This Week In Cardiology

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

A non-significant but wonderful trial in AF, smoking and HF, vitamins, and pre-op risk screening are the topics discussed by John Mandrola, MD, in this week’s podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I – DECAAF II Trial DECAAF II: AF, Fibrosis Ablation Technique Falls Short, but Signs of Hope https://www.medscape.com/viewarticle/957469 • Effect of MRI-Guided Fibrosis Ablation vs Conventional Catheter Ablation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial Fibrillation https://jamanetwork.com/journals/jama/article-abstract/2793452 • Association of Atrial Tissue Fibrosis Identified by Delayed Enhancement MRI and Atrial Fibrillation Catheter Ablation https://jamanetwork.com/journals/jama/fullarticle/1820433 II – Smoking and HF Cigarettes Linked to HF With Preserved or Reduced EF https://www.medscape.com/viewarticle/976066?src= • Cigarette Smoking, Cessation, and Risk of Heart Failure W

Statin Intolerance, external validity of trials, contrast shortage, and expansion of cardiology into diabetes and nephrology are the topics John Mandrola, MD, discusses in this week’s podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I - Statin Intolerance - New National Lipid Association Statement on Statin Intolerance https://www.medscape.com/viewarticle/975674 - What proportion of symptomatic side effects in patients taking statins are genuinely caused by the drug? Systematic review of randomized placebo-controlled trials to aid individual patient choice. https://academic.oup.com/eurjpc/article/21/4/464/5926070 - Unblinded and Blinded N-of-1 Trials Versus Usual Care: A Randomized Controlled Trial to Increase Statin Uptake in Primary Care. https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.120.007793 - Role of Blinding in N-of-1 Trials https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.122.008914 - N-of-1

More ISCHEMIA controversy, health Insurance and CV outcomes, testosterone, and flawed observational studies are the topics discussed by John Mandrola, MD in this week’s podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I – More Ischemia Controversy - Data Concerns Mount Despite ISCHEMIA Substudy Correction https://www.medscape.com/viewarticle/974974 - ISCHEMIA Substudy Data Just Don't Add Up, Cardiac Surgeons Say https://www.medscape.com/viewarticle/974107 - Initial Invasive or Conservative Strategy for Stable Coronary Disease https://www.nejm.org/doi/full/10.1056/nejmoa1915922 - Outcomes in the ISCHEMIA Trial Based on Coronary Artery Disease and Ischemia Severity https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.049755 - Link to Bakaeen and Sabik Second letter (agree to terms to download the letter): https://protect-us.mimecast.com/s/nfDdCwp5G6HLjLO9GHV9Cnm?domain=wetransfer.com II – Health Insurance

Devices for HF, Twitter for disseminating science, HDL levels, and dubious post-hoc studies are the topics John Mandrola, MD, discusses in this week’s podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I – Interatrial Shunts for HF - Interatrial Shunt in HF Hints at Heart Structural, Functional Benefits https://www.medscape.com/viewarticle/974776 - Atrial shunt device for heart failure with preserved and mildly reduced ejection fraction (REDUCE LAP-HF II): a randomised, multicentre, blinded, sham-controlled trial https://doi.org/10.1016/S0140-6736(22)00016-2 - Reducing Lung CongestIon Symptoms in Advanced Heart Failure (RELIEVE-HF) https://clinicaltrials.gov/ct2/show/NCT03499236 II – Twitter for Science Communication - Twitter Promotion Boosts Visibility, Citation for CV Research https://www.medscape.com/viewarticle/974653 - Twitter promotion is associated with higher citation rates of cardiovascular articles: t

Ischemia vs anatomic testing for CAD, UK-TAVI trial, TAVI for AR? and post-PCI anti-thrombotics are the topics John Mandrola, MD, discusses in this week’s podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I – Ischemic vs Anatomic Evaluation for CAD - ISCHEMIA Substudy Data Just Don't Add Up, Cardiac Surgeons Say https://www.medscape.com/viewarticle/974107 - Outcomes in the ISCHEMIA Trial Based on Coronary Artery Disease and Ischemia Severity https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.120.049755 - Initial Invasive or Conservative Strategy for Stable Coronary Disease https://www.nejm.org/doi/full/10.1056/nejmoa1915922 - Forget Ischemia: It’s All About the Plaque https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.054102 - Optimal Medical Therapy With or Without Percutaneous Coronary Intervention to Reduce Ischemic Burden https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.107.74396

Obstructive hypertrophic cardiomyopathy and mavacamten, SGLT2 inhibitors, the triple whammy, espresso, and clinician burnout are the topics John Mandrola, MD, covers in today’s podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I – Mavacamten - FDA Clears Mavacamten (Camzyos) for Obstructive Hypertrophic Cardiomyopathy https://www.medscape.com/viewarticle/972945 - Mavacamten for treatment of symptomatic obstructive hypertrophic cardiomyopathy (EXPLORER-HCM): a randomised, double-blind, placebo-controlled, phase 3 trial https://doi.org/10.1016/S0140-6736(20)31792-X - FDA approves new drug to improve heart function in adults with rare heart condition https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-new-drug-improve-heart-function-adults-rare-heart-condition II – Dapagliflozin in HFpEF - Positive Topline Results for Dapagliflozin in HFpEF: DELIVER https://www.medscape.com/viewarticle/973490 - Empaglif