Medmastery's Cardiology Digest

In today’s episode of Cardiology Digest, we look at three recent research papers that can impact your clinical practice. They’re from NEJM Evidence, the European Heart Journal, and The New England Journal of Medicine.

STUDY #1: Today’s journey begins with a study examining the interplay between influenza and myocardial infarctions. Could the flu shot be more than just a seasonal precaution?  

de Boer, AR, Riezebos-Brilman, A, van Hout, D, et al. 2024. Influenza infection and acute myocardial infarction. NEJM Evid. 7:EVIDoa2300361. (https://doi.org/10.1056/EVIDoa2300361)

STUDY #2: Next, we wade into a cath lab debate over fasting protocols. Join us to explore research that flips traditional pre-procedure fasting requirements on their head. Are we on the brink of a new era? 

Ferreira, D, Hardy, J, Meere, W, et al. 2024. Fasting vs no fasting prior to catheterisation laboratory procedures: The SCOFF trial. Eur Heart J. Published online. (https://doi.org/10.1093/eurheartj/ehae573)

STUDY #3: Finally, we dig into the complexities of anticoagulation in transcatheter aortic-valve replacement patients. This study sheds light on the choice between interrupting or continuing anticoagulation, and has implications for everyday practice.

van Ginkel, DJ, Bor, WL, Aarts, HM, et al. 2024. Continuation versus interruption of oral anticoagulation during TAVI. N Engl J Med. Published online. (https://doi.org/10.1056/NEJMoa2407794)

Tune in for a captivating discussion that promises to enrich your clinical acumen! 

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Coronary Angiography Essentials (3 CME)

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Percutaneous Coronary Intervention Essentials (6 CME)

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In this episode of Medmastery’s Cardiology Digest, we dive into three groundbreaking studies that are set to reshape our understanding and approach to cardiology.

STUDY #1: First, we discuss a landmark piece of research that sheds new light on the benefits of percutaneous coronary intervention for patients with significant coronary artery disease who need a transcatheter aortic valve replacement. This study addresses important questions about patient selection for this intervention.  

Lønborg, J, Jabbari, R, Sabbah, M, et al. 2024. PCI in patients undergoing transcatheter aortic-valve implantation. N Engl J Med. Published online. (https://doi.org/10.1056/NEJMoa2401513)

STUDY #2: Next, we examine an insightful meta-analysis that evaluates patient-level data to inform the future of dual antiplatelet therapy after percutaneous coronary intervention. Discover the factors influencing the transition to ticagrelor monotherapy post-PCI and why this could change current guideline recommendations. 

Valgimigli, M, Hong, S, Gragnano, F, et al. 2024. De-escalation to ticagrelor monotherapy versus 12 months of dual antiplatelet therapy in patients with and without acute coronary syndromes: A systematic review and individual patient-level meta-analysis of randomized trials. Lancet. 10456: 937–948. (https://doi.org/10.1016/S0140-6736(24)01616-7)

STUDY #3: Lastly, we take a closer look at the EPIC-CAD study, which aligns with previous findings from the AFIRE trial. Learn why anticoagulant monotherapy is now being considered for the majority of patients with atrial fibrillation who require anticoagulation and have stable coronary artery disease, and what this means for your clinical practice.

Cho, MS, Kang, D-Y, Ahn, J-M, et al. 2024. Edoxaban antithrombotic therapy for atrial fibrillation and stable coronary artery disease. N Engl J Med. Published online. (https://doi.org/10.1056/NEJMoa2407362)

Tune in to this episode for an engaging in-depth discussion of these studies and stay ahead in the ever-evolving field of cardiology! 

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Percutaneous Coronary Intervention Essentials Workshop (6 CME)

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Stay ahead with the newest cardiology research findings that could change your clinical practice!

STUDY #1: First up, we explore new data on edoxaban dosage for older patients with atrial fibrillation. If we could give older patients a lower dose of edoxaban to reduce the risk of bleeding, will they still benefit from a lower risk for stroke? 

Zimerman, A, Braunwald, E,  Steffel, J, et al. 2024. Dose reduction of edoxaban in patients 80 years and older with atrial fibrillation: Post hoc analysis of the ENGAGE AF-TIMI 48 randomized clinical trial. JAMA Cardiol. Published online. (https://doi.org/10.1001/jamacardio.2024.1793)

STUDY #2: Next, we delve into the nuanced world of invasive versus noninvasive treatment of non-ST-segment elevation myocardial infarction (NSTEMI). You’ll find out if mortality rates go up when we use a less invasive approach. 

Kunadian, V, Mossop, H, Shields, C, et al. 2024. Invasive treatment strategy for older patients with myocardial infarction. N Engl J Med. Published online. (https://doi.org/10.1056/NEJMoa2407791)

STUDY #3: Lastly, we break down the latest findings on chelation therapy in patients with stable coronary artery disease and diabetes. Tune it to see whether the latest data challenges your perspective on the efficacy of EDTA in reducing cardiovascular risks.

Lamas, GA, Anstrom, KJ, Navas-Acien, A, et al. 2024. Edetate disodium-based chelation for patients with a previous myocardial infarction and diabetes: TACT2 randomized clinical trial. JAMA. Published online. (https://doi.org/10.1001/jama.2024.11463)

Join us to uncover these critical insights, discussions, and more. Let's turn data into actionable wisdom and elevate your cardiology practice. 

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ECG Mastery Program (34 CME)

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Welcome to the latest episode of Medmastery’s Cardiology Digest, where In less than 15 minutes we’ll get you up to date on breakthrough studies and advancements in cardiology that can impact your clinical practice!

STUDY #1: Brace yourself for insights into a study that evaluated rapid uptitration of evidence-based therapies for heart failure. Join us as we dissect the feasibility, resource demands, and patient implications? 

Biegus, J, Mebazaa, A, Davison, B, et al. 2024. Effects of rapid uptitration of neurohormonal blockade on effective, sustainable decongestion and outcomes in STRONG-HF. J Am Coll Cardiol. 4: 323–336.  (https://doi.org/10.1016/j.jacc.2024.04.055)

STUDY #2: Next, we examine a recent paper that challenges hospital-centric treatment paradigms for acute pulmonary embolism. Discover how some low-risk patients could benefit from home treatment, and what conditions are essential to ensure their safety and effective care. 

Luijten, D, Douillet, D, Luijken, K, et al. 2024. Safety of treating acute pulmonary embolism at home: An individual patient data meta-analysis. Eur Heart J. 32: 2933–2950. (https://doi.org/10.1093/eurheartj/ehae378)

STUDY #3: Finally, we dive into a large cohort study looking at bariatric surgery in obese patients with obstructive sleep apnea, and see whether losing weight actually had a significant impact on cardiovascular outcomes.

Aminian, A, Wang, L, Al Jabri, A, et al. 2024. Adverse cardiovascular outcomes in patients with obstructive sleep apnea and obesity: Metabolic surgery vs usual care. J Am Coll Cardiol. Published online. (https://doi.org/10.1016/j.jacc.2024.06.008)

This episode promises to be packed with actionable insights on this thought-provoking cardiology research. Don’t miss out—press play and enrich your practice today! 

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Chest X-ray Essentials (7 CME)

Chest X-ray Essentials Workshop (1 CME)

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This week, we have three compelling research papers that are sure to expand your clinical acumen.

STUDY #1: We explore the debate surrounding the new PREVENT calculator’s impact on predictions of 10-year risk for atherosclerotic cardiovascular disease and statin eligibility. Will the current guidelines from the American Heart Association and American College of Cardiology remain the gold standard, or are we on the cusp of a significant paradigm shift? 

Diao, JA, Shi, I, Murthy, VL, et al. 2024. Projected changes in statin and antihypertensive therapy eligibility with the AHA PREVENT cardiovascular risk equations. JAMA. Published online. (https://doi.org/10.1001/jama.2024.12537)

Grant, JK, Ndumele, CE, and Martin, SS. 2024. The evolving landscape of cardiovascular risk assessment. JAMA. Published online. (https://doi.org/10.1001/jama.2024.13247)

Khan SS, and Lloyd-Jones, DM. 2024. Statins for primary prevention of cardiovascular disease — With PREVENT, what's a clinician to do? JAMA. Published online. (https://doi.org/10.1001/jama.2024.13887)

Khan, SS, Matsushita, K, Sang, Y, et al. 2023. Development and Validation of the American Heart Association’s PREVENT Equations. J Circulation. 6: 430-449. (https://doi.org/10.1161/CIRCULATIONAHA.123.067626)

STUDY #2: Next, we dive into a great study examining the connection between antihypertensive medications and eczematous dermatitis in older adults. This extensive population-based research offers great insights that could change your approach to managing hypertension in patients with dermatologic concerns. Could your favorite antihypertensive medication be the culprit behind your patient's new skin condition?

Ye, M, Chan, LN, Douglas, I, et al. 2024. Antihypertensive medications and eczematous dermatitis in older adults. JAMA Dermatol. Published online. (https://doi.org/10.1001/jamadermatol.2024.1230)

Joly, P, Benoit-Corven, C, Baricault, S, et al. Sophie Baricault. 2007. Chronic Eczematous Eruptions of the Elderly Are Associated with Chronic Exposure to Calcium Channel Blockers: Results from a Case–Control Study. J Invest Derm. 12: 2766-2771. (https://doi.org/10.1038/sj.jid.5701018)

Summers, EM, Bingham, CS, Dahle, KW, et al. 2013. Chronic Eczematous Eruptions in the Aging Further Support for an Association With Exposure to Calcium Channel Blocker. JAMA Dermatol. 7: 814-818. doi:10.1001/jamadermatol.2013.511

STUDY #3: Finally, we dissect a hotly discussed study linking semaglutide with non-arteritic anterior ischemic optic neuropathy. Garnering attention both in academia and the lay media, this study's robust methodology lends significant weight to its findings. But does this potential risk necessitate altering prescribing habits for semaglutide?

Hathaway, JT, Shah, MP, Hathaway, DB, et al. 2024. Risk of nonarteritic anterior ischemic optic neuropathy in patients prescribed semaglutide. JAMA Ophthalmol. 2024. Published online. (https://doi.org/10.1001/jamaophthalmol.2024.2296)

Join us for a closer look at these pivotal studies. It's a conversation you won’t want to miss. 

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Hypertension Mini (1 CME)

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In this episode of Cardiology Digest, we dive into top journals like JAMA Cardiology to bring you three of the most compelling recent research papers from the field of cardiology.

STUDY #1: First, see how the new Boston Scientific cryoballoon measures up against Medtronic's product. Did the newcomer outshine the veteran, or does it come with hidden risks? Discover the head-to-head results and what they mean for the future of atrial fibrillation cryoablation. 

Reichlin, T, Kueffer, T, Knecht, S et al. 2024. PolarX vs Arctic Front for cryoballoon ablation of paroxysmal AF: The randomized COMPARE CRYO study. JACC Clin Electrophysiol. In Press, Corrected Proof. (https://doi.org/10.1016/j.jacep.2024.03.021)

STUDY #2: Next, we explore the intersection of aging, aortic stenosis, and osteosarcopenia in elderly patients undergoing transcatheter aortic valve replacement. This study highlights a radiographic method that reveals a high-risk subpopulation within this demographic. See how this insight can shape our approach to transcatheter aortic valve replacement, and what it means for patient care strategies.

Solla-Suarez, P, Arif, S, Ahmad, F, et al. 2024. Osteosarcopenia and mortality in older adults undergoing transcatheter aortic valve replacement. JAMA Cardiol. 7: 611-618. (https://doi.org/10.1001/jamacardio.2024.0911)

O'Gara, P, Guduguntla, V, Bonow, R, et al. 2024, Osteosarcopenia and mortality after transcatheter aortic valve replacement. JAMA Cardiol. 7: 618-619. (https://doi.org/10.1001/jamacardio.2024.1018)

STUDY #3: Finally, we turn our attention to the pressing issue of hypertensive disorders in pregnancy. Discover why close postpartum monitoring is critical and what the latest research suggests about the persistence of hypertension in new mothers. Could longer follow-ups hold the key to better postpartum care?

Hauspurg, A, Venkatakrishnan, K, Collins, L, et al. 2024. Postpartum ambulatory blood pressure patterns following new-onset hypertensive disorders of pregnancy. JAMA Cardiol. Published online (https://doi.org/10.1001/jamacardio.2024.1389)

Join us to unravel these important studies and their implications for your practice and patients. Ready to stay ahead in the rapidly evolving world of cardiology? Hit play and let's get started! 

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Ready to dig into the latest cardiology research? In less than 15 minutes, we'll give you the low-down on three new studies that’ll help you in clinical practice.

STUDY #1: First, we explore safety outcomes for carotid artery stenting and see how this could impact your clinical discussions and decision-making. And if you practice in the U.S., now that Medicare and Medicaid cover this procedure for a broader range of patients, this info will prove to be especially important. 

Uchida, K, Sakakibara, F, Sakai, N, et al. 2024. Real-world outcomes of carotid artery stenting in symptomatic and asymptomatic patients with carotid artery stenosis. JACC Cardiovasc Interv. 9: 1160-1162. (https://doi.org/10.1016/j.jcin.2024.03.014)

STUDY #2: Next, we tackle a common cardiology conundrum: how should we handle significant coronary artery disease lesions discovered incidentally in patients with severe aortic stenosis who are undergoing transcatheter aortic valve replacement? Is it better to treat these lesions beforehand, or is there a better strategy? We'll probe the debate, highlighting the potential implications of this new data.

Colaiori, I, Paolucci, L, Mangiacapra, F, et al. 2024. Natural history of coronary atherosclerosis in patients with aortic stenosis undergoing transcatheter aortic valve replacement: The role of quantitative flow ratio. Circ Cardiovasc Interv. 0: e013705. (https://doi.org/10.1161/CIRCINTERVENTIONS.123.013705)

STUDY #3: Lastly, we sip our way through the nuances of coffee consumption and its impact on blood pressure and cardiac arrhythmias. A new study lets us know whether our patients' daily caffeine fix can be left off the list of cardiac concerns.

Trevano, F, Vela-Bernal, S, Facchetti, R, et al. 2024. Habitual coffee consumption and office, home, and ambulatory blood pressure: Results of a 10-year prospective study. J Hypertens. 6: 1094-1100. (https://doi.org/10.1097/HJH.0000000000003709)

Join us to break down these studies, and elevate your cardiology knowledge!

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Coronary Angiography Essentials (3 CME)

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In less than 15 minutes, Medmastery’s Cardiology Digest will give you the low-down on some of the most compelling studies in cardiology that clinicians with an interest in cardiovascular health need to know about.

STUDY #1: We kick things off by exploring exactly where the CHA2DS2-VASc score fits into anticoagulation decisions in patients with silent atrial fibrillation. Building on the main findings from the ARTESiA and NOAH-AFNET 6 trials, this study sparks a thought-provoking discussion on the future of risk stratification. Tune in to hear insights that could shape your clinical practice. 

Lopes, RD, Granger, CB, Wojdyla, DM, et al. 2024. Apixaban versus aspirin according to CHA2DS2-VASc score in subclinical atrial fibrillation: Insights from ARTESiA. J Am Coll Cardiol. In Press, Journal Pre-proof. (https://doi.org/10.1016/j.jacc.2024.05.002)

STUDY #2: Next, we break down misconceptions surrounding race and treatment efficacy in heart failure with reduced ejection fraction. This study shines a light on the impacts of renin-angiotensin system inhibition across different racial groups. See how these findings challenge the outdated genetic constructs of race, and what they mean for your approach to patient care.

Shen, L, Lee, MM, Jhund, PS, et al. 2024. Revisiting race and the benefit of RAS blockade in heart failure: A meta-analysis of randomized clinical trials. JAMA. 24: 2094–2104. (https://doi.org/10.1001/jama.2024.6774)

STUDY #3: Finally, we turn our focus to the V142I transthyretin gene variant, to evaluate its impacts on cardiovascular health within the U.S. Black population. This research not only highlights the need for targeted genetic screening but also raises important questions about the accessibility of costly treatments for transthyretin amyloidosis.

Selvaraj, S, Claggett, B, Shah, SH,  et al. 2024. Cardiovascular burden of the V142I transthyretin variant. JAMA. 21: 1824–1833. (https://doi.org/10.1001/jama.2024.4467)

Maurer, MS, Miller, EJ, Ruberg, FL, et al. 2024. Addressing health disparities—The case for variant transthyretin cardiac amyloidosis grows stronger. JAMA. 21: 1809–1811. (https://doi.org/10.1001/jama.2024.2868)

Yancy, CW. 2024. Heart failure in African American individuals, Version 2.0. JJAMA. 21: 1807–1808. (https://doi.org/10.1001/jama.2024.5217)

Don't miss out on this rich discussion that promises to enhance your understanding and expertise! 

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In this episode of Cardiology Digest, we explore groundbreaking studies from the past couple of months that are expanding our understanding of best practices for atrial fibrillation management, as well as lipid-lowering therapies after an acute myocardial infarction.

STUDY #1: First up, what happens when a seemingly promising ablation strategy for nonparoxysmal atrial fibrillation disappoints? We're diving into why early nonrandomized trials can often give us hope, but the real story unfolds when randomized trials are performed. How does pulmonary vein isolation stack up against additional treatments, and is there a role for the routine use of left atrial appendage ligation in atrial fibrillation ablation? 

Lakkireddy, DR, Wilber, DJ, Mittal, S, et al. 2024. Pulmonary vein isolation with or without left atrial appendage ligation in atrial fibrillation: The aMAZE randomized clinical trial. JAMA. 13: 1099–1108. (https://jamanetwork.com/journals/jama/article-abstract/2816924)

STUDY #2: Next, can early rhythm control in atrial fibrillation significantly reduce dementia risk? Our second study reveals compelling associations that persist even after rigorous sensitivity analyses. We explore the aggressive use of antiarrhythmic medications in treating new-onset atrial fibrillation, and see what recent research suggests about this approach.

Lee S-R, Choi, E-K, Lee, S-W, et al. 2024. Early rhythm control and incident dementia in patients with atrial fibrillation and prior stroke. JACC Clin Electrophysiol. Online ahead of print. (https://www.sciencedirect.com/science/article/abs/pii/S2405500X24001889)

STUDY #3: Lastly, we turn our attention to older adults who’ve had an acute myocardial infarction, and what to do about lipid-lowering therapy—what's the latest evidence? This new study provides welcome insights, especially given the previous exclusion of this age group from randomized trials. How do high-intensity therapies fare in older patients compared to their younger counterparts, and what potential confounders should we keep in mind? See how these findings impact clinical practice!

Fayol, A, Schiele, F, Ferrières, J, et al. 2024. Association of use and dose of lipid-lowering therapy post acute myocardial infarction with 5-year survival in older adults. Circ Cardiovasc Qual Outcomes. 5: e010685. https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.123.010685

Join us to explore the potential impacts of these studies, the ongoing debates they spark within the cardiology community, and to see how these findings could influence your clinical decisions.

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Atrial Fibrillation Essentials (1 CME): 

Pacemaker Essentials (5 CME)

Pacemaker Essentials Workshop (1 CME)

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Welcome to the latest episode of Cardiology Digest, where we chart a course through groundbreaking studies that are shaping cardiology practice!  

STUDY #1: First, we discuss the nuanced world of drug interactions involving diltiazem and direct-acting oral anticoagulants like apixaban and rivaroxaban. Tune in as we scrutinize the study's limitations and practical implications for your patients with atrial fibrillation. 

Ray, WA, Chung, CP, Stein, CM, et al. 2024. Serious bleeding in patients with atrial fibrillation using diltiazem with apixaban or rivaroxaban. JAMA. 18: 1565–1575. (https://jamanetwork.com/journals/jama/article-abstract/2817546)

STUDY #2: Next, we turn our attention to a case-control study examining the bleeding risks associated with the combination of selective serotonin reuptake inhibitors and anticoagulants in patients with atrial fibrillation. Are the bleeding risks substantial enough to rethink this combination therapy, or are there scenarios where the benefits outweigh the dangers? We'll leave no stone unturned.

Rahman, AA, Platt, RW, Beradid, S, et al. 2024. Concomitant use of selective serotonin reuptake inhibitors with oral anticoagulants and risk of major bleeding. JAMA. 3: e243208. (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2816687)

STUDY #3: Finally, we explore a fascinating meta analysis that looked at renal denervation and its long-term efficacy in controlling blood pressure. See how renal denervation stacks up against traditional antihypertensive medications and what you need to consider when thinking about incorporating it into your treatment arsenal.

Sesa-Ashton, G, Nolde, JM, Muente, I, et al. 2024. Long-term blood pressure reductions following catheter-based renal denervation: A systematic review and meta-analysis. Hypertension. 6: e63–e70. (https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.123.22314)

Join us to explore the potential impacts of these studies, the ongoing debates they spark within the cardiology community, and to see how these findings could influence your clinical decisions.

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Atrial Fibrillation Essentials (1 CME): 

Pacemaker Essentials (5 CME)

Pacemaker Essentials Workshop (1 CME)

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Show notes:

Visit us at  https://www.medmastery.com/podcasts/cardiology-podcast.