Holds Up Against DOACs Out to 4 Years https://www.medscape.com/viewarticle/962608

- LAAO vs DOAC: PRAGUE-17 Falls Short https://www.medscape.com/viewarticle/933641

- Left Atrial Appendage Closure versus Non-Warfarin Oral Anticoagulation in Atrial Fibrillation: 4-Year Outcomes of PRAGUE-17 https://www.jacc.org/doi/10.1016/j.jacc.2021.10.023

- Does Percutaneous Left Atrial Appendage Closure Stand the Test of Time? https://www.jacc.org/doi/10.1016/j.jacc.2021.10.022

II - SURTAVI (TAVR vs SAVR)

- SURTAVI at 5 Years Reinforces TAVR but Was It Long-term Enough? https://www.medscape.com/viewarticle/962484

- Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients https://www.nejm.org/doi/full/10.1056/NEJMoa1700456

III - Renal Denervation

- Renal Denervation Adds Clout to BP Meds in Resistant HTN: RADIANCE-HTN TRIO https://www.medscape.com/viewarticle/962508

- Renal Denervation Remains Only Promising in Meta-Analysis https://www.medscape.com/viewarticle/962369

- Renal Denervation for Hypertension: A Systematic Review and Meta-Analysis of Randomized, Blinded, Placebo-Controlled Trials https://doi.org/10.1016/j.jcin.2021.09.020

IV - AHA Preview

- AHA 2021 Puts Scientific Dialogue, Health Equity Center Stage https://www.medscape.com/viewarticle/962524

- Mandrola Previews the Virtual AHA 2021 https://www.medscape.com/viewarticle/962468

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Questions or feedback, please contact [email protected]

FFR-guided PCI, ISCHEMIA trial challenged, QFR, and one of the most important studies of 2021 are discussed by John Mandrola, MD, in this week’s podcast. To read a partial transcript or to comment, visit: https://www.medscape.com/twic

I - FFR-Guided PCI

- FFR-Guided PCI Falls Short vs CABG in Multivessel CAD: FAME 3 https://www.medscape.com/viewarticle/962274

- Fractional Flow Reserve–Guided PCI as Compared with Coronary Bypass Surgery https://www.nejm.org/doi/full/10.1056/NEJMoa2112299

- The fallacies of fractional flow reserve https://pubmed.ncbi.nlm.nih.gov/31889563/

II - ISCHEMIA-Trial Challenged

- How Applicable is ISCHEMIA Trial to US Clinical Practice? https://www.medscape.com/viewarticle/962233

- Comparison of Patients Undergoing Percutaneous Coronary Intervention in Contemporary U.S. Practice With ISCHEMIA Trial Population https://www.jacc.org/doi/full/10.1016/j.jcin.2021.08.047

- The Glass Is at Least Half Full https://www.jacc.org/doi/10.1016/j.jcin.2021.08.054

- Initial Invasive or Conservative Strategy for Stable Coronary Disease https://www.nejm.org/doi/full/10.1056/nejmoa1915922

III - QFR

- FAVOR III China: QFR-Guided PCI Shows Advantage Over Angiography https://www.medscape.com/viewarticle/962328

- Angiographic quantitative flow ratio-guided coronary intervention (FAVOR III China): a multicentre, randomised, sham-controlled trial https://doi.org/10.1016/S0140-6736(21)02248-0

Features:

- The MI–Mortality Mismatch: When Lowering MI Doesn't Extend Life https://www.medscape.com/viewarticle/962276

- Assessment of Nonfatal Myocardial Infarction as a Surrogate for All-Cause and Cardiovascular Mortality in Treatment or Prevention of Coronary Artery Disease https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2785560

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Questions or feedback, please contact [email protected]

ESUS, CAC 0, Takotsubo syndrome, and chest pain are the topics John Mandrola, MD, covers in today’s podcast. To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I – ESUS

Anticoagulation May Benefit Stroke Patients With LV Dysfunction https://www.medscape.com/viewarticle/961815

- Left Ventricular Dysfunction Among Patients With Embolic Stroke of Undetermined Source and the Effect of Rivaroxaban vs AspirinA Subgroup Analysis of the NAVIGATE ESUS Randomized Clinical Trial

https://jamanetwork.com/journals/jamaneurology/article-abstract/2785030

- Rivaroxaban for Stroke Prevention after Embolic Stroke of Undetermined Source

https://www.nejm.org/doi/10.1056/NEJMoa1802686

- Dabigatran for Prevention of Stroke after Embolic Stroke of Undetermined Source

https://www.nejm.org/doi/10.1056/NEJMoa1813959

II – CAC

CAC Score 0 Unreliable to Rule Out Stenosis in Younger Patients https://www.medscape.com/viewarticle/961801

- Association of Age With the Diagnostic Value of Coronary Artery Calcium Score for Ruling Out Coronary Stenosis in Symptomatic Patients https://jamanetwork.com/journals/jamacardiology/fullarticle/2785586

- The Case Against Coronary Artery Calcium Scoring for Cardiovascular Disease Risk Assessment

https://www.aafp.org/afp/2019/1215/p734.html

III – Takotsubo Cardiomyopathy

Broken Heart Syndrome: On the Rise, Especially in Women 50-74

https://www.medscape.com/viewarticle/961307

- Sex‐ and Age‐Based Temporal Trends in Takotsubo Syndrome Incidence in the United States

https://www.ahajournals.org/doi/10.1161/JAHA.120.019583

IV- Chest Pain Guidelines

AHA/ACC Issues First Comprehensive Guidance on Chest Pain

https://www.medscape.com/viewarticle/961806

- 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines https://www.jacc.org/doi/10.1016/j.jacc.2021.07.052

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

Questions or feedback, please contact [email protected]