The PRAGUE-25 study evaluated the effectiveness of two treatment strategies in patients with both atrial fibrillation (AF) and obesity: catheter ablation versus lifestyle modification (including weight loss and increased physical activity) combined with antiarrhythmic drug therapy. While motivated patients who adhered to lifestyle changes experienced a reduction in AF episodes, the study found that catheter ablation was significantly more effective in achieving and maintaining sinus rhythm. 

In this episode, Drs. Joseph Marine and Pavel Osmancik discuss the trial’s findings, highlighting that catheter ablation outperformed lifestyle modification and medication in restoring and sustaining normal heart rhythm. 

SUGGESTED MATERIALS 

1. Osmancik P, Havránek Š, Bulková V, et al. Catheter ablation versus antiarrhythmic drugs with risk factor modification for treatment of atrial fibrillation: a protocol of a randomised controlled trial (PRAGUE-25 trial). BMJ Open. 2022 Jun 15;12(6):e056522. doi: 10.1136/bmjopen-2021-056522. 

1. Pathak RK, Middeldorp ME, Meredith M, Mehta AB, Mahajan R, Wong CX, Twomey D, Elliott AD, Kalman JM, Abhayaratna WP, Lau DH, Sanders P. Long-Term Effect of Goal-Directed Weight Management in an Atrial Fibrillation Cohort: A Long-Term Follow-Up Study (LEGACY). J Am Coll Cardiol. 2015 May 26;65(20):2159-69. doi: 10.1016/j.jacc.2015.03.002.  

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A Global Cardiovascular Risk Consortium study of nearly 2 million people worldwide found that avoiding five modifiable risk factors—hypertension, hyperlipidemia, abnormal weight, diabetes, and smoking—by age 50 added over a decade of life expectancy for both sexes. Midlife control of systolic blood pressure and smoking yielded the greatest global gains. 

In this interview, Drs. Roger S. Blumenthal and Christina Magnussen discuss how this landmark study moves beyond a predominantly North American and European focus, translating abstract risk factors into tangible years of healthy life for patients. 

SUGGESTED MATERIALS 

1. The Global Cardiovascular Risk Consortium. Global effect of cardiovascular risk factors on lifetime estimates. NEJM. Published online March 30, 2025. Doi: 10.1056/NEJMoa2415879 

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The ZENITH trial evaluated sotatercept, an activin signaling inhibitor, in patients with advanced pulmonary arterial hypertension (PAH) at high risk of death. Sotatercept met its primary endpoint—time to first morbidity or mortality event—prompting an independent data monitoring committee to recommend early trial termination and offer the drug to all participants. 

In this interview, Drs. Allen J. Taylor and Marc Humbert discuss how ZENITH highlights sotatercept’s clinical benefit even in the sickest PAH patients, offering renewed hope for a disease long seen as unrelenting. 

 SUGGESTED MATERIALS 

1. Humbert M, McLaughlin VV, Badesch DB, et al., for the ZENITH Trial Investigators. Sotatercept in Patients With Pulmonary Arterial Hypertension at High Risk for Death. N Engl J Med 2025;Mar 31:[Epub ahead of print]. 

2. Hoeper MM, Badesch DB, Ghofrani HA, et al.; STELLAR Trial Investigators. Phase 3 trial of sotatercept for treatment of pulmonary arterial hypertension. N Engl J Med 2023;388:1478-90.  

3. Humbert M, McLaughlin V, Gibbs JSR, et al.; PULSAR Trial Investigators. Sotatercept for the treatment of pulmonary arterial hypertension. N Engl J Med 2021;384:1204-15. 

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The “Cardiac Arrest During Long-Distance Running Races: 2010–2023” study analyzed the incidence and outcomes of sudden cardiac arrests (SCAs) occurring during marathons and half-marathons in the United States. Known as the RACER2 study, it serves as a follow-up to the original RACER1 study, which covered the years 2000–2009. 

 In this episode, Drs. Jonathan H. Kim and Aaron L. Baggish discussed the study findings, emphasizing the importance of continued vigilance and preparedness to further reduce the risk of fatal outcomes during endurance events. 

 SUGGESTED MATERIALS  

 1. Kim JH, Rim AJ, Miller JT, et al. Cardiac Arrest During Long-Distance Running Races. JAMA. Published online March 30, 2025. doi:10.1001/jama.2025.3026. 

2. Kim JH, Malhotra R, Chiampas G, d'Hemecourt P, Troyanos C, Cianca J, Smith RN, Wang TJ, Roberts WO, Thompson PD, Baggish AL; Race Associated Cardiac Arrest Event Registry (RACER) Study Group. Cardiac arrest during long-distance running races. N Engl J Med. 2012;366:130-40.  

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Funded by the Congressionally Directed Medical Research Programs (CDMRP) of the Department of Defense, the WARRIOR (Women's IschemiA TRial to Reduce events In non-ObstRuctive CAD) Trial addresses the urgent need for evidence-based care in a growing population of patients—particularly women—experiencing ischemia without obstructive coronary artery disease (INOCA). 

This clinical strategy trial compares optimal medical therapy with usual care in women with angina but no significant coronary blockages. In this episode, Drs. Nanette Kass Wenger and Noel Bairey Merz discuss the trial’s design, enrollment progress, follow-up strategies, and the primary and secondary outcomes that could reshape cardiovascular care for women. 

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Patients with peripheral artery disease (PAD) often experience significant walking difficulties, and there are limited therapies available to improve their mobility. Investigation made through the STRIDE (Effects of Semaglutide on Functional Capacity in Patients With Type 2 Diabetes and Peripheral Arterial Disease) trial focused on semaglutide, a drug known for promoting weight loss, reducing inflammation, and lowering the risk of heart attack or stroke, to determine if it could enhance the functional abilities of PAD patients. 

 In this interview, Drs. Alison Bailey and Marc Bonaca discuss how the STRIDE trial data supports the use of semaglutide for individuals with PAD and type 2 diabetes, highlighting its cardiometabolic, cardiovascular, and kidney benefits, as well as its ability to improve function, symptoms, and overall quality of life. 

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Transcatheter aortic valve replacement (TAVR) has emerged as the preferred treatment for aortic stenosis. However, there is a lack of long-term outcome data for low-risk patients. The 5-year results from the Evolut Low-Risk randomized trial address this gap, offering compelling evidence with no significant negative signals regarding TAVR's clinical outcomes and valve performance. 

In this episode, Drs. Richard A. Chazal and Michael J. Reardon delve into the 5-year results from the Evolut Low-Risk randomized trial, offering valuable insights about the future of TAVR and its impact on patient care. 

Related References: 

1. Popma JJ, Deeb GM, Yakubov SJ, et al; Evolut Low Risk Trial Investigators. Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients. N Engl J Med. 2019 May 2;380(18):1706-1715. doi: 10.1056/NEJMoa1816885. Epub 2019 Mar 16. PMID: 30883053. 

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Fluid restriction is often recommended for heart failure (HF) patients to prevent congestion, but its benefits and safety are unclear. The FRESH-UP study is the first to show that strict fluid restriction does not improve health status for chronic, symptomatic HF patients and may increase thirst distress without reducing mortality, hospitalization, acute kidney injury, or medication needs. 

In this interview, Roland RJ van Kimmenade, MD and Alison L. Bailey, MD, FACC discuss the impacts of the FRESH-UP study and how liberal fluid intake is safe for chronic HF patients, even enhancing their well-being. Providers are encouraged to reconsider universal fluid restrictions and adopt a more individualized approach. 

 RELATED REFERENCES: 

1. Herrmann JJ, Brunner-La Rocca HP, Baltussen LE, et al. Liberal Fluid Intake Versus Fluid Restriction in Chronic Heart Failure: A Randomized Clinical Trial. Nat Med 2025;Mar 30:[Epub ahead of print]. 

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare and potentially fatal form of elevated blood pressure in the lungs. CTEPH treatment overall is a very complex clinical assessment and medical decision. Treatment options may include pulmonary thromboendarterectomy (PTE) surgery, balloon pulmonary angioplasty (BPA), or medical therapy.  

In this interview, Drs. Shashank Sinha and Anjali Vaidya discuss how to approach the treatment decision for CTEPH once a diagnosis has been made.  

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The 2024 American Heart Association/American College of Cardiology (AHA/ACC)/multisociety guideline for perioperative cardiovascular (CV) management for noncardiac surgery, released in September 2024, marks the fourth comprehensive revision of the perioperative guideline since its inception in 1996. This latest update reflects the most current, evidence-based recommendations, shaped by expert clinical insight, to guide the management of patients with CV conditions undergoing noncardiac surgery. 

 In this interview, Drs. Andrew Kates and Annemarie Thompson discuss the key updates from the 2014 guideline, highlighting significant changes and exploring its guidance on evaluating patients with CV disease before noncardiac surgery.  

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