This Week in Cardiology

Tirzepatide vs semaglutide in obesity; GLP1a use is complicated; HF outcomes; the misuse of meta-analyses in HF; and a breakthrough in HF care are the topics John Mandrola, MD, covers this week.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. SURMOUNT 5

• Clinicaltrials.gov https://clinicaltrials.gov/study/NCT05822830
• Press Release

II. Access to GLP-1 Agonist Drugs

• CMS statement https://www.cms.gov/newsroom/press-releases/biden-harris-administration-announces-medicare-advantage-and-medicare-part-d-prescription-drug

III. SUMMIT TRIAL commentary

Has Tirzepatide Scaled the HFpEF/Obesity SUMMIT?

https://www.medscape.com/viewarticle/has-tirzepatide-scaled-hfpef-obesity-summit-2024a1000m2h

IV. Blank Spot in HF Evidence – All cause hospitalizations

• Sayed and colleagues What Is Success in HF Trials? https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2827168
• EMPEROR-Preserved https://www.nejm.org/doi/full/10.1056/NEJMoa2107038
• Mayo Observational Study 10.1016/j.mayocp.2016.11.009
• DIG Trial https://jamanetwork.com/journals/jama/fullarticle/195990

V. Misuse of Meta-analysis by HF Community

• Lu and colleagues PARAGON/PARADIGM Meta-analysis https://jamanetwork.com/journals/jamacardiology/fullarticle/2823259
• Desai 2004 https://jamanetwork.com/journals/jama/fullarticle/199995
• PARADIGM HF https://www.nejm.org/doi/full/10.1056/NEJMoa1409077
• PARAGON HF https://www.nejm.org/doi/full/10.1056/NEJMoa1908655

VI Integration of Palliative Care Into HF Care

• Chuzi and colleagues Palliative Care in HF 10.1016/j.cardfail.2024.10.435
• Kotecha and colleagues Beta-blocker Metaanalysis 10.1016/S0140-6736(14)61373-8

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An AHA review: the OPTION, SUMMIT, VANISH 2, SARAH, and CLEAR trials 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. OPTION Trial

For AF, LAA Rivals Anticoagulants After Ablation

https://www.medscape.com/viewarticle/af-laa-rivals-anticoagulants-after-ablation-2024a1000l7n

4 Reasons to Question Percutaneous Left Atrial Appendage Closure After AF Ablation

https://www.medscape.com/viewarticle/4-reasons-question-percutaneous-left-atrial-appendage-2024a1000l0u

• OPTION in NEJM https://www.nejm.org/doi/full/10.1056/NEJMoa2408308

II. SUMMIT Trial

Tirzepatide Reduces Heart Failure Events in HFpEF With Obesity

https://www.medscape.com/viewarticle/tirzepatide-reduces-heart-failure-events-hfpef-obesity-2024a1000kx5

• SUMMIT in NEJM https://www.nejm.org/doi/full/10.1056/NEJMoa2410027

III. VANISH Trial

New Trial Result Pushes Past Antiarrhythmic Therapy After MI

https://www.medscape.com/viewarticle/new-trial-result-pushes-past-antiarrhythmic-therapy-after-mi-2024a1000l08

• VANISH 2 https://www.nejm.org/doi/full/10.1056/NEJMoa2409501
• VANISH 1 https://www.nejm.org/doi/full/10.1056/NEJMoa1513614

IV. Cardioprotection

Common Heart Failure Drugs Ease Heart Damage During Chemo https://www.medscape.com/viewarticle/common-heart-failure-drugs-ease-heart-damage-during-chemo-2024a1000l14

• Strain Imaging Review Article https://www.jacc.org/doi/10.1016/j.jcmg.2024.07.011

V. CLEAR trial

Spironolactone Shows Mixed Results in Acute MI

https://www.medscape.com/viewarticle/spironolactone-shows-mixed-results-acute-mi-2024a1000l41

Routine Colchicine or MRA Post-MI: No CLEAR Benefit

https://www.medscape.com/viewarticle/routine-colchicine-or-mra-post-mi-no-clear-benefit-2024a1000la2

• CLEAR-Spironolactone https://www.nejm.org/doi/full/10.1056/NEJMoa2405923
• CLEAR-Colchicine https://www.nejm.org/doi/full/10.1056/NEJMoa2405922

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Tirzepatide, AF screening, and an AHA preview, including VT ablation, LAAC at the time of AF ablation, BP targets, and GLP1 agonists in HF 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. Tirzepatide

• SURMOUNT 1 – Three-year results https://www.nejm.org/doi/full/10.1056/NEJMoa2410819

II. AF Screening

• GUARD AF https://www.jacc.org/doi/10.1016/j.jacc.2024.08.019
• LOOP 10.1016/S0140-6736(21)01698-6
• STROKE STOP 10.1016/S0140-6736(21)01637-8

III. LAAC with AF ablation

Mandrola Previews the OPTION Trial, the Most Worrisome Study at AHA 2024

https://www.medscape.com/viewarticle/mandrola-previews-option-trial-most-worrisome-study-aha-2024-2024a1000kmz

• The OPTION Trial Rationale https://doi.org/10.1016/j.ahj.2022.05.003

IV. Blood Pressure Targets

• BPROAD https://onlinelibrary.wiley.com/doi/10.1111/1753-0407.13411
• ACCORD - https://www.nejm.org/doi/full/10.1056/NEJMoa1001286

V. GLP1a for HFpEF

• SUMMIT at Clinicaltrials.gov https://clinicaltrials.gov/study/NCT04847557

VI. VT Ablation

• VANISH2 Rationale https://doi.org/10.1016/j.ahj.2024.04.009
• VANISH 1 https://www.nejm.org/doi/full/10.1056/NEJMoa1513614

VII. Spironolactone Results of CLEAR-SYNERGY

Nov 08, 2024 This Week in Cardiology Podcast

https://www.medscape.com/viewarticle/1001865

'No Hint of Benefit' in Large Colchicine Trial

https://www.medscape.com/viewarticle/no-hint-benefit-large-colchicine-trial-2024a1000ko4

• CLEAR SYNERGY Rationale https://pubmed.ncbi.nlm.nih.gov/38936755/

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The EARLY TAVR trial, colchicine after MI, and the TRISCEND II trial of tricuspid valve replacement 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 TAVR

• EARLY TAVR https://www.acc.org/latest-in-cardiology/clinical-trials/2024/10/24/14/42/early-tavr
• Rationale https://doi.org/10.1016/j.ahj.2023.11.019
• AVATAR https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057639
• RECOVERY https://www.nejm.org/doi/full/10.1056/NEJMoa1912846
• FAME 2 https://www.nejm.org/doi/full/10.1056/NEJMoa1205361
• Rajkumar; Faith Healing in Unblinded Trials https://pubmed.ncbi.nlm.nih.gov/29530888/
• PARTNER 3 trial https://www.nejm.org/doi/full/10.1056/NEJMoa2307447
• EARLY TAVR: A Positive Trial That Fails to Inform Clinical Decisions https://www.medscape.com/viewarticle/early-tavr-positive-trial-fails-inform-clinical-decisions-2024a1000kec

II. Colchicine

• Meta-analysis https://doi.org/10.1016/j.eclinm.2024.102835
• Clear-Synergy Rationale https://pubmed.ncbi.nlm.nih.gov/38936755/
• COLCOT (post MI) https://www.nejm.org/doi/full/10.1056/NEJMoa1912388
• LoDoCo (Chronic CAD) https://www.nejm.org/doi/full/10.1056/NEJMoa2021372

III. TRISCEND II Trial

• TRISCEND II Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2401918

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Listener feedback on PFA and STEMI/NSTEMI paradigm, oral semaglutide, symptomatic vs asymptomatic AF, and the win-ratio 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. Listener Feedback

Oct 18, 2024 This Week in Cardiology Podcast

https://www.medscape.com/viewarticle/1001769

• Pulsed Field Ablation

https://www.hrsonline.org/guidance/safety-alerts/boston-scientific-cardiac-cryoablation-system

• STEMI/NSTEMI https://doi.org/10.1016/j.jacadv.2024.101314

II. Oral Semaglutide

• Press Release: https://www.novonordisk.com/content/nncorp/global/en/news-and-media/news-and-ir-materials/news-details.html?id=171480
• Rationale Paper SOUL trial

III. Symptomatic vs Asymptomatic AF

• Meta-analysis in EHJ
• Meta-analysis of rate vs rhythm-control strategies https://doi.org/10.1016/j.jacep.2024.03.006

IV. The Win Ratio

• Pocock and colleagues https://doi.org/10.1093/eurheartj/ehae647

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Listener feedback on the c-statistic, atherosclerotic plaque imaging, WATCHMAN implant decisions in the US, and deprescribing 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:

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I.Listener Feedback

Oct 11, 2024 This Week in Cardiology Podcast

https://www.medscape.com/viewarticle/1001735

• Nancy Cook; C-statistic https://doi.org/10.1161/CIRCULATIONAHA.106.672402

II. Plaque Imaging

New Evidence That Plaque Buildup Shouldn't Be Ignored

https://www.medscape.com/viewarticle/new-evidence-plaque-buildup-shouldnt-be-ignored-2024a1000ihw

• Fuster and colleagues; Imaging vs CAC

III. WATCHMAN Decisions

• Zeitler and colleagues. Long-term Outcomes

IV. Deprescribing

Cognitive Decline and Antihypertensive Use: New Data

https://www.medscape.com/viewarticle/cognitive-decline-and-antihypertensive-use-new-data-2024a1000isw?form=fpf

• Jing and colleagues.

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Reader feedback on cardiac devices and PFA, a new paradigm in the language of MI, sudden cardiac death, and measuring blood pressure 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:

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I. Listener Feedback

Sep 20, 2024 This Week in Cardiology Podcast

https://www.medscape.com/viewarticle/1001631

• Cardiac Devices

https://www.acpjournals.org/doi/10.7326/ANNALS-24-00724

• Impact of PFA on Intraluminal Esophageal Temperature https://onlinelibrary.wiley.com/doi/10.1111/jce.16096

II. Towards a New Classification of MI

• McLaren and colleagues; From STEMI to OMI https://doi.org/10.1016/j.jacadv.2024.101314

III. Sudden Death After MI.

• EHJ Paper; SCD After MI https://doi.org/10.1093/eurheartj/ehae326
• Barsheshet and colleagues; Risk Score to Predict Benefit of ICD https://doi.org/10.1016/j.jacc.2012.02.036
• Zegard and colleagues; Myocardial Fibrosis and SCD 10.1016/j.jacc.2020.10.046
• MADIT RIT https://www.nejm.org/doi/full/10.1056/NEJMoa1211107

IV. BP Readings

Poor Arm Position May Significantly Skew BP Readings

https://www.medscape.com/viewarticle/poor-arm-position-may-significantly-skew-bp-readings-2024a1000icv?form=fpf

• ARMS Crossover RCT

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Reader feedback on LGE pre-ICDs, PFA for AF ablation, CTO-PCI, endovascular ablation of the greater splanchnic nerve in HFpEF, and data sharing are the topics John Mandrola, MD, covers this week.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

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I. Listener Feedback

Sept 27, 2024 This Week in Cardiology Podcast

https://www.medscape.com/viewarticle/1001666

• JAMA Meta-analysis https://jamanetwork.com/journals/jama/fullarticle/2823869/

II. Pulsed Field Ablation for AF

Feb 02, 2024 This Week in Cardiology Podcast https://www.medscape.com/viewarticle/999995

• ADMIRE Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.070333
• ADVENT Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2307291

III. PCI for CTO

• EuroCTO One Year SAQ Results https://doi.org/10.1093/eurheartj/ehy220
• EuroCTO Hard Outcomes https://eurointervention.pcronline.com/article/three-year-outcomes-of-eurocto-a-randomized-multicentre-trial-comparing-revascularization-and-optimal-medical-therapy-for-chronic-total-coronary-occlusions
• Faith Healing and Subtraction Anxiety https://doi.org/10.1161/CIRCOUTCOMES.118.004665
• DECISION CTO trial https://doi.org/10.1161/CIRCULATIONAHA.118.031313
• ISCHEMIA CTO Rationale and Design https://doi.org/10.1016/j.ahj.2022.11.016

IV. Greater Splanchnic Nerve Ablation for HFpEF

• REBALANCE HF https://jamanetwork.com/journals/jamacardiology/fullarticle/2823999

V. Data Sharing

The Pros and Cons of Clinical Trial Data Sharing

https://www.medscape.com/viewarticle/862815

• Kramer and Nallamothu, Caution in Data Sharing https://www.ahajournals.org/doi/full/10.1161/CIRCOUTCOMES.124.010257
• Nosek, Variability in Analytic Methods https://journals.sagepub.com/doi/10.1177/2515245917747646
• Zeraatker, Variability in Analytic Methods

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Surgical clearance, NICM assessment, dueling perspectives on PCI as first-line therapy for angina, GDMT in HFrEF 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. New ACC Peri-operative Guidelines Released

• ACC Guideline document https://www.jacc.org/doi/10.1016/j.jacc.2024.06.013
• J Vasc Surg https://www.jvascsurg.org/article/S0741-5214(21)00335-9/fulltext
• McFalls and colleagues; CARP https://www.nejm.org/doi/full/10.1056/NEJMoa041905

II. NICM – We may be doing it wrong in Selecting ICDs

• JAMA Meta-analysis https://jamanetwork.com/journals/jama/fullarticle/2823869/
• German CMR ICD Trial https://www.clinicaltrials.gov/study/NCT04558723
• BRITISH CMR trial https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/britishusing-cmr-scar-as-risk-indication-tool-in-nicm-and-severe-lvsd/

III. When Should PCI be Used in Chronic Stable CAD?

• Rajkumar and Al-Lamee; PCI First https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.124.011201

• Boden and De Caterina; Meds First https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.124.011268
• ORBITA 10.1016/S0140-6736(17)32714-9
• ORBITA 2 trial https://www.nejm.org/doi/full/10.1056/NEJMoa2310610

IV. GDMT Underuse in HFrEF

• Greene and colleagues https://doi.org/10.1016/j.jchf.2024.08.002
• DAPA HF https://www.nejm.org/doi/full/10.1056/NEJMoa1911303
• RALES https://www.nejm.org/doi/full/10.1056/NEJM199909023411001

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Listener feedback, K levels post cardiac surgery, cardiac device safety, disparities in preventive care, stopping trials early, and a SHAM-PVI update are the topics John Mandrola, MD, covers this week.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. Listener Feedback

Sep 13, 2024 This Week in Cardiology Podcast

https://www.medscape.com/viewarticle/1001596

• Sripal Bangalore Tweet on Yusef Meta-analysis https://x.com/SripalBangalore/status/1750116964893094125

II. Post Cardiac Surgery AF

• TIGHT K Trial https://jamanetwork.com/journals/jama/fullarticle/2823246

III. Evidence Base for New Cardiac Devices

• Annals of IM Survey Observational Study https://www.acpjournals.org/doi/10.7326/ANNALS-24-00724

IV. Disparities in Care

• JAMA Network Open Paper on Insurer Denials of Preventive Care https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2823677

V. Stopping Trials Early

• Kaul and Butler; Insights on Recent CKD Trials https://doi.org/10.1016/j.jacc.2024.07.026
• Bassler Systematic Review https://jamanetwork.com/journals/jama/fullarticle/185591

VI. Sham PVI

AF Ablation Works…But: The Positive SHAM-PVI Trial

https://www.medscape.com/viewarticle/af-ablation-works-positive-sham-pvi-trial-2024a1000gzl?&icd=login_success_email_match_fpf

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