This Week In Cardiology

The AMAZE trial of left atrial appendage isolation, non-statin oral lipid lowering drugs, EHR alerts, non-MD care, and obesity are the topics John Mandrola, MD, discusses in this week’s podcast. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I – aMAZE Trial - No Advantage Shown for LAA Ligation as Adjunct to Pulmonary Vein Isolation https://www.medscape.com/viewarticle/962954 - Safety and Procedural Success of Left Atrial Appendage Exclusion With the Lariat Device https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2289126 - Left Atrial Appendage Isolation in Patients With Longstanding Persistent AF Undergoing Catheter Ablation: BELIEF Trial https://pubmed.ncbi.nl m.nih.gov/27788847/ II – Non-Statin Lipid Lowering - Obicetrapib: CETP Inhibitor Impresses in LDL Lowering https://www.medscape.com/viewarticle/963611 - Daily Oral PCSK9 Inhibitor Encouraging in Phase 1 Trials https://www.medscape.com/viewarticle/963550 III – EHR Alerts and Prognosis - EHR Alerts Have

In AHA 2021 Part 1, John Mandrola, MD, reports on selected sessions from the virtual American Heart Association meeting. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I - AVATAR - Early SAVR Tops Watchful Waiting in Severe, Asymptomatic Aortic Stenosis: AVATAR https://www.medscape.com/viewarticle/962904 - Aortic Valve ReplAcemenT versus Conservative Treatment in Asymptomatic SeveRe Aortic Stenosis: The AVATAR Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057639 - Early Surgery or Conservative Care for Asymptomatic Aortic Stenosis https://www.nejm.org/doi/full/10.1056/NEJMoa1912846 II - TCV Repair - Concomitant Tricuspid-Mitral Surgery Beneficial but With a Tradeoff https://www.medscape.com/viewarticle/962899 - Concomitant Tricuspid Repair in Patients with Degenerative Mitral Regurgitation https://www.nejm.org/doi/full/10.1056/NEJMoa2115961 III - PALACS - Procedure Reduces Postop AF After Cardiac Surgery: PALACS https://www.medscape.com/viewarticle/962907 -

Left atrial appendage closure vs DOACs, TAVR vs SAVR, renal denervation, and an AHA 2021 preview are the topics John Mandrola, MD, discusses in this week’s podcast. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I - LAAC - PRAGUE-17: LAA Closure Holds Up Against DOACs Out to 4 Years https://www.medscape.com/viewarticle/962608 - LAAO vs DOAC: PRAGUE-17 Falls Short https://www.medscape.com/viewarticle/933641 - Left Atrial Appendage Closure versus Non-Warfarin Oral Anticoagulation in Atrial Fibrillation: 4-Year Outcomes of PRAGUE-17 https://www.jacc.org/doi/10.1016/j.jacc.2021.10.023 - Does Percutaneous Left Atrial Appendage Closure Stand the Test of Time? https://www.jacc.org/doi/10.1016/j.jacc.2021.10.022 II - SURTAVI (TAVR vs SAVR) - SURTAVI at 5 Years Reinforces TAVR but Was It Long-term Enough? https://www.medscape.com/viewarticle/962484 - Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients https://www.nejm.org/doi/full/10.1056/NEJMoa1700456 III

FFR-guided PCI, ISCHEMIA trial challenged, QFR, and one of the most important studies of 2021 are discussed by John Mandrola, MD, in this week’s podcast. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I - FFR-Guided PCI - FFR-Guided PCI Falls Short vs CABG in Multivessel CAD: FAME 3 https://www.medscape.com/viewarticle/962274 - Fractional Flow Reserve–Guided PCI as Compared with Coronary Bypass Surgery https://www.nejm.org/doi/full/10.1056/NEJMoa2112299 - The fallacies of fractional flow reserve https://pubmed.ncbi.nlm.nih.gov/31889563/ II - ISCHEMIA-Trial Challenged - How Applicable is ISCHEMIA Trial to US Clinical Practice? https://www.medscape.com/viewarticle/962233 - Comparison of Patients Undergoing Percutaneous Coronary Intervention in Contemporary U.S. Practice With ISCHEMIA Trial Population https://www.jacc.org/doi/full/10.1016/j.jcin.2021.08.047 - The Glass Is at Least Half Full https://www.jacc.org/doi/10.1016/j.jcin.2021.08.054 - Initial Invasive or Conservative St

ESUS, CAC 0, Takotsubo syndrome, and chest pain are the topics John Mandrola, MD, covers in today’s podcast. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I – ESUS Anticoagulation May Benefit Stroke Patients With LV Dysfunction https://www.medscape.com/viewarticle/961815 - Left Ventricular Dysfunction Among Patients With Embolic Stroke of Undetermined Source and the Effect of Rivaroxaban vs AspirinA Subgroup Analysis of the NAVIGATE ESUS Randomized Clinical Trial https://jamanetwork.com/journals/jamaneurology/article-abstract/2785030 - Rivaroxaban for Stroke Prevention after Embolic Stroke of Undetermined Source https://www.nejm.org/doi/10.1056/NEJMoa1802686 - Dabigatran for Prevention of Stroke after Embolic Stroke of Undetermined Source https://www.nejm.org/doi/10.1056/NEJMoa1813959 II – CAC CAC Score 0 Unreliable to Rule Out Stenosis in Younger Patients https://www.medscape.com/viewarticle/961801 - Association of Age With the Diagnostic Value of Coronary Artery Calcium S

Aspirin for primary prevention, induced hypothermia, half-dose DOAC, and social media, are the topics John Mandrola, MD, discusses in this week’s podcast. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I - ASA for Primary Prevention - USPSTF Rules Out Aspirin for Over 60s in Primary CVD Prevention https://www.medscape.com/viewarticle/960745 - Aspirin Use to Prevent Cardiovascular Disease: Preventive Medication https://www.uspreventiveservicestaskforce.org/uspstf/document/draft-evidence-review/aspirin-use-to-prevent-cardiovascular-disease-preventive-medication - Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31924-X/fulltext - Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus https://www.nejm.org/doi/full/10.1056/nejmoa1804988 - Effect of Aspirin on Cardiovasc

Two NEJM papers on mRNA-related myocarditis, AF and stroke, intensifying BP meds, and CCTA and high-sensitivity troponin are the topics John Mandrola, MD, covers in this week's podcast. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I -- Vaccine-Induced Myocarditis New Reports Help Nail Down Myocarditis Risk With COVID-19 Vaccine https://www.staging.medscape.com/viewarticle/960537 • Myocarditis after BNT162b2 mRNA Vaccine against Covid-19 in Israel https://www.nejm.org/doi/full/10.1056/NEJMoa2109730 • Myocarditis after Covid-19 Vaccination in a Large Health Care Organization https://www.nejm.org/doi/full/10.1056/NEJMoa2110737 II – AF and Stroke AF a Stroke Cause or Innocent Bystander? The Debate Continues https://www.medscape.com/viewarticle/960224 • Temporal Association Between Episodes of Atrial Fibrillation and Risk of Ischemic Stroke https://jamanetwork.com/journals/jamacardiology/fullarticle/2784332 • It's Time to Rethink (and Retrial) Our Framework for Stroke Preventio

Coronary artery calcification and exercise, translating clinical trials, the question of metabolically healthy obesity, and Watchman complications are the topics John Mandrola, MD, discusses in this week’s podcast. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I - CAC and Physical Activity - Physical Activity Paradoxically Tied to Higher Coronary Calcium https://www.medscape.com/viewarticle/959366 - Physical activity and the progression of coronary artery calcification http://dx.doi.org/10.1136/heartjnl-2021-319346 II - Translating Clinical Trials - SYNTAX Score II 2020 Wobbles in Real-World Validation https://www.medscape.com/viewarticle/958834 - Redevelopment and validation of the SYNTAX score II to individualise decision making between percutaneous and surgical revascularisation in patients with complex coronary artery disease: secondary analysis of the multicentre randomised controlled SYNTAXES trial with external cohort validation https://doi.org/10.1016/S0140-6736(20)3

Dual antiplatelet therapy after PCI, statin side effects, nightshift work and AF, and a cautionary note regarding therapeutic enthusiasm in HF care are the topics John Mandrola, MD, discusses in this week’s podcast. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I - COVID - Alaska Sets Record for Daily COVID Cases https://www.medscape.com/viewarticle/958999 II - MASTER DAPT - MASTER DAPT: 1 Month DAPT Enough After High-Bleeding-Risk PCI https://www.medscape.com/viewarticle/957463 - Antiplatelets and Anticoagulation Post-PCI: More on MASTER DAPT https://www.medscape.com/viewarticle/958002 - Dual Antiplatelet Therapy after PCI in Patients at High Bleeding Risk https://www.nejm.org/doi/full/10.1056/NEJMoa2108749 - Abbreviated Antiplatelet Therapy in Patients at High Bleeding Risk With or Without Oral Anticoagulant Therapy After Coronary Stenting: An Open-Label, Randomized, Controlled Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.056680 III - Statins and Side E

Cardiac arrest care, finerenone, carotids, meds post TAVI: less is more and the new may not be as grand as the tried and true. John Mandrola, MD, provides a third ESC review. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I - Cardiac Arrest Care - Angiography Can Wait for Cardiac Arrest Without ST-Elevation https://www.medscape.com/viewarticle/957471 - Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation https://www.nejm.org/doi/full/10.1056/NEJMoa2101909 - Coronary Angiography after Cardiac Arrest without ST-Segment Elevation https://www.nejm.org/doi/full/10.1056/NEJMoa1816897 II - Finerenone - FIDELITY: Finerenone Cuts CV Risk in T2D Across CKD Spectrum https://www.medscape.com/viewarticle/957470 - Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes https://www.nejm.org/doi/full/10.1056/NEJMoa2110956 - Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes https://www.nejm.org/doi/full/10.1056/NEJMoa202584

ESC Wrap-up Part II: EMPEROR-Preserved, and the STEP, Guide-HF, and IAMI trials, are discussed by John Mandrola, MD, in this week’s podcast. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I - HFpEF - EMPEROR-Preserved: Empagliflozin Scores HFpEF Breakthrough https://www.medscape.com/viewarticle/957405 - Empagliflozin in Heart Failure with a Preserved Ejection Fraction https://www.nejm.org/doi/full/10.1056/NEJMoa2107038 II - BP Targets - STEP: Lowering Blood Pressure Below 130 mm Hg Shows CV Benefit https://www.medscape.com/viewarticle/957566 - Trial of Intensive Blood-Pressure Control in Older Patients with Hypertension https://www.nejm.org/doi/full/10.1056/NEJMoa2111437 III- PA Catheter Monitoring - GUIDE-HF: CardioMEMS-Guided Meds Fall Short in Mild to Moderate Heart Failure https://www.medscape.com/viewarticle/957390 - Haemodynamic-guided management of heart failure (GUIDE-HF): a randomised controlled trial https://doi.org/10.1016/S0140-6736(21)01754-2 - Wireless pulmonary

EMPEROR-Preserved, the LOOP study, ablate-and-pace for AF, and salt substitute and stroke: John Mandrola, MD provides a first of two ESC reviews. To read a partial transcript or to comment, visit: https://www.medscape.com/twic 1 - HFpEF - EMPEROR-Preserved: Empagliflozin Scores HFpEF Breakthrough https://www.medscape.com/viewarticle/957405 - Empagliflozin in Heart Failure with a Preserved Ejection Fraction https://www.nejm.org/doi/full/10.1056/NEJMoa2107038 - Empagliflozin and Major Renal Outcomes in Heart Failure https://www.nejm.org/doi/full/10.1056/NEJMc2112411 - Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure https://www.nejm.org/doi/full/10.1056/NEJMoa2022190 2 - AF Screening - LOOP Trial Undercuts Value of Long-term Continuous ECG Screening for Atrial Fibrillation https://www.medscape.com/viewarticle/957473 - Implantable loop recorder detection of atrial fibrillation to prevent stroke (The LOOP Study): a randomised controlled trial https://www.thelancet.com/journals/lancet/article/

COVID-19, NEJM vaccine safety paper, full-dose anticoagulation in COVID-19, AF and Exercise, and early results on EMPEROR-Preserved are the studies John Mandrola, MD, discusses in this week’s podcast. https://www.medscape.com/twic 1 - COVID-19 - Heart Inflammation More Common After COVID Than After Vaccination https://www.medscape.com/viewarticle/957343 - Safety of the BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Setting https://www.nejm.org/doi/full/10.1056/NEJMoa2110475 2 - Full dose AC in COVID-19 - Heparin's COVID-19 Benefit Greatest in Moderately Ill Patients https://www.medscape.com/viewarticle/956630 - Therapeutic Anticoagulation with Heparin in Noncritically Ill Patients with Covid-19 https://www.nejm.org/doi/full/10.1056/NEJMoa2105911 - Therapeutic Anticoagulation with Heparin in Critically Ill Patients with Covid-19 https://www.nejm.org/doi/full/10.1056/NEJMoa2103417 3 - AF and Exercise - Aerobic Exercise Can Reduce AF Frequency, Severity: ACTIVE-AF https://www.medscape.com/viewarticle/957322 4 -

COVID-19, Simpson’s Paradox, LAA appendage closure, multimorbidity, and an ESC preview are the topics John Mandrola, MD discusses in today’s podcast. https://www.medscape.com/twic 1 - COVID-19 - Lacking Beds, Hospitals Ship COVID-19 Patients to Other States https://www.medscape.com/viewarticle/956917 - Efficacy and Safety of Same-Day Discharge for Atrial Fibrillation Ablation https://pubmed.ncbi.nlm.nih.gov/32553209/ 2 - Simpson’s Paradox - Israeli data: How can efficacy vs. severe disease be strong when 60% of hospitalized are vaccinated? https://www.covid-datascience.com/post/israeli-data-how-can-efficacy-vs-severe-disease-be-strong-when-60-of-hospitalized-are-vaccinated - Simpson’s Paradox and Interpreting Data https://towardsdatascience.com/simpsons-paradox-and-interpreting-data-6a0443516765 - How SIMPSON'S PARADOX explains weird COVID19 statistics https://www.youtube.com/watch?v=t-Ci3FosqZs 3 - Left Atrial Appendage Closure - FDA Approves Abbott's Amplatzer Amulet for Atrial Fibrillation https://www.meds

COVID-19, vaccine-induced myocarditis, Watchman complications, SGLT2 inhibitors, and cardiogenic shock are the topics John Mandrola, MD, discusses in this week’s podcast. https://www.medscape.com/twic 1 - COVID-19 - 18 Months Later, the COVID-19 Memories Won’t Go Away https://www.medscape.com/viewarticle/956335 2 - Vaccine-Myocarditis - Myocarditis in Adolescents After COVID-19 Vaccine Typically Mild https://www.medscape.com/viewarticle/956359 - Association of Myocarditis With BNT162b2 Messenger RNA COVID-19 Vaccine in a Case Series of Children https://jamanetwork.com/journals/jamacardiology/fullarticle/2783052 3 - Watchman - 'Striking' Difference in Adverse Events in Women With Watchman LAAO https://www.medscape.com/viewarticle/956593 - Sex Differences in Procedural Outcomes Among Patients Undergoing Left Atrial Appendage Occlusion https://jamanetwork.com/journals/jamacardiology/fullarticle/2782726 4 - SGLT2 Inhibitors - EU Approves Dapagliflozin for Kidney Disease, Regardless of Diabetes https://www.medscap

The COVID-19 surge, vaccine-induced myocarditis, Heart Rhythm news, the state of medical evidence, and doctors in unions are discussed by John Mandrola, MD, in this week's podcast. https://www.medscape.com/twic 1- COVID-19 Texas COVID-19 Wave Is Climbing More Steeply Than Past Waves https://www.medscape.com/viewarticle/956104 White House Says US Can Provide COVID-19 Boosters if Needed https://www.medscape.com/viewarticle/956016 2- Vaccine-Myocarditis Myocarditis Tied to COVID-19 Shots More Common Than Reported? https://www.medscape.com/viewarticle/956089 3- Heart Rhythm News The Three Big Stories from the Heart Rhythm Society's 2021 Meeting https://www.medscape.com/viewarticle/955989 4- Medical Evidence Despite Retraction, Study Using Fraudulent Surgisphere Data Still Cited https://www.medscape.com/viewarticle/956090 Ongoing Citations of a Retracted Study Involving Cardiovascular Disease, Drug Therapy, and Mortality in COVID-19 https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2782460 5-

Two studies on alcohol and AF incidence and an important paper on stable CAD are the topics John Mandrola discusses in this week’s podcast. https://www.medscape.com/twic 1 - COVID-19 New Vaccinations Increasing in COVID Hot Spots https://www.medscape.com/viewarticle/955680 2 - Alcohol - Moderate Drinking Protective After MI, Stroke in 'Flawed' Study https://www.medscape.com/viewarticle/955474 - Risk Thresholds for Total and Beverage-Specific Alcohol Consumption and Incident Atrial Fibrillation https://doi.org/10.1016/j.jacep.2021.05.013 - Can a Drink a Day Keep the Electrophysiologist Away? https://doi.org/10.1016/j.jacep.2021.06.010 - Association of alcohol consumption with morbidity and mortality in patients with cardiovascular disease: original data and meta-analysis of 48,423 men and women https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-021-02040-2 3 - Coronary Artery Disease - CLARIFY Confirms Meds, Watchful Waiting in Angina, Stable CAD https://www.medscape.com/viewarticle/955313 - Interna

COVID-19 messaging, coffee, CTA and statins, and Watchman problems are the topics discussed by John Mandrola, MD, in this week’s podcast. https://www.medscape.com/twic 1- COVID-19: - COVID-19 Cases in US Triple Over 2 Weeks Amid Misinformation https://www.medscape.com/viewarticle/955269 - Effectiveness of Covid-19 Vaccines against the B.1.617.2 (Delta) Variant https://www.nejm.org/doi/full/10.1056/NEJMoa2108891 - What Really Happened With that Weird Yankees COVID Outbreak https://nymag.com/intelligencer/2021/05/what-really-happened-with-that-weird-yankees-covid-outbreak.html 2- Coffee: - Coffee Not Linked to Increased Arrhythmia Risk in New Study https://www.medscape.com/viewarticle/954992 - Coffee Consumption and Incident Tachyarrhythmias https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2782015 - Another Cup of Coffee Without an Arrhythmia, Please https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2782021 3- CTA and Statins: - CTA May Guide Primary Prevention Statins in Nonobs

COVID-19, Ivermectin, a dissolving pacer, clinician well-being, and finerenone are discussed this week. 1 COVID-19 US 'Losing Time' Against Delta Variant, NIH Chief Says https://www.medscape.com/viewarticle/954882 Ivermectin for COVID: How Do We Know What to Believe? https://www.medscape.com/viewarticle/954681 2 Dissolving Pacemaker Dissolving Pacemaker Impressive in Early Research https://www.medscape.com/viewarticle/954774 3 Clinician Well-being Global Heart Organizations Unite to Promote Clinician Well-Being https://www.medscape.com/viewarticle/954803 Clinician Well-Being: Addressing Global Needs for Improvements in the Health Care Field A Joint Opinion From the American College of Cardiology, American Heart Association, European Society of Cardiology, and the World Heart Federation https://www.jacc.org/toc/jacc/0/0 From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider https://www.annfammed.org/content/12/6/573.full Bullying in Academic Medicine Rife, Underreported https://www.med

COVID-19, mRNA-vaccine-induced myocarditis, type 2 diabetes in kids, optimal medical therapy for CAD, and Alcohol are the topics discussed by John Mandrola, MD, in this week’s podcast. https://www.medscape.com/twic 1-COVID - Fast-spreading Delta Variant, Vaccination Rates, Reintroduction of Indoor Masks: COVID-19 Global Weekly Highlights https://www.medscape.com/viewarticle/940446 - Health care 'breaking point': Cox confirms some Springfield COVID-19 patients transferred to St. Louis, Kansas City https://www.news-leader.com/story/news/local/ozarks/2021/06/29/springfield-covid-delta-variant-missouri-hospitals-cox-some-patients-transferred-vaccines/7787970002/ 2- COVID Vaccine-Induced Myocarditis - New Details of Myocarditis Linked to COVID Vaccines https://www.medscape.com/viewarticle/954061 - Myocarditis Following Immunization With mRNA COVID-19 Vaccines in Members of the US Military https://jamanetwork.com/journals/jamacardiology/fullarticle/2781601 - Patients With Acute Myocarditis Following mRNA COVID-19 V