'Why we do What we do in Cardiology'

By Bishnu Subedi

I am Dr. Bishnu Subedi. I am a cardiologist in the United States. In the era of evidence-based medicine, our practice is usually guided by a scientific study, expert society statements, or clinical gu... more

FAQs about 'Why we do What we do in Cardiology':

How many episodes does 'Why we do What we do in Cardiology' have?

The podcast currently has 35 episodes available.

'Why we do What we do in Cardiology' episodes:

November 30, 2023Electrophysiology: Important EP Updates from 2023
Heart Rhythm 2023: Innovations in Ablation, Devices, and Conduction System Pacing.
Catheter Ablation and LAAO Advance:
CASTLE-HTx: Ablation for AF proved beneficial in patients with advanced heart failure, potentially paving the way for wider adoption.

Pulsed-field ablation (PFA): PULSED AF and ADVENT trials showed promise for novel PFA technologies like PulseSelect (Medtronic) and Farapulse (Boston Scientific).

Left atrial appendage occlusion (LAAO): WATCH-TAVR confirmed LAAO safety and efficacy alongside TAVI in severe aortic stenosis and AF.

Updated AF guidelines: Both US and European guidelines incorporated advancements in ablation, LAAO, and medications.
Medical Therapies: Mixed Bag:
NOAH-AFNET 6: Edoxaban (Savaysa) increased risks in patients with subclinical AF detected by implanted devices.

ARTESiA: Apixaban (Eliquis) reduced stroke but increased major bleeding in subclinical AF patients.

Meta-analysis: DOACs reduce ischemic stroke but significantly increase major bleeding in subclinical AF.

AZALEA-TIMI 71: Abelacimab (Anthos Therapeutics) showed promise for reducing bleeding compared to rivaroxaban in AF patients.

ReVeRA-201: Etripamil nasal spray effectively reduced ventricular rate in AF with rapid ventricular rate.

FRAIL-AF: Switching frail elderly AF patients from warfarin to DOACs increased bleeding risks.
Pacing and ICDs: Conduction System Pacing Takes Center Stage:
Large observational study: LBBAP outperformed biventricular pacing in CRT patients.

HOT-CRT pilot study: His-bundle pacing improved LV function more than biventricular pacing in CRT candidates.

EHRA consensus statement: Standardized implantation technique for conduction system pacing.

DANPACE II: Reducing atrial pacing in sinus node dysfunction patients did not lower AF risk but increased presyncope/syncope.

US FDA approves first EVICD: Aurora EV-ICD by Medtronic avoids transvenous lead complications.
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6min
October 19, 2023PCI: Complete PCI in ACS and multi-vessel CAD, a systematic review
Key Points:
Multi-vessel coronary disease (MVD) in acute myocardial infarction (AMI) is still a difficult condition to manage.

Complete revascularization improves outcomes for hemodynamically stable patients without any safety concerns.

A personalized approach and evaluation by a team of heart specialists is recommended for making decisions in complex cases.

More randomized trials are needed to better understand the best timing and guidance strategy for complete revascularization.
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3min
September 11, 2023 Afib: FRAIL-AF Trial: Anticoagulation in Frail Older Patients with Afib
Key findings of the FRAIL-AF trial:
* Switching from vitamin K antagonist (VKA) to non-vitamin K antagonist oral anticoagulant (NOAC) therapy was associated with an increased risk of major and clinically relevant bleeding (hazard ratio [HR] 1.69, 95% CI 1.23-2.32).
* There was no difference in the risk of thromboembolic events between the two groups.
* The trial included 1,330 patients with atrial fibrillation (AF) who were 75 years of age or older and had at least two of the following frailty criteria:
* Self-reported difficulty walking 100 meters
* Weight loss of >10% in the past year
* Low physical activity
* Low grip strength
* The trial was conducted in 26 centers in the Netherlands and lasted for a median of 2.4 years.
* The main author of the trial is Linda Joosten, MD, from the University Medical Center Utrecht in the Netherlands. The trial was published in the journal Circulation on September 1, 2023.
Link to article: https://doi.org/10.1161/CIRCULATIONAHA.123.066485
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3min
September 03, 2023CHF: Semaglutide in HFpEF across obesity classes (STEP-HFpEF trial)
Summary of the STEP-HFpEF trial 2023 published in Nature Medicine
The STEP-HFpEF trial was a study of semaglutide in patients with obesity phenotype of heart failure and preserved ejection fraction (HFpEF).

Semaglutide improved symptoms, physical limitations, exercise function, and reduced body weight in patients with HFpEF and obesity.

The benefits of semaglutide were consistent across obesity categories.

The magnitude of the benefit of semaglutide was directly related to the extent of weight loss.

Patients who received semaglutide had a 16.6-point improvement in their Kansas City Cardiomyopathy Questionnaire-Clinical Summary Score (KCCQ-CSS), compared to an 8.7-point improvement in the placebo group.
Patients who received semaglutide walked an additional 21.5 meters in the 6-minute walk test, compared to 1.2 meters in the placebo group.

Patients who received semaglutide had a 43.5% reduction in their C-reactive protein (CRP) levels, compared to a 7.3% reduction in the placebo group.
Overall, the STEP-HFpEF trial showed that semaglutide is a promising treatment option for patients with the obesity phenotype of HFpEF. Semaglutide improved these patients' symptoms, physical limitations, exercise function, and reduced body weight. The magnitude of the benefit was directly related to the extent of weight loss.

Link to the article:
https://doi.org/10.1038/s41591-023-02526-x
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4min
September 03, 2023Acute MI: Complete or Culprit-Only PCI in Older Patients with MI (FIRE trial)
Key points of the FIRE trial:
The study was a randomized trial of complete revascularization vs. culprit-only revascularization in older patients (≥75 years of age) with myocardial infarction and multi-vessel disease.

A total of 1445 patients were enrolled.

The primary outcome was a composite of death, myocardial infarction, stroke, or any revascularization at 1 year.

The key secondary outcome was a composite of cardiovascular death or myocardial infarction.

Safety was assessed as a composite of contrast-associated acute kidney injury, stroke, or bleeding.

The results showed that complete revascularization was associated with a lower risk of the primary outcome (15.7% vs. 21.0%, P=0.01) and the key secondary outcome (8.9% vs. 13.5%, P=0.01).

There was no difference in safety between the two groups.
In conclusion, the study found that complete revascularization is beneficial in older patients with myocardial infarction and multivessel disease. It is associated with a lower risk of death, myocardial infarction, stroke, and any revascularization at 1 year.
Here are some additional details from the study:
The median age of the patients was 80 years.

About 36% of the patients were women.

About 35% of the patients were admitted for ST-segment elevation myocardial infarction.

The safety outcome did not appear to differ between the groups, but the study was not powered to detect differences in safety.
The study findings support the use of complete revascularization in older patients with myocardial infarction and multivessel disease. However, it is important to note that the study was conducted in a single center and the results may not be generalizable to all patients. Further research is needed to confirm the findings of this study.

Link to the article:
DOI: 10.1056/NEJMoa2300468
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4min
August 30, 2023CAD: ACC/AHA 2023 Chronic Coronary Disease Guideline Key Points: J Am Coll Cardiol. 2023 Aug, 82 (9) 956–960
These are the key points from this 2023 ACC/AHA guideline in managing chronic coronary disease.
Patients with chronic coronary disease should receive care from a team of healthcare professionals (Team-based, patient-centered care)

All patients with chronic coronary disease should be encouraged to make healthy lifestyle changes (nonpharmacologic therapies).

Patients with chronic coronary disease who can exercise should be encouraged to participate in habitual physical activity.

Sodium-glucose cotransporter two inhibitors and glucagon-like peptide-1 receptor agonists can be helpful for some patients with chronic coronary disease.

Beta-blockers are no longer recommended for all patients with chronic coronary disease except in people who have had a heart attack in the past year, have a left ventricular ejection fraction of less than 50%, or have another condition that requires them to take beta-blockers.

Statins are still the first-line therapy for lowering cholesterol in patients with chronic coronary disease. Consider PCSK9i, inclisiran, and bempedoic acid as alternative or additional therapies.

Shorter durations of dual antiplatelet therapy are safe and effective in many patients with chronic coronary disease.

There is no evidence that nonprescription or dietary supplements benefit patients with chronic coronary disease.

Routine periodic anatomic or ischemic testing is not recommended for risk stratification or to guide therapeutic decision-making in patients with chronic coronary disease.

E-cigarettes increase the likelihood of successful smoking cessation compared with nicotine replacement therapy, but they are not recommended as first-line therapy for smoking cessation.

Reference article: https://doi.org/10.1016/j.jacc.2023.06.006
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4min
August 28, 2023Cardiomyopathy: TTR Amyloid: efficacy and safety of acoramidis in transthyretin amyloid cardiomyopathy - ATTRibute-CM Trial, ESC Meeting August 2023
The ATTRibute-CM trial was a randomized, double-blind, placebo-controlled trial that evaluated the efficacy and safety of acoramidis in patients with transthyretin amyloid cardiomyopathy (ATTR-CM). The trial enrolled 632 patients with symptomatic ATTR-CM. Patients were randomly assigned to receive either acoramidis 800 mg twice daily or a placebo for 30 months.
The trial's primary endpoint was a hierarchical analysis of all-cause mortality, cardiovascular-related hospitalization, NT-proBNP, and 6-minute walk distance. The trial found that acoramidis was associated with a number of benefits compared to placebo, including:
A 25% reduction in all-cause mortality

A 50% reduction in cardiovascular-related hospitalizations

A 39.64-meter improvement in 6-minute walk distance

A 9.94-point improvement in KCCQ-OS score

A 7.1 mg/dL increase in serum transthyretin levels
Acoramidis was generally well-tolerated. The most common side effects were nausea, vomiting, and diarrhea.
The results of the ATTRibute-CM trial suggest that acoramidis is an effective and safe treatment for ATTR-CM. Acoramidis is a potential alternative to tafamidis, the only other FDA-approved drug tafamidis for treating ATTR-CM.
Here are some additional details about the ATTRibute-CM trial:
The trial was conducted in 40 countries.

The median age of the participants was 78 years.

The majority of the participants were male (90%).

The most common ATTR-CM subtype was wild-type (80%).

The trial was funded by Akcea Therapeutics.
The results of the ATTRibute-CM trial are a major step forward in the treatment of ATTR-CM. Acoramidis offers a new option for patients with this serious condition, and it is likely to be an important treatment option for many years to come.
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7min
August 27, 2023Cardiac arrest: Expedited transfer to a cardiac arrest center for non-ST-elevation out-of-hospital cardiac arrest-The ARREST trial: The Lancet, August 2023
Key Points from ARREST trial findings:
The study included 862 patients who were resuscitated after a cardiac arrest.

The patients were randomly assigned to be taken to either a well-resourced cardiac arrest center or the nearest emergency department.

The primary outcome of the study was survival to 30 days. The secondary outcome was survival to 90 days.

There was no difference in the survival rate between the two groups of patients (63% in the cardiac arrest center group vs. 63% in the emergency department group).

The authors of the study say that the results suggest that there is no need to transport patients to a cardiac arrest center after a cardiac arrest if the nearest emergency department can provide the same level of care.

Link to the reference article:
https://doi.org/10.1016/S0140-6736(23)01351-X
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6min
August 26, 2023Infective Endocarditis: 2023 ESC Guidelines for the management of endocarditis in European Heart Journal
Here is a summary of the key points from the 2023 ESC guidelines for the management of endocarditis:
Prevention: People at high risk of endocarditis should take steps to prevent it, such as taking antibiotics before dental procedures.

Diagnosis: The diagnosis of endocarditis is based on a combination of clinical features, blood cultures, and imaging studies.

Antimicrobial therapy: The duration of antibiotic treatment depends on whether the infection is native valve endocarditis (NVE) or prosthetic valve endocarditis (PVE).

Indications for surgery: Surgery may be indicated in patients with endocarditis who have heart failure, uncontrolled infection, or a high risk of emboli.

Other complications of IE: IE can also lead to other complications, such as neurological problems, infective aneurysms, and myocarditis.

Surgical therapy: Surgery may be necessary to treat complications of IE, such as heart failure or uncontrolled infection.

Outcome after discharge: Patients treated for IE should remain under close surveillance for long-term complications.

Patient-centered care: A recovery plan should be developed for patients treated for IE, considering their individual needs.

Sex differences: Female sex is less common in patients diagnosed with IE.

Link to Reference article:
https://doi.org/10.1093/eurheartj/ehad193
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16min
August 22, 2023 LAA: Comparison of Initial Antithrombotic Regimens after Left Atrial Appendage Occlusion: JACC Aug 2023
This review highlights the following points:
There are different ways to prevent blood clots in patients who have undergone LAAO for atrial fibrillation (AF).
Taking a direct oral anticoagulant (DOAC) alone is associated with a lower risk of blood clots in the device and death than not taking any antithrombotic medication.
For patients who are not at high risk of bleeding, taking a DOAC alone is likely the best way to prevent blood clots after LAAO. This is because it balances the risk of bleeding and blood clots.
Link for the article:
DOI: 10.1016/j.jacc.2023.08.010
...more
5min

FAQs about 'Why we do What we do in Cardiology':

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The podcast currently has 35 episodes available.

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'Why we do What we do in Cardiology'

FAQs about 'Why we do What we do in Cardiology':

How many episodes does 'Why we do What we do in Cardiology' have?

'Why we do What we do in Cardiology' episodes:

FAQs about 'Why we do What we do in Cardiology':

How many episodes does 'Why we do What we do in Cardiology' have?

More shows like 'Why we do What we do in Cardiology'

This Week in Cardiology

Core IM | Internal Medicine Podcast