This Week In Cardiology

AF ablation vs rate control in HF, TAVI vs SAVR, atherosclerosis, and surrogate endpoints in observational studies 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 ablation vs Rate Control RAFT-AF, Despite Itself, Hints at Advantage for Ablation Rhythm Control in Heart Failure With AF https://www.medscape.com/viewarticle/951326 • Randomized Ablation-Based Rhythm-Control Versus Rate-Control Trial in Patients with Heart Failure and Atrial Fibrillation: Results from the RAFT-AF trial https://www.ahajournals.org/doi/suppl/10.1161/CIRCULATIONAHA.121.057095 • Catheter Ablation for Atrial Fibrillation with Heart Failure https://www.nejm.org/doi/full/10.1056/nejmoa1707855 • Lenient versus Strict Rate Control in Patients with Atrial Fibrillation https://www.nejm.org/doi/full/10.1056/nejmoa1001337 II – TAVI vs SAVR Surgery Groups Push Back on VARC-3 Valve

AF screening, CTA, stroke prevention and broken observational studies, and medical writing 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 Screening - Handheld ECGs Ease A-Fib Screening in the Very Elderly https://www.medscape.com/viewarticle/969846 - Screening for Atrial Fibrillation in Older Adults at Primary Care Visits: the VITAL-AF Randomized Controlled Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057014 II - CTA - DISCHARGE: CTA Shows Safety Edge vs Cath in Intermediate-Risk Stable Chest Pain https://www.medscape.com/viewarticle/969732 - CT or Invasive Coronary Angiography in Stable Chest Pain https://www.nejm.org/doi/full/10.1056/NEJMoa2200963 III - Stroke Prevention post TAVI - Silver Lining Emerges for Embolic Protection in Post-TAVR Stroke https://www.medscape.com/viewarticle/969992 - Cerebral Embolic Protection and

An update to CardioMEMs post, ARBs and cancer, troponins, empagliflozin, and low-value care 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 – Invasive Monitoring for HF - FDA Expands Eligibility for CardioMEMS Heart Failure System https://www.medscape.com/viewarticle/969004 - Haemodynamic-guided management of heart failure (GUIDE-HF): a randomised controlled trial https://doi.org/10.1016/S0140-6736(21)01754-2 II – ARBs and Cancer - ARBs and Cancer Risk: New Meta-Analysis Raises Questions Again https://www.medscape.com/viewarticle/969510 - Risk of cancer with angiotensin-receptor blockers increases with increasing cumulative exposure: Meta-regression analysis of randomized trials https://doi.org/10.1371/journal.pone.0263461 - Marciniak Meta-analysis in FDA Medical Review 206316Orig1Orig2s000 https://rb.gy/myhlvy III – Troponins and Cardiac Surgery

FDA approval of CardioMEMS, statins, VT storm, and fish oil and AF are the topics covered 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 - Invasive Monitoring for HF - FDA Expands Eligibility for CardioMEMS Heart Failure System https://www.medscape.com/viewarticle/969004 - 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 II - Statin Use in Primary Prevention - USPSTF Tweaks Primary Prevention Statin Recommendations in New Draft Guidance https://www.medscape.com/viewarticle/968963 - Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: Preventive Medication https://www.uspreventiveservicestaskforce.org/uspstf/docu

Spinal cord stimulation to prevent post-cardiac surgery AF, statin intolerance, heart failure with preserved ejection fraction, and Vitamin D 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 Post-Cardiac Surgery AF Spinal Cord Stimulation May Cut AF After Cardiac Surgery https://www.medscape.com/viewarticle/968478 • Autonomic Neuromodulation for Atrial Fibrillation Following Cardiac Surgery: JACC Review Topic of the Week https://www.jacc.org/doi/10.1016/j.jacc.2021.12.010 • Temporary Spinal Cord Stimulation to Prevent Postcardiac Surgery Atrial Fibrillation: 30-Day Safety and Efficacy Outcomes https://www.jacc.org/doi/10.1016/j.jacc.2021.08.078 II – Statin Intolerance Statin Intolerance 'Overestimated and Overdiagnosed' https://www.medscape.com/viewarticle/968627 • Prevalence of statin intolerance: a meta-analysis https://doi.org/10.1093/eurheartj/ehac015 I

LDL equations, stroke interventions, post-PCI antiplatelets, the transitive function and network meta-analysis, and lipoprotein(a) 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 - LDL-C Equations: - Standard LDL Equations Yield Discordant Results https://www.medscape.com/viewarticle/968112 - Discordance Between Standard Equations for Determination of LDL Cholesterol in Patients With Atherosclerosis https://www.jacc.org/doi/10.1016/j.jacc.2021.11.042 - LDL-C Estimation: The Perils of Living With Imperfection https://www.jacc.org/doi/10.1016/j.jacc.2021.12.005 II - Acute Stroke Care - Endovascular Therapy Benefits Stroke With Larger Ischemic Core? https://www.medscape.com/viewarticle/968203 - Endovascular Therapy for Acute Stroke with a Large Ischemic Region https://www.nejm.org/doi/full/10.1056/NEJMoa2118191 III - Post PCI Antiplatelet Regimens - St

Interatrial shunt therapy, the power of the RCT, chronic stress, anxiety and cardiometabolic risk, and TAVR, are the topics covered 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 - Interatrial Shunt - Interatrial Shunt Falters in Preserved, Mid-Range LVEF Heart Failure: REDUCE LAP-HF 2 https://www.medscape.com/viewarticle/967792 - Atrial shunt device for heart failure with preserved and mildly reduced ejection fraction (REDUCE LAP-HF II): a randomised, multicentre, blinded, sham-controlled trial https://doi.org/10.1016/S0140-6736(22)00016-2 II - Chronic Stress - Chronic Stress Accelerates Aging: Epigenetic Evidence https://www.medscape.com/viewarticle/967828 - Psychological and biological resilience modulates the effects of stress on epigenetic aging https://www.nature.com/articles/s41398-021-01735-7 - DNA methylation GrimAge strongly predicts lifespan and healthspan ht

AF Screening, alcohol, sports-related sudden death, non-MD-led healthcare, and CPR 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 Screening - USPSTF Says Evidence Still Lacking for AF Screening in Asymptomatic Patients https://www.medscape.com/viewarticle/967275 - Screening for Atrial Fibrillation US Preventive Services Task Force Recommendation Statement https://jamanetwork.com/journals/jama/fullarticle/2788340 - Screening for Atrial Fibrillation—New Devices, Same Challenges https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2788475 - 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 II - Vaccine Induced Myocarditis - Hong Kong, US, Israeli Data Illuminate COVID Vaccine Myocarditis https://www.medscape.com/vi

Olive oil, breastfeeding and CV health, informed consent during stroke, and controversy regarding revascularization guidelines 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 – Olive Oil - Olive Oil Intake Tied to Reduced Mortality https://www.medscape.com/viewarticle/966366 - Consumption of Olive Oil and Risk of Total and Cause-Specific Mortality Among U.S. Adults https://www.jacc.org/doi/full/10.1016/j.jacc.2021.10.041 - Can Small Amounts of Olive Oil Keep the Death Away? https://www.jacc.org/doi/10.1016/j.jacc.2021.11.006 II – Breastfeeding and CV Maternal Health - Breastfeeding Linked to Lower CVD Risk in Later Life https://www.medscape.com/viewarticle/966767 - Breastfeeding Is Associated With a Reduced Maternal Cardiovascular Risk: Systematic Review and Meta‐Analysis Involving Data From 8 Studies and 1 192 700 Parous Women https://www.ahajournals.

Xeno-transplantation, weight loss drugs, DOAC coverage, vitamin D, LAAC and frailty, and recalled LVADs 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 – Xenotransplantation - Pig Heart Successfully Transplanted to Man https://www.medscape.com/viewarticle/966367 - What Does a Pig-to-Human Heart Transplant Mean for Medicine? https://www.medscape.com/viewarticle/966488 II – Weight Loss Drugs - Wegovy Tops Sibling Saxenda for Weight Loss https://www.medscape.com/viewarticle/966376 - Effect of Weekly Subcutaneous Semaglutide vs Daily Liraglutide on Body Weight in Adults With Overweight or Obesity Without Diabetes https://jamanetwork.com/journals/jama/article-abstract/2787907 III – DOAC Coverage - CVS Caremark Formulary Change Freezes Out Apixaban https://www.medscape.com/viewarticle/966588 IV – Vitamin D - More Vitamin D Not Better for Reducing Cancer or CVD Incidence https://www.medscape.com/viewarticle/966333

Causes of sudden death, inclisiran, DOAC choices, and alcohol and VT/VF are the topics 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 – Causes of Sudden Death - Cardiac Device Interrogation After Death 'Richly Informative' https://www.medscape.com/viewarticle/965730 - Postmortem Interrogation of Cardiac Implantable Electronic Devices: A 15-Year Experience https://www.jacc.org/doi/full/10.1016/j.jacep.2021.10.011 - Sudden Death in Patients With Cardiac Implantable Electronic Devices https://pubmed.ncbi.nlm.nih.gov/26098676/ - Cardiac Implantable Electronic Device Interrogation at Forensic Autopsy https://www.ahajournals.org/doi/full/10.1161/circulationaha.117.032367 II – Inclisiran - FDA Approves First-in-Class Inclisiran to Lower LDL-C https://www.medscape.com/viewarticle/965464 - ORION: Inclisiran Phase 3 Trials Published https://www.medscape.com/viewarticle/927107 - Meta-Analysis of Inclisiran for the Treatment of Hy

PFO closure, trans-mitral procedures, yoga as therapy, and a year-end-review 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 – PFO Closure - Heterogeneity of Treatment Effects in an Analysis of Pooled Individual Patient Data From Randomized Trials of Device Closure of Patent Foramen Ovale After Stroke https://jamanetwork.com/journals/jama/fullarticle/2787115 - Patent Foramen Ovale Closure—Harnessing Clinical Trial Evidence to Inform Individualized Treatment Decisions https://jamanetwork.com/journals/jama/fullarticle/2787132 - Personalized evidence based medicine: predictive approaches to heterogeneous treatment effects https://pubmed.ncbi.nlm.nih.gov/30530757/ - Lord’s Paradox by Stephen Senn https://www.linkedin.com/pulse/cause-concern-stephen-senn/ II – Trans-Mitral Procedures - Transcatheter Mitral Valve Procedures Up Tenfold Since 2014 https://www.medscape.com/viewarticle/964657 - Transcatheter Mitral Valve

AF triggers, rising BP during the pandemic, long COVID, cardiac arrest care, 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 – AF Triggers - Alcoholic Drinks Stand Out in Novel Trial Exploring AF Triggers https://www.medscape.com/viewarticle/962911 - Individualized Studies of Triggers of Paroxysmal Atrial Fibrillation https://jamanetwork.com/journals/jamacardiology/article-abstract/2786196 II – BP Increase During the Pandemic - Blood Pressure Control Worsened During COVID Pandemic https://www.medscape.com/viewarticle/964329 - Rise in Blood Pressure Observed Among US Adults During the COVID-19 Pandemic https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057075 III – DOAC after VTE - Apixaban Outmatches Rivaroxaban for VTE in Study https://www.medscape.com/viewarticle/964301 - Risk for Recurrent Venous Thromboembolism and Bleeding With Apixaban Compared With Rivaroxaban: An Analysis of R

The AMAZE trial of left atrial appendage isolation, non-statin oral lipid lowering drugs, EHR alerts, non-MD care, and obesity 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 – aMAZE Trial - No Advantage Shown for LAA Ligation as Adjunct to Pulmonary Vein Isolation https://www.medscape.com/viewarticle/962954 - Safety and Procedural Success of Left Atrial Appendage Exclusion With the Lariat Device https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2289126 - Left Atrial Appendage Isolation in Patients With Longstanding Persistent AF Undergoing Catheter Ablation: BELIEF Trial https://pubmed.ncbi.nl m.nih.gov/27788847/ II – Non-Statin Lipid Lowering - Obicetrapib: CETP Inhibitor Impresses in LDL Lowering https://www.medscape.com/viewarticle/963611 - Daily Oral PCSK9 Inhibitor Encouraging in Phase 1 Trials https://www.medscape.com/viewarticle/963550 III – EHR Alerts and Prognosis - EHR Alerts Have

In AHA 2021 Part 1, John Mandrola, MD, reports on selected sessions from the virtual American Heart Association meeting. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I - AVATAR - Early SAVR Tops Watchful Waiting in Severe, Asymptomatic Aortic Stenosis: AVATAR https://www.medscape.com/viewarticle/962904 - Aortic Valve ReplAcemenT versus Conservative Treatment in Asymptomatic SeveRe Aortic Stenosis: The AVATAR Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057639 - Early Surgery or Conservative Care for Asymptomatic Aortic Stenosis https://www.nejm.org/doi/full/10.1056/NEJMoa1912846 II - TCV Repair - Concomitant Tricuspid-Mitral Surgery Beneficial but With a Tradeoff https://www.medscape.com/viewarticle/962899 - Concomitant Tricuspid Repair in Patients with Degenerative Mitral Regurgitation https://www.nejm.org/doi/full/10.1056/NEJMoa2115961 III - PALACS - Procedure Reduces Postop AF After Cardiac Surgery: PALACS https://www.medscape.com/viewarticle/962907 -

Left atrial appendage closure vs DOACs, TAVR vs SAVR, renal denervation, and an AHA 2021 preview 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 - LAAC - PRAGUE-17: LAA Closure Holds Up Against DOACs Out to 4 Years https://www.medscape.com/viewarticle/962608 - LAAO vs DOAC: PRAGUE-17 Falls Short https://www.medscape.com/viewarticle/933641 - Left Atrial Appendage Closure versus Non-Warfarin Oral Anticoagulation in Atrial Fibrillation: 4-Year Outcomes of PRAGUE-17 https://www.jacc.org/doi/10.1016/j.jacc.2021.10.023 - Does Percutaneous Left Atrial Appendage Closure Stand the Test of Time? https://www.jacc.org/doi/10.1016/j.jacc.2021.10.022 II - SURTAVI (TAVR vs SAVR) - SURTAVI at 5 Years Reinforces TAVR but Was It Long-term Enough? https://www.medscape.com/viewarticle/962484 - Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients https://www.nejm.org/doi/full/10.1056/NEJMoa1700456 III

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 St

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 S

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 Cardiovasc

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 Preventio