This Week in Cardiology

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 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

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 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

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 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 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 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

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 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

Dual antiplatelet therapy after PCI, statin side effects, nightshift work and AF, and a cautionary note regarding therapeutic enthusiasm in HF care 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 - COVID - Alaska Sets Record for Daily COVID Cases https://www.medscape.com/viewarticle/958999 II - MASTER DAPT - MASTER DAPT: 1 Month DAPT Enough After High-Bleeding-Risk PCI https://www.medscape.com/viewarticle/957463 - Antiplatelets and Anticoagulation Post-PCI: More on MASTER DAPT https://www.medscape.com/viewarticle/958002 - Dual Antiplatelet Therapy after PCI in Patients at High Bleeding Risk https://www.nejm.org/doi/full/10.1056/NEJMoa2108749 - Abbreviated Antiplatelet Therapy in Patients at High Bleeding Risk With or Without Oral Anticoagulant Therapy After Coronary Stenting: An Open-Label, Randomized, Controlled Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.056680 III - Statins and Side Effects - Most Muscle Pain on Statins Not a Drug Effect: SAMSON in Print https://www.medscape.com/viewarticle/958877 - Side Effect Patterns in a Crossover Trial of Statin, Placebo, and No Treatment https://doi.org/10.1016/j.jacc.2021.07.022 IV - Nightshift Work and AF - Regular Nightshift Work Linked to Atrial Fibrillation, CHD https://www.medscape.com/viewarticle/959346?src= - Long-term night shift work is associated with the risk of atrial fibrillation and coronary heart disease https://doi.org/10.1093/eurheartj/ehab505 V - Enthusiasm for HF Therapy - Empagliflozin's HFpEF Efficacy Catalyzes Redefinition of HF https://www.medscape.com/viewarticle/959249 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

Cardiac arrest care, finerenone, carotids, meds post TAVI: less is more and the new may not be as grand as the tried and true. John Mandrola, MD, provides a third ESC review. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I - Cardiac Arrest Care - Angiography Can Wait for Cardiac Arrest Without ST-Elevation https://www.medscape.com/viewarticle/957471 - Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation https://www.nejm.org/doi/full/10.1056/NEJMoa2101909 - Coronary Angiography after Cardiac Arrest without ST-Segment Elevation https://www.nejm.org/doi/full/10.1056/NEJMoa1816897 II - Finerenone - FIDELITY: Finerenone Cuts CV Risk in T2D Across CKD Spectrum https://www.medscape.com/viewarticle/957470 - Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes https://www.nejm.org/doi/full/10.1056/NEJMoa2110956 - Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes https://www.nejm.org/doi/full/10.1056/NEJMoa2025845 III - Carotid Intervention - ACST-2: Carotid Stenting, Surgery on Par in Asymptomatic Patients https://www.medscape.com/viewarticle/957474 - Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy https://doi.org/10.1016/S0140-6736(21)01910-3 IV - Post TAVI DOAC - 'Less Is More' for Edoxaban in Post-TAVI Anticoagulation: ENVISAGE-TAVI AF https://www.medscape.com/viewarticle/957466 - Edoxaban versus Vitamin K Antagonist for Atrial Fibrillation after TAVR https://www.nejm.org/doi/full/10.1056/NEJMoa2111016 - ATLANTIS Hints at How to Choose Post-TAVR Antithrombotics https://www.medscape.com/viewarticle/951234 - A Controlled Trial of Rivaroxaban after Transcatheter Aortic-Valve Replacement https://www.nejm.org/doi/full/10.1056/NEJMoa1911425 Features: - What Are the Implications of ACST-2 for Patients With Asymptomatic Carotid Stenosis? https://www.medscape.com/viewarticle/957502 - Top 5 Studies From ESC 2021 https://www.medscape.com/viewarticle/958598 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

ESC Wrap-up Part II: EMPEROR-Preserved, and the STEP, Guide-HF, and IAMI trials, 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 - HFpEF - EMPEROR-Preserved: Empagliflozin Scores HFpEF Breakthrough https://www.medscape.com/viewarticle/957405 - Empagliflozin in Heart Failure with a Preserved Ejection Fraction https://www.nejm.org/doi/full/10.1056/NEJMoa2107038 II - BP Targets - STEP: Lowering Blood Pressure Below 130 mm Hg Shows CV Benefit https://www.medscape.com/viewarticle/957566 - Trial of Intensive Blood-Pressure Control in Older Patients with Hypertension https://www.nejm.org/doi/full/10.1056/NEJMoa2111437 III- PA Catheter Monitoring - GUIDE-HF: CardioMEMS-Guided Meds Fall Short in Mild to Moderate Heart Failure https://www.medscape.com/viewarticle/957390 - Haemodynamic-guided management of heart failure (GUIDE-HF): a randomised controlled trial https://doi.org/10.1016/S0140-6736(21)01754-2 - Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial https://doi.org/10.1016/S0140-6736(11)60101-3 IV - Influenza Vaccine - Seasonal Flu Vax Cuts Post-MI Mortality in IAMI Trial https://www.medscape.com/viewarticle/957575 - Influenza Vaccination after Myocardial Infarction: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial https://doi.org/10.1161/CIRCULATIONAHA.121.057042 - Stopping randomized trials early for benefit and estimation of treatment effects: systematic review and meta-regression analysis https://pubmed.ncbi.nlm.nih.gov/20332404/ 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

EMPEROR-Preserved, the LOOP study, ablate-and-pace for AF, and salt substitute and stroke: John Mandrola, MD provides a first of two ESC reviews. To read a partial transcript or to comment, visit: https://www.medscape.com/twic 1 - HFpEF - EMPEROR-Preserved: Empagliflozin Scores HFpEF Breakthrough https://www.medscape.com/viewarticle/957405 - Empagliflozin in Heart Failure with a Preserved Ejection Fraction https://www.nejm.org/doi/full/10.1056/NEJMoa2107038 - Empagliflozin and Major Renal Outcomes in Heart Failure https://www.nejm.org/doi/full/10.1056/NEJMc2112411 - Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure https://www.nejm.org/doi/full/10.1056/NEJMoa2022190 2 - AF Screening - LOOP Trial Undercuts Value of Long-term Continuous ECG Screening for Atrial Fibrillation https://www.medscape.com/viewarticle/957473 - Implantable loop recorder detection of atrial fibrillation to prevent stroke (The LOOP Study): a randomised controlled trial https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01698-6/fulltext - Subclinical Atrial Fibrillation and the Risk of Stroke https://www.nejm.org/doi/full/10.1056/nejmoa1105575 3 - Ablate and Pace for AF and HF - APAF-CRT: 'Ablate and Pace' Cuts Mortality in Narrow-QRS HF, Permanent AF https://www.medscape.com/viewarticle/957467 - A randomized controlled trial of atrioventricular junction ablation and cardiac resynchronization therapy in patients with permanent atrial fibrillation and narrow QRS https://academic.oup.com/eurheartj/article/39/45/3999/5078460 - AV junction ablation and cardiac resynchronization for patients with permanent atrial fibrillation and narrow QRS: the APAF-CRT mortality trial https://doi.org/10.1093/eurheartj/ehab569 4 - Salt Substitute and Stroke - Salt Substitute Shows Clear Reduction in Stroke, CV Events, and Death https://www.medscape.com/viewarticle/957472 - Effect of Salt Substitution on Cardiovascular Events and Death https://www.nejm.org/doi/full/10.1056/NEJMoa2105675 Features: - Incremental, Not Monumental, Win for Empagliflozin in Heart Failure With Preserved Ejection Fraction https://www.medscape.com/viewarticle/957465 - Empagliflozin in HFpEF: Putting EMPEROR-Preserved in Context https://www.medscape.com/viewarticle/957388 - Lessons on AF Screening From the LOOP Study https://www.medscape.com/viewarticle/957512 - Ablate-and-Pace Delivers a Huge Win for Those Sick With AF https://www.medscape.com/viewarticle/958033 - Will the Positive Findings From the SSaSS Trial on Salt Substitution Silence the Salt Skeptics? https://www.medscape.com/viewarticle/957510 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

COVID-19, NEJM vaccine safety paper, full-dose anticoagulation in COVID-19, AF and Exercise, and early results on EMPEROR-Preserved are the studies John Mandrola, MD, discusses in this week's podcast. https://www.medscape.com/twic 1 - COVID-19 - Heart Inflammation More Common After COVID Than After Vaccination https://www.medscape.com/viewarticle/957343 - Safety of the BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Setting https://www.nejm.org/doi/full/10.1056/NEJMoa2110475 2 - Full dose AC in COVID-19 - Heparin's COVID-19 Benefit Greatest in Moderately Ill Patients https://www.medscape.com/viewarticle/956630 - Therapeutic Anticoagulation with Heparin in Noncritically Ill Patients with Covid-19 https://www.nejm.org/doi/full/10.1056/NEJMoa2105911 - Therapeutic Anticoagulation with Heparin in Critically Ill Patients with Covid-19 https://www.nejm.org/doi/full/10.1056/NEJMoa2103417 3 - AF and Exercise - Aerobic Exercise Can Reduce AF Frequency, Severity: ACTIVE-AF https://www.medscape.com/viewarticle/957322 4 - EMPEROR AF - EMPEROR-Preserved: Empagliflozin Scores HFpEF Breakthrough https://www.medscape.com/viewarticle/957405 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