This Week In Cardiology

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)3

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 E

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/NEJMoa202584

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

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/

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 -

COVID-19, Simpson’s Paradox, LAA appendage closure, multimorbidity, and an ESC preview are the topics John Mandrola, MD discusses in today’s podcast. https://www.medscape.com/twic 1 - COVID-19 - Lacking Beds, Hospitals Ship COVID-19 Patients to Other States https://www.medscape.com/viewarticle/956917 - Efficacy and Safety of Same-Day Discharge for Atrial Fibrillation Ablation https://pubmed.ncbi.nlm.nih.gov/32553209/ 2 - Simpson’s Paradox - Israeli data: How can efficacy vs. severe disease be strong when 60% of hospitalized are vaccinated? https://www.covid-datascience.com/post/israeli-data-how-can-efficacy-vs-severe-disease-be-strong-when-60-of-hospitalized-are-vaccinated - Simpson’s Paradox and Interpreting Data https://towardsdatascience.com/simpsons-paradox-and-interpreting-data-6a0443516765 - How SIMPSON'S PARADOX explains weird COVID19 statistics https://www.youtube.com/watch?v=t-Ci3FosqZs 3 - Left Atrial Appendage Closure - FDA Approves Abbott's Amplatzer Amulet for Atrial Fibrillation https://www.meds

COVID-19, vaccine-induced myocarditis, Watchman complications, SGLT2 inhibitors, and cardiogenic shock are the topics John Mandrola, MD, discusses in this week’s podcast. https://www.medscape.com/twic 1 - COVID-19 - 18 Months Later, the COVID-19 Memories Won’t Go Away https://www.medscape.com/viewarticle/956335 2 - Vaccine-Myocarditis - Myocarditis in Adolescents After COVID-19 Vaccine Typically Mild https://www.medscape.com/viewarticle/956359 - Association of Myocarditis With BNT162b2 Messenger RNA COVID-19 Vaccine in a Case Series of Children https://jamanetwork.com/journals/jamacardiology/fullarticle/2783052 3 - Watchman - 'Striking' Difference in Adverse Events in Women With Watchman LAAO https://www.medscape.com/viewarticle/956593 - Sex Differences in Procedural Outcomes Among Patients Undergoing Left Atrial Appendage Occlusion https://jamanetwork.com/journals/jamacardiology/fullarticle/2782726 4 - SGLT2 Inhibitors - EU Approves Dapagliflozin for Kidney Disease, Regardless of Diabetes https://www.medscap

The COVID-19 surge, vaccine-induced myocarditis, Heart Rhythm news, the state of medical evidence, and doctors in unions are discussed by John Mandrola, MD, in this week's podcast. https://www.medscape.com/twic 1- COVID-19 Texas COVID-19 Wave Is Climbing More Steeply Than Past Waves https://www.medscape.com/viewarticle/956104 White House Says US Can Provide COVID-19 Boosters if Needed https://www.medscape.com/viewarticle/956016 2- Vaccine-Myocarditis Myocarditis Tied to COVID-19 Shots More Common Than Reported? https://www.medscape.com/viewarticle/956089 3- Heart Rhythm News The Three Big Stories from the Heart Rhythm Society's 2021 Meeting https://www.medscape.com/viewarticle/955989 4- Medical Evidence Despite Retraction, Study Using Fraudulent Surgisphere Data Still Cited https://www.medscape.com/viewarticle/956090 Ongoing Citations of a Retracted Study Involving Cardiovascular Disease, Drug Therapy, and Mortality in COVID-19 https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2782460 5-

Two studies on alcohol and AF incidence and an important paper on stable CAD are the topics John Mandrola discusses in this week’s podcast. https://www.medscape.com/twic 1 - COVID-19 New Vaccinations Increasing in COVID Hot Spots https://www.medscape.com/viewarticle/955680 2 - Alcohol - Moderate Drinking Protective After MI, Stroke in 'Flawed' Study https://www.medscape.com/viewarticle/955474 - Risk Thresholds for Total and Beverage-Specific Alcohol Consumption and Incident Atrial Fibrillation https://doi.org/10.1016/j.jacep.2021.05.013 - Can a Drink a Day Keep the Electrophysiologist Away? https://doi.org/10.1016/j.jacep.2021.06.010 - Association of alcohol consumption with morbidity and mortality in patients with cardiovascular disease: original data and meta-analysis of 48,423 men and women https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-021-02040-2 3 - Coronary Artery Disease - CLARIFY Confirms Meds, Watchful Waiting in Angina, Stable CAD https://www.medscape.com/viewarticle/955313 - Interna

COVID-19 messaging, coffee, CTA and statins, and Watchman problems are the topics discussed by John Mandrola, MD, in this week’s podcast. https://www.medscape.com/twic 1- COVID-19: - COVID-19 Cases in US Triple Over 2 Weeks Amid Misinformation https://www.medscape.com/viewarticle/955269 - Effectiveness of Covid-19 Vaccines against the B.1.617.2 (Delta) Variant https://www.nejm.org/doi/full/10.1056/NEJMoa2108891 - What Really Happened With that Weird Yankees COVID Outbreak https://nymag.com/intelligencer/2021/05/what-really-happened-with-that-weird-yankees-covid-outbreak.html 2- Coffee: - Coffee Not Linked to Increased Arrhythmia Risk in New Study https://www.medscape.com/viewarticle/954992 - Coffee Consumption and Incident Tachyarrhythmias https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2782015 - Another Cup of Coffee Without an Arrhythmia, Please https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2782021 3- CTA and Statins: - CTA May Guide Primary Prevention Statins in Nonobs

COVID-19, Ivermectin, a dissolving pacer, clinician well-being, and finerenone are discussed this week. 1 COVID-19 US 'Losing Time' Against Delta Variant, NIH Chief Says https://www.medscape.com/viewarticle/954882 Ivermectin for COVID: How Do We Know What to Believe? https://www.medscape.com/viewarticle/954681 2 Dissolving Pacemaker Dissolving Pacemaker Impressive in Early Research https://www.medscape.com/viewarticle/954774 3 Clinician Well-being Global Heart Organizations Unite to Promote Clinician Well-Being https://www.medscape.com/viewarticle/954803 Clinician Well-Being: Addressing Global Needs for Improvements in the Health Care Field A Joint Opinion From the American College of Cardiology, American Heart Association, European Society of Cardiology, and the World Heart Federation https://www.jacc.org/toc/jacc/0/0 From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider https://www.annfammed.org/content/12/6/573.full Bullying in Academic Medicine Rife, Underreported https://www.med

COVID-19, mRNA-vaccine-induced myocarditis, type 2 diabetes in kids, optimal medical therapy for CAD, and Alcohol are the topics discussed by John Mandrola, MD, in this week’s podcast. https://www.medscape.com/twic 1-COVID - Fast-spreading Delta Variant, Vaccination Rates, Reintroduction of Indoor Masks: COVID-19 Global Weekly Highlights https://www.medscape.com/viewarticle/940446 - Health care 'breaking point': Cox confirms some Springfield COVID-19 patients transferred to St. Louis, Kansas City https://www.news-leader.com/story/news/local/ozarks/2021/06/29/springfield-covid-delta-variant-missouri-hospitals-cox-some-patients-transferred-vaccines/7787970002/ 2- COVID Vaccine-Induced Myocarditis - New Details of Myocarditis Linked to COVID Vaccines https://www.medscape.com/viewarticle/954061 - Myocarditis Following Immunization With mRNA COVID-19 Vaccines in Members of the US Military https://jamanetwork.com/journals/jamacardiology/fullarticle/2781601 - Patients With Acute Myocarditis Following mRNA COVID-19 V

Myocarditis and the COVID vaccine, lipid lowering guidelines, financial toxicity, and deprescribing statins are the topics covered by John Mandrola, MD, in this week’s podcast. https://www.medscape.com/twic 1 – COVID Varied COVID Vaccination Rates May Lead to 'Two Americas' https://www.medscape.com/viewarticle/953658 Nearly All COVID Deaths in US Are Now Among Unvaccinated https://www.medscape.com/viewarticle/953703 2 - COVID Vaccine Myocarditis FDA to Add Myocarditis Warning to mRNA COVID-19 Vaccines https://www.medscape.com/viewarticle/953647 3 – Lipid Guidelines Clinicians Slow to Implement Lipid-Lowering Guidelines: GOULD Registry https://www.medscape.com/viewarticle/953688 - Use of Lipid-Lowering Therapies Over 2 Years in GOULD, a Registry of Patients With Atherosclerotic Cardiovascular Disease in the US https://jamanetwork.com/journals/jamacardiology/fullarticle/2780713 4 - Financial Toxicity Financial Burden Higher With CVD Than Cancer https://www.medscape.com/viewarticle/953687 - Atherosclerotic Cardi

COVID vaccine myocarditis, Christian Eriksen and sudden cardiac death, therapeutic hypothermia, and revascularization of stable CAD are the topics John Mandrola, MD, discusses in this week’s podcast. https://www.medscape.com/twic 1- COVID-Vaccine-Myocarditis AHA: Don't Delay COVID Shot While CDC Reviews Myocarditis Cases https://www.medscape.com/viewarticle/953233 Myocarditis after BNT162b2 and mRNA-1273 Vaccination https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.055913 2- Christian Eriksen Christian Eriksen: un survivant qui doit nous inspirer https://francais.medscape.com/voirarticle/3607279 Danish Soccer Player Suffered Cardiac Arrest During Euro Match https://www.webmd.com/news/20210614/danish-soccer-player-suffered-cardiac-arrest-during-euro-match Point/Counterpoint on Halting Implantation of the Subcutaneous ICD https://www.jacc.org/doi/10.1016/j.jacep.2021.03.006 3- Therapeutic Hypothermia Trial Supports Therapeutic Hypothermia in Nonshockable Cardiac Arrest https://www.medscape.com/viewart

COVID vaccine myocarditis, AF post-stroke, semaglutide, and iPhones and cardiac devices are the topics John Mandrola, MD, discusses in this week’s podcast. https://www.medscape.com/twic COVID-Vaccine-Myocarditis More Evidence Links COVID Vaccines to Rare Cases of Myocarditis in Youth https://www.medscape.com/viewarticle/952905 - Symptomatic Acute Myocarditis in Seven Adolescents Following the Pfizer-BioNTech COVID-19 Vaccination https://pediatrics.aappublications.org/content/early/2021/06/04/peds.2021-052478 - At Least 18 Cases of Apparent Heart Problems in Young People in CT After COVID-19 Vaccine https://www.nbcconnecticut.com/news/coronavirus/connecticut-confirms-at-least-18-cases-of-apparent-heart-problems-in-young-people-after-covid-19-vaccination/2494534/ - C.D.C. Is Investigating a Heart Problem in a Few Young Vaccine Recipients https://www.nytimes.com/2021/05/22/health/cdc-heart-teens-vaccination.html - EMA Statement: https://www.ema.europa.eu/en/news/meeting-highlights-pharmacovigilance-risk-assessme

John Mandrola, MD, presents an ACC 2021 recap. https://www.medscape.com/twic ACC 2021 Reveiw I -- Left Atrial Appendage Closure LAAOS III: Surgical LAA Closure Cuts AF Stroke Risk by One Third https://www.medscape.com/viewarticle/951232 - Left Atrial Appendage Occlusion during Cardiac Surgery to Prevent Stroke https://www.nejm.org/doi/full/10.1056/NEJMoa2101897 Watchman Registry: 1-Year Stroke Estimates Reassuringly Low https://www.medscape.com/viewarticle/951235 II - Angiotensin-Neprilysin Inhibition PARADISE-MI: Sacubitril/Valsartan Can't Beat Ramipril in Patients With Acute MI https://www.medscape.com/viewarticle/951236 Life Trial Rationale Paper: https://doi.org/10.1016/j.jchf.2020.05.005 III - Renal Denervation Ultrasound Renal Denervation Drops BP in Patients on Triple Therapy https://www.medscape.com/viewarticle/951248 IV -- Clopidogrel vs ASA post Stent HOST-EXAM: Clopidogrel Beats Aspirin as Monotherapy After Stenting https://www.medscape.com/viewarticle/951294 - Aspirin versus clopidogrel for chroni

The upcoming ACC meeting, polypharmacy, finerenone, and ethics and professionalism are the topics covered by John Mandrola, MD, in this week’s podcast. https://www.medscape.com/twic ACC Preview: ACC.21 Looks to Repeat Success Despite Pandemic Headwinds https://www.medscape.com/viewarticle/950836 - Level and Prevalence of Spin in Published Cardiovascular Randomized Clinical Trial Reports With Statistically Nonsignificant Primary Outcomes: A Systematic Review https://pubmed.ncbi.nlm.nih.gov/31050775/ Polypharmacy Hypertension Worsened by Commonly Used Prescription Meds https://www.medscape.com/viewarticle/950724 Finerenone Finerenone Scores Second Pivotal-Trial Success in Diabetic Kidney Disease https://www.medscape.com/viewarticle/951027 - Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes https://www.nejm.org/doi/full/10.1056/NEJMoa2025845 Ethics and Professionalism AHA/ACC Guidance on Ethics, Professionalism in Cardiovascular Care https://www.medscape.com/viewarticle/951018 - 2020 Ame

COVID-19 and BMI, TAVR vs SAVR, subcutaneous ICD, SGLT2 inhibitors, and physician-Moms are the topics John Mandrola, MD, discusses in this week’s podcast. https://www.medscape.com/twic COVID-19 COVID-19 Severity Starts in Normal BMI Range, Especially in Young https://www.medscape.com/viewarticle/950568 - Associations between body-mass index and COVID-19 severity in 6·9 million people in England: a prospective, community-based, cohort study https://www.thelancet.com/journals/landia/article/PIIS2213-8587(21)00089-9/fulltext TAVR vs SAVR VARC-3 Sets Goalpost for Future Aortic Valve Trials https://www.medscape.com/viewarticle/950012 - Valve Academic Research Consortium 3: updated endpoint definitions for aortic valve clinical research https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehaa799/6237954 TAVR Availability Patchy Growth of TAVR Programs Leaves Poorer Communities Behind https://www.medscape.com/viewarticle/950316 S-ICD Trade-offs Between Subcutaneous, Transvenous ICDs on Display i

COVID-19 and global vaccinations, AF screening, conduction-system pacing, FDA ban on menthol tobacco, and a heartfelt essay are the topics John Mandrola, MD, discusses in this week’s podcast. https://www.medscape.com/twic COVID-19 Indians Rush for COVID-19 Vaccines as Death Toll Passes 200,000 https://www.medscape.com/viewarticle/950095 - Vaccine Breakthrough Infections with SARS-CoV-2 Variants https://www.nejm.org/doi/full/10.1056/NEJMoa2105000 AF Screening: Modest Clinical Gain for AF Screening of Asymptomatic Elderly: STROKESTOP https://www.medscape.com/viewarticle/949950 - Mass Screening for Untreated Atrial Fibrillation The STROKESTOP Study https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.114.014343 - Does screening for disease save lives in asymptomatic adults? Systematic review of meta-analyses and randomized trials https://pubmed.ncbi.nlm.nih.gov/25596211/ - Toward evidence-based medical statistics. 2: The Bayes factor https://pubmed.ncbi.nlm.nih.gov/10383350 Conduction System Pacing Keeping Pac