Stopping oral anticoagulation after AF ablation, the core problem with paradoxes like the smoker?s paradox, chronic total occlusion PCI, and an ACC/EHRA preview are discussed by John Mandrola, MD, in this week's podcast.

This podcast is intended for healthcare professionals only.

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I Oral Anticoagulation after Successful AF Ablation

Iwawakie et al https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2831851 OCEAN protocol paper https://doi.org/10.1016/j.ahj.2017.12.007

II Smoker?s Paradox

Presch et al https://www.jacc.org/doi/10.1016/j.jcin.2024.12.028 Gupta et al https://doi.org/10.1161/JAHA.116.003370

III CTO PCI

Main sub-analysis paper Bangalore et al https://doi.org/10.1016/j.jacc.2025.01.029 DECISION CTO https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.031313 Main EURO CTO trial https://doi.org/10.1093/eurheartj/ehy220 3-year MACE of EURO CTO https://eurointervention.pcronline.com/article/three-year-outcomes-of-eurocto-a-randomized-multicentre-trial-comparing-revascularization-and-optimal-medical-therapy-for-chronic-total-coronary-occlusions EXPLORE https://www.jacc.org/doi/abs/10.1016/j.jacc.2016.07.744 ISCHEMIA CTO https://www.clinicaltrials.gov/study/NCT03563417  

IV ACC and EHRA Preview

Mandrola?s 5 Trials to Look for at the 2025 American College of Cardiology Scientific Sessions https://www.medscape.com/viewarticle/mandrolas-5-trials-look-2025-american-college-cardiology-2025a10006zu

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A large trial in cardiac pacing finally published, PVCs and cardiomyopathy, cannabis, CV risk and the danger of observational studies, and the tale of two disparate statin trials are the topics John Mandrola, MD, discusses in this week?s podcast.

This podcast is intended for healthcare professionals only.

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I BioPace Trial

Trial manuscript https://doi.org/10.1093/europace/euaf029

II Another Belief Challenged in EP this week?PVCs and CM ?

UC Paper https://doi.org/10.1016/j.jacep.2025.01.004 JACC Review https://doi.org/10.1016/j.jacc.2024.03.416 Lee et al https://heart.bmj.com/content/105/18/1408

III Cannabis and CV Risk

Cannabis and MACE in JACC Advances: https://www.jacc.org/doi/10.1016/j.jacadv.2025.101698 Zeraatkar ?Grilling the data https://doi.org/10.1016/j.jclinepi.2024.111278 PLOS-1 10.1371/journal.pone.0199705

IV Cardio-oncology

Jacc Onc Substdy https://www.jacc.org/doi/10.1016/j.jaccao.2024.11.008 Editorial https://www.jacc.org/doi/10.1016/j.jaccao.2025.01.006 STOP CA JAMA 2023 https://jamanetwork.com/journals/jama/fullarticle/2807988 PREVENT https://evidence.nejm.org/doi/10.1056/EVIDoa2200097

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Listener feedback, resistant hypertension, K-binders for MRA use in heart failure, nutritional epidemiology, and a positive study for vitamin D are the topics John Mandrola, MD, discusses in this week's podcast.

This podcast is intended for healthcare professionals only.

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I Listener Feedback

Califf editorial https://www.jacc.org/doi/10.1016/j.jaccas.2020.01.003

II Resistant HTN

Positive Topline Results for Lorundrostat in Hypertension

https://www.medscape.com/viewarticle/positive-topline-results-lorundrostat-hypertension-2025a100062e

III K-Binding

REALIZE K Trial https://doi.org/10.1016/j.jacc.2024.11.014 Packer Editorial https://doi.org/10.1016/j.jacc.2025.01.011 Diamond Trial EHJ https://doi.org/10.1093/eurheartj/ehac401 REALIZE K Commentary https://www.medscape.com/viewarticle/realize-k-new-potassium-binder-help-keep-spiro-board-2024a1000m2c

IV Butter vs Plant-based Oils and Mortality

JAMA-IM Study https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2831265 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 Cookbook Review https://doi.org/10.3945/ajcn.112.047142

V Vitamin D

Impact Factor https://www.medscape.com/viewarticle/rare-win-vitamin-d-this-time-ms-2025a10005ul D-Lay trial https://jamanetwork.com/journals/jama/fullarticle/2831270

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Listener feedback on asymptomatic aortic stenosis (AS), transcatheter aortic valve replacement (TAVR) vs surgical aortic valve replacement (SAVR), coronary artery calcium (CAC), and revascularization for patients with ischemic LV dysfunction are discussed by John Mandrola, MD, in today's podcast.

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I Aortic Valve Intervention for Asymptomatic AS

Asymptomatic Aortic Stenosis: ?Time to Act? or Not So Fast?

https://www.medscape.com/viewarticle/asymptomatic-aortic-stenosis-time-act-or-not-so-fast-2025a10005o9

EARLY TAVR: A Positive Trial That Fails to Inform Clinical Decisions

https://www.medscape.com/viewarticle/early-tavr-positive-trial-fails-inform-clinical-decisions-2024a1000kec

Reddy et al: https://doi.org/10.1016/j.jacc.2024.12.031 Wallach editorial https://doi.org/10.1016/j.jacc.2025.01.020 Guerrero https://www.tctmd.com/slide/tavr-young-patients-current-treatment-patterns-us

II CAC - Coronary Artery Calcium

Coronary Artery Calcium Testing?Too Early, Too Late, Too Often https://jamanetwork.com/journals/jamacardiology/fullarticle/2830950 CAUGHT-CAD https://jamanetwork.com/journals/jama/fullarticle/2831115

III CABG, PCI or Meds for Ischemic LV Dysfunction

STICH https://www.nejm.org/doi/full/10.1056/NEJMoa1100356 STICHES https://www.nejm.org/doi/full/10.1056/NEJMoa1602001 REVIVED BCIS https://www.nejm.org/doi/full/10.1056/NEJMoa2206606 EHJ paper https://doi.org/10.1093/eurheartj/ehaf080

IV Preview

https://www.medscape.com/viewarticle/shed-lead-and-injuries-should-cath-labs-go-lead-free-2024a1000hnb

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The treatment of asymptomatic aortic stenosis, the move to composite endpoints in trials, IFR vs FFR and high-frequency low tidal volume ventilation for AF ablation are the topics John Mandrola, MD, discusses in today's podcast.

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I Aortic valve intervention for Asymptomatic AS

Lindman editorial https://jamanetwork.com/journals/jamacardiology/fullarticle/2829881 Trends https://pmc.ncbi.nlm.nih.gov/articles/PMC11308430/ Podcast EARLY TAVR Nov 8, 2024 This Week in Cardiology Podcast https://www.medscape.com/viewarticle/1001865 Faith Healing and Subtraction Anxiety https://www.ahajournals.org/doi/10.1161/circoutcomes.118.004665 Early TAVR trial https://www.nejm.org/doi/10.1056/NEJMoa2405880 EVOLVED https://jamanetwork.com/journals/jama/fullarticle/2825540 AVATAR https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057639

II Trial Endpoints

Shepshelovich https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2830023 Brown meta-analysis https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2785560

III IFR vs FFR?a debate b/w RCTs and observational data

5-year DEFINE https://jamanetwork.com/journals/jamacardiology/fullarticle/2824470 5-year SwedeHeart IFR https://doi.org/10.1016/j.jacc.2021.12.030 Eftekhari meta-analysis https://doi.org/10.1093/eurheartj/ehad582 Gotberg SWEDEHEART Registry https://doi.org/10.1016/j.jcin.2024.12.003 Editorial of SWEDEHEART-Registry https://doi.org/10.1016/j.jcin.2024.12.014

IV High-frequency low-tidal-volume ventilation for AF ablation

Osorio et al https://doi.org/10.1016/j.hrthm.2024.07.094

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Blanking period after AF ablation, periprocedural MI after PCI in non-STEMI, predicting AF after ischemic stroke, and the proper standards for mitral valve repair in primary mitral regurgitation are the topics John Mandrola, MD, discusses in today?s podcast.

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I AF blanking period

CIRCA DOSE Research letter https://www.ahajournals.org/doi/10.1161/CIRCEP.124.013232 Circa-Dose https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.119.042622 COMPARE CRYO
 https://doi.org/10.1016/j.jacep.2024.03.021 Mohanty et al
 10.1016/j.hrthm.2024.08.011 Ruzieh, Foy, Mandrola Patients? Lives Don?t Pause for Blanking Periods https://doi.org/10.1016/j.ahjo.2024.100497

II Periprocedural MI and Future events

Circulation paper https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.070729

III AI to detect AF related stroke

eClinical Medicine Paper
 https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00050-1/fulltext

IV Mitral Valve Repair

JACC paper -- https://doi.org/10.1016/j.jacc.2024.10.108

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Silent cerebral embolism after LAAC, AI in ECG rhythm analysis, anti-thrombotic strategies in patients with AF and CAD, and subclinical AF are the topics John Mandrola, MD, covers in today?s podcast.

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I. Silent Cerebral Embolism after LAAC

JAHA Case Series  https://www.ahajournals.org/doi/10.1161/JAHA.124.037968 JACC  https://doi.org/10.1016/j.jacc.2018.12.039

II. AI Transforming Rhythm Monitor Reading

Johnson and colleagues RCT https://www.nature.com/articles/s41591-025-03516-x

III. Anticoagulation Alone or OAC plus antiplatelets in patients with CAD and AF

Rashedi and colleagues Meta-analysis https://doi.org/10.1016/j.jacc.2024.12.030 AQUATIC https://clinicaltrials.gov/study/NCT04217447

IV. DOAC for Subclinical AF ? A Subgroup Analysis of ARTESIA

Anticoagulation Uncertainty in Embolic Stroke of Undetermined Source https://www.medscape.com/viewarticle/anticoagulation-uncertainty-embolic-stroke-undetermined-2024a1000h5e

Lancet Neurology Subgroup Analysis of ARTESIA 10.1016/S1474-4422(24)00475-7 ARTESIA https://www.nejm.org/doi/full/10.1056/NEJMoa2310234 NOAH https://www.nejm.org/doi/full/10.1056/NEJMoa2303062 RE-SPECT ESUS https://www.nejm.org/doi/full/10.1056/NEJMoa1813959 NAVIGATE ESUS https://www.nejm.org/doi/full/10.1056/NEJMoa1802686

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Sugar-sweetened beverages, the epidemiology of driving after an ICD, BP measurements, and massive EBM lesson in EVT for acute stroke are the topics John Mandrola, MD, discusses in today's podcast.

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I. Sugar-Sweetened Beverages

Sugary Drinks Fuel Millions of Diabetes and CVD Cases https://www.medscape.com/viewarticle/sugary-drinks-fuel-millions-diabetes-and-cvd-cases-2025a10002wr

Nature Medicin;e Epidemiologic Study https://www.nature.com/articles/s41591-024-03345-4 JAMA-Network Open;  Beverage Tax Observational Study https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2829505 Lancet Regional Health; Beverage Tax Philadelphia EHR 10.1016/j.lana.2024.100906

II. Driving With an ICD

JACC Electrophysiology paper https://doi.org/10.1016/j.jacep.2024.12.002 Earlier HEART paper https://heart.bmj.com/content/110/24/1401

III. Blood Pressure Measurements and Simple RCTs

BP Readings in Noisy Market as Good as Quiet Office?

https://www.medscape.com/viewarticle/bp-readings-noisy-market-good-quiet-office-2025a10002z0

Annals of Internal Medicine Study https://www.acpjournals.org/doi/10.7326/ANNALS-24-00873

IV. A Big Shake-up in Interventional Stroke Care

Endovascular Therapy Fails to Show Benefit in Distal Occlusion Stroke  https://www.medscape.com/viewarticle/endovascular-therapy-fails-show-benefit-distal-occlusion-2025a100035u ESCAPE-MeVO https://www.nejm.org/doi/full/10.1056/NEJMoa2411668 DISTAL trial https://www.nejm.org/doi/full/10.1056/NEJMoa2408954 J. Mocco Editorial https://www.nejm.org/doi/full/10.1056/NEJMe2500492

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Another negative AF ablation trial, predicting AF after stroke, the value of RCTs, troponin testing in the ED and surgical aortic valve choice are the topics John Mandrola, MD, discusses this week.

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I AF ablation

Coronary Sinus Isolation for High-Burden Atrial Fibrillation: A Randomized Clinical Trial https://doi.org/10.1016/j.jacep.2024.09.017 Approaches to Catheter Ablation for Persistent Atrial Fibrillation (STAR AFII) https://www.nejm.org/doi/full/10.1056/NEJMoa1408288 Effect of Catheter Ablation With Vein of Marshall Ethanol Infusion vs Catheter Ablation Alone on Persistent Atrial Fibrillation: The VENUS Randomized Clinical Trial https://doi.org/10.1001/jama.2020.16195 Hybrid Convergent Procedure for the Treatment of Persistent and Long-Standing Persistent Atrial Fibrillation: Results of CONVERGE Clinical Trial https://www.ahajournals.org/doi/10.1161/CIRCEP.120.009288

II Post-Stroke AF monitoring

Prediction of atrial fibrillation after a stroke event: a systematic review with meta-analysisMeta-analysis 10.1016/j.hrthm.2025.01.026 Dabigatran for Prevention of Stroke after Embolic Stroke of Undetermined Source https://www.nejm.org/doi/full/10.1056/NEJMoa1813959 Rivaroxaban for Stroke Prevention after Embolic Stroke of Undetermined Source (Navigate ESUS https://www.nejm.org/doi/full/10.1056/NEJMoa1802686 Apixaban to Prevent Recurrence After Cryptogenic Stroke in Patients With Atrial Cardiopathy (ARCADIA) https://jamanetwork.com/journals/jama/fullarticle/2814933

III RCTs

Large simple randomized controlled trials?from drugs to medical devices: lessons from recent experience https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-025-08724-x Outcomes 1 Year after Thrombus Aspiration for Myocardial Infarction (TASTE) https://www.nejm.org/doi/full/10.1056/NEJMoa1405707

IV Troponin Testing in the ED

Cardiac Biomarker Testing in US Emergency Departments https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2829344 Updating Our Thinking on Troponin Use and Interpretation https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2777967

V Choice of AVR

Bioprosthetic vs Mechanical Aortic Valve Replacement in Patients 40-75 Years https://doi.org/10.1016/j.jacc.2025.01.013

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Familial hypercholesterolemia, cardiac arrest therapy, Factor XI inhibition, and tricuspid valve interventions are the topics John Mandroa, MD, discusses in this week?s podcast.

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I. Familial hypercholesterolemia

Danish Registry Study: https://doi.org/10.1093/eurheartj/ehae912

II. Cardiac Arrest

Vallentin and Colleagues RCT https://www.nejm.org/doi/full/10.1056/NEJMoa2407616

III. Factor XI

AZALEA https://www.nejm.org/doi/full/10.1056/NEJMoa2406674 OCEANIC https://www.nejm.org/doi/full/10.1056/NEJMoa2407105 VTE Study of Abelacimab 2021 https://www.nejm.org/doi/10.1056/NEJMoa2105872

IV. Tricuspid Valve Interventions

TRILUMINATE 1-year Study https://doi.org/10.1016/j.jacc.2024.10.086 Stone Editorial https://doi.org/10.1016/j.jacc.2024.11.045 TRISCEND Main Paper https://www.nejm.org/doi/full/10.1056/NEJMoa2401918 QOL Paper https://doi.org/10.1016/j.jacc.2024.10.067 PASTE Registry https://doi.org/10.1016/j.jacc.2024.10.068 AL-Lamee Editorial https://doi.org/10.1016/j.jacc.2024.10.085

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Renal denervation, the obesity paradox, JACC and the FINEARTS trial of finerenone in HFpEF, a setback for a PFA system, and coffee are the topics Jon Mandrola, MD, covers this week.

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I. RDN

CMS https://www.cms.gov/medicare-coverage-database/view/ncacal-tracking-sheet.aspx?ncaid=318 Messerli https://doi.org/10.1016/j.jacc.2024.09.1244 Filippone https://doi.org/10.1016/j.amjmed.2023.05.010

II. Finerenone

FINEHEARTS -HF NEJM https://www.nejm.org/doi/full/10.1056/NEJMoa2407107 FIDELIO-DKD https://www.nejm.org/doi/full/10.1056/NEJMoa2025845 FIGARO-DKD https://www.nejm.org/doi/full/10.1056/NEJMoa2110956 Why Have We Not Been Able to Demonstrate Reduced Mortality in Patients With HFmrEF/HFpEF? https://doi.org/10.1016/j.jacc.2024.08.033 Regional Variation TOPCAT https://www.ahajournals.org/doi/10.1161/circulationaha.114.013255 Time from WHF Subanalysis https://doi.org/10.1016/j.jacc.2024.09.004 REDEFINE - https://clinicaltrials.gov/study/NCT06008197 Health status paper https://doi.org/10.1016/j.jacc.2024.09.023 Obesity subanalysis https://doi.org/10.1016/j.jacc.2024.10.111 Kidney outcomes https://www.sciencedirect.com/science/article/pii/S0735109724102525 Kidney outcomes 2 https://doi.org/10.1016/j.jacc.2024.11.020 Kaul editorial https://doi.org/10.1016/j.jacc.2024.11.024

III. PFA Setback

J&J Halts Varipulse Field Ablation for AFib

https://www.medscape.com/viewarticle/j-j-halts-varipulse-field-ablation-afib-2025a10000j8

IV. Coffee

Stop the Coffee Studies https://www.medscape.com/viewarticle/883709

Coffee drinking timing and mortality in US adults 

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Alcohol and cancer, GLP-1 trial representativeness, diagnosing CAD, changing stroke rates in patients with AF, blanking periods after AF ablation are the topics John Mandrola, MD, covers this week.

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I. Surgeon General Causes Hoopla Regarding ETOH Warning

Dry January: Should Doctors Make It Year-Round?

https://www.medscape.com/viewarticle/dry-january-should-doctors-make-it-year-round-2025a100009t

Surgeon General Warning https://www.hhs.gov/about/news/2025/01/03/us-surgeon-general-issues-new-advisory-link-alcohol-cancer-risk.html GBD 2016 Collaboration Lancet https://doi.org/10.1016/S0140-6736(18)31310-2 RCT Voskobonik and colleagues https://www.nejm.org/doi/full/10.1056/NEJMoa1817591 Marcus and colleagues; UCSF https://pubmed.ncbi.nlm.nih.gov/33516710/ Review of ETOH AF https://doi.org/10.1016/j.jacc.2016.08.074

II. GLP-1 Agonists for Obesity ?Trial vs Real World

Generalizability of Trial Results https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2826335 HRS Document ICD http://dx.doi.org/10.1016/j.hrthm.2014.03.041

III. Stress Testing and CAD Severity

Reynolds and colleagues. Observational ISCHEMIA Sub-analysis https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.123.013743 Foy Meta-analysis https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2655243 ISCHEMIA https://www.nejm.org/doi/full/10.1056/NEJMoa1915922

IV. Changing Stroke Rates with AF

Teppo and colleagues. Finnish Study https://doi.org/10.1016/j.jacep.2024.10.029 Quinn and colleagues. https://www.ahajournals.org/doi/10.1161/circulationaha.116.024057

V. Patients? Lives Don?t Pause for Blanking Periods

Ruzieh and colleagues. https://doi.org/10.1016/j.ahjo.2024.100497

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Listener feedback, multiple studies in AF ablation,

a DANISH trial substudy of ICDs in NICM, and more data on eye complications of GLP-1 agonists are the topics John Mandrola, MD, covers in this week?s podcast.

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I. CCTA Feedback

Foy meta-analysis https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2655243 DANCAVAS https://www.nejm.org/doi/full/10.1056/NEJMoa2208681

II. Listener Feedback on my negative take of the OPTION Trial.

Option trial https://www.nejm.org/doi/pdf/10.1056/NEJMoa2408308 My Preview https://www.medscape.com/viewarticle/mandrola-previews-option-trial-most-worrisome-study-aha-2024-2024a1000kmz 4 Reasons to Question Percutaneous Left Atrial Appendage Closure After AF Ablation https://www.medscape.com/viewarticle/4-reasons-question-percutaneous-left-atrial-appendage-2024a1000l0u

III. AF Ablation 

PVI Add-Ons Provide Better Control of Persistent AF

https://www.medscape.com/viewarticle/pvi-add-ons-provide-better-control-persistent-af-2024a1000lcm

VENUS https://jamanetwork.com/journals/jama/fullarticle/2772281 PROMPT AF https://jamanetwork.com/journals/jama/fullarticle/2826710 STAR AF 2 https://www.nejm.org/doi/full/10.1056/NEJMoa1408288 CRRF-PeAF https://pmc.ncbi.nlm.nih.gov/articles/PMC9241129/ CAVAC trial https://doi.org/10.1161/CIRCEP.124.012917 CRRF-PeAF from multiple centers in Japan (not published)

IV. DANISH Trial Substudy

Danish Trial Substudy https://www.ahajournals.org/doi/epdf/10.1161/CIRCULATIONAHA.124.071777 Danish Main https://www.nejm.org/doi/full/10.1056/NEJMoa1608029 MADIT-2 EF Substudy https://doi.org/10.1016/S0002-9149(01)01729-5 SCD-HeFT subgroup https://www.nejm.org/doi/full/10.1056/NEJMoa043399 Appraisal of ICD to Prevent SCD https://doi.org/10.1016/j.jacc.2008.05.058

V. Eye disease and GLP-1 Agonists

Jul 26, 2024 This Week in Cardiology Podcast

https://www.medscape.com/viewarticle/1001384

Semaglutide vs No Semagutide and Eye Disease https://link.springer.com/epdf/10.1186/s40942-024-00620-x Semaglutide vs SGLT- Inhibitors and Eye Disease https://www.medrxiv.org/content/10.1101/2024.12.09.24318574v1.full-text

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US doc's pay, the ticagrelor controversy and new RCTs, clopidogrel beats ASA, holding antiplatelets for non-cardiac surgery, and Prof Cleland and ASA dogma 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. US Healthcare

Mandrola?s Top 10 Stories in 2024 https://www.medscape.com/viewarticle/mandrolas-top-10-stories-2024-2024a1000mxe?_gl=1*dcvmkh*_gcl_au*MTgzOTY2ODQ0Ni4xNzI5MjU4NjUz

CMS Proposal

II. Ticagrelor Controversy

New Investigation Casts Doubt on Landmark Ticagrelor Trial

https://www.medscape.com/viewarticle/new-investigation-casts-doubt-landmark-ticagrelor-trial-2024a1000n1d

Doshi Review https://www.bmj.com/content/387/bmj.q2550 PLATO https://www.nejm.org/doi/full/10.1056/NEJMoa0904327 ISAR REACT 5 https://www.nejm.org/doi/full/10.1056/NEJMoa1908973 Bates Review https://www.ahajournals.org/doi/epub/10.1161/JAHA.123.031606 Victor Serebuany and Dan Atar Editorial https://doi.org/10.1093/eurheartj/ehp545

III. New Ticagrelor vs Clopdiogrel trial

Preprint: https://www.medrxiv.org/content/10.1101/2024.11.06.24316875v1.full-text

IV. Clopidogrel Better Than ASA Even in HBR

Substudy Long-Term Aspirin vs Clopidogrel After Coronary Stenting by Bleeding Risk and Procedural Complexity HOST-EXAM 10.1016/S0140-6736(21)01063-1 HOST-EXAM-Extended https://doi.org/10.1161/CIRCULATIONAHA.122.062770

V. ASA During Non-Cardiac Surgery

ASSURE DES https://doi.org/10.1016/j.jacc.2024.08.024

VII. Professor Cleland on ASA for Secondary Prevention

Cleland Editorial https//jamanetwork.com/journals/jamacardiology/article-abstract/2827201 ASA Meta-analysis 10.1016/S0140-6736(09)60503-1 AMIS https://jamanetwork.com/journals/jama/fullarticle/368745 SAPAT 10.1016/0140-6736(92)92619-Q

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Tirzepatide vs semaglutide in obesity; GLP1a use is complicated; HF outcomes; the misuse of meta-analyses in HF; and a breakthrough in HF care 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. SURMOUNT 5

Clinicaltrials.gov https://clinicaltrials.gov/study/NCT05822830 Press Release  

II. Access to GLP-1 Agonist Drugs

CMS statement https://www.cms.gov/newsroom/press-releases/biden-harris-administration-announces-medicare-advantage-and-medicare-part-d-prescription-drug

III. SUMMIT TRIAL commentary

Has Tirzepatide Scaled the HFpEF/Obesity SUMMIT?

https://www.medscape.com/viewarticle/has-tirzepatide-scaled-hfpef-obesity-summit-2024a1000m2h

IV. Blank Spot in HF Evidence ? All cause hospitalizations
 

Sayed and colleagues What Is Success in HF Trials? https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2827168 EMPEROR-Preserved https://www.nejm.org/doi/full/10.1056/NEJMoa2107038 Mayo Observational Study 10.1016/j.mayocp.2016.11.009 DIG Trial https://jamanetwork.com/journals/jama/fullarticle/195990

V. Misuse of Meta-analysis by HF Community

Lu and colleagues PARAGON/PARADIGM Meta-analysis https://jamanetwork.com/journals/jamacardiology/fullarticle/2823259 Desai 2004 https://jamanetwork.com/journals/jama/fullarticle/199995 PARADIGM HF https://www.nejm.org/doi/full/10.1056/NEJMoa1409077 PARAGON HF https://www.nejm.org/doi/full/10.1056/NEJMoa1908655

VI Integration of Palliative Care Into HF Care

Chuzi and colleagues Palliative Care in HF 10.1016/j.cardfail.2024.10.435 Kotecha and colleagues Beta-blocker Metaanalysis 10.1016/S0140-6736(14)61373-8

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An AHA review: the OPTION, SUMMIT, VANISH 2, SARAH, and CLEAR 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:

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I. OPTION Trial

For AF, LAA Rivals Anticoagulants After Ablation

https://www.medscape.com/viewarticle/af-laa-rivals-anticoagulants-after-ablation-2024a1000l7n

4 Reasons to Question Percutaneous Left Atrial Appendage Closure After AF Ablation

https://www.medscape.com/viewarticle/4-reasons-question-percutaneous-left-atrial-appendage-2024a1000l0u

OPTION in NEJM https://www.nejm.org/doi/full/10.1056/NEJMoa2408308

II. SUMMIT Trial

Tirzepatide Reduces Heart Failure Events in HFpEF With Obesity

https://www.medscape.com/viewarticle/tirzepatide-reduces-heart-failure-events-hfpef-obesity-2024a1000kx5

SUMMIT in NEJM https://www.nejm.org/doi/full/10.1056/NEJMoa2410027

III. VANISH Trial

New Trial Result Pushes Past Antiarrhythmic Therapy After MI

https://www.medscape.com/viewarticle/new-trial-result-pushes-past-antiarrhythmic-therapy-after-mi-2024a1000l08

VANISH 2 https://www.nejm.org/doi/full/10.1056/NEJMoa2409501 VANISH 1 https://www.nejm.org/doi/full/10.1056/NEJMoa1513614

IV. Cardioprotection

Common Heart Failure Drugs Ease Heart Damage During Chemo https://www.medscape.com/viewarticle/common-heart-failure-drugs-ease-heart-damage-during-chemo-2024a1000l14

Strain Imaging Review Article https://www.jacc.org/doi/10.1016/j.jcmg.2024.07.011

V. CLEAR trial

Spironolactone Shows Mixed Results in Acute MI

https://www.medscape.com/viewarticle/spironolactone-shows-mixed-results-acute-mi-2024a1000l41

Routine Colchicine or MRA Post-MI: No CLEAR Benefit

https://www.medscape.com/viewarticle/routine-colchicine-or-mra-post-mi-no-clear-benefit-2024a1000la2

CLEAR-Spironolactone https://www.nejm.org/doi/full/10.1056/NEJMoa2405923 CLEAR-Colchicine https://www.nejm.org/doi/full/10.1056/NEJMoa2405922

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Tirzepatide, AF screening, and an AHA preview, including VT ablation, LAAC at the time of AF ablation, BP targets, and GLP1 agonists in HF 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:

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I. Tirzepatide

SURMOUNT 1 ? Three-year results https://www.nejm.org/doi/full/10.1056/NEJMoa2410819

II. AF Screening

GUARD AF https://www.jacc.org/doi/10.1016/j.jacc.2024.08.019 LOOP 10.1016/S0140-6736(21)01698-6 STROKE STOP 10.1016/S0140-6736(21)01637-8

III. LAAC with AF ablation 

Mandrola Previews the OPTION Trial, the Most Worrisome Study at AHA 2024

https://www.medscape.com/viewarticle/mandrola-previews-option-trial-most-worrisome-study-aha-2024-2024a1000kmz

The OPTION Trial
Rationale https://doi.org/10.1016/j.ahj.2022.05.003

IV. Blood Pressure Targets

BPROAD https://onlinelibrary.wiley.com/doi/10.1111/1753-0407.13411 ACCORD - https://www.nejm.org/doi/full/10.1056/NEJMoa1001286

V. GLP1a for HFpEF

SUMMIT at Clinicaltrials.gov https://clinicaltrials.gov/study/NCT04847557

VI. VT Ablation

VANISH2 Rationale https://doi.org/10.1016/j.ahj.2024.04.009 VANISH 1 https://www.nejm.org/doi/full/10.1056/NEJMoa1513614

VII. Spironolactone Results of CLEAR-SYNERGY 

Nov 08, 2024 This Week in Cardiology Podcast

https://www.medscape.com/viewarticle/1001865

'No Hint of Benefit' in Large Colchicine Trial

https://www.medscape.com/viewarticle/no-hint-benefit-large-colchicine-trial-2024a1000ko4

CLEAR SYNERGY Rationale https://pubmed.ncbi.nlm.nih.gov/38936755/

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The EARLY TAVR trial, colchicine after MI, and the TRISCEND II trial of tricuspid valve replacement 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. Early TAVR

EARLY TAVR https://www.acc.org/latest-in-cardiology/clinical-trials/2024/10/24/14/42/early-tavr Rationale https://doi.org/10.1016/j.ahj.2023.11.019 AVATAR https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057639 RECOVERY https://www.nejm.org/doi/full/10.1056/NEJMoa1912846 FAME 2 https://www.nejm.org/doi/full/10.1056/NEJMoa1205361 Rajkumar; Faith Healing in Unblinded Trials https://pubmed.ncbi.nlm.nih.gov/29530888/ PARTNER 3 trial https://www.nejm.org/doi/full/10.1056/NEJMoa2307447 EARLY TAVR: A Positive Trial That Fails to Inform Clinical Decisions https://www.medscape.com/viewarticle/early-tavr-positive-trial-fails-inform-clinical-decisions-2024a1000kec

II. Colchicine

Meta-analysis https://doi.org/10.1016/j.eclinm.2024.102835 Clear-Synergy Rationale https://pubmed.ncbi.nlm.nih.gov/38936755/ COLCOT (post MI) https://www.nejm.org/doi/full/10.1056/NEJMoa1912388 LoDoCo (Chronic CAD) https://www.nejm.org/doi/full/10.1056/NEJMoa2021372  

III. TRISCEND II Trial

TRISCEND II Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2401918

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Listener feedback on PFA and STEMI/NSTEMI paradigm, oral semaglutide, symptomatic vs asymptomatic AF, and the win-ratio 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

Oct 18, 2024 This Week in Cardiology Podcast

https://www.medscape.com/viewarticle/1001769

Pulsed Field Ablation

https://www.hrsonline.org/guidance/safety-alerts/boston-scientific-cardiac-cryoablation-system

STEMI/NSTEMI https://doi.org/10.1016/j.jacadv.2024.101314

II. Oral Semaglutide

Press Release: https://www.novonordisk.com/content/nncorp/global/en/news-and-media/news-and-ir-materials/news-details.html?id=171480 Rationale Paper SOUL trial

III. Symptomatic vs Asymptomatic AF

Meta-analysis in EHJ   Meta-analysis of rate vs rhythm-control strategies https://doi.org/10.1016/j.jacep.2024.03.006

IV. The Win Ratio

Pocock and colleagues https://doi.org/10.1093/eurheartj/ehae647

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Listener feedback on the c-statistic, atherosclerotic plaque imaging, WATCHMAN implant decisions in the US, and deprescribing are the topics John Mandrola, MD, discusses in this week?s podcast.

This podcast is intended for healthcare professionals only.

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I.Listener Feedback

Oct 11, 2024 This Week in Cardiology Podcast

https://www.medscape.com/viewarticle/1001735

Nancy Cook; C-statistic https://doi.org/10.1161/CIRCULATIONAHA.106.672402

II. Plaque Imaging

New Evidence That Plaque Buildup Shouldn't Be Ignored

https://www.medscape.com/viewarticle/new-evidence-plaque-buildup-shouldnt-be-ignored-2024a1000ihw

Fuster and colleagues; Imaging vs CAC  

III. WATCHMAN Decisions

Zeitler and colleagues. Long-term Outcomes

IV. Deprescribing

Cognitive Decline and Antihypertensive Use: New Data

https://www.medscape.com/viewarticle/cognitive-decline-and-antihypertensive-use-new-data-2024a1000isw?form=fpf

Jing and colleagues.

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Reader feedback on cardiac devices and PFA, a new paradigm in the language of MI, sudden cardiac death, and measuring blood pressure 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

Sep 20, 2024 This Week in Cardiology Podcast

https://www.medscape.com/viewarticle/1001631

Cardiac Devices

https://www.acpjournals.org/doi/10.7326/ANNALS-24-00724

Impact of PFA on Intraluminal Esophageal Temperature https://onlinelibrary.wiley.com/doi/10.1111/jce.16096

II. Towards a New Classification of MI

McLaren and colleagues; From STEMI to OMI https://doi.org/10.1016/j.jacadv.2024.101314

III. Sudden Death After MI.

EHJ Paper; SCD After MI https://doi.org/10.1093/eurheartj/ehae326 Barsheshet and colleagues; Risk Score to Predict Benefit of ICD https://doi.org/10.1016/j.jacc.2012.02.036 Zegard and colleagues; Myocardial Fibrosis and SCD 10.1016/j.jacc.2020.10.046 MADIT RIT https://www.nejm.org/doi/full/10.1056/NEJMoa1211107

IV. BP Readings

Poor Arm Position May Significantly Skew BP Readings

https://www.medscape.com/viewarticle/poor-arm-position-may-significantly-skew-bp-readings-2024a1000icv?form=fpf

ARMS Crossover RCT

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Reader feedback on LGE pre-ICDs, PFA for AF ablation, CTO-PCI, endovascular ablation of the greater splanchnic nerve in HFpEF, and data sharing are the topics John Mandrola, MD, covers this week.

This podcast is intended for healthcare professionals only.

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I. Listener Feedback

Sept 27, 2024 This Week in Cardiology Podcast

https://www.medscape.com/viewarticle/1001666

JAMA Meta-analysis https://jamanetwork.com/journals/jama/fullarticle/2823869/

II. Pulsed Field Ablation for AF

Feb 02, 2024 This Week in Cardiology Podcast https://www.medscape.com/viewarticle/999995

ADMIRE Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.070333 ADVENT Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2307291

III. PCI for CTO

EuroCTO One Year SAQ Results https://doi.org/10.1093/eurheartj/ehy220 EuroCTO Hard Outcomes https://eurointervention.pcronline.com/article/three-year-outcomes-of-eurocto-a-randomized-multicentre-trial-comparing-revascularization-and-optimal-medical-therapy-for-chronic-total-coronary-occlusions Faith Healing and Subtraction Anxiety https://doi.org/10.1161/CIRCOUTCOMES.118.004665 DECISION CTO trial https://doi.org/10.1161/CIRCULATIONAHA.118.031313 ISCHEMIA CTO Rationale and Design https://doi.org/10.1016/j.ahj.2022.11.016

IV. Greater Splanchnic Nerve Ablation for HFpEF

REBALANCE HF https://jamanetwork.com/journals/jamacardiology/fullarticle/2823999

V. Data Sharing

The Pros and Cons of Clinical Trial Data Sharing

https://www.medscape.com/viewarticle/862815

Kramer and Nallamothu, Caution in Data Sharing https://www.ahajournals.org/doi/full/10.1161/CIRCOUTCOMES.124.010257 Nosek, Variability in Analytic Methods https://journals.sagepub.com/doi/10.1177/2515245917747646 Zeraatker, Variability in Analytic Methods  

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Surgical clearance, NICM assessment, dueling perspectives on PCI as first-line therapy for angina, GDMT in HFrEF are the topics John Mandrola, MD, discusses in this week's podcast.

This podcast is intended for healthcare professionals only.

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I. New ACC Peri-operative Guidelines Released

ACC Guideline document https://www.jacc.org/doi/10.1016/j.jacc.2024.06.013 J Vasc Surg https://www.jvascsurg.org/article/S0741-5214(21)00335-9/fulltext McFalls and colleagues; CARP https://www.nejm.org/doi/full/10.1056/NEJMoa041905

II. NICM ? We may be doing it wrong in Selecting ICDs

JAMA Meta-analysis https://jamanetwork.com/journals/jama/fullarticle/2823869/ German CMR ICD Trial https://www.clinicaltrials.gov/study/NCT04558723 BRITISH CMR trial https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/britishusing-cmr-scar-as-risk-indication-tool-in-nicm-and-severe-lvsd/

III. When Should PCI be Used in Chronic Stable CAD?

 

Rajkumar and Al-Lamee; PCI First https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.124.011201

 

Boden and De Caterina; Meds First https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.124.011268 ORBITA 10.1016/S0140-6736(17)32714-9 ORBITA 2 trial https://www.nejm.org/doi/full/10.1056/NEJMoa2310610

IV. GDMT Underuse in HFrEF

Greene and colleagues https://doi.org/10.1016/j.jchf.2024.08.002 DAPA HF https://www.nejm.org/doi/full/10.1056/NEJMoa1911303 RALES https://www.nejm.org/doi/full/10.1056/NEJM199909023411001

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Listener feedback, K levels post cardiac surgery, cardiac device safety, disparities in preventive care, stopping trials early, and a SHAM-PVI update are the topics John Mandrola, MD, covers this week.

This podcast is intended for healthcare professionals only.

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I. Listener Feedback

Sep 13, 2024 This Week in Cardiology Podcast

https://www.medscape.com/viewarticle/1001596

Sripal Bangalore Tweet on Yusef Meta-analysis https://x.com/SripalBangalore/status/1750116964893094125

II. Post Cardiac Surgery AF

TIGHT K Trial https://jamanetwork.com/journals/jama/fullarticle/2823246

III. Evidence Base for New Cardiac Devices

Annals of IM Survey Observational Study https://www.acpjournals.org/doi/10.7326/ANNALS-24-00724

IV. Disparities in Care

JAMA Network Open Paper on Insurer Denials of Preventive Care https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2823677

V. Stopping Trials Early

Kaul and Butler; Insights on Recent CKD Trials https://doi.org/10.1016/j.jacc.2024.07.026 Bassler Systematic Review https://jamanetwork.com/journals/jama/fullarticle/185591

VI. Sham PVI

AF Ablation Works?But: The Positive SHAM-PVI Trial

https://www.medscape.com/viewarticle/af-ablation-works-positive-sham-pvi-trial-2024a1000gzl?&icd=login_success_email_match_fpf

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More from ESC: the SCOFF trial and fasting before cardiac cath, MATTERHORN, humbling data with AI, plus a reflection on the work of being a patient are the topics John Mandrola, MD, covers this week.

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I. Fasting Before Cardiac Procedures

The SCOFF Trial https://doi.org/10.1093/eurheartj/ehae573

II. MV repair for Functional MR

Large Trials Support Mitral Valve Repair in Heart Failure

MATTERHORN https://www.nejm.org/doi/full/10.1056/NEJMoa2408739

III. AI in Medicine

Rapidx AI Project https://healthtranslationsa.org.au/project/rapid-x-ai/ PROTEUS Trial Rationale paper https://pubmed.ncbi.nlm.nih.gov/37192698/

IV. Time Toxicity

Time Toxicity https://link.springer.com/article/10.1007/s00520-024-08844-1 Thread X https://x.com/EnriqueSoto8/status/1833587144256065859

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Feedback on ABYSS and beta-blockers, more ESC recap, including SHAM-PVI, FINEARTS-HF, and RESHAPE HF2 trials are the topics John Mandrola, MD, discusses in today?s podcast.

This podcast is intended for healthcare professionals only.

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I. Feedback on ABYSS

Setbacks After Stopping Beta-Blockers

https://www.medscape.com/viewarticle/setbacks-after-stopping-beta-blockers-2024a1000fv7

Beta-Blockers Post-MI? No for Me, Even After the ABYSS Trial

https://www.medscape.com/viewarticle/beta-blockers-post-mi-no-me-even-after-abyss-trial-2024a1000fva

ABYSS trial https://www.nejm.org/doi/full/10.1056/NEJMoa2404204 REDUCE AMI https://www.nejm.org/doi/full/10.1056/NEJMoa2401479 QOL paper REDUCE AMI https://doi.org/10.1093/ehjcvp/pvae062 Atenolol ED paper 10.1016/j.ehj.2003.08.016

II. SHAM-PVI

JAMA SHAM-PVI paper https://jamanetwork.com/journals/jama/article-abstract/2823283 Gupta QOL paper https://pubmed.ncbi.nlm.nih.gov/33952593/

III. FINEARTS HF

Finerenone Benefits Heart Failure With Preserved EF

https://www.medscape.com/viewarticle/finerenone-benefits-heart-failure-preserved-ef-2024a1000fza

Topline Finerenone Results Point to Advance in Heart Failure

https://www.medscape.com/viewarticle/topline-finerenone-results-point-advance-heart-failure-2024a1000fq2

FINEHEARTS -HF NEJM https://www.nejm.org/doi/full/10.1056/NEJMoa2407107 FIDELIO-DKD https://www.nejm.org/doi/full/10.1056/NEJMoa2025845 FIGARO-DKD https://www.nejm.org/doi/full/10.1056/NEJMoa2110956 Why Have We Not Been Able to Demonstrate Reduced Mortality in Patients With HFmrEF/HFpEF? https://doi.org/10.1016/j.jacc.2024.08.033

IV. RESHAPE HF

TEER in Functional MR: Data Deluge, but No Easy Answers

https://www.medscape.com/viewarticle/teer-functional-mr-data-deluge-no-easy-answers-2024a1000fvg

Mitra FR https://www.nejm.org/doi/full/10.1056/NEJMoa1805374 COAPT https://www.nejm.org/doi/full/10.1056/NEJMoa1806640 RESHAPE- HF2 https://www.nejm.org/doi/full/10.1056/NEJMoa2314328 RESHAPE Subgroup paper https://doi.org/10.1016/j.jacc.2024.08.027

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From ESC: post-MI beta blockers, a new therapy for ATTR-CM, holding RASi before non-cardiac surgery, good news in HFpEF, and an ESC preview 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. ABYSS

ABYSS trial https://www.nejm.org/doi/full/10.1056/NEJMoa2404204 REDUCE AMI https://www.nejm.org/doi/full/10.1056/NEJMoa2401479

II. ATTR -CM HELIOS B

Positive Top Line Results for Vutrisiran in Cardiac Amyloidosis

https://www.medscape.com/viewarticle/positive-top-line-results-vutrisiran-cardiac-amyloidosis-2024a1000cjj

HELIOS A https://www.tandfonline.com/doi/full/10.1080/13506129.2022.2091985 HELIOS B https://www.nejm.org/doi/full/10.1056/NEJMoa2409134

III. STOP or NOT Trial

Observational Study Showing Benefits of Holding RASi https://doi.org/10.1097/ALN.0000000000001404 STOP or NOT Protocol Paper -- https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-019-3247-1 JAMA STOP or NOT https://jamanetwork.com/journals/jama/fullarticle/2823118

IV. GLP1a in HFpEF

The GLP-1 Agonist Semaglutide in HFpEF Cleared a Low Bar https://www.medscape.com/viewarticle/995872

STEP-HFpEF https://www.nejm.org/doi/full/10.1056/NEJMoa2306963 STEP-HFpEF-DM https://www.nejm.org/doi/full/10.1056/NEJMoa2313917 SELECT https://www.nejm.org/doi/full/10.1056/NEJMoa2307563 FLOW https://www.nejm.org/doi/full/10.1056/NEJMoa2403347 Lancet Meta-analysis https://doi.org/10.1016/S0140-6736(24)01643-X

V. ESC Preview

Mandrola's Five Big Trials to Look for at ESC 2024

https://www.medscape.com/viewarticle/mandrolas-five-big-trials-look-esc-2024-2024a1000fkt

Topline Finerenone Results Point to Advance in Heart Failure

https://www.medscape.com/viewarticle/topline-finerenone-results-point-advance-heart-failure-2024a1000fq2

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Suicidal ideation and GLP-1 agonists, a repeat of PARADIGM HF in Chagas CM, CASTLE HTx critical appraisal, and primary prevention of SCD in HF 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. Suicidal ideation with GLP-1

Signal of Suicidality With GLP-1 RA Semaglutide, but Experts Urge Caution

https://www.medscape.com/viewarticle/signal-suicidality-glp-1-ra-semaglutide-experts-urge-caution-2024a1000fa7

Disproportionality Analysis from World Health Organization Data on Semaglutide, Liraglutide, and Suicidality   Variability in Disproportionality paper https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2021.668765/full

II. PARACHUTE HF: Repeating the Mistakes in PARADIGM HF

PARACHUTE HF https://www.jacc.org/doi/10.1016/j.jchf.2024.05.021 SOLVD https://www.nejm.org/doi/full/10.1056/NEJM199108013250501 CONSENSUS trial https://www.nejm.org/doi/full/10.1056/NEJM198706043162301 Meta-analysis of Low vs High Dose ACE/ARB https://doi.org/10.1161/CIRCHEARTFAILURE.117.003956 Meta-analysis of Sac/Val vs ARB/ACE Inhibitors https://link.springer.com/article/10.1007/s00228-024-03686-6 PARADISE MI https://www.nejm.org/doi/full/10.1056/NEJMoa2104508

III. CASTLE HTx Critical Appraisal

Critical Appraisal of CASTLE HTx https://doi.org/10.1016/j.jacc.2024.06.020 CASTLE HTx https://www.nejm.org/doi/10.1056/NEJMoa2306037 CASTLE AF https://www.nejm.org/doi/full/10.1056/NEJMoa1707855

IV. More Data Suggesting Modest Benefits of the Primary Prevention ICD

First and Recurrent ICD Shocks: JICE Paper from Denmark https://link.springer.com/article/10.1007/s10840-024-01873-0 HF trialists https://www.nejm.org/doi/full/10.1056/NEJMoa1609758
PROFID Trial https://profid-project.eu/ DANISH  https://www.nejm.org/doi/full/10.1056/NEJMoa1608029 SCD-HeFT https://www.nejm.org/doi/full/10.1056/NEJMoa043399

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Diuretic therapy in HFrEF, AF ablation, TACT 2 and the story of subgroups, and SGLT2 inhibitor underuse are the topics John Mandrola, MD, discusses in this week?s podcast.

This podcast is intended for healthcare professionals only.

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I. Diuretic Therapy in HF

Dapa vs Metolazone Trial https://doi.org/10.1093/eurheartj/ehad341
ADVOR https://www.nejm.org/doi/10.1056/NEJMoa2203094

II. Rapid Medication Titration for Acute HF

ACC Decision Pathway https://www.jacc.org/doi/10.1016/j.jacc.2024.06.002

III. SGLT2 Inhibitor Use in the US

Shin and Colleagues; JACC  https://www.sciencedirect.com/science/article/abs/pii/S0735109724076332 Editorial  https://doi.org/10.1016/j.jacc.2024.07.001

IV. AF Ablation: General Anesthesia vs Conscious Sedation

Da Riis-Vestergaard and Colleagues  https://doi.org/10.1093/europace/euae203

V. TACT 2 Published

TACT 1 https://jamanetwork.com/journals/jama/fullarticle/1672238 TACT 1 DM https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.113.000663 TACT 2 https://jamanetwork.com/journals/jama/fullarticle/2822472

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Prediction models vs clinical judgement, CCTA quantification of atherosclerosis, AF ablation plus LAAO, atrial shunt devices, and HF medical therapy are topics John Mandrola, MD, covers this week.

This podcast is intended for healthcare professionals only.

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I.Clinical Prediction Models vs Clinical Judgement

Did Statin Decision-Making Just Get Harder? 

https://www.medscape.com/viewarticle/did-statin-decision-making-just-get-harder-2024a1000egl

Colunga-Lozano and colleagues https://doi.org/10.1016/j.jclinepi.2023.10.016 Aug 02, 2024 This Week in Cardiology Podcast https://www.medscape.com/viewarticle/1001429

II. CCTA Quantification of Atherosclerosis

Atherosclerosis Quantification and Cardiovascular Risk: the ISCHEMIA Trial https://doi.org/10.1093/eurheartj/ehae471 Circulation ISCHEMIA sub study 2021 ? Severity of CAD and Outcomes https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.049755 ISCHEMIA Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1915922

III. Combined AF Ablation and LAAO

Review from Mills and colleagues https://doi.org/10.1016/j.tcm.2023.11.003 Link to CMS Rule on AF Ablation and LAAO https://hrs2.informz.net/z/cjUucD9taT05MjU3ODgyJnA9MSZ1PTkwMDQ2MTk4MCZsaT04NTU1OTQxMg/index.html

IV. Atrial Shunt Devices

No Net HF Benefit for Interatrial Shunt Device

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

Original REDUCE-LAP-HF-II https://doi.org/10.1016/S0140-6736(22)00016-2 Two-year results of REDUCE-LAP-HF-II https://doi.org/10.1016/j.jchf.2024.04.011 Apr 19, 2024 This Week in Cardiology Podcast

V. Optimal HF Therapy

Rao and colleagues; CHAMP HF https://doi.org/10.1016/j.jchf.2024.05.026

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Two downsides of PFA including autonomic tone and hemolysis, a bad surrogate in AF care, and controversies in defining cardiac risk 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.PFA and Its (lack of) Effect on Autonomic Tone

Pulsed Field Ablation for AF: Are US Electrophysiologists Too Easily Impressed?

https://www.medscape.com/viewarticle/pulsed-field-ablation-af-are-us-electrophysiologists-too-2024a1000d2v

Autonomic Tone Paper https://doi.org/10.1016/j.jacep.2024.05.005 ADVENT https://www.nejm.org/doi/full/10.1056/NEJMoa2307291

II. Second PFA Study JACC-EP?on Hemolysis
 

Hemolysis study https://doi.org/10.1016/j.jacep.2024.05.001 MANIFEST 17K https://www.nature.com/articles/s41591-024-03114-3 Defaye Editorial https://www.jacc.org/doi/abs/10.1016/j.jacep.2024.06.007

III. A Self-serving Surrogate Marker:  Diagnosis to Ablation Time.

CAPLA Study https://jamanetwork.com/journals/jama/fullarticle/2800186 CAPLA Substudy https://doi.org/10.1016/j.jacep.2024.05.031 EHJ RCT Early vs Late https://doi.org/10.1093/eurheartj/ehad247 LOOP; Diederichsen and colleagues  10.1016/j.jacc.2019.09.050 Groningen and Maastricht Group study https://heart.bmj.com/content/109/3/186

IV. Future Cardiac Risk

Diao and colleagues Study of AHA PREVENT Risk Equations https://jamanetwork.com/journals/jama/fullarticle/2821624 JAMA Editorial https://jamanetwork.com/journals/jama/fullarticle/2821542 Another JAMA Editorial https://jamanetwork.com/journals/jama/fullarticle/2821628

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Health and income, high BP in the hospital, and more on subclinical AF and when to use anticoagulants 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. Health and Income 

A Cash Giveaway to Improve Health

https://www.medscape.com/viewarticle/cash-giveaway-improve-health-2024a1000dhf?form=fpf

JAMA RCT https://jamanetwork.com/journals/jama/fullarticle/2821454 NBER RCT https://www.nber.org/papers/w32711 Have We Missed the Hidden Cause of Medical Overuse? https://www.medscape.com/viewarticle/908309 Mar 17, 2023 This Week in Cardiology Podcast https://www.medscape.com/viewarticle/989775

Other References 

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

II. Elevated BP in the hospital

JAMA-IM https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2821364

III. Short-duration Subclinical AF

Apixaban Cuts Stroke but Ups Bleeding in Subclinical AF: ARTESIA

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

ARTESiA https://www.nejm.org/doi/full/10.1056/NEJMoa2310234 ARTESiA CHADSVASC Subgroup  https://www.jacc.org/doi/10.1016/j.jacc.2024.05.002 NOAH https://www.nejm.org/doi/full/10.1056/NEJMoa2303062 EHJ NOAH subanalysis https://doi.org/10.1093/eurheartj/ehae225 Stroke: Prolonged Heart Rhythm Monitoring After Stroke https://www.ahajournals.org/doi/10.1161/STROKEAHA.123.045843 EHRA Analysis https://esc365.escardio.org/EHRA-Congress/sessions/10668

 

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Vulnerable plaque and scientific method; industry payments to trainees; tirzepatide or semaglutide; trial interpretation; and PFA are the topics John Mandrola, MD, covers in today?s podcast.

This podcast is intended for healthcare professionals only.

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I. Non-invasive Imaging for Vulnerable Plaque
 

PET Imaging Finds Vulnerable Plaques That Cause MI

https://www.medscape.com/viewarticle/pet-imaging-finds-vulnerable-plaques-cause-mi-2024a1000cm2

JACC paper https://doi.org/10.1016/j.jacc.2024.03.419 Original JAMA-Card paper https://jamanetwork.com/journals/jamacardiology/fullarticle/2806690

II. Industry Payments to Fellows

JAMA Network Letter https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2821267

III. GLP-1a Class Effect?

Semaglutide Significantly Improves Chronic Kidney Disease

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

Mounjaro Beats Ozempic, So Why Isn?t It More Popular?

https://www.medscape.com/viewarticle/mounjaro-beats-ozempic-so-why-isnt-it-more-popular-2024a1000ckd

JAMA-Internal Medicine: Semaglutide vs Tirzepatide https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2821080  SELECT trial https://www.nejm.org/doi/full/10.1056/NEJMoa2307563 FLOW trial https://www.nejm.org/doi/full/10.1056/NEJMoa2403347 SURPASS-CVOT ? Rationale https://doi.org/10.1016/j.ahj.2023.09.007

IV. Colchicine and Trial Interpretation in the Lancet

CONVINCE https://doi.org/10.1016/S0140-6736(24)00968-1

V. PFA

Pulsed Field Ablation for AF: Are US Electrophysiologists Too Easily Impressed?

https://www.medscape.com/viewarticle/pulsed-field-ablation-af-are-us-electrophysiologists-too-2024a1000d2v

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Venous closure devices, GLP1-s linked to blindness and cancer, resisting the urge to do an ECG, and transcatheter edge-to-edge repair (TEER) for secondary mitral regurgitation are the topics discussed this week.

This podcast is intended for healthcare professionals only.

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I Listener Feedback

Venous vascular closure system vs. figure-of-eight suture following atrial fibrillation ablation: the STYLE-AF Study https://doi.org/10.1093/europace/euae105

II GLP1-s and Blindness

Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglutide https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2820255 Locke Twitter  https://x.com/doc_BLocke/status/1808972226655629610 When to Start a Statin Is a Preference-Sensitive Decision https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.117.029808

III GLP1-s and Cancer

Glucagon-Like Peptide 1 Receptor Agonists and 13 Obesity-Associated Cancers in Patients With Type 2 Diabetes https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2820833

IV Screening ECG

Routine Electrocardiogram Screening and Cardiovascular Disease Events in Adultshttps://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2820721 Clinical outcomes in systematic screening for atrial fibrillation (STROKESTOP)  https://doi.org/10.1016/S0140-6736(21)01637-8 Implantable loop recorder detection of atrial fibrillation to prevent stroke (The LOOP Study) https://doi.org/10.1016/S0140-6736(21)01698-6

IV TEER for Secondary Mitral Regurgitation

Randomized investigation of the MitraClip device in heart failure: Design and rationale of the RESHAPE-HF2 trial design https://doi.org/10.1002/ejhf.3247 Percutaneous repair of moderate-to-severe or severe functional mitral regurgitation in patients with symptomatic heart failure: Baseline characteristics of patients in the RESHAPE-HF2 trial and comparison to COAPT and MITRA-FR trials https://onlinelibrary.wiley.com/doi/full/10.1002/ejhf.3286 Jun 21, 2024 This Week in Cardiology Podcast https://www.medscape.com/viewarticle/1001237 Stats Blog https://www.r-bloggers.com/2023/07/the-benjamini-hochberg-procedure-fdr-and-p-value-adjusted-explained/

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Screening echo, multivitamins, wasteful research, another PA sensor for HF, vascular closure devices, and GLP-1 marketing as science research are the topics John Mandrola, MD, discusses this week.

This podcast is intended for healthcare professionals only.

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I. Screening for Valvular HD in the Elderly

EHJ-CV Imaging Paper https://doi.org/10.1093/ehjci/jeae127

II. Vitamins and Wasteful Research

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

May 10, 2024 This Week in Cardiology Podcast

https://www.medscape.com/viewarticle/1000772

Multivitamin Paper https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2820369 Physicians Health Study II https://jamanetwork.com/journals/jama/fullarticle/1389615

III. FDA Has Approved Another PA Sensor

Link to slides https://c212.net/c/link/?t=0&l=en&o=4104690-1&h=4197477262&u=https%3A%2F%2Fendotronix.com%2FEndotronix-PROACTIVE-HF-LBCT-THT-2024.pdf&a=here

IV. Vascular Closure Devices in Electrophysiology.

Vascular Closure Devices Study  https://onlinelibrary.wiley.com/doi/full/10.1111/jce.16345

V. SURMOUNT-OSA

SURMOUNT OSA Paper https://www.nejm.org/doi/full/10.1056/NEJMoa2404881 SELECT https://www.nejm.org/doi/full/10.1056/NEJMoa2307563 June 21, 2024 This Week in Cardiology Podcast https://www.medscape.com/viewarticle/1001237 JAMA Systematic Review and Meta-analysis https://jamanetwork.com/journals/jama/fullarticle/2643307 SAVE https://www.nejm.org/doi/full/10.1056/NEJMoa1606599 Norwegian study https://doi.org/10.1016/j.hrthm.2022.06.016

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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.

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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.

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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.

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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.

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https://www.medscape.com/twic

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:

https://www.medscape.com/twic

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:

https://www.medscape.com/twic

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:

https://www.medscape.com/twic

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:

https://www.medscape.com/twic

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.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. DanGer-Shock Trial

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

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

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

II. REDUCE-AMI Trial

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

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

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

III. PREVENT Trial

Preventive PCI for Vulnerable Plaques Reduces Cardiac Events

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

Preventive Coronary Stents: Not There Yet

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

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

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

Empagliflozin Fails to Reduce Events After Acute MI

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

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

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

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. Statins and Diabetes

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

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

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

III. Tricuspid Valve Interventions

FDA Clears TriClip for Tricuspid Regurgitation

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

FDA Panel in Favor of TriClip for Tricuspid Regurgitation

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

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

IV. ACC Preview

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

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

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

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

https://www.medscape.com/twic

I. Intermittent Fasting

No, Intermittent Fasting Won't Kill You

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

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

II. Stroke Prevention with OAC

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

III. Heterogenous Treatment Effects in Trials

Pivotal CV Trials May Not Apply to Complex Patients

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

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

IV. Frailty and HF

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

V. ECG in LBBB

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

VI. Industry Payments to Doctors

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

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

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

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I. Denmark Notes

II. FDA approval of Semaglutide

FDA Approves Semaglutide for Cardiovascular Risk Reduction

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

Select Trial

III. PPG Monitor Accuracy

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

IV. AAD and Bradycardia

Anti-arrhythmic Drugs Linked to Bradycardia in Patients With AF

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

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

V. Finding Signals in RCTs
 

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

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

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. Plastics and Heart Disease

Plastic Particles in Carotid Plaques Linked to CV Events

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

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

II. MINT trial LTE and Bayes Theorem

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

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

III. Brugada Syndrome

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

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