This Week in Cardiology

Impella, digital health, low-value processes, are tricuspid valve interventions with pacing leads are the topics Dr. 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. Impella Class I Recall

FDA Class I Recall for Some Abiomed Impella Heart Pumps

https://www.medscape.com/viewarticle/992845

- A Prospective, Randomized Clinical Trial of Hemodynamic Support With Impella 2.5 Versus Intra-Aortic Balloon Pump in Patients Undergoing High-Risk Percutaneous Coronary Intervention

https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.112.098194

- Percutaneous Mechanical Circulatory Support Versus Intra-Aortic Balloon Pump in Cardiogenic Shock After Acute Myocardial Infarction

https://doi.org/10.1016/j.jacc.2016.10.022

https://www.sciencedirect.com/science/article/pii/S0735109716367675?via%3Dihub

- The Evolving Landscape of Impella Use in the United States Among Patients Undergoing Percutaneous Coronary Intervention With Mechanical Circulatory Support

https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.119.044007

- Association of Use of an Intravascular Microaxial Left Ventricular Assist Device vs Intra-aortic Balloon Pump With In-Hospital Mortality and Major Bleeding Among Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock

https://jamanetwork.com/journals/jama/fullarticle/2761003

- Danish Cardiogenic Shock Trial (DanShock)

https://clinicaltrials.gov/ct2/show/NCT01633502

II. Wearable Devices

- Use of Wearable Devices in Individuals With or at Risk for Cardiovascular Disease in the US, 2019 to 2020 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2805753 doi:10.1001/jamanetworkopen.2023.16634

- Implantable loop recorder detection of atrial fibrillation to prevent stroke (The LOOP Study): a randomised controlled trial

https://doi.org/10.1016/S0140-6736(21)01698-6

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01698-6/fulltext

- Prevalence and Prognostic Significance of Bradyarrhythmias in Patients Screened for Atrial Fibrillation vs Usual Care

https://jamanetwork.com/journals/jamacardiology/fullarticle/2801362

III. The Cost of Quality Measures

- The Volume and Cost of Quality Metric Reporting

https://jamanetwork.com/journals/jama/fullarticle/2805705

- Goodhart's law

https://en.wikipedia.org/wiki/Goodhart%27s_law

IV. Tricuspid Valve Interventions and Pacing Leads

Leadless Dual-Chamber Pacemaker Clears Early Safety, Performance Hurdles

https://www.medscape.com/viewarticle/992464

- Transcatheter Tricuspid Valve Replacement With the EVOQUE System: 1-Year Outcomes of a Multicenter, First-in-Human Experience

https://www.jacc.org/doi/10.1016/j.jcin.2022.01.280

- Effects of Implantable Cardioverter-Defibrillator Leads on the Tricuspid Valve and Right Ventricle: A Randomized Comparison of Transvenous versus Subcutaneous Leads

https://eppro01.ativ.me/src/EventPilot/php/express/web/planner.php?id=HRS23&utm_source=heartrhythm&utm_medium=nav-button&utm_campaign=hr23-webtracking

- Management and Outcomes of Transvenous Pacing Leads in Patients Undergoing Transcatheter Tricuspid Valve Replacement

https://www.jacc.org/doi/10.1016/j.jcin.2020.04.054

- TRILUMINATE trial -- Transcatheter Repair for Patients with Tricuspid Regurgitation

https://www.nejm.org/doi/full/10.1056/NEJMoa2300525

https://www.nejm.org/doi/full/10.1056/NEJMoa2300525

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

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Listener feedback on the most important study in a decade, MONITOR-HF, a flawed paper and analysis, and the tension between pathos and logos 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

Earlier Anticoagulation Safe in Stroke With AF: ELAN

https://www.medscape.com/viewarticle/992411

- Early versus Later Anticoagulation for Stroke with Atrial Fibrillation

https://www.nejm.org/doi/full/10.1056/NEJMoa2303048

- Fibrinolysis or Primary PCI in ST-Segment Elevation Myocardial Infarction

https://www.nejm.org/doi/full/10.1056/nejmoa1301092

II. Monitor HF

CardioMEMS Boosts QoL, Curbs HF Hospitalizations: MONITOR-HF

https://www.medscape.com/viewarticle/992333

- Remote haemodynamic monitoring of pulmonary artery pressures in patients with chronic heart failure (MONITOR-HF): a randomised clinical trial

https://doi.org/10.1016/S0140-6736(23)00923-6

- Remote pulmonary artery pressure monitoring in heart failure care: part of the new normal?

https://doi.org/10.1016/S0140-6736(23)01010-3

- Sowell's A Conflict of Visions

https://en.wikipedia.org/wiki/A_Conflict_of_Visions

III. Intensive BP Treatment in Older Patients – Pathos vs Logos

- Clinical Outcomes of Intensive Inpatient Blood Pressure Management in Hospitalized Older

Adultshttps://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2805021

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

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An HRS meeting recap, Impella failure, sacubitril/valsartan, the purpose of trials, and a major breakthrough in evidence generation 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. HRS Meeting Recap

II. Impella in VT ablation

- First-in-human Experience with Impella 5.0/5.5 for High-Risk Patients with Advanced Heart Failure Undergoing VT Ablationhttps://www.jacc.org/doi/10.1016/j.jacc.2023.05.012

III. Sacubitril/Valsartan

ARNI Bests ARB to Reduce NT-proBNP in Stabilized Preserved-EF HF

https://www.medscape.com/viewarticle/992461

- Angiotensin-Neprilysin Inhibition in Patients With Mildly Reduced or Preserved Ejection Fraction and Worsening Heart Failure

https://www.jacc.org/doi/10.1016/j.jacc.2023.04.019

- Angiotensin–Neprilysin Inhibition in Heart Failure with Preserved Ejection Fraction

https://www.nejm.org/doi/full/10.1056/nejmoa1908655

- Sacubitril/valsartan in heart failure with mildly reduced or preserved ejection fraction: a pre-specified participant-level pooled analysis of PARAGLIDE-HF and PARAGON-HF

https://doi.org/10.1093/eurheartj/ehad344

- Bogdan Tweet

https://twitter.com/bogdienache/status/1660356776204595201?s=20

IV. Big Change in Reporting of Medical Evidence – Elan Trial

- Early versus Later Anticoagulation for Stroke with Atrial Fibrillationhttps://www.nejm.org/doi/full/10.1056/NEJMoa2303048

- Early versus Late initiation of direct oral Anticoagulants in post-ischaemic stroke patients with atrial fibrillatioN (ELAN): Protocol for an international, multicentre, randomised-controlled, two-arm, open, assessor-blinded trial https://doi.org/10.1177/23969873221106043

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

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When to use an ICD, risk stratification for HCM, blending EP and structural cardiology to improve care in post-TAVI patients, and hsTroponins 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. ICD in Patients with NICM

Simple Risk Score Predicts VT in Nonischemic Cardiomyopathy

https://www.medscape.com/viewarticle/992018

- Declining Risk of Sudden Death in Heart Failure https://www.nejm.org/doi/full/10.1056/NEJMoa1609758

- Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure https://www.nejm.org/doi/full/10.1056/NEJMoa1608029

- Reduction in mortality from implantable cardioverter-defibrillators in non-ischaemic cardiomyopathy patients is dependent on the presence of left ventricular scar https://doi.org/10.1093/eurheartj/ehy437

- RCT of Implantable Defibrillators in Patients With Non Ischemic Cardiomyopathy, Scar and Severe Systolic Heart Failure (BRITISH) https://clinicaltrials.gov/ct2/show/NCT05568069

II. Risk Stratification in HCM

- Changing Risk Stratification in Hypertrophic Cardiomyopathy? https://www.medscape.com/viewarticle/992014

- NOAH–AFNET 6 trial terminates ahead of time (NOAH AFNET 6 trial) https://dzhk.de/en/news/latest-news/article/noah-afnet-6-trial-terminates-ahead-of-time-noah-afnet-6-trial/

III. Blending EP and Structural to Improve TAVI Care

- Impact of Right Ventricular Pacing in Patients With TAVR Undergoing Permanent Pacemaker Implantation https://www.jacc.org/doi/full/10.1016/j.jcin.2023.02.003

IV. Troponins

- Age-Specific Cut-Offs Needed for Cardiac Troponin Tests? https://www.medscape.com/viewarticle/992167

- Myocardial Injury Thresholds for 4 High-Sensitivity Troponin Assays in U.S. Adults https://www.jacc.org/doi/full/10.1016/j.jacc.2023.03.403

- What Is a Normal Troponin Anyway? https://www.jacc.org/doi/10.1016/j.jacc.2023.03.404

- Updating Our Thinking on Troponin Use and Interpretation https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2777967

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

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Two new papers on left atrial appendage occlusion, the promise of DNA, statins in the elderly, and SGLT2 inhibitors 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

- When to Start a Statin Is a Preference-Sensitive Decision

https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.117.029808

II. Left Atrial Appendage Closure

LAA Closure Outcomes Improve With CCTA: Swiss-Apero Subanalysis

https://www.medscape.com/viewarticle/991623

- Impact of Preprocedural Computed Tomography on Left Atrial Appendage Closure Success: A Swiss-Apero Trial Subanalysis https://doi.org/10.1016/j.jcin.2023.02.027

- Outcomes of percutaneous left atrial appendage occlusion device implantation in atrial fibrillation patients based on underlying stroke risk https://doi.org/10.1093/europace/euad049

III. Polygenic Risk Scores

- Predictive Accuracy of a Polygenic Risk Score Compared With a Clinical Risk Score for Incident Coronary Heart Disease https://jamanetwork.com/journals/jama/fullarticle/2761086

- Cardiovascular Disease Risk Assessment Using Traditional Risk Factors and Polygenic Risk Scores in the Million Veteran Program https://jamanetwork.com/journals/jamacardiology/article-abstract/2804439

- Validity of polygenic risk scores: are we measuring what we think we are? https://doi.org/10.1093/hmg/ddz205

IV. Statins in Older Patients

High Cholesterol in Seniors: Use Statins for Primary Prevention?

https://www.medscape.com/viewarticle/991801

V. SGLT2 Inhibitors

FDA Expands Use of Dapagliflozin to Broader Range of HF

https://www.medscape.com/viewarticle/991736

- Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction

https://www.nejm.org/doi/full/10.1056/NEJMoa2206286

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

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Beta-blockers post MI, public perception of statins, trust in the medical profession, BMI, and TAVI 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. Post-MI Beta Blockers

Long-term Beta-Blockers Not Needed After MI with Preserved Systolic Function? https://www.medscape.com/viewarticle/991542

- Association of beta-blockers beyond 1 year after myocardial infarction and cardiovascular outcomes https://heart.bmj.com/content/early/2023/04/16/heartjnl-2022-322115

- Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure

https://www.nejm.org/doi/full/10.1056/nejmoa1608029

II. Statin Perceptions

Statin Misinformation on Social Media Flagged by AI

https://www.medscape.com/viewarticle/991585

- Artificial Intelligence–Enabled Analysis of Statin-Related Topics and Sentiments on Social Media

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2803988

III. BMI

BMI Is a Flawed Measure of Obesity. What Are Alternatives?

https://www.medscape.com/viewarticle/991210

IV. TAVI Access

Better Access to Transcatheter Aortic Valve Replacement Associated With Improved Outcomes

https://www.medscape.com/viewarticle/991573

- Regional Differences in Outcomes for Patients Undergoing Transcatheter Aortic Valve Replacement in New York State and Ontario https://doi.org/10.1016/j.cjca.2023.01.025

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

Questions or feedback, please contact: [email protected]

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Two studies of cardiac device infections, observational studies, RCTs, and our ways of knowing in Medicine 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. Cardiac Device Infection

Mortality Climbs When CIED Infections Are 'Delayed' After Implant

https://www.medscape.com/viewarticle/990692

- Association of the Timing and Extent of Cardiac Implantable Electronic Device Infections With Mortality

https://jamanetwork.com/journals/jamacardiology/fullarticle/2803627

- Low Utilization of Lead Extraction Among Patients With Infective Endocarditis and Implanted Cardiac Electronic Devices https://www.jacc.org/doi/full/10.1016/j.jacc.2023.02.042

- Cardiac Implantable Electronic Devices and Infective Endocarditis: A Call to Arms...∗ https://www.jacc.org/doi/full/10.1016/j.jacc.2023.02.043

II. Can RCTs be Emulated with Real World Evidence?

- Emulation of Randomized Clinical Trials With Nonrandomized Database Analyses https://jamanetwork.com/journals/jama/fullarticle/2804067

- Randomized Trials vs Real-world Evidence https://jamanetwork.com/journals/jama/fullarticle/2804092

- Reanalyses of Randomized Clinical Trial Data

https://jamanetwork.com/journals/jama/fullarticle/1902230

III. Multi-Morbidity Effects in Trials

Pivotal CV Trials May Not Apply to Complex Patients

https://www.medscape.com/viewarticle/989129

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

Questions or feedback, please contact: [email protected]

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

John Mandrola, MD discusses early vs delayed AF ablation, a report on a devastating complication of AF ablation, and a potential crosswind for a major therapeutic fashion in electrophysiology.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit: https://www.medscape.com/twic

I Early Vs Delayed Ablation

- Impact of Early Versus Delayed Atrial Fibrillation Catheter Ablation on Atrial Arrhythmia Recurrences

https://doi.org/10.1093/eurheartj/ehad247

- Diagnosis-to-Ablation Time and Recurrence of Atrial Fibrillation Following Catheter Ablation

https://www.ahajournals.org/doi/full/10.1161/CIRCEP.119.008128

- Cryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation

https://www.nejm.org/doi/full/10.1056/nejmoa2029980

- Progression of Atrial Fibrillation after Cryoablation or Drug Therapy

https://www.nejm.org/doi/full/10.1056/NEJMoa2212540

II Atrial-Esophageal Fistula

CT and Surgery Best Diagnose and Manage Esophageal Fistula

https://www.medscape.com/viewarticle/990933

- A worldwide survey on incidence, management and prognosis of oesophageal fistula formation following atrial fibrillation catheter ablation: The POTTER-AF study https://doi.org/10.1093/eurheartj/ehad250

- Oesophageal Probe Evaluation in Radiofrequency Ablation of Atrial Fibrillation (OPERA): results from a prospective randomized trial https://doi.org/10.1093/europace/euaa209

- Temperature monitoring and temperature-driven irrigated radiofrequency energy titration do not prevent thermally induced esophageal lesions in pulmonary vein isolation: A randomized study controlled by esophagoscopy before and after catheter ablation https://doi.org/10.1016/j.hrthm.2021.02.003

III High-Power Short-Duration Ablation

Short, High-Power Ablation on Par With Standard AF Ablation

https://www.medscape.com/viewarticle/972087

- Power-Fast Trial

https://clinicaltrials.gov/ct2/show/NCT04153747

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

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SCAI consensus document on LAAC, semaglutide/tirzepatide disruption, NSAIDs, and interventional echocardiography are the topics discussed by John Mandrola, MD, on 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. SCAI Consensus Document

New Update on Left Atrial Appendage Closure Recommendations

https://www.medscape.com/viewarticle/990507

- SCAI/HRS Expert Consensus Statement on Transcatheter Left Atrial Appendage Closure

https://doi.org/10.1016/j.jscai.2022.100577

- Transcatheter Left Atrial Appendage Closure Comes of Age

https://doi.org/10.1016/j.jscai.2023.100592

- EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion – an update https://doi.org/10.1093/europace/euz258

II. Semaglutide and Tirzepatide Disruption

Tirzepatide Powers 'Unprecedented' Weight Loss in Obesity Trial

https://www.medscape.com/viewarticle/975061

- Obesity Management in Primary Care

https://reference.medscape.com/recap/982874

- The $76 Billion Diet Industry Asks: What to Do About Ozempic?

https://www.wsj.com/amp/articles/ozempic-wegovy-mounjaro-weight-loss-industry-89419ecb

III. NSAIDs and HF

NSAID Use in Diabetes May Worsen Risk for First HF Hospitalization

https://www.medscape.com/viewarticle/990642

- Heart Failure Following Anti-Inflammatory Medications in Patients With Type 2 Diabetes Mellitus

https://doi.org/10.1016/j.jacc.2023.02.027

IV. Interventional Echocardiography

New ASE Guideline on Interventional Echocardiography Training

https://www.medscape.com/viewarticle/990520

- Recommendations for Special Competency in Echocardiographic Guidance of Structural Heart Disease Interventions: From the American Society of Echocardiography

https://doi.org/10.1016/j.echo.2023.01.014

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

Questions or feedback, please contact: [email protected]

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Chat GPT, a relatively unknown therapy for HFpEF, and two fun studies on statins and secondary prevention 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. Artificial Intelligence and CHAT GPT

Can ChatGPT Replace Diabetes Educators? Perhaps Not Yet

https://www.medscape.com/viewarticle/990381

- Potential and Pitfalls of ChatGPT and Natural-Language Artificial Intelligence Models for Diabetes Education

https://doi.org/10.2337/dc23-0197

II. Exercise and HFpEF

AHA, ACC Advocate Supervised Exercise Training in HFpEF

https://www.medscape.com/viewarticle/990351

- Supervised Exercise Training for Chronic Heart Failure With Preserved Ejection Fraction: A Scientific Statement From the American Heart Association and American College of Cardiology

https://doi.org/10.1016/j.jacc.2023.02.012

III. Statins and Muscles

Statins Don't Worsen Muscle Injury From Moderately Intense Exercise

https://www.medscape.com/viewarticle/990473

- Prolonged Moderate-Intensity Exercise Does Not Increase Muscle Injury Markers in Symptomatic or Asymptomatic Statin Users https://doi.org/10.1016/j.jacc.2023.01.043

IV. Statins in Secondary Prevention

Treat to LDL Target or High-Intensity Statin for All With Clinical CAD: LODESTAR

https://www.medscape.com/viewarticle/989884

- Treat-to-Target or High-Intensity Statin in Patients With Coronary Artery Disease

https://jamanetwork.com/journals/jama/article-abstract/2802214

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

Questions or feedback, please contact: [email protected]

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.