This Week in Cardiology

Two great stories of translation science leading to beneficial drugs in terrible diseases of the heart and the Sisyphean task of predicting the need for pacing after TAVI 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 Sotatercept

• HYPERION Trial https://www.nejm.org/doi/10.1056/NEJMoa2508170
• ZENITH Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2415160
• Evidence report on treatment for PAH https://icer.org/news-insights/press-releases/icer-publishes-final-evidence-report-on-treatment-for-pulmonary-arterial-hypertension/
• PAH Sotatercept Editorial https://www.nejm.org/doi/full/10.1056/NEJMe2503944

II Acoramidis and ATTR Cardiomyopathy

• ATTRIBUTE-CM Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2305434?logout=true
• ATTRIBUTE-CM Analysis - Substudy https://www.jacc.org/doi/10.1016/j.jacc.2025.09.013
• Tafamadis Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1805689

III Pacing After TAVI

• Prophylactic pacemaker after TAVI https://www.jacc.org/doi/10.1016/j.jacep.2025.07.028
• PROMOTE study https://doi.org/10.1016/j.hrthm.2024.12.019
• Evaluation of ESC criteria on RBBB patients undergoing TAVI https://doi.org/10.1016/j.hrthm.2024.11.030
• Editorial on Heart Rhythm journal papers https://www.heartrhythmjournal.com/article/S1547-5271(25)00114-6/abstract

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A bold trial in valvular heart disease, a CV prevention trial whose message is humility, VTE dogma challenged, more news on oral GLP-1 agonists, and a few public service announcements 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 DOUBLE-CHOICE: Minimalist Approach to TAVI May Be as Good as Standard of Care https://www.medscape.com/viewarticle/double-choice-minimalist-approach-tavi-may-be-good-standard-2025a1000pp7

• Patient & Physician Perspectives on CV Risk https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.124.011837

II KP Vaccinate Trial

• KP Vaccinate Trial https://evidence.nejm.org/doi/full/10.1056/EVIDoa2500208
• IAMI trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057042
• Increasing Flu Vaccinations in Patients With Chronic Disease https://jamanetwork.com/journals/jama/fullarticle/2824956
• MI FREEE Trial https://www.nejm.org/doi/full/10.1056/NEJMsa1107913

III Hi PRO Trial

• Apixaban for Extended Treatment of VTE https://www.nejm.org/doi/full/10.1056/NEJMoa2509426
• Recurrent VTE in Patients with Provoked VTE https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/226140

IV Oral GLP-1 Agonists

• ATTAIN 1 Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2511774

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More trials at ESC, including PARACHUTE HF, DAPA ACT HF-TIMI 68, AMALFI, and a super-interesting modeling study of when to start oral anticoagulants in AF, 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 PARACHUTE HF

First Evidence of Treatment Benefit in Chagas Heart Failure

https://www.medscape.com/viewarticle/first-evidence-treatment-benefit-chagas-heart-failure-2025a1000oem

• PARACHUTE-HF https://www.jacc.org/doi/10.1016/j.jchf.2024.05.021

II SGLT2i Early Initiation — DAPA ACT HF-TIMI 68 Trial

Trial Data Support In-Hospital Initiation of SGLT2 Inhibitors for Heart Failure https://www.medscape.com/viewarticle/trial-data-support-hospital-initiation-sglt2-inhibitors-2025a1000o5q

• DAPA ACT HF-TIMI 68

https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.125.076575

III AMALFI Trial of AF Screening

Remote ECG Screening Ups Atrial Fibrillation Detection 'Modestly' https://www.medscape.com/viewarticle/remote-ecg-screening-ups-atrial-fibrillation-detection-2025a1000myx

• AMALFI Trial https://jamanetwork.com/journals/jama/article-abstract/2838482
• STROKESTOP Trial https://www.thelancet.com/article/S0140-6736(21)01637-8/fulltext
• LOOP Trial 10.1016/S0140-6736(21)01698-6 External Link

IV Finding that Sweet Spot of Stroke Risk Threshold for Starting DOAC therapy

• Stroke Risk Threshold for non-Vitamin K Antagonist OAC in AF https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.125.012090
• Variations in Rates of Stroke Across Patients With AF https://www.ahajournals.org/doi/10.1161/circulationaha.116.024057

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More from ESC including: Valvular HD guidelines, a new drug class for HTN, myosin inhibition in HCM, vericiguat, and digoxin are the topic discussed by John Mandrola, MD.

This podcast is intended for healthcare professionals only.

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I New European Valvular Heart Disease Guidelines

• 2025 ESC/EACTS Guidelines for the management of valvular heart disease https://doi.org/10.1093/eurheartj/ehaf194
• Debate: Does Asymptomatic Aortic Stenosis Warrant Early Intervention? https://exp.medscape.com/debates/does-asymptomatic-aortic-stenosis-warrant-early-intervention/
• Surgical Ablation of Atrial Fibrillation during Mitral-Valve Surgery https://www.nejm.org/doi/full/10.1056/NEJMoa1500528
• Surgical ablation of atrial fibrillation: a systematic review and meta-analysis https://doi.org/10.1093/europace/eux336

II New Drug for Resistant HTN

• Baxdrostat: A 'Game Changer' for Hypertension? https://www.medscape.com/viewarticle/baxdrostat-game-changer-hypertension-2025a1000mz7

• Efficacy and Safety of Baxdrostat in Uncontrolled and Resistant Hypertension https://www.nejm.org/doi/full/10.1056/NEJMoa2507109
• Lorundrostat Efficacy and Safety in Patients with Uncontrolled Hypertension https://www.nejm.org/doi/10.1056/NEJMoa2501440

III HCM News at ESC

• New Trials Clarify Role of Myosin Inhibitors for Hypertrophic Cardiomyopathy https://www.medscape.com/viewarticle/new-trials-clarify-role-myosin-inhibitors-hypertrophic-2025a1000myv

• MAPLE HCM https://www.nejm.org/doi/full/10.1056/NEJMoa2504654
• SEQUOIA HCM https://www.nejm.org/doi/10.1056/NEJMoa2401424
• ODYSSEY HCM https://www.nejm.org/doi/full/10.1056/NEJMoa2505927

IV Vericiguat at ESC

• New Data Said to Support Vericiguat as Standard Therapy for Heart Failurehttps://www.medscape.com/viewarticle/new-data-said-support-vericiguat-standard-therapy-heart-2025a1000mz9

• VICTOR https://doi.org/10.1016/S0140-6736(25)01665-4
• VICTORIA https://www.nejm.org/doi/full/10.1056/NEJMoa1915928
• An individual participant data analysis of the VICTORIA and VICTOR trials https://doi.org/10.1016/S0140-6736(25)01682-4

V More on Digoxin

• RATE AF substudy https://doi.org/10.1002/ejhf.70022
• Main RATE-AF trial https://jamanetwork.com/journals/jama/fullarticle/2774407
• Efficacy of β blockers in patients with heart failure plus atrial fibrillation: an individual-patient data meta-analysis https://doi.org/10.1016/S0140-6736(14)61373-8

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The big beta-blocker story from ESC, dual pathway therapy with aspirin and OAC, stopping OAC after successful AF ablation, and DANCAVAS II trial are the topics John Mandrola, MD, discusses 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 Listener Feedback

This Week in Cardiology Podcast – August 29 https://www.medscape.com/viewarticle/1002877

II The Big Beta-blocker Story from ESC

Beta-Blockers Post-MI: A Clear Clinical Message https://www.medscape.com/viewarticle/beta-blockers-post-mi-clear-clinical-message-2025a1000mz0

• REBOOT https://www.nejm.org/doi/full/10.1056/NEJMoa2504735
• BETAMI-DANBLOCK https://www.nejm.org/doi/abs/10.1056/NEJMoa2505985

• REDUCE AMI https://www.nejm.org/doi/10.1056/NEJMoa2401479
• CAPITAL RCT https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0199347
• Post Hoc Analysis From REBOOT Trial https://eurointervention.pcronline.com/article/effect-of-beta-blocker-withholding-or-withdrawal-after-myocardial-infarction-without-reduced-ejection-fraction-on-ischaemic-events-a-post-hoc-analysis-from-the-reboot-trial
• Beta-Blockers After MI With Mildly Reduced Ejection Fraction https://doi.org/10.1016/S0140-6736(25)01592-2
• CAPRICORN 10.1016/S0140-6736(00)04560-8 External Link
• BHAT https://jamanetwork.com/journals/jama/fullarticle/370103
• ISIS 1 https://pubmed.ncbi.nlm.nih.gov/2873379/

III Aspirin and OAC Combination Clearly Dangerous

Aspirin Plus Oral Anticoagulants Raises Mortality, Bleeding https://www.medscape.com/viewarticle/aspirin-plus-oral-anticoagulants-raises-mortality-bleeding-2025a1000nam

• AQUATIC https://www.nejm.org/doi/full/10.1056/NEJMoa2507532
• AFIRE https://www.nejm.org/doi/full/10.1056/NEJMoa1904143
• EPIC CAD https://www.nejm.org/doi/10.1056/NEJMoa2407362
• OAC-ALONE https://pubmed.ncbi.nlm.nih.gov/30586700/

IV Stop or Continue OAC after Successful AF Ablation

• ALONE-AF https://jamanetwork.com/journals/jama/fullarticle/2838294
• OCEAN trial protocol https://doi.org/10.1016/j.ahj.2017.12.007

V DANCAVAS II Trial

• DANCAVAS II https://doi.org/10.1093/eurheartj/ehaf704
• DANCAVAS I https://www.nejm.org/doi/full/10.1056/NEJMoa2208681

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CAC 0 takes a gut punch, ICD therapies cannot be surrogates for benefit, and two important trials from ESC 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 CAC 0

• LDL-C and CVD Risk With CAC Score 0 https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehaf497/8228645

II ICD Therapies

• Contemporary ICD Benefit https://www.jacc.org/doi/10.1016/j.jacep.2025.06.028
• PROFID Trial https://profid-project.eu/profid-ehra-trial/
• MADIT-RIT Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1211107
• Declining Risk of Sudden Death in HF https://www.nejm.org/doi/full/10.1056/NEJMoa1609758

III Digit-HF

• DIGIT-HF Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2415471
• Digoxin–Mortality: Comparison in the DIG trial https://academic.oup.com/eurheartj/article/40/40/3336/5520008

IV POTCAST

• POTCAST trial https://www.nejm.org/doi/full/10.1056/NEJMoa2509542

ESC Preview

IV HTN Guidelines

• New Blood Pressure Guidelines: 4 Things I Like and 2 Concerns https://www.medscape.com/viewarticle/new-blood-pressure-guidelines-4-thing-i-and-2-concerns-2025a1000m1x

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John Mandrola discusses conduction system pacing vs standard pacing, withdrawing HF meds when AF is corrected and patient selection in LAAO.

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I Conduction System Pacing

• CSPACE trial https://doi.org/10.1016/j.jacc.2025.06.043
• BLOCK HF trial https://www.nejm.org/doi/full/10.1056/NEJMoa1210356
• BioPace trial https://doi.org/10.1093/europace/euaf029

II Withdrawing Meds After AF Corrected

• WITHDRAW AF https://doi.org/10.1093/eurheartj/ehaf563
• TRED HF https://pubmed.ncbi.nlm.nih.gov/30429050/

III Patient Selection in Left Atrial Appendage Occlusion

• Long-Term Outcomes Following LAAO in Medicare Beneficiaries: Outcomes From the National Cardiovascular Data Registry https://www.ahajournals.org/doi/10.1161/JAHA.124.039780

ESC Preview

IV HTN Guidelines

• New Blood Pressure Guidelines: 4 Things I Like and 2 Concerns https://www.medscape.com/viewarticle/new-blood-pressure-guidelines-4-thing-i-and-2-concerns-2025a1000m1x

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Big new hypertension guidelines, ultraprocessed foods, coronary sinus reduction and evidence-based medicine, and more news on pulsed field ablation for atrial fibrillation 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 HTN Guidelines

• BP Meds Should Begin Promptly, New ACC/AHA Guidelines Say

https://www.medscape.com/viewarticle/bp-meds-should-begin-promptly-new-acc-aha-guidelines-say-2025a1000lms

• Guideline for Management of High Blood Pressure https://www.ahajournals.org/doi/10.1161/CIR.0000000000001356
• BPROAD trial https://www.nejm.org/doi/full/10.1056/NEJMoa2412006
• Trial Score Framework https://pmc.ncbi.nlm.nih.gov/articles/PMC6459598/

II UltraProcessed Foods

• AHA statement on Ultraprocessed Foods and Cardiometabolic Health
• https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000001365

III Refractory Angina and the Coronary Sinus Reducer – A Lesson in EBM

• Coronary Sinus Reducer Shows Promise, With Caveats https://www.medscape.com/viewarticle/coronary-sinus-reducer-shows-promise-caveats-2025a1000l76

• Coronary Sinus Reducer — Meta-analysis https://www.jacc.org/doi/10.1016/j.jcin.2025.06.012
• COSIRA II Trial https://clinicaltrials.gov/study/NCT05102019

IV Pulsed Field Ablation Still Looking Strong

• Management of OACs After PFA 10.1016/j.hrthm.2025.03.1952 External Link

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Listener feedback on SURPASS CVOT, AF ablation and the limits of meta-analyses, a Watchman alert from FDA, and oral anticoagulation choices in elderly patients are discussed by John Mandola, MD, in this week's podcast.

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I SURPASS CVOT

• This Week in Cardiology Podcast, August 1 https://www.medscape.com/viewarticle/1002781
• Mounjaro Appears More Heart Protective Than Trulicity in Trial Of Eli Lilly Diabetes Drugs

https://www.medscape.com/s/viewarticle/mounjaro-proves-more-heart-protective-than-trulicity-trial-2025a1000kct

II Catheter and Surgical AF ablation

• Catheter and Surgical Ablation for AF: Meta-Analysis https://www.acpjournals.org/doi/10.7326/ANNALS-25-00253

III Watchman Air Embolism Alerts

• Looming Pay Cut to LAAO Triggers Objection From Card Groups

https://www.medscape.com/viewarticle/looming-pay-cut-laao-triggers-objection-card-groups-2025a1000l0j

• FDA Alert https://www.fda.gov/medical-devices/medical-device-recalls/early-alert-watchman-access-system-issue-boston-scientific

IV Switching Oral Anticoagulants in Frail Older Adults Patients

• FRAIL AF Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.066485
• COMBINE AF Substudy https://doi.org/10.1016/j.jacc.2025.05.060
• The Most Important Study From ESC: FRAIL-AF https://www.medscape.com/viewarticle/996063

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Exercise and CV outcomes, aldosterone modulation, AI for ECG reading, GLP-1 comparisons, end-of-life decisions, and another well-meaning policy that caused harm in veterans are 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:

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I Exercise and CV outcomes

II Aldosterone Modulation in Cardio-Kidney Disease

• Aldosterone and Aldosterone Modulation https://doi.org/10.1016/j.jacc.2025.06.012
• Randomized Aldactone Evaluation Study https://www.nejm.org/doi/full/10.1056/NEJM199909023411001

III AI vs MD ECG-Reading for Cath Lab Activation

• Accuracy of Cath Lab Activation Decisions https://doi.org/10.1016/j.ajem.2025.07.061

IV Tirzepatide vs Dulaglutide - SURPASS CVOT Study

• Eli Lilly Press Release https://investor.lilly.com/news-releases/news-release-details/lillys-mounjaro-tirzepatide-gipglp-1-dual-agonist-demonstrated
• REWIND Study 10.1016/S0140-6736(19)31149-3 External Link

V End-of-Life Decisions

Doctors' Own End-of-Life Choices Defy Common Medical Practice

https://www.medscape.com/viewarticle/doctors-own-end-life-choices-defy-common-medical-practice-2025a1000k01

• Physicians' Preferences for Their Own End of Life https://jme.bmj.com/content/early/2025/06/05/jme-2024-110192
• How US Doctors Die: A Cohort Study https://agsjournals.onlinelibrary.wiley.com/doi/full/10.1111/jgs.14112

VI Well-Meaning Policies That Make Sense

• The Mission Act and Cardiovascular Procedures https://jamanetwork.com/journals/jama/fullarticle/2837067

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