This Week in Cardiology

Tricuspid regurgitation therapy, two more left atrial appendage trials, and reflections on being too soft on medical science 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. Tricuspid Regurgitation

Trilogy TAVR Safe, Effective in Aortic Regurgitation

https://www.medscape.com/viewarticle/997782

The TRILUMINATE Transcatheter Tricuspid Repair Trial: Positive but No Benefit?

https://www.medscape.com/viewarticle/989105

Transcatheter Tricuspid Valve Repair Effective, Safe for Regurgitation: TRILUMINATE

https://www.medscape.com/s/viewarticle/989103

- TRILUMINATE NEJM https://www.nejm.org/doi/full/10.1056/NEJMoa2300525

II. LAA Occlusion

Different Strengths for LAA Closure Devices?

https://www.medscape.com/viewarticle/962893

- Swiss Apero – Original paper https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057859

- Swiss Apero – One-year https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.067599

Peri-device Leaks After Watchman https://pubmed.ncbi.nlm.nih.gov/35902169/

TAVR With Left Atrial Appendage Occlusion Non-inferior to TAVR Plus Medical Therapy https://www.medscape.com/viewarticle/997725

- WATCH TAVR Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.067312

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More on the Million Hearts RCT, ENRICH AF, TAVI vs SAVR, the Partner 3 and Evolut-low-risk trials, and myocardial viability 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. Listener Feedback Million Hearts

CMS 'Million Hearts' CVD Risk Reduction Model Works

https://www.medscape.com/viewarticle/997551

- RCT JAMA - https://jamanetwork.com/journals/jama/fullarticle/2810696

AC in ICH - ENRICH AF

Oral Anticoagulation in ICH Patients With AF: New Data https://www.medscape.com/viewarticle/997547

- Lancet Neurology Meta-analysis https://doi.org/10.1016/S1474-4422(23)00315-0

- ENRICH AF letter https://doi.org/10.1016/S0140-6736(23)02025-1

II. TAVI vs SAVR

Low-Risk TAVR Studies: Divergent Long-Term Results

https://www.medscape.com/viewarticle/997784

- Partner 3 Main Results

- Partner 3 – Five Year

- Original EVOLUT -LR https://www.nejm.org/doi/10.1056/NEJMoa1816885

- EVOLUT 3-year https://doi.org/10.1016/j.jacc.2023.02.017

- EVOLUT -LR 4-year https://doi.org/10.1016/j.jacc.2023.09.813

III. Myocardial Viability

Viability-Guided PCI Doubted in Stable Severe CAD: REVIVED-BCIS2

https://www.medscape.com/viewarticle/989101

- Revived BCIS – Original paper https://www.nejm.org/doi/10.1056/NEJMoa2206606

- JAMA Cardiology Viability paper https://jamanetwork.com/journals/jamacardiology/fullarticle/2810727

- STICH Viability Paper - https://www.nejm.org/doi/full/10.1056/NEJMoa1100358

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Listener feedback, oral anticoagulation in patients with ICH, an example of statistical significance but not clinical significance, and statins and diabetes 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

October 13, 2023 This Week in Cardiology Podcast https://www.medscape.com/viewarticle/997281

- European Heart Journal: IVI for PCI https://doi.org/10.1093/eurheartj/ehad430

- Elgendy Meta-analysis of Imaging in PCI: https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.116.003700

- ULTIMATE: https://www.jacc.org/doi/10.1016/j.jacc.2018.09.013

- ILUMEIN IV: https://www.nejm.org/doi/full/10.1056/NEJMoa2305861

- OCTOBER: https://www.nejm.org/doi/full/10.1056/NEJMoa2307770

- Main STEP-HFpEF paper

- Letter to the Editor on Lack of Obesity Paradox https://doi.org/10.1016/j.amjcard.2019.04.037

II. Anticoagulation in ICH

Oral Anticoagulation in ICH Patients With AF: New Data https://www.medscape.com/viewarticle/997547

- Lancet Neuro Meta-analysis https://doi.org/10.1016/S1474-4422(23)00315-0

- ENRICH AF letter https://doi.org/10.1016/S0140-6736(23)02025-1

III. Million Hearts

CMS 'Million Hearts' CVD Risk Reduction Model Works https://www.medscape.com/viewarticle/997551

- RCT JAMA

IV. Statin Choice and Diabetes

April 7, 2023 This Week in Cardiology Podcast

https://www.medscape.com/viewarticle/990542

- LODESTAR Main Study

- LODESTAR Substudy

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Three stories regarding GLP-1 agonists, imaging during PCI, and the power of sham controls in procedure trials 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. FLOW Trial Positive

Novo Nordisk Stops Ozempic Kidney Trial After Early Signs of Success https://www.medscape.com/s/viewarticle/997237

- FLOW Trial – press release https://www.novonordisk.com/content/nncorp/global/en/news-and-media/news-and-ir-materials/news-details.html?id=166327

II. STEP HFpEF

Semaglutide Win in HFpEF With Obesity Regardless of Ejection Fraction: STEP-HFpEF

https://www.medscape.com/viewarticle/997185

The GLP-1 Agonist Semaglutide in HFpEF Cleared a Low Bar

https://www.medscape.com/viewarticle/995872

- STEP HFpEF substudy

- STEP HFpEF main paper

III. GLP-1 Agonist Adverse Effects

GLP-1 Agonists Linked to Higher Risk for Rare but Serious GI Complications

https://www.medscape.com/viewarticle/997128

- GI Adverse Effects of GLP-1 Agonists https://jamanetwork.com/journals/jama/fullarticle/2810542

IV. Imaging in PCI

Intravascular Imaging in PCI: Time for a Guideline Update?

https://www.medscape.com/viewarticle/995677

- Intravascular imaging during percutaneous coronary intervention: temporal trends and clinical outcomes in the USA https://academic.oup.com/eurheartj/article/44/38/3845/7226277

- HEART Review of Studies of Intracoronary Imaging During PCI https://heart.bmj.com/content/107/9/755

V. The Power of Placebo (Sham) control

Hopeful Insights, No Overall HFpEF Gains From Splanchnic Nerve Ablation: REBALANCE-HF

https://www.medscape.com/viewarticle/997318

- Transvenous Right GSN Ablationin HFpEF https://doi.org/10.1016/j.jchf.2022.05.009

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https://www.medscape.com/author/bob-harrington

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Coated vs uncoated ASA, a new trial in CAD, conflicts of interest, first AF in the hospital, and changing HTN scoring and CHADSVASC 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. ASA

No Benefit of Enteric-Coated Aspirin vs Uncoated in CVD https://www.medscape.com/viewarticle/997119

- JAMA Cardiology: Coated vs Uncoated ASA https://jamanetwork.com/journals/jamacardiology/fullarticle/2809795

- ADAPTABLE https://www.nejm.org/doi/10.1056/NEJMoa2102137

II. RECHARGE

- Revascularization Choices Among Under-Represented Groups Evaluation (The RECHARGE Program) https://www.pcori.org/research-results/2023/revascularization-choices-among-under-represented-groups-evaluation-recharge-program

- Gaudino/Stone: Reconsidering Coronary Revascularization Trials

III. Conflicts of Interest

- Financial Conflicts of Interest in Public Comments on Medicare National Coverage Determinations of Medical Devices https://jamanetwork.com/journals/jama/fullarticle/2808721

IV. First AF in the Hospital

Decoding AFib Recurrence: PCPs' Role in Personalized Care https://www.medscape.com/viewarticle/997011

- Annals of Internal Medicine: AF Recurrence https://doi.org/10.7326/M23-1411

V. Changing CHADSVASC Score

- JAMA Network Open: HTN Guidelines and CHADSVASC Up-Scoring https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2809933

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Reader feedback, leadless pacing, ABIM, SGLT2 inhibitors, peri-operative MI after cardiac surgery, and. AHA late-breakers 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. Reader Feedback

Sep 22, 2023 This Week in Cardiology Podcast

https://www.medscape.com/viewarticle/996694

- ODYSSEY OUTCOMES trial https://www.nejm.org/doi/full/10.1056/nejmoa1801174

- FOURIER https://www.nejm.org/doi/full/10.1056/nejmoa1615664

II. Leadless Pacing

- Leadless vs Transvenous Pacemaker Study https://doi.org/10.1093/europace/euad269

III. ABIM News

Heart Societies Ready to Split From ABIM Over Long-Standing MOC Disputes

https://www.medscape.com/viewarticle/996747

IV. SGLT2 inhibitors

Empagliflozin Gets FDA Nod for CKD Without T2D or HF

https://www.medscape.com/viewarticle/996873

- EMPA-Kidney https://www.nejm.org/doi/full/10.1056/NEJMoa2204233

V. Peri-Op MI after Cardiac Surgery

Cardiac Troponin Predicts Mortality Post Surgery

https://www.medscape.com/viewarticle/996877

- Austrian Perioperative MI study https://doi.org/10.1016/j.jacc.2023.07.011

- Vision https://www.nejm.org/doi/10.1056/NEJMoa2000803

VI. AHA Late Breakers

- Link to Late-Breakers https://professional.heart.org/en/meetings/scientific-sessions/programming/late-breaking-science#late-breaking

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https://www.medscape.com/author/bob-harrington

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Coronary calcium, cardiac arrest survival, Factor XI drug findings, APCs and a potential new board certification in cardiology are the topics discussed by John Mandrola, MD 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 Coronary Artery Calcium

- CONFIRM Registry - https://doi.org/10.1016/j.jcmg.2023.03.008

- CURE -- https://www.nejm.org/doi/full/10.1056/nejmoa010746

II Cardiac Arrest

Cardiac Arrest Centers No Benefit in OHCA Without STEMI

https://www.medscape.com/viewarticle/995885

- Cycling coverage https://velo.outsideonline.com/road/road-racing/nathan-van-hooydonck-forced-to-end-to-racing-career-due-to-heart-condition/

- ARREST https://doi.org/10.1016/S0140-6736(23)01351-X

- SCD in Athletes Bob Harrington and Manesh Patel https://www.medscape.com/viewarticle/995575

III Factor XI

Trial Halted for Bleeding Reduction With Abelacimab vs Rivaroxaban in AF

https://www.medscape.com/viewarticle/996587

- Press Release - https://anthostherapeutics.com/wp-content/uploads/2023/09/2023-09-18-Anthos-Press-Release-final.pdf

- Abelacimab, a Factor XI Inhibitor, Prevents VTE With Low Bleeding Risk in Knee Replacement

- NEJM proof-of-concept https://www.nejm.org/doi/full/10.1056/NEJMoa2105872

- OCEANIC-AF https://classic.clinicaltrials.gov/ct2/show/NCT05643573

- Will Factor XI Be the Goldilocks Anticoagulant Target? https://www.medscape.com/viewarticle/979634

IV APC Care

NPs and PAs Handling Increasingly More Primary Care Visits: New Studies https://www.medscape.com/viewarticle/996709

BMJ paper -- https://www.bmj.com/content/382/bmj-2022-073933

V Possible Cardiology Board Certification Changes

- Heart Societies Ready to Split From ABIM Over MOC Disputes https://www.medscape.com/viewarticle/996747

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https://www.medscape.com/author/bob-harrington

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Reader feedback, imaging in the cath lab, AF ablation to relieve anxiety, and some possible help in hypertension 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. Reader Feedback

Sep 08, 2023 This Week in Cardiology Podcast https://www.medscape.com/viewarticle/996233

First Clinical Trial of CTO Procedures Fails to Deliver https://www.medscape.com/viewarticle/877405

- DanGerShock trial https://pubmed.ncbi.nlm.nih.gov/31176289/

II. Imaging in the Cath Lab

Should Intravascular Imaging Be Almost Routine in PCI? https://www.medscape.com/viewarticle/996375

- ILUMIEN IV https://www.nejm.org/doi/full/10.1056/NEJMoa2305861

- OCTOBER https://www.nejm.org/doi/full/10.1056/NEJMoa2307770

III. AF Ablation to Relieve Anxiety

- REMEDIAL Trial https://jamanetwork.com/journals/jama/fullarticle/2809419

- Sohaib and Francis; Meta analysis of Symptomatic Response Effect of CRT Pacing https://pubmed.ncbi.nlm.nih.gov/24259043/

IV. HTN

'New Dawn' for Aldosterone as Drug Target in Hypertension? https://www.medscape.com/viewarticle/996316

- TARGET HTN - https://jamanetwork.com/journals/jama/fullarticle/2809625

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ESC Recap Part 2: ECLS-SHOCK, FIRE, MULTISTARS-AMI, HEART FID, and DANPACE II are the trials 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. Cardiogenic Shock

ECMO for Shock in Acute MI Won't Help, May Harm: ECLS-SHOCK https://www.medscape.com/viewarticle/995882

- ECLS-SHOCK trial https://www.nejm.org/doi/full/10.1056/NEJMoa2307227

- ECMO-CS trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.062949

II. FIRE TRIAL

FIRE a Win for Physiology-Guided MI Complete Revascularization in Older Patients https://www.medscape.com/viewarticle/995875

- FIRE Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2300468

- COMPLETE Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1907775

III. Immediate vs Staged Revascularization

Parity for Prompt vs Staged STEMI Complete Revascularization: MULTISTARS-AMI https://www.medscape.com/viewarticle/995961

- MULTISTARS AMI trial https://www.nejm.org/doi/full/10.1056/NEJMoa2307823

- Complete Revascularization Now Compulsory? MULTISTARS-AMI and FIRE in Context https://www.medscape.com/viewarticle/995676

IV. Iron-Supplementation in Heart Failure

IV Iron Shows Only Modest Benefit in HF: HEART-FID https://www.medscape.com/viewarticle/995874

- HEART-FID https://www.nejm.org/doi/full/10.1056/NEJMoa2304968

- EHJ meta-analysis of Iron Supplementation https://doi.org/10.1093/eurheartj/ehad586

V. AF Prevention with Pacing

Minimizing Atrial Pacing No Benefit in Sinus Node Disease: DANPACE II https://www.medscape.com/viewarticle/996076

- DANPACE II https://doi.org/10.1093/eurheartj/ehad564

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ESC Wrap-up 1: Obesity, heart failure with preserved EF and reduced EF, AF, frailty, evidence translation, and catheter ablation 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. FRAIL AF

-FRAIL-AF Study

https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.066485

-The Most Important Study From ESC: FRAIL-AF

https://www.medscape.com/viewarticle/996063

II. STEP-HFpEF

Wegovy Scores HFpEF Benefits in People With Obesity

https://www.medscape.com/viewarticle/995844

GLP-1 Agonist Semaglutide in HFpEF Cleared Low Bar

https://www.medscape.com/viewarticle/995872

Semaglutide's Big Step in HFpEF With Obesity: Investigator Inteview

https://www.medscape.com/viewarticle/995673

-Semaglutide in Obese Patients With HFpEF

https://www.nejm.org/doi/full/10.1056/NEJMoa2306963

III. NOAH AFNET 6

Anticoagulation No Benefit in Presumed AF Detected by Cardiac Devices

https://www.medscape.com/viewarticle/995861

How Much AF Warrants Anticoagulation? NOAH-AFNET 6 Provides Clues

https://www.medscape.com/viewarticle/995871

-NOAH AFNET-6 – NEJM

https://www.nejm.org/doi/full/10.1056/NEJMoa2303062

IV. ADVENT

Pulsed Field Ablation Challenges Conventional Devices in AF

https://www.medscape.com/viewarticle/995884

Pulsed Field Ablation Noninferior but Underwhelming in ADVENT

https://www.medscape.com/viewarticle/995898

-PPFA vs Thermal Ablation for PAF

https://www.nejm.org/doi/10.1056/NEJMoa2307291

V. BUDAPEST CRT

Impact of RV Pacing in Heart Failure, CRT Benefit Shown in BUDAPEST-CRT

https://www.medscape.com/viewarticle/996035

Supporting Evidence for a Common Practice: BUDAPEST CRT

https://www.medscape.com/viewarticle/995880

-BUDAPEST CRT Study: European Heart Journal

https://doi.org/10.1093/eurheartj/ehad591

VI. CASTLE HTx

Advanced HF No Obstacle to AF Ablation Success: CASTLE-HTx

https://www.medscape.com/viewarticle/995897

AF Ablation in End-Stage HF: Is CASTLE-HTx Too Good to Be True?

https://www.medscape.com/viewarticle/995974

-CASTLE AF (2018)

https://www.nejm.org/doi/full/10.1056/nejmoa1707855

-CASTLE HTx

https://www.nejm.org/doi/full/10.1056/NEJMoa2306037

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https://www.medscape.com/author/bob-harrington

Questions or feedback, please contact [email protected]

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