This Week In Cardiology

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 Patient

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

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 - Sac

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 Se

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 Polygeni

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/

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 Rand

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.med

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:

Chat GPT, a relatively unknown therapy for HFpEF, and two fun studies on statins and secondary prevention 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. Artificial Intelligence and CHAT GPT Can ChatGPT Replace Diabetes Educators? Perhaps Not Yet https://www.medscape.com/viewarticle/990381 - Potential and Pitfalls of ChatGPT and Natural-Language Artificial Intelligence Models for Diabetes Education https://doi.org/10.2337/dc23-0197 II. Exercise and HFpEF AHA, ACC Advocate Supervised Exercise Training in HFpEF https://www.medscape.com/viewarticle/990351 - Supervised Exercise Training for Chronic Heart Failure With Preserved Ejection Fraction: A Scientific Statement From the American Heart Association and American College of Cardiology https://doi.org/10.1016/j.jacc.2023.02.012 III. Statins and Muscles Statins Don't Worsen Muscle Injury From Moderate

Diets, coronary artery calcium, statins, basic CAD knowledge, and AF ablation 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. Diet Some Diets Better Than Others for Heart Protection https://www.medscape.com/viewarticle/990305 - Comparison of seven popular structured dietary programmes and risk of mortality and major cardiovascular events in patients at increased cardiovascular risk: systematic review and network meta-analysis https://doi.org/10.1136/bmj-2022-072003 Plant-Based Diets Not Always Healthy; Quality Is Key https://www.medscape.com/viewarticle/990178 - Association of Healthful Plant-based Diet Adherence With Risk of Mortality and Major Chronic Diseases Among Adults in the UK https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2802814 II. CAC and Statins - Using the Coronary Artery Calcium Score to Guide Statin Therapy https://www

Exercise, sudden cardiac death in sports, new TAVI data, behavioral psychology, EHR doing good things, maybe, and coffee 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. Fitness and Longevity Even Small Changes in Fitness Tied to Lower Mortality Risk https://www.medscape.com/viewarticle/989906 - Changes in Cardiorespiratory Fitness and Survival in Patients With or Without Cardiovascular Disease https://www.jacc.org/doi/full/10.1016/j.jacc.2023.01.027 II. SCD in Sports Sports-Related Sudden Cardiac Arrest 'Extremely' Rare in Women https://www.medscape.com/viewarticle/990025 - Incidence of Cardiac Arrest During Sports Among Women in the European Union https://www.jacc.org/doi/full/10.1016/j.jacc.2023.01.015 - Sex-Related Differences in Sports-Related Sudden Cardiac Death Should Be Reflected in Guideline Screening Recommendations∗   https://www.jacc.or

ACC Recap No. 2: Pacing in HFpEF, Oral PCSK9 inhibitor, PAH, soft thinking on adherence, and so called metabolically healthy obese 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. Pacing in HFpEF No Exercise Boost From Pacemaker in HFpEF With Impaired HR Response: RAPID-HF https://www.medscape.com/viewarticle/989681 - Rate-Adaptive Atrial Pacing for Heart Failure With Preserved Ejection FractionThe RAPID-HF Randomized Clinical Trial https://jamanetwork.com/journals/jama/article-abstract/2802147 - Accelerated Pacing a Possible Strategy for Preserved-EF Heart Failure? https://www.medscape.com/viewarticle/987815 - Could a Breakthrough in Heart Failure With Preserved Ejection Fraction Just Take a Change of Pace? - https://www.medscape.com/viewarticle/988088 - Effect of Personalized Accelerated Pacing on Quality of Life, Physical Activity, and Atrial Fibrillatio

ACC Recap Part 1: Sports, bempedoic acid NASCARs, tricuspid regurgitation, and more on revascularization of stable CAD. 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. Sports Cardiology Even Vigorous Exercise Appears Safe for Patients With Hypertrophic Cardiomyopathy: LIVE-HCM https://www.medscape.com/viewarticle/989351 - Lifelong endurance exercise and its relation with coronary atherosclerosis https://doi.org/10.1093/eurheartj/ehad152 - Increased average longevity among the "Tour de France" cyclists https://pubmed.ncbi.nlm.nih.gov/21618162/ II. Clear Outcomes Bempedoic Acid Cuts CV Events in Statin-Intolerant Patients: CLEAR Outcomes https://www.medscape.com/viewarticle/989100 - Bempedoic Acid and Cardiovascular Outcomes in Statin-Intolerant Patients https://www.nejm.org/doi/full/10.1056/NEJMoa2215024 - Bodgan Enache Tweet https://twitter.com/

Renal denervation, AF ablation, omecamtiv mecarbil, and an ACC Preview 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. AF Ablation - Initial Findings From the National Cardiovascular Data Registry of Atrial Fibrillation Ablation Procedures https://www.jacc.org/doi/10.1016/j.jacc.2022.11.060 II. Renal Denervation Consistent BP Cut With Renal Denervation: More on RADIANCE https://www.medscape.com/viewarticle/989006 - Endovascular Ultrasound Renal Denervation to Treat HypertensionThe RADIANCE II Randomized Clinical Trial https://jamanetwork.com/journals/jama/fullarticle/2801849 - Patient-Level Pooled Analysis of Ultrasound Renal Denervation in the Sham-Controlled RADIANCE II, RADIANCE-HTN SOLO, and RADIANCE-HTN TRIO Trials https://jamanetwork.com/journals/jamacardiology/fullarticle/2802098 - Is There a Role for Renal Denervation in the Treatment of

Reporting on potential fraud in medicine, AF, stroke, a possible new cholesterol-lowering drug, and the tone of debate in medical science 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. Potential Fraud in Medicine Inside the Big Business of Clogged Arteries https://www.medscape.com/viewarticle/988448 II. AF Screening and Stroke STROKE AF at 3 Years: High AF Rate After Atherosclerotic Stroke https://www.medscape.com/viewarticle/988076 Severity and Etiology of Incident Stroke in Patients Screened for Atrial Fibrillation vs Usual Care and the Impact of Prior Stroke https://jamanetwork.com/journals/jamaneurology/fullarticle/2795865 III. Bempedoic Acid New Studies Give Bempedoic Acid a Bump as Lipid-Lowering Agent https://www.medscape.com/viewarticle/911100 - Rationale and design of the CLEAR-outcomes trial: Evaluating the effect of bempedoic acid on ca

Bradyarrhythmia during AF screening, thrombolysis in stroke, NP vs MD care, and the most biased paper this year — on LAAO — 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. Screening with ILR - Ade Adamson Tweet https://twitter.com/AdeAdamson/status/1625878856820482048?s=20 - The Rapid Rise in Cutaneous Melanoma Diagnoses https://www.nejm.org/doi/full/10.1056/NEJMsb2019760 - Loop Trial 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 II. Thrombolysis in Mild Stroke Thrombolysis Not Necessary in Mild Nondisabling Stroke: ARAMIS https://www.medscape.com/viewarticle/988381 - PRISMS Trial https://jamanetwork.com/journals/jama/fullart

Drug and non-drug therapies for HFpEF, the search for AF, and exercise as medicine 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. SGLT2 Inhibitors in HFpEF Dapagliflozin Gets Expanded Heart Failure Indication in Europe https://www.medscape.com/viewarticle/988034 Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction https://www.nejm.org/doi/full/10.1056/NEJMoa2206286 II. HFpEF and Heart Rate Accelerated Pacing a Possible Strategy for Preserved-EF Heart Failure? https://www.medscape.com/viewarticle/987815 III. Stroke and AF STROKE AF at 3 Years: High AF Rate After Atherosclerotic Stroke https://www.medscape.com/viewarticle/988076 Effect of Long-term Continuous Cardiac Monitoring vs Usual Care on Detection of Atrial Fibrillation in Patients With Stroke Attributed to Large- or Small-Vessel Disease https://jamanetwork.com

A possible major breakthrough in thinking about diastolic dysfunction and HFpEF, MRI scanning and cardiac devices, and AF and dementia 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. New Thinking in HFpEF Accelerated Pacing a Possible Strategy for Preserved-EF Heart Failure? https://www.medscape.com/viewarticle/987815 - Effect of Personalized Accelerated Pacing on Quality of Life, Physical Activity, and Atrial Fibrillation in Patients With Preclinical and Overt Heart Failure With Preserved Ejection Fraction: The myPACE Randomized Clinical Trial https://jamanetwork.com/journals/jamacardiology/fullarticle/2801001 - Effect of β-Blocker Withdrawal on Functional Capacity in Heart Failure and Preserved Ejection Fraction https://doi.org/10.1016/j.jacc.2021.08.073 - A Targeted Treatment Opportunity for HFpEF: Taking Advantage of Diastolic Tone https://www.aha

Exercise for AF, drugs have more than one effect, AI bots and the future of medicine, and the good and bad news about prognosis in HF 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. AF and Exercise Aerobic Exercise Can Reduce AF Frequency, Severity: ACTIVE-AF https://www.medscape.com/viewarticle/957322 An Exercise and Physical Activity Program in Patients With Atrial Fibrillation: The ACTIVE-AF Randomized Controlled Trial https://www.jacc.org/doi/full/10.1016/j.jacep.2022.12.002 Early Rhythm-Control Therapy in Patients with Atrial Fibrillation https://www.nejm.org/doi/full/10.1056/NEJMoa2019422 II. GLP-1 Inhibitors and Retinopathy Eye Check Important Before Starting Semaglutide for Diabetes https://www.medscape.com/viewarticle/987418 Glucagon-like peptide 1-receptor agonists and A1c: Good for the heart but less so for the eyes? https://doi.org/1