This Week in Cardiology

More from ESC: the SCOFF trial and fasting before cardiac cath, MATTERHORN, humbling data with AI, plus a reflection on the work of being a patient 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. Fasting Before Cardiac Procedures

• The SCOFF Trial https://doi.org/10.1093/eurheartj/ehae573

II. MV repair for Functional MR

Large Trials Support Mitral Valve Repair in Heart Failure

• MATTERHORN https://www.nejm.org/doi/full/10.1056/NEJMoa2408739

III. AI in Medicine

• Rapidx AI Project https://healthtranslationsa.org.au/project/rapid-x-ai/
• PROTEUS Trial Rationale paper https://pubmed.ncbi.nlm.nih.gov/37192698/

IV. Time Toxicity

• Time Toxicity https://link.springer.com/article/10.1007/s00520-024-08844-1
• Thread X https://x.com/EnriqueSoto8/status/1833587144256065859

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Feedback on ABYSS and beta-blockers, more ESC recap, including SHAM-PVI, FINEARTS-HF, and RESHAPE HF2 trials are the topics John Mandrola, MD, discusses 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. Feedback on ABYSS

Setbacks After Stopping Beta-Blockers

https://www.medscape.com/viewarticle/setbacks-after-stopping-beta-blockers-2024a1000fv7

Beta-Blockers Post-MI? No for Me, Even After the ABYSS Trial

https://www.medscape.com/viewarticle/beta-blockers-post-mi-no-me-even-after-abyss-trial-2024a1000fva

• ABYSS trial https://www.nejm.org/doi/full/10.1056/NEJMoa2404204
• REDUCE AMI https://www.nejm.org/doi/full/10.1056/NEJMoa2401479
• QOL paper REDUCE AMI https://doi.org/10.1093/ehjcvp/pvae062
• Atenolol ED paper 10.1016/j.ehj.2003.08.016

II. SHAM-PVI

• JAMA SHAM-PVI paper https://jamanetwork.com/journals/jama/article-abstract/2823283
• Gupta QOL paper https://pubmed.ncbi.nlm.nih.gov/33952593/

III. FINEARTS HF

Finerenone Benefits Heart Failure With Preserved EF

https://www.medscape.com/viewarticle/finerenone-benefits-heart-failure-preserved-ef-2024a1000fza

Topline Finerenone Results Point to Advance in Heart Failure

https://www.medscape.com/viewarticle/topline-finerenone-results-point-advance-heart-failure-2024a1000fq2

• FINEHEARTS -HF NEJM https://www.nejm.org/doi/full/10.1056/NEJMoa2407107
• FIDELIO-DKD https://www.nejm.org/doi/full/10.1056/NEJMoa2025845
• FIGARO-DKD https://www.nejm.org/doi/full/10.1056/NEJMoa2110956
• Why Have We Not Been Able to Demonstrate Reduced Mortality in Patients With HFmrEF/HFpEF? https://doi.org/10.1016/j.jacc.2024.08.033

IV. RESHAPE HF

TEER in Functional MR: Data Deluge, but No Easy Answers

https://www.medscape.com/viewarticle/teer-functional-mr-data-deluge-no-easy-answers-2024a1000fvg

• Mitra FR https://www.nejm.org/doi/full/10.1056/NEJMoa1805374
• COAPT https://www.nejm.org/doi/full/10.1056/NEJMoa1806640
• RESHAPE- HF2 https://www.nejm.org/doi/full/10.1056/NEJMoa2314328
• RESHAPE Subgroup paper https://doi.org/10.1016/j.jacc.2024.08.027

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From ESC: post-MI beta blockers, a new therapy for ATTR-CM, holding RASi before non-cardiac surgery, good news in HFpEF, and an ESC preview 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. ABYSS

• ABYSS trial https://www.nejm.org/doi/full/10.1056/NEJMoa2404204
• REDUCE AMI https://www.nejm.org/doi/full/10.1056/NEJMoa2401479

II. ATTR -CM HELIOS B

Positive Top Line Results for Vutrisiran in Cardiac Amyloidosis

https://www.medscape.com/viewarticle/positive-top-line-results-vutrisiran-cardiac-amyloidosis-2024a1000cjj

• HELIOS A https://www.tandfonline.com/doi/full/10.1080/13506129.2022.2091985
• HELIOS B https://www.nejm.org/doi/full/10.1056/NEJMoa2409134

III. STOP or NOT Trial

• Observational Study Showing Benefits of Holding RASi https://doi.org/10.1097/ALN.0000000000001404
• STOP or NOT Protocol Paper -- https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-019-3247-1
• JAMA STOP or NOT https://jamanetwork.com/journals/jama/fullarticle/2823118

IV. GLP1a in HFpEF

The GLP-1 Agonist Semaglutide in HFpEF Cleared a Low Bar https://www.medscape.com/viewarticle/995872

• STEP-HFpEF https://www.nejm.org/doi/full/10.1056/NEJMoa2306963
• STEP-HFpEF-DM https://www.nejm.org/doi/full/10.1056/NEJMoa2313917
• SELECT https://www.nejm.org/doi/full/10.1056/NEJMoa2307563
• FLOW https://www.nejm.org/doi/full/10.1056/NEJMoa2403347
• Lancet Meta-analysis https://doi.org/10.1016/S0140-6736(24)01643-X

V. ESC Preview

Mandrola's Five Big Trials to Look for at ESC 2024

https://www.medscape.com/viewarticle/mandrolas-five-big-trials-look-esc-2024-2024a1000fkt

Topline Finerenone Results Point to Advance in Heart Failure

https://www.medscape.com/viewarticle/topline-finerenone-results-point-advance-heart-failure-2024a1000fq2

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Suicidal ideation and GLP-1 agonists, a repeat of PARADIGM HF in Chagas CM, CASTLE HTx critical appraisal, and primary prevention of SCD in HF are the topics John Mandrola, MD, covers this week.

This podcast is intended for healthcare professionals only.

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I. Suicidal ideation with GLP-1

Signal of Suicidality With GLP-1 RA Semaglutide, but Experts Urge Caution

https://www.medscape.com/viewarticle/signal-suicidality-glp-1-ra-semaglutide-experts-urge-caution-2024a1000fa7

• Disproportionality Analysis from World Health Organization Data on Semaglutide, Liraglutide, and Suicidality
• Variability in Disproportionality paper https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2021.668765/full

II. PARACHUTE HF: Repeating the Mistakes in PARADIGM HF

• PARACHUTE HF https://www.jacc.org/doi/10.1016/j.jchf.2024.05.021
• SOLVD https://www.nejm.org/doi/full/10.1056/NEJM199108013250501
• CONSENSUS trial https://www.nejm.org/doi/full/10.1056/NEJM198706043162301
• Meta-analysis of Low vs High Dose ACE/ARB https://doi.org/10.1161/CIRCHEARTFAILURE.117.003956
• Meta-analysis of Sac/Val vs ARB/ACE Inhibitors https://link.springer.com/article/10.1007/s00228-024-03686-6
• PARADISE MI https://www.nejm.org/doi/full/10.1056/NEJMoa2104508

III. CASTLE HTx Critical Appraisal

• Critical Appraisal of CASTLE HTx https://doi.org/10.1016/j.jacc.2024.06.020
• CASTLE HTx https://www.nejm.org/doi/10.1056/NEJMoa2306037
• CASTLE AF https://www.nejm.org/doi/full/10.1056/NEJMoa1707855

IV. More Data Suggesting Modest Benefits of the Primary Prevention ICD

• First and Recurrent ICD Shocks: JICE Paper from Denmark https://link.springer.com/article/10.1007/s10840-024-01873-0
• HF trialists https://www.nejm.org/doi/full/10.1056/NEJMoa1609758 PROFID Trial https://profid-project.eu/
• DANISH https://www.nejm.org/doi/full/10.1056/NEJMoa1608029
• SCD-HeFT https://www.nejm.org/doi/full/10.1056/NEJMoa043399

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Diuretic therapy in HFrEF, AF ablation, TACT 2 and the story of subgroups, and SGLT2 inhibitor underuse are the topics John Mandrola, MD, discusses in this week's podcast.

This podcast is intended for healthcare professionals only.

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I. Diuretic Therapy in HF

• Dapa vs Metolazone Trial https://doi.org/10.1093/eurheartj/ehad341 ADVOR https://www.nejm.org/doi/10.1056/NEJMoa2203094

II. Rapid Medication Titration for Acute HF

• ACC Decision Pathway https://www.jacc.org/doi/10.1016/j.jacc.2024.06.002

III. SGLT2 Inhibitor Use in the US

• Shin and Colleagues; JACC https://www.sciencedirect.com/science/article/abs/pii/S0735109724076332
• Editorial https://doi.org/10.1016/j.jacc.2024.07.001

IV. AF Ablation: General Anesthesia vs Conscious Sedation

• Da Riis-Vestergaard and Colleagues https://doi.org/10.1093/europace/euae203

V. TACT 2 Published

• TACT 1 https://jamanetwork.com/journals/jama/fullarticle/1672238
• TACT 1 DM https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.113.000663
• TACT 2 https://jamanetwork.com/journals/jama/fullarticle/2822472

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Prediction models vs clinical judgement, CCTA quantification of atherosclerosis, AF ablation plus LAAO, atrial shunt devices, and HF medical therapy are 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.Clinical Prediction Models vs Clinical Judgement

Did Statin Decision-Making Just Get Harder?

https://www.medscape.com/viewarticle/did-statin-decision-making-just-get-harder-2024a1000egl

• Colunga-Lozano and colleagues
• https://doi.org/10.1016/j.jclinepi.2023.10.016
• Aug 02, 2024 This Week in Cardiology Podcast
• https://www.medscape.com/viewarticle/1001429

II. CCTA Quantification of Atherosclerosis

• Atherosclerosis Quantification and Cardiovascular Risk: the ISCHEMIA Trial https://doi.org/10.1093/eurheartj/ehae471
• Circulation ISCHEMIA sub study 2021 – Severity of CAD and Outcomes https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.049755
• ISCHEMIA Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1915922

III. Combined AF Ablation and LAAO

• Review from Mills and colleagues https://doi.org/10.1016/j.tcm.2023.11.003
• Link to CMS Rule on AF Ablation and LAAO https://hrs2.informz.net/z/cjUucD9taT05MjU3ODgyJnA9MSZ1PTkwMDQ2MTk4MCZsaT04NTU1OTQxMg/index.html

IV. Atrial Shunt Devices

No Net HF Benefit for Interatrial Shunt Device

https://www.medscape.com/viewarticle/no-net-hf-benefit-interarterial-shunt-device-2024a10006kk

• Original REDUCE-LAP-HF-II https://doi.org/10.1016/S0140-6736(22)00016-2
• Two-year results of REDUCE-LAP-HF-II https://doi.org/10.1016/j.jchf.2024.04.011
• Apr 19, 2024 This Week in Cardiology Podcast

V. Optimal HF Therapy

• Rao and colleagues; CHAMP HF https://doi.org/10.1016/j.jchf.2024.05.026

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Two downsides of PFA including autonomic tone and hemolysis, a bad surrogate in AF care, and controversies in defining cardiac risk are the topics John Mandrola, MD, covers in this week's podcast.

This podcast is intended for healthcare professionals only.

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I.PFA and Its (lack of) Effect on Autonomic Tone

Pulsed Field Ablation for AF: Are US Electrophysiologists Too Easily Impressed?

https://www.medscape.com/viewarticle/pulsed-field-ablation-af-are-us-electrophysiologists-too-2024a1000d2v

• Autonomic Tone Paper https://doi.org/10.1016/j.jacep.2024.05.005
• ADVENT https://www.nejm.org/doi/full/10.1056/NEJMoa2307291

II. Second PFA Study JACC-EP—on Hemolysis

• Hemolysis study https://doi.org/10.1016/j.jacep.2024.05.001
• MANIFEST 17K https://www.nature.com/articles/s41591-024-03114-3
• Defaye Editorial https://www.jacc.org/doi/abs/10.1016/j.jacep.2024.06.007

III. A Self-serving Surrogate Marker: Diagnosis to Ablation Time.

• CAPLA Study https://jamanetwork.com/journals/jama/fullarticle/2800186
• CAPLA Substudy https://doi.org/10.1016/j.jacep.2024.05.031
• EHJ RCT Early vs Late https://doi.org/10.1093/eurheartj/ehad247
• LOOP; Diederichsen and colleagues 10.1016/j.jacc.2019.09.050
• Groningen and Maastricht Group study https://heart.bmj.com/content/109/3/186

IV. Future Cardiac Risk

• Diao and colleagues Study of AHA PREVENT Risk Equations https://jamanetwork.com/journals/jama/fullarticle/2821624
• JAMA Editorial https://jamanetwork.com/journals/jama/fullarticle/2821542
• Another JAMA Editorial https://jamanetwork.com/journals/jama/fullarticle/2821628

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Health and income, high BP in the hospital, and more on subclinical AF and when to use anticoagulants 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. Health and Income

A Cash Giveaway to Improve Health

https://www.medscape.com/viewarticle/cash-giveaway-improve-health-2024a1000dhf?form=fpf

• JAMA RCT https://jamanetwork.com/journals/jama/fullarticle/2821454
• NBER RCT https://www.nber.org/papers/w32711
• Have We Missed the Hidden Cause of Medical Overuse? https://www.medscape.com/viewarticle/908309
• Mar 17, 2023 This Week in Cardiology Podcast https://www.medscape.com/viewarticle/989775

Other References

• Health Care Access and Management of Cardiovascular Risk Factors Among Working-Age Adults With Low Income by State Medicaid Expansion Status https://jamanetwork.com/journals/jamacardiology/article-abstract/2793120
• Rand Link https://www.rand.org/pubs/reports/R3055.html
• The Oregon Health Insurance Experiment https://www.healthaffairs.org/do/10.1377/hpb20150716.236899/full/
• Effect of Health Insurance in India: A Randomized Controlled Trial https://www.nber.org/papers/w29576
• Full Coverage for Preventive Medications after Myocardial Infarction https://www.nejm.org/doi/full/10.1056/nejmsa1107913
• Effect of Medication Co-payment Vouchers on P2Y12 Inhibitor Use and Major Adverse Cardiovascular Events Among Patients With Myocardial InfarctionThe ARTEMIS Randomized Clinical Trial https://jamanetwork.com/journals/jama/fullarticle/2720024

II. Elevated BP in the hospital

• JAMA-IM https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2821364

III. Short-duration Subclinical AF

Apixaban Cuts Stroke but Ups Bleeding in Subclinical AF: ARTESIA

https://www.medscape.com/viewarticle/998379

• ARTESiA https://www.nejm.org/doi/full/10.1056/NEJMoa2310234
• ARTESiA CHADSVASC Subgroup https://www.jacc.org/doi/10.1016/j.jacc.2024.05.002
• NOAH https://www.nejm.org/doi/full/10.1056/NEJMoa2303062
• EHJ NOAH subanalysis https://doi.org/10.1093/eurheartj/ehae225
• Stroke: Prolonged Heart Rhythm Monitoring After Stroke https://www.ahajournals.org/doi/10.1161/STROKEAHA.123.045843
• EHRA Analysis https://esc365.escardio.org/EHRA-Congress/sessions/10668

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Vulnerable plaque and scientific method; industry payments to trainees; tirzepatide or semaglutide; trial interpretation; and PFA are the topics John Mandrola, MD, covers in today's podcast.

This podcast is intended for healthcare professionals only.

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I. Non-invasive Imaging for Vulnerable Plaque

PET Imaging Finds Vulnerable Plaques That Cause MI

https://www.medscape.com/viewarticle/pet-imaging-finds-vulnerable-plaques-cause-mi-2024a1000cm2

• JACC paper https://doi.org/10.1016/j.jacc.2024.03.419
• Original JAMA-Card paper https://jamanetwork.com/journals/jamacardiology/fullarticle/2806690

II. Industry Payments to Fellows

• JAMA Network Letter https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2821267

III. GLP-1a Class Effect?

Semaglutide Significantly Improves Chronic Kidney Disease

https://www.medscape.com/viewarticle/semaglutide-significantly-improves-chronic-kidney-disease-2024a10009w9

Mounjaro Beats Ozempic, So Why Isn't It More Popular?

https://www.medscape.com/viewarticle/mounjaro-beats-ozempic-so-why-isnt-it-more-popular-2024a1000ckd

• JAMA-Internal Medicine: Semaglutide vs Tirzepatide https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2821080
• SELECT trial https://www.nejm.org/doi/full/10.1056/NEJMoa2307563
• FLOW trial https://www.nejm.org/doi/full/10.1056/NEJMoa2403347
• SURPASS-CVOT – Rationale https://doi.org/10.1016/j.ahj.2023.09.007

IV. Colchicine and Trial Interpretation in the Lancet

• CONVINCE https://doi.org/10.1016/S0140-6736(24)00968-1

V. PFA

Pulsed Field Ablation for AF: Are US Electrophysiologists Too Easily Impressed?

https://www.medscape.com/viewarticle/pulsed-field-ablation-af-are-us-electrophysiologists-too-2024a1000d2v

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Venous closure devices, GLP1-s linked to blindness and cancer, resisting the urge to do an ECG, and transcatheter edge-to-edge repair (TEER) for secondary mitral regurgitation are the topics discussed this week.

This podcast is intended for healthcare professionals only.

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I Listener Feedback

• Venous vascular closure system vs. figure-of-eight suture following atrial fibrillation ablation: the STYLE-AF Study https://doi.org/10.1093/europace/euae105

II GLP1-s and Blindness

• Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglutide https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2820255
• Locke Twitter https://x.com/doc_BLocke/status/1808972226655629610
• When to Start a Statin Is a Preference-Sensitive Decision https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.117.029808

III GLP1-s and Cancer

• Glucagon-Like Peptide 1 Receptor Agonists and 13 Obesity-Associated Cancers in Patients With Type 2 Diabetes https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2820833

IV Screening ECG

• Routine Electrocardiogram Screening and Cardiovascular Disease Events in Adultshttps://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2820721
• Clinical outcomes in systematic screening for atrial fibrillation (STROKESTOP) https://doi.org/10.1016/S0140-6736(21)01637-8
• Implantable loop recorder detection of atrial fibrillation to prevent stroke (The LOOP Study) https://doi.org/10.1016/S0140-6736(21)01698-6

IV TEER for Secondary Mitral Regurgitation

• Randomized investigation of the MitraClip device in heart failure: Design and rationale of the RESHAPE-HF2 trial design https://doi.org/10.1002/ejhf.3247
• Percutaneous repair of moderate-to-severe or severe functional mitral regurgitation in patients with symptomatic heart failure: Baseline characteristics of patients in the RESHAPE-HF2 trial and comparison to COAPT and MITRA-FR trials https://onlinelibrary.wiley.com/doi/full/10.1002/ejhf.3286
• Jun 21, 2024 This Week in Cardiology Podcast
• https://www.medscape.com/viewarticle/1001237
• Stats Blog https://www.r-bloggers.com/2023/07/the-benjamini-hochberg-procedure-fdr-and-p-value-adjusted-explained/

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