This Week In Cardiology

AHA 2022, Part 2: IRONMAN, ECMO-CS, CTS-AMI, and PROGRESSIVE AF are the trials John Mandrola, MD, reviews in this week’s podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Pushback on PROMINENT Zimerman Thread: https://twitter.com/AndreZimerman/status/1593019800036708353 II. IRONMAN IRONMAN Galvanizes Case for IV Iron Repletion in Heart Failure https://www.medscape.com/viewarticle/984030 Is Iron Replacement in Heart Failure Worth the Trouble? https://www.medscape.com/viewarticle/983622 - Intravenous ferric derisomaltose in patients with heart failure and iron deficiency in the UK (IRONMAN): an investigator-initiated, prospective, randomised, open-label, blinded-endpoint trial https://doi.org/10.1016/S0140-6736(22)02083-9 III. ECMO-CS Avoid Routine Early ECMO in Severe Cardiogenic Shock: ECMO-CS https://www.medscape.com/viewarticle/983618 - Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shoc

AHA 2022 Part 1: ISCHEMIA-EXTEND, STRONG-HF, chlorthalidone vs HCTZ, experts vs practitioners; torsemide vs furosemide; and TG lowering are discussed by John Mandrola, MD, in this week’s podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. AHA Meta-comments II. ISCHEMIA-Extended - ISCHEMIA-EXTEND: Conservative Stable CAD Management Holds Up https://www.medscape.com/viewarticle/983657 - Survival After Invasive or Conservative Management of Stable Coronary Disease https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.062714 III. STRONG-HF - Rapidly, Fully Optimize HF Meds After Hospital Discharge: STRONG-HF https://www.medscape.com/viewarticle/983870 - STRONG HF: More Beats Less After Discharge for Heart Failure https://www.medscape.com/viewarticle/983698 - Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-labe

AF conversion in the ED, HRT, a shining example of evidence-based medicine and less-is-more, multimorbidity, and what’s coming at AHA are the topics John Mandrola, MD, covers in this week’s podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. AF Conversion - IV Potassium and Magnesium an Acute Treatment for AF? https://www.medscape.com/viewarticle/983137 - Association of Intravenous Potassium and Magnesium Administration With Spontaneous Conversion of Atrial Fibrillation and Atrial Flutter in the Emergency Department https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2797474 II. HRT - USPSTF Doesn't Change Postmenopausal Hormone Recommendations https://www.medscape.com/viewarticle/983349 - Hormone Therapy To Prevent Disease and Prolong Life in Postmenopausal Women https://doi.org/10.7326/0003-4819-117-12-1016 - Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal WomenPrincipal Resu

ERASE AF follow-up, recreational drugs and AF, etripamil, misuse of science, and diabetes as a cardiovascular risk factor are the topics John Mandrola, MD, discusses in this week’s podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Follow-up on ERASE AF II. Recreational Drugs Four Commonly Abused Drugs Linked With Atrial Fibrillation https://www.medscape.com/viewarticle/983052 III. Etripamil RAPID: Positive Data for Etripamil Nasal Spray in Paroxysmal SVT https://www.medscape.com/viewarticle/982787 - Milestone Pharmaceuticals Announces Positive Results from Phase 3 RAPID Clinical Trial of Etripamil Nasal Spray in Patients with Paroxysmal Supraventricular Tachycardia https://investors.milestonepharma.com/news-releases/news-release-details/milestone-pharmaceuticals-announces-positive-results-phase-3 IV. Misuse of Science When Bad Actors Hijack Good Research https://www.medscape.com/viewarticle/982936 - Level an

The ERASE AF ablation trial, left bundle pacing, finerenone, and perceptions of cardiology are the topics John Mandrola, MD, discusses in this week’s podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. AF Ablation - Low-Voltage Myocardium-Guided Ablation Trial of Persistent Atrial Fibrillation https://evidence.nejm.org/doi/10.1056/EVIDoa2200141 - Approaches to Catheter Ablation for Persistent Atrial Fibrillation https://www.nejm.org/doi/full/10.1056/NEJMoa1408288 - Effect of MRI-Guided Fibrosis Ablation vs Conventional Catheter Ablation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial Fibrillation https://jamanetwork.com/journals/jama/fullarticle/2793452 - Circumferential Pulmonary Vein Isolation Plus Low-Voltage Area Modification in Persistent Atrial Fibrillation: The STABLE-SR-II Trial https://www.jacc.org/doi/full/10.1016/j.jacep.2022.03.012 - Effect of Catheter Ablation With Vein of Marsh

Chest pain evaluation in the ED, peer review, the NordICC trial, and a surgeon lost too early are the topics John Mandrola, MD, discusses in this week’s podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Chest Pain Consensus Pathway - ACC Issues Guidance on ED Evaluation of Acute Chest Pain https://www.medscape.com/viewarticle/982302 - 2022 ACC Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain in the Emergency Department: A Report of the American College of Cardiology Solution Set Oversight Committee https://www.jacc.org/doi/10.1016/j.jacc.2022.08.750 - 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines https://www.ahajournals.org/doi/10.1161/CIR.0000000000001030#d20522356e1 II. Peer Revie

Post-PCI antiplatelet therapy, palliative care in patients with HF, Watchman information on hospital websites, and HCM in athletes are the topics John Mandrola, MD, covers in this week’s podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Post-Stent Antiplatelet Therapy SMART-CHOICE 3-Year Results Support Dropping Aspirin After PCI https://www.medscape.com/viewarticle/981741 Long-term Effects of P2Y12 Inhibitor Monotherapy After Percutaneous Coronary Intervention https://jamanetwork.com/journals/jamacardiology/fullarticle/2796902 The Smart(est) Choice for Dual Antiplatelet Therapy is a Patient-Directed One https://jamanetwork.com/journals/jamacardiology/fullarticle/2796904 Effect of P2Y12 Inhibitor Monotherapy vs Dual Antiplatelet Therapy on Cardiovascular Events in Patients Undergoing Percutaneous Coronary Intervention https://jamanetwork.com/journals/jama/fullarticle/2736564 II. Palliative Care in HF Home-

Pulmonary embolism, coffee, when DOACs don’t work, lipoprotein (a), and the marginal benefits of current CV therapy are the topics John Mandrola, MD, discusses in this week’s podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Pulmonary Embolism - Positive Data on Thrombectomy Catheter That Avoids Thrombolytics in Acute PE https://www.medscape.com/viewarticle/981322 - Acute Outcomes for the Full US Cohort of the FLASH Mechanical Thrombectomy Registry in Pulmonary Embolism https://eurointervention.pcronline.com/article/acute-outcomes-for-the-full-us-cohort-of-the-flash-mechanical-thrombectomy-registry-in-pulmonary-embolism - PEERLESS Study https://clinicaltrials.gov/ct2/show/NCT05111613 - Ultrasound-facilitated, Catheter-directed, Thrombolysis in Intermediate-high Risk Pulmonary Embolism (HI-PEITHO) https://clinicaltrials.gov/ct2/show/NCT04790370 - A Prospective, Single-Arm, Multicenter Trial of Catheter-Direct

In this week’s podcast, John Mandrola, MD, discusses the PROTECTED TAVR trial, renal denervation, left atrial appendage closure and deprescribing aspirin. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I Cerebral Embolic Protection After TAVI - Clear Stroke Benefit Eludes Embolic Protection: PROTECTED TAVR https://www.medscape.com/viewarticle/980978 - Cerebral Embolic Protection during Transcatheter Aortic-Valve Replacement https://www.nejm.org/doi/10.1056/NEJMoa2204961 - Protection Against Cerebral Embolism During Transcatheter Aortic Valve Replacement https://doi.org/10.1016/j.jacc.2016.10.023 - Angiotensin–Neprilysin Inhibition in Heart Failure with Preserved Ejection Fraction https://www.nejm.org/doi/full/10.1056/NEJMoa1908655 - Five-Year Outcomes of the Danish Cardiovascular Screening (DANCAVAS) Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2208681 - Randomised Trial Of Intravenous Streptokinase, Oral Aspiri

The safety of very low LDL-C, the win-ratio analytic method, sacubitril/valsartan, SGLT2 inhibitors, and percutaneous left atrial appendage closure are discussed in this week’s podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I PCSK9I Evolocumab Benefits Accrue With Longer Follow-up: FOURIER OLE https://www.medscape.com/viewarticle/979950 - Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease https://www.nejm.org/doi/full/10.1056/nejmoa1615664 - Long-Term Evolocumab in Patients with Established Atherosclerotic Cardiovascular Disease https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.061620 II Analytic Methods and Re-Analysis of Old Trials - PARADISE-MI Results Obscured As Post Hoc Analysis Finds Flaws https://www.medscape.com/viewarticle/980776 - Angiotensin Receptor–Neprilysin Inhibition in Acute Myocardial Infarction https://www.nejm.org/doi/10.1056/NEJMoa2104508 - Impact of Sacub

A potential new anticoagulant, surveillance stress testing, a trial misinterpretation, an old diuretic, and AI in cardiology are the topics John Mandrola, MD, discusses in this week’s podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Factor XI inhibitors - Factor XIa Inhibitor After MI, Stroke Encouraging in Early Phase 2 Studies https://www.medscape.com/viewarticle/979942 - AXIOMATIC-SSP: Cautious Optimism on Factor XI Inhibitor in Stroke https://www.medscape.com/viewarticle/979860 II. Surveillance Stress Testing - No Benefit of Routine Stress Test POST-PCI in High-Risk Patients https://www.medscape.com/viewarticle/979866 - Routine Functional Testing or Standard Care in High-Risk Patients after PCI https://www.nejm.org/doi/full/10.1056/NEJMoa2208335 III. New Diuretic for Acute Heart Failure - Vintage Drug Atop IV Loop Diuretics Boosts Decongestion in ADHF: ADVOR https://www.medscape.com/viewarticle/979851 -

A second ESC review covering REVIVED, the DANCAVAS CV screening trial, DELIVER on dapagliflozin in HF with mildly reduced EF, and the INVICTUS trial of rivaroxaban in rheumatic heart disease. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I REVIVED BCIS - PCI Fails to Beat OMT in Ischemic Cardiomyopathy: REVIVED-BCIS2 https://www.medscape.com/viewarticle/979853 - Percutaneous Revascularization for Ischemic Left Ventricular Dysfunction https://www.nejm.org/doi/full/10.1056/NEJMoa2206606 - Coronary-Artery Bypass Surgery in Patients with Left Ventricular Dysfunction https://www.nejm.org/doi/full/10.1056/nejmoa1100356 II DANCAVAS - DANCAVAS Misses Primary Endpoint but Hints at Benefit from Comprehensive CV Screening https://www.medscape.com/viewarticle/979854 - Five-Year Outcomes of the Danish Cardiovascular Screening (DANCAVAS) Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2208681 - Defibrillator Implantation in Pat

Early rhythm control in AF, treating coronary artery disease before transcatheter aortic valve implantation, and an ESC 2022 preview are the topics John Mandrola, MD, covers in this week’s podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Early Rhythm Control - Early AF Rhythm-Control Advantage Climbs With Comorbidity Burden: EAST-AFNET4 https://www.medscape.com/viewarticle/979627 - Early Rhythm Control in Patients With Atrial Fibrillation and High Comorbidity Burden https://www.ahajournals.org/doi/suppl/10.1161/CIRCULATIONAHA.122.060274 Early Rhythm-Control Therapy in Patients with Atrial Fibrillation https://www.nejm.org/doi/full/10.1056/NEJMoa2019422 II. CAD and Aortic Stenosis - No Survival Gains Seen From Pre-TAVR PCI of Complex CAD https://www.medscape.com/viewarticle/979408 - The Effect of Coronary Lesion Complexity and Preprocedural Revascularization on 5-Year Outcomes After TAVR https://doi.org/10.1

The obesity paradox in AF and paradoxes in general, digital health gets whacked again, and direct-to-consumer ads are the topics discussed by John Mandrola, MD in this week’s podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Collider Bias and the Obesity Paradox - 'Obesity Paradox' in Atrial Fibrillation Challenged as Mortality Climbs With BMI https://www.medscape.com/viewarticle/979150 - Association of body mass index with outcomes in patients with newly diagnosed atrial fibrillation: GARFIELD-AF https://openheart.bmj.com/content/9/2/e002038 - Collider bias https://catalogofbias.org/biases/collider-bias/ - Pediatric obesity appears to lower the risk of diabetes if selection bias is ignored https://pubmed.ncbi.nlm.nih.gov/29374028/ - Effect of Caloric Restriction or Aerobic Exercise Training on Peak Oxygen Consumption and Quality of Life in Obese Older Patients With Heart Failure With Preserved Ejection Frac

AF screening; sodium, potassium, BP, and CV outcomes; drug prices; and cardio-respiratory fitness are the topics John Mandrola, MD, covers in this week’s podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. AF Screening - Using Wearable Devices to Detect AF Is 'Cost Effective' https://www.medscape.com/viewarticle/978861 - Cost-effectiveness of Screening for Atrial Fibrillation Using Wearable Devices https://jamanetwork.com/journals/jama-health-forum/fullarticle/2794835 - Screening for Atrial Fibrillation in Asymptomatic Older Adults https://www.nejm.org/doi/full/10.1056/NEJMclde2203726 II. Salt Substitutes - More Evidence Salt Substitutes Lower Risk of CVD and Death https://www.medscape.com/viewarticle/978999 - Effects of salt substitutes on clinical outcomes: a systematic review and meta-analysis https://heart.bmj.com/content/early/2022/07/21/heartjnl-2022-321332 - Effect of Salt Substitution on Cardiovascular

Hyperkalemia in heart failure, CV health in America, primary prevention ICDs, and a debate about posters at medical meetings are the topics discussed by John Mandrola, MD in this week’s podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Hyperkalemia in Heart Failure - DIAMOND: Adding Patiromer Helps Optimize HF Meds, Foils Hyperkalemia https://www.medscape.com/viewarticle/971616 - Patiromer for the management of hyperkalemia in heart failure with reduced ejection fraction: the DIAMOND trial https://doi.org/10.1093/eurheartj/ehac401 - Potassium Binders for Patients With Heart Failure? The Real Enlightenment of the DIAMOND Trial https://doi.org/10.1093/eurheartj/ehac399 - The Effect of Spironolactone on Morbidity and Mortality in Patients with Severe Heart Failure https://www.nejm.org/doi/full/10.1056/nejm199909023411001 - Eplerenone in Patients with Systolic Heart Failure and Mild Symptoms https://www.nejm.org

A big new HF and EP trial, doctors and probability, LV assist devices in cardiogenic shock, vitamin D, and exercise in PAD are the topics John Mandrola, MD, discusses in this week’s podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Left vs Left RCT Taking Cardiac Pacing From Boring to Super-Cool https://www.medscape.com/viewarticle/973615 Conduction-System Pacing Shines vs BiV Pacing for CRT in Early Studies https://www.medscape.com/viewarticle/974173 • Baylor led research awarded $31 Million for Resynchronization Therapy in Patients with Heart Failure https://www.bcm.edu/news/baylor-led-research-awarded-31-million-for-resynchronization-therapy-in-patients-with-heart-failure II. Probability and Conjunction Fallacy Is What You Call Probable...Impossible? https://www.medscape.com/viewarticle/976451 • Analysis of Physicians’ Probability Estimates of a Medical Outcome Based on a Sequence of Events https://jaman

Therapeutic fashion and conduction system pacing, early rhythm control in AF, statins in CKD, and salt intake in HF are the topics discussed by John Mandrola, MD, in this week’s podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I – Therapeutic Fashion and Conduction System Pacing - Medical Necessity vs Therapeutic Fashion: How Evidence-Based Is Your Field of Medicine? https://www.medscape.com/viewarticle/977358 - Conduction System Pacing Noninferior to Biventricular Pacing for HF With Wide QRS https://www.medscape.com/viewarticle/971740 - His Corrective Pacing or Biventricular Pacing for Cardiac Resynchronization in Heart Failure https://www.jacc.org/doi/full/10.1016/j.jacc.2019.04.026 II – Early Rhythm Control - Benefit of Early Rhythm Control Questioned in Newly Diagnosed Atrial Fibrillation https://www.medscape.com/viewarticle/977584 - Presenting Pattern of Atrial Fibrillation and Outcomes of Early Rhythm Co

The LIFE study, multimorbidity and evidence translation, cardiac arrest and therapeutic fashion, diabetes and cardiology, and EP cuts are the topics John Mandrola, MD, tackles in this week’s podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I – LIFE Study and Substudy - LIFE: ARNI Does Not Best Valsartan in Advanced Heart Failure https://www.medscape.com/viewarticle/952681 - Tolerability of Sacubitril/Valsartan in Patients With Advanced Heart Failure: Analysis of the LIFE Trial Run-In https://www.jacc.org/doi/10.1016/j.jchf.2022.04.013 - Effect of Treatment With Sacubitril/Valsartan in Patients With Advanced Heart Failure and Reduced Ejection FractionA Randomized Clinical Trial https://jamanetwork.com/journals/jamacardiology/fullarticle/2785700 II – Early Angiography and Therapeutic Fashion - Emergency Angiography for Cardiac Arrest Without ST Elevation? https://www.medscape.com/viewarticle/975434 - Emergency v

On this week’s podcast, John Mandrola, MD discusses fish oil, America’s heart health, pharmacists and prescribing and statins This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I - Fish Oil - New Biomarker Data Add to Concerns Over REDUCE-IT Trial https://www.medscape.com/viewarticle/976490 - Effects of Randomized Treatment With Icosapent Ethyl and a Mineral Oil Comparator on Interleukin-1β, Interleukin-6, C-Reactive Protein, Oxidized Low-Density Lipoprotein Cholesterol, Homocysteine, Lipoprotein(a), and Lipoprotein-Associated Phospholipase A2: A REDUCE-IT Biomarker Substudy https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.059410 - Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia https://www.nejm.org/doi/full/10.1056/nejmoa1812792 - Effect of High-Dose Omega-3 Fatty Acids vs Corn Oil on Major Adverse Cardiovascular Events in Patients at High Cardiovascular RiskThe STRENGTH Randomized