This Week in Cardiology

The podcast dives into the controversial KETO-CTA study, exploring its impact on cholesterol and plaque progression. It examines subclinical atrial fibrillation and the questions surrounding the need for anticoagulation treatment. Additionally, there’s an exciting discussion on the ESSENCE trial, highlighting the potential benefits of GLP-1 agonists for fatty liver disease, suggesting significant implications for cardiology. The balance between lifestyle changes and treatment strategies for cardiovascular care is also scrutinized, inviting a thoughtful dialogue.

The FDA's recent approval of TAVR for asymptomatic aortic stenosis raises questions about trial biases and the necessity of immediate intervention. Innovative diagnostic tools, including machine learning methods to differentiate tachycardia types, are explored for their potential to enhance cardiac care. Additionally, discussions on the implications of the PRAETORIAN-XL trial highlight concerns around methodologies in device therapy, shedding light on how these factors could alter patient outcomes.

AI and ECGs, novel ways to treat hypertension, combined lipid-lowering therapy after myocardial infarction, PFA and silent stroke, a move toward accountability in AF ablation, and pacing issues in TTVR 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 Help with ECGs in the ED AI Shows Promise for Rapid NSTEMI Diagnosis https://www.medscape.com/viewarticle/ai-shows-promise-rapid-nstemi-diagnosis-2025a10009pw Buscher et al https://doi.org/10.1093/eurheartj/ehaf254 II A Novel way to Treat HTN A Pacemaker to Control BP Gets FDA Breakthrough Designation https://www.medscape.com/viewarticle/pacemaker-control-bp-gets-fda-breakthrough-designation-2025a10009t3 JAHA paper https://www.ahajournals.org/doi/10.1161/JAHA.120.020492 Backbeat https://clinicaltrials.gov/study/NCT06059638 III Type of PFA may matter for Silent Cerebral Lesions Paper https://www.ahajournals.org/doi/10.1161/CIRCEP.125.013719 IV Accountability coming to US AF ablation Heart Rhythm Society Releases a Document on Establishing Centers of Excellence for AF ablation -- Press Release https://www.hrsonline.org/news/new-white-paper-on-atrial-fibrillation-centers-of-excellence/ V Pacing in Patients with Undergoing Transcatheter Tricuspid Valve Replacement Paper https://doi.org/10.1016/j.hrthm.2025.02.004 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

This week, the discussion centers on the significant findings from the FAME 3 trial, showing stents can be as effective as surgery for triple-vessel disease. TAVR outcomes in low-risk patients are explored, revealing similar results to traditional surgery. The implications of pacemaker use after TAVR also come into play. Additionally, mavacamten's limitations for treating hypertrophic cardiomyopathy are analyzed, prompting a deeper look into the evolving landscape of cardiac treatments.

The TAP-IT, STRIDE, FreshUP, and SINGLE SHOT CHAMPION trials 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: https://www.medscape.com/twic I TAP IT  TAP IT trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.073521 II STRIDE LANCET Ref 10.1016/S0140-6736(25)00509-4 SUMMIT HF https://www.nejm.org/doi/full/10.1056/NEJMoa2410027 III FRESH UP No Need to Restrict Fluids in Stable Heart Failure https://www.medscape.com/viewarticle/no-need-restrict-fluids-stable-heart-failure-2025a10008bu Nature (Trial) https://www.nature.com/articles/s41591-025-03628-4 SODIUM HF https://pubmed.ncbi.nlm.nih.gov/35381194/ IV PFA for AF ablation SINGLE SHOT CHAMPION https://www.nejm.org/doi/full/10.1056/NEJMoa2502280 ADVENT https://www.nejm.org/doi/full/10.1056/NEJMoa2307291 Foy et al https://pmc.ncbi.nlm.nih.gov/articles/PMC11852674/ MANIFEST REDO Study https://doi.org/10.1093/europace/euaf012 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Discover cutting-edge insights from recent clinical trials presented at the 2025 ACC. Hear about the WARRIOR trial's impact on non-obstructive coronary artery disease, and explore findings from PROTECT TAVI regarding cerebral embolic protection. Dive into DAPATAVI, where SGLT2 inhibitors emerge as potential new standards following TAVI. Plus, learn how oral semaglutide is shifting the landscape of diabetes management and its effects on cardiovascular outcomes!

Stopping oral anticoagulation after AF ablation, the core problem with paradoxes like the smoker’s paradox, chronic total occlusion PCI, and an ACC/EHRA preview 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: https://www.medscape.com/twic I Oral Anticoagulation after Successful AF Ablation Iwawakie et al https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2831851 OCEAN protocol paper https://doi.org/10.1016/j.ahj.2017.12.007 II Smoker’s Paradox Presch et al https://www.jacc.org/doi/10.1016/j.jcin.2024.12.028 Gupta et al https://doi.org/10.1161/JAHA.116.003370 III CTO PCI Main sub-analysis paper Bangalore et al https://doi.org/10.1016/j.jacc.2025.01.029 DECISION CTO https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.031313 Main EURO CTO trial https://doi.org/10.1093/eurheartj/ehy220 3-year MACE of EURO CTO https://eurointervention.pcronline.com/article/three-year-outcomes-of-eurocto-a-randomized-multicentre-trial-comparing-revascularization-and-optimal-medical-therapy-for-chronic-total-coronary-occlusions EXPLORE https://www.jacc.org/doi/abs/10.1016/j.jacc.2016.07.744 ISCHEMIA CTO https://www.clinicaltrials.gov/study/NCT03563417   IV ACC and EHRA Preview Mandrola’s 5 Trials to Look for at the 2025 American College of Cardiology Scientific Sessions https://www.medscape.com/viewarticle/mandrolas-5-trials-look-2025-american-college-cardiology-2025a10006zu You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

A recent trial sheds light on cardiac pacing and its implications for treatment strategies. The curious relationship between PVCs and cardiomyopathy is explored, challenging established norms. Cannabis use emerges as a contentious topic, revealing increased cardiovascular risks, yet the study's methodology is put under scrutiny. Listeners are invited to ponder the complexities of these findings while contemplating the future direction of research in cardiology.

Healthcare professionals weigh in on the complexities of resistant hypertension treatments and potassium management in heart failure. A pivotal study reveals interesting insights on the health implications of butter versus plant-based oils for mortality. The podcast also critiques nutritional studies, identifying statistical flaws and misleading conclusions. Additionally, there's exciting news about a promising vitamin D trial that shows benefits for multiple sclerosis patients, emphasizing the need for rigorous research in dietary impacts.

The discussion centers on asymptomatic aortic stenosis and the debate over when to act. Insights into TAVR vs. SAVR highlight survival rates and treatment options. Coronary artery calcium scoring is evaluated, probing its timing and frequency in testing. Additionally, a meta-analysis examining medical therapy versus procedures for ischemic left ventricular dysfunction sheds light on evolving treatment perspectives. Young cardiologists are rethinking the role of medical therapy, hinting at future orthopedic challenges within cardiology.