This Week in Cardiology

PFO closure, trans-mitral procedures, yoga as therapy, and a year-end-review are the topics John Mandrola, MD, covers in this week's podcast. To read a partial transcript or to comment, visit: https://www.medscape.com/twic

I – PFO Closure

- Heterogeneity of Treatment Effects in an Analysis of Pooled Individual Patient Data From Randomized Trials of Device Closure of Patent Foramen Ovale After Stroke https://jamanetwork.com/journals/jama/fullarticle/2787115

- Patent Foramen Ovale Closure—Harnessing Clinical Trial Evidence to Inform Individualized Treatment Decisions https://jamanetwork.com/journals/jama/fullarticle/2787132

- Personalized evidence based medicine: predictive approaches to heterogeneous treatment effects https://pubmed.ncbi.nlm.nih.gov/30530757/

- Lord's Paradox by Stephen Senn https://www.linkedin.com/pulse/cause-concern-stephen-senn/

II – Trans-Mitral Procedures

- Transcatheter Mitral Valve Procedures Up Tenfold Since 2014 https://www.medscape.com/viewarticle/964657

- Transcatheter Mitral Valve Therapy in the United States: A Report From the STS-ACC TVT Registry https://www.jacc.org/doi/full/10.1016/j.jacc.2021.07.058

- Percutaneous Repair or Surgery for Mitral Regurgitation https://www.nejm.org/doi/full/10.1056/nejmoa1009355

- Transcatheter Mitral-Valve Repair in Patients with Heart Failure https://www.nejm.org/doi/full/10.1056/NEJMoa1806640

- Percutaneous Repair or Medical Treatment for Secondary Mitral Regurgitation https://www.nejm.org/doi/full/10.1056/NEJMoa1805374

III – Yoga for Vasovagal Syncope

- Yoga Effective Adjunct Therapy in Recurrent Vasovagal Syncope https://www.medscape.com/viewarticle/964644

- Effect of Yoga on Clinical Outcomes and Quality of Life in Patients With Vasovagal Syncope (LIVE-Yoga) https://www.jacc.org/doi/full/10.1016/j.jacep.2021.09.007

- Effect of Yoga on Arrhythmia Burden, Anxiety, Depression, and Quality of Life in Paroxysmal Atrial Fibrillation: The YOGA My Heart Study https://www.jacc.org/doi/full/10.1016/j.jacc.2012.11.060

- Effects of yoga in patients with paroxysmal atrial fibrillation - a randomized controlled study https://pubmed.ncbi.nlm.nih.gov/26976659/

IV – Top Ten of 2021

- Mandrola's Top 10 Cardiology Stories of 2021 https://www.medscape.com/viewarticle/964818

- Top Cardiology Trials of 2021 https://www.medscape.com/viewarticle/963475

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Questions or feedback, please contact [email protected]

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AF triggers, rising BP during the pandemic, long COVID, cardiac arrest care, and social media are the topics John Mandrola, MD discusses in this week's podcast. To read a partial transcript or to comment, visit: https://www.medscape.com/twic

I – AF Triggers

- Alcoholic Drinks Stand Out in Novel Trial Exploring AF Triggers https://www.medscape.com/viewarticle/962911

- Individualized Studies of Triggers of Paroxysmal Atrial Fibrillation https://jamanetwork.com/journals/jamacardiology/article-abstract/2786196

II – BP Increase During the Pandemic

- Blood Pressure Control Worsened During COVID Pandemic https://www.medscape.com/viewarticle/964329

- Rise in Blood Pressure Observed Among US Adults During the COVID-19 Pandemic https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057075

III – DOAC after VTE

- Apixaban Outmatches Rivaroxaban for VTE in Study https://www.medscape.com/viewarticle/964301

- Risk for Recurrent Venous Thromboembolism and Bleeding With Apixaban Compared With Rivaroxaban: An Analysis of Real-World Data https://www.acpjournals.org/doi/full/10.7326/M21-0717

- Ticagrelor or Prasugrel in Patients with Acute Coronary Syndromes https://www.nejm.org/doi/full/10.1056/NEJMoa1908973

IV – Long Covid

- In Long COVID, CPET Finds Abnormalities Other Tests Don't https://www.medscape.com/viewarticle/964250

- Use of Cardiopulmonary Stress Testing for Patients With Unexplained Dyspnea Post–Coronavirus Disease https://doi.org/10.1016/j.jchf.2021.10.002

V – Cardiac Arrest Care

- Calcium Does Not Benefit Patients in Cardiac Arrest https://www.medscape.com/viewarticle/964059

- Effect of Intravenous or Intraosseous Calcium vs Saline on Return of Spontaneous Circulation in Adults With Out-of-Hospital Cardiac Arrest https://jamanetwork.com/journals/jama/fullarticle/2786819

VI – Social Media

- Online Reviews Most Important Factor in Choosing a Doctor: Survey https://www.medscape.com/viewarticle/964264

Features:

- Booze Out, Coffee Okay to Outsmart Atrial Fibrillation? https://www.medscape.com/viewarticle/961993

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Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine

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Questions or feedback, please contact [email protected]

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The AMAZE trial of left atrial appendage isolation, non-statin oral lipid lowering drugs, EHR alerts, non-MD care, and obesity are the topics John Mandrola, MD, discusses in this week's podcast. To read a partial transcript or to comment, visit: https://www.medscape.com/twic

I – aMAZE Trial

- No Advantage Shown for LAA Ligation as Adjunct to Pulmonary Vein Isolation https://www.medscape.com/viewarticle/962954

- Safety and Procedural Success of Left Atrial Appendage Exclusion With the Lariat Device https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2289126

- Left Atrial Appendage Isolation in Patients With Longstanding Persistent AF Undergoing Catheter Ablation: BELIEF Trial https://pubmed.ncbi.nl m.nih.gov/27788847/

II – Non-Statin Lipid Lowering

- Obicetrapib: CETP Inhibitor Impresses in LDL Lowering https://www.medscape.com/viewarticle/963611

- Daily Oral PCSK9 Inhibitor Encouraging in Phase 1 Trials https://www.medscape.com/viewarticle/963550

III – EHR Alerts and Prognosis

- EHR Alerts Have No Impact on Inpatient HF Treatment or Outcomes https://www.medscape.com/viewarticle/963002

- REVeAL-HF: Design and Rationale of a Pragmatic Randomized Controlled Trial Embedded Within Routine Clinical Practice https://www.jacc.org/doi/full/10.1016/j.jchf.2021.03.006

IV – Non-MD Care Models

- Remote Non-Physician Care Helps BP, LDL Control https://www.medscape.com/viewarticle/963783

- A Remotely Delivered Hypertension and Lipid Program in 10,000 Patients Across a Diverse Health Care Network https://www.abstractsonline.com/pp8/?_ga=2.141042993.2042594723.1635046736-1021258137.1633710264#!/9349/presentation/18153

V – Obesity in the Young

- Obesity Rates Soar in Early Adulthood in the US https://www.medscape.com/viewarticle/963511

- Trends in Obesity Prevalence Among Adults Aged 18 Through 25 Years, 1976-2018 https://jamanetwork.com/journals/jama/article-abstract/2786516

Features

- Doubting the BELIEF Trial on LAA Isolation https://www.medscape.com/viewarticle/850822

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Questions or feedback, please contact [email protected]

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In AHA 2021 Part 1, John Mandrola, MD, reports on selected sessions from the virtual American Heart Association meeting.

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

I - AVATAR

- Early SAVR Tops Watchful Waiting in Severe, Asymptomatic Aortic Stenosis: AVATAR https://www.medscape.com/viewarticle/962904

- Aortic Valve ReplAcemenT versus Conservative Treatment in Asymptomatic SeveRe Aortic Stenosis: The AVATAR Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057639

- Early Surgery or Conservative Care for Asymptomatic Aortic Stenosis https://www.nejm.org/doi/full/10.1056/NEJMoa1912846

II - TCV Repair

- Concomitant Tricuspid-Mitral Surgery Beneficial but With a Tradeoff https://www.medscape.com/viewarticle/962899

- Concomitant Tricuspid Repair in Patients with Degenerative Mitral Regurgitation https://www.nejm.org/doi/full/10.1056/NEJMoa2115961

III - PALACS

- Procedure Reduces Postop AF After Cardiac Surgery: PALACS https://www.medscape.com/viewarticle/962907

- Posterior left pericardiotomy for the prevention of atrial fibrillation after cardiac surgery: an adaptive, single-centre, single-blind, randomised, controlled trial https://doi.org/10.1016/S0140-6736(21)02490-9

IV - Left Main CAD

- Left-Main PCI, CABG Mortality Similar; Choice Remains Complex https://www.medscape.com/viewarticle/963198

- Percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass grafting in left main coronary artery disease: an individual patient data meta-analysis https://doi.org/10.1016/S0140-6736(21)02334-5

Features:

- Questions Remain on Tricuspid Repair at Time of Mitral Surgery https://www.medscape.com/viewarticle/962902

- Despite Positive Trials, Early Surgery in Asymptomatic AS Should Wait https://www.medscape.com/viewarticle/962926

- Can New Meta-analysis of PCI vs CABG for Left Main CAD Settle the Debate? https://www.medscape.com/viewarticle/963295

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Questions or feedback, please contact [email protected]

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Left atrial appendage closure vs DOACs, TAVR vs SAVR, renal denervation, and an AHA 2021 preview are the topics John Mandrola, MD, discusses in this week's podcast. To read a partial transcript or to comment, visit: https://www.medscape.com/twic

I - LAAC

- PRAGUE-17: LAA Closure Holds Up Against DOACs Out to 4 Years https://www.medscape.com/viewarticle/962608

- LAAO vs DOAC: PRAGUE-17 Falls Short https://www.medscape.com/viewarticle/933641

- Left Atrial Appendage Closure versus Non-Warfarin Oral Anticoagulation in Atrial Fibrillation: 4-Year Outcomes of PRAGUE-17 https://www.jacc.org/doi/10.1016/j.jacc.2021.10.023

- Does Percutaneous Left Atrial Appendage Closure Stand the Test of Time? https://www.jacc.org/doi/10.1016/j.jacc.2021.10.022

II - SURTAVI (TAVR vs SAVR)

- SURTAVI at 5 Years Reinforces TAVR but Was It Long-term Enough? https://www.medscape.com/viewarticle/962484

- Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients https://www.nejm.org/doi/full/10.1056/NEJMoa1700456

III - Renal Denervation

- Renal Denervation Adds Clout to BP Meds in Resistant HTN: RADIANCE-HTN TRIO https://www.medscape.com/viewarticle/962508

- Renal Denervation Remains Only Promising in Meta-Analysis https://www.medscape.com/viewarticle/962369

- Renal Denervation for Hypertension: A Systematic Review and Meta-Analysis of Randomized, Blinded, Placebo-Controlled Trials https://doi.org/10.1016/j.jcin.2021.09.020

IV - AHA Preview

- AHA 2021 Puts Scientific Dialogue, Health Equity Center Stage https://www.medscape.com/viewarticle/962524

- Mandrola Previews the Virtual AHA 2021 https://www.medscape.com/viewarticle/962468

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Questions or feedback, please contact [email protected]

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FFR-guided PCI, ISCHEMIA trial challenged, QFR, and one of the most important studies of 2021 are discussed by John Mandrola, MD, in this week's podcast. To read a partial transcript or to comment, visit: https://www.medscape.com/twic

I - FFR-Guided PCI

- FFR-Guided PCI Falls Short vs CABG in Multivessel CAD: FAME 3 https://www.medscape.com/viewarticle/962274

- Fractional Flow Reserve–Guided PCI as Compared with Coronary Bypass Surgery https://www.nejm.org/doi/full/10.1056/NEJMoa2112299

- The fallacies of fractional flow reserve https://pubmed.ncbi.nlm.nih.gov/31889563/

II - ISCHEMIA-Trial Challenged

- How Applicable is ISCHEMIA Trial to US Clinical Practice? https://www.medscape.com/viewarticle/962233

- Comparison of Patients Undergoing Percutaneous Coronary Intervention in Contemporary U.S. Practice With ISCHEMIA Trial Population https://www.jacc.org/doi/full/10.1016/j.jcin.2021.08.047

- The Glass Is at Least Half Full https://www.jacc.org/doi/10.1016/j.jcin.2021.08.054

- Initial Invasive or Conservative Strategy for Stable Coronary Disease https://www.nejm.org/doi/full/10.1056/nejmoa1915922

III - QFR

- FAVOR III China: QFR-Guided PCI Shows Advantage Over Angiography https://www.medscape.com/viewarticle/962328

- Angiographic quantitative flow ratio-guided coronary intervention (FAVOR III China): a multicentre, randomised, sham-controlled trial https://doi.org/10.1016/S0140-6736(21)02248-0

Features:

- The MI–Mortality Mismatch: When Lowering MI Doesn't Extend Life https://www.medscape.com/viewarticle/962276

- Assessment of Nonfatal Myocardial Infarction as a Surrogate for All-Cause and Cardiovascular Mortality in Treatment or Prevention of Coronary Artery Disease https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2785560

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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.

ESUS, CAC 0, Takotsubo syndrome, and chest pain are the topics John Mandrola, MD, covers in today's podcast. To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I – ESUS

Anticoagulation May Benefit Stroke Patients With LV Dysfunction https://www.medscape.com/viewarticle/961815

- Left Ventricular Dysfunction Among Patients With Embolic Stroke of Undetermined Source and the Effect of Rivaroxaban vs AspirinA Subgroup Analysis of the NAVIGATE ESUS Randomized Clinical Trial

https://jamanetwork.com/journals/jamaneurology/article-abstract/2785030

- Rivaroxaban for Stroke Prevention after Embolic Stroke of Undetermined Source

https://www.nejm.org/doi/10.1056/NEJMoa1802686

- Dabigatran for Prevention of Stroke after Embolic Stroke of Undetermined Source

https://www.nejm.org/doi/10.1056/NEJMoa1813959

II – CAC

CAC Score 0 Unreliable to Rule Out Stenosis in Younger Patients https://www.medscape.com/viewarticle/961801

- Association of Age With the Diagnostic Value of Coronary Artery Calcium Score for Ruling Out Coronary Stenosis in Symptomatic Patients https://jamanetwork.com/journals/jamacardiology/fullarticle/2785586

- The Case Against Coronary Artery Calcium Scoring for Cardiovascular Disease Risk Assessment

https://www.aafp.org/afp/2019/1215/p734.html

III – Takotsubo Cardiomyopathy

Broken Heart Syndrome: On the Rise, Especially in Women 50-74

https://www.medscape.com/viewarticle/961307

- Sex‐ and Age‐Based Temporal Trends in Takotsubo Syndrome Incidence in the United States

https://www.ahajournals.org/doi/10.1161/JAHA.120.019583

IV- Chest Pain Guidelines

AHA/ACC Issues First Comprehensive Guidance on Chest Pain

https://www.medscape.com/viewarticle/961806

- 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines https://www.jacc.org/doi/10.1016/j.jacc.2021.07.052

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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.

Aspirin for primary prevention, induced hypothermia, half-dose DOAC, and social media, are the topics John Mandrola, MD, discusses in this week's podcast. To read a partial transcript or to comment, visit: https://www.medscape.com/twic

I - ASA for Primary Prevention

- USPSTF Rules Out Aspirin for Over 60s in Primary CVD Prevention https://www.medscape.com/viewarticle/960745

- Aspirin Use to Prevent Cardiovascular Disease: Preventive Medication https://www.uspreventiveservicestaskforce.org/uspstf/document/draft-evidence-review/aspirin-use-to-prevent-cardiovascular-disease-preventive-medication

- Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31924-X/fulltext

- Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus https://www.nejm.org/doi/full/10.1056/nejmoa1804988

- Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly https://www.nejm.org/doi/full/10.1056/NEJMoa1805819

- Effect of Aspirin on All-Cause Mortality in the Healthy Elderly https://www.nejm.org/doi/full/10.1056/nejmoa1803955

II - Induced Hypothermia

- No Benefit From Lower Temps for Out-of-Hospital Cardiac Arrest https://www.medscape.com/viewarticle/961191

- The CAPITAL CHILL Randomized Clinical Trial https://jamanetwork.com/journals/jama/fullarticle/2785263

- Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest https://www.nejm.org/doi/10.1056/NEJMoa1310519

- Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest https://www.nejm.org/doi/full/10.1056/NEJMoa2100591

III - Half-dose DOAC

- Half-Dose DOACs Cut Bleeding, Thrombus Risk Post-Watchman LAA Closure https://www.medscape.com/viewarticle/960974

- Half-Dose Direct Oral Anticoagulation Versus Standard Antithrombotic Therapy After Left Atrial Appendage Occlusion https://www.jacc.org/doi/full/10.1016/j.jcin.2021.07.031

IV - Social Media

- Navigating Benefits, Pitfalls of Social Media as a Female Doctor https://www.medscape.com/viewarticle/961150

- Gender Differences in Physician Use of Social Media for Professional Advancement https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2779868

Features:

- USPSTF Statement on Aspirin: Poor Messaging at Best https://www.medscape.com/viewarticle/961118

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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 NEJM papers on mRNA-related myocarditis, AF and stroke, intensifying BP meds, and CCTA and high-sensitivity troponin are the topics John Mandrola, MD, covers in this week's podcast. To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I -- Vaccine-Induced Myocarditis

New Reports Help Nail Down Myocarditis Risk With COVID-19 Vaccine

https://www.staging.medscape.com/viewarticle/960537

• Myocarditis after BNT162b2 mRNA Vaccine against Covid-19 in Israel

https://www.nejm.org/doi/full/10.1056/NEJMoa2109730

• Myocarditis after Covid-19 Vaccination in a Large Health Care Organization

https://www.nejm.org/doi/full/10.1056/NEJMoa2110737

II – AF and Stroke

AF a Stroke Cause or Innocent Bystander? The Debate Continues

https://www.medscape.com/viewarticle/960224

• Temporal Association Between Episodes of Atrial Fibrillation and Risk of Ischemic Stroke

https://jamanetwork.com/journals/jamacardiology/fullarticle/2784332

• It's Time to Rethink (and Retrial) Our Framework for Stroke Prevention in Atrial Fibrillation

https://jamanetwork.com/journals/jamacardiology/fullarticle/2784335

III- Intensification of BP Control

Adding New Hypertensive May Be More Potent Than Upping Doses

https://www.medscape.com/viewarticle/960454

• Adding a New Medication Versus Maximizing Dose to Intensify Hypertension Treatment in Older Adults

https://doi.org/10.7326/M21-1456

IV- Hs-troponin and CAD

Troponin Levels Tied to Increased CAD Risk, May Guide Imaging /viewarticle/960146

• Troponin-Guided Coronary Computed Tomographic Angiography After Exclusion of Myocardial Infarction

https://doi.org/10.1016/j.jacc.2021.07.055

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https://www.medscape.com/features/public/machine

The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD.

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.

Coronary artery calcification and exercise, translating clinical trials, the question of metabolically healthy obesity, and Watchman complications are the topics John Mandrola, MD, discusses in this week's podcast. To read a partial transcript or to comment, visit: https://www.medscape.com/twic

I - CAC and Physical Activity

- Physical Activity Paradoxically Tied to Higher Coronary Calcium https://www.medscape.com/viewarticle/959366

- Physical activity and the progression of coronary artery calcification http://dx.doi.org/10.1136/heartjnl-2021-319346

II - Translating Clinical Trials

- SYNTAX Score II 2020 Wobbles in Real-World Validation https://www.medscape.com/viewarticle/958834

- Redevelopment and validation of the SYNTAX score II to individualise decision making between percutaneous and surgical revascularisation in patients with complex coronary artery disease: secondary analysis of the multicentre randomised controlled SYNTAXES trial with external cohort validation https://doi.org/10.1016/S0140-6736(20)32114-0

- External Validation of the SYNTAX Score II 2020 https://www.jacc.org/doi/full/10.1016/j.jacc.2021.07.027

III - Healthy and Obesity

- 'Metabolically Healthy Obesity' Has Heart Risks. Is it a Misnomer? https://www.medscape.com/viewarticle/959994

- Metabolically healthy obesity and cardiovascular events: A nationwide cohort study https://doi.org/10.1111/dom.14492

- Relation of Obesity to New-Onset Atrial Fibrillation and Atrial Flutter in Adults https://pubmed.ncbi.nlm.nih.gov/29501206/

- Paediatric obesity appears to lower the risk of diabetes if selection bias is ignored https://pubmed.ncbi.nlm.nih.gov/29374028

IV - Watchman Complications

- FDA Investigating Potential Sex Differences in LAAO Adverse Outcomes https://www.medscape.com/viewarticle/959806

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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.