This Week in Cardiology

AF screening, BNP, a new SGLT2 inhibitor, a sky-is-blue study, and the UK Mini Mitral surgical trial are discussed 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 AF Screening - Effects of Atrial Fibrillation Screening According to N-Terminal Pro-B-Type Natriuretic Peptide: A Secondary Analysis of the Randomized LOOP Study https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.064361 - 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 - Natural History of Subclinical Atrial Fibrillation Detected by Implanted Loop Recorders https://www.jacc.org/doi/full/10.1016/j.jacc.2019.09.050 - Prevalence and Prognostic Significance of Bradyarrhythmias in Patients Screened for Atrial Fibrillation vs Usual Care https://jamanetwork.com/journals/jamacardiology/fullarticle/2801362 - Stepwise mass screening for atrial fibrillation using N-terminal pro b-type natriuretic peptide: the STROKESTOP II study design https://doi.org/10.1093/europace/euw319 - Current misconception 3: that subgroup-specific trial mortality results often provide a good basis for individualising patient care https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068511/ II Frailty and GDMT of HFrEF Frailty Linked to Lower Use of Guideline Treatments in HFrEF https://www.medscape.com/viewarticle/993218 - Physical Frailty and Use of Guideline‐Recommended Drugs in Patients With Heart Failure and Reduced Ejection Fraction https://www.ahajournals.org/doi/10.1161/JAHA.122.026844 III Sotagliflozin FDA Approves New Drug, Sotagliflozin, for Heart Failure https://www.medscape.com/viewarticle/992518 - Sotagliflozin in Patients with Diabetes and Chronic Kidney Disease https://www.nejm.org/doi/full/10.1056/NEJMoa2030186 - Sotagliflozin in Patients with Diabetes and Recent Worsening Heart Failure https://www.nejm.org/doi/full/10.1056/NEJMoa2030183 IV Mini-Mitral Support for Minimally Invasive Mitral Valve Repair: Mini Mitral Published https://www.medscape.com/viewarticle/993191 - Minithoracotomy vs Conventional Sternotomy for Mitral Valve Repair https://jamanetwork.com/journals/jama/article-abstract/2805908 You may also like: 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 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: news@medscape.net

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 You may also like: 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 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 news@medscape.net

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 You may also like: 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 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: news@medscape.net

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 You may also like: 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 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: news@medscape.net

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 You may also like: 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 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 news@medscape.net

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 You may also like: 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 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 news@medscape.net

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 You may also like: 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 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: news@medscape.net

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 You may also like: 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 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: news@medscape.net

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 You may also like: 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 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: news@medscape.net

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 You may also like: 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 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: news@medscape.net