This Week In Cardiology

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 Sym

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 -   M

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

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

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/10.1

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

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 - Gaudi

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.ne

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

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, an

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/

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://jam

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 - Stepw

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 Patient

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

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 - Sac

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 Se

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 Polygeni

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/

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 Rand