This Week In Cardiology

Approval of first-generation devices, the ticagrelor controversy, ICD longevity, the PRAGUE-25 trial (one of the most important trials of the year), and some thoughts on the end of EP as a profession 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 More Ticagrelor Controversy BMJ Investigation Finds More Concerns in Ticagrelor Trials https://www.medscape.com/viewarticle/investigation-bmj-raises-more-concerns-about-ticagrelor-2025a1000gh3 Ticagrelor PLATO study https://www.bmj.com/content/389/bmj.r1201 Ticagrelor vs Clopidogrel https://www.nejm.org/doi/full/10.1056/NEJMoa0904327 Review of the Ticagrelor Trials Evidence Base https://www.ahajournals.org/doi/10.1161/JAHA.123.031606 The Plato Trial: Do you believe in magic? https://doi.org/10.1093/eurheartj/ehp545 ONSET/OFFSET Antiplatelet Effects https://www.ahajournals.org/doi/10.1161/circulationah

FDA approves triple-drug polypill, a change of opinion, a deep dive into invasive pulmonary embolism therapies, heart disease trends, and diabetes care is on fire 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 FDA News in HTN FDA announcement https://george-medicines.com/george-medicines-announces-fda-approval-of-widaplik-telmisartan-amlodipine-and-indapamide-a-new-single-pill-combination-treatment-for-hypertension-in-adults-including-initial-treatment/ Lancet Study https://doi.org/10.1016/S0140-6736(24)01744-6 JACC study vs placebo https://www.jacc.org/doi/abs/10.1016/j.jacc.2024.08.025 JAMA Cardiology Meta-analysis https://jamanetwork.com/journals/jamacardiology/fullarticle/2804313 II Invasive PE Therapy EHJ-Open review: https://academic.oup.com/ehjopen/article/5/3/oeaf071/8156689 PEITHO Trial https://www.nejm.org/doi/10.1056/NEJMoa1302097 R

A big, deep dive into CTA and fractional flow reserve CT, and a sobering report on the new EVOQUE valve 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 Listener Feedback and Correction CRAAFT HF https://clinicaltrials.gov/study/NCT06505798 II Imaging and Behavior Change SCOT HEART 1 https://www.nejm.org/doi/full/10.1056/NEJMoa1805971 Five Reasons I Don't Believe an Imaging Test Improves Outcomes https://www.medscape.com/viewarticle/901204 SCOT HEART 2 https://www.jacc.org/doi/10.1016/j.jcmg.2024.05.016 III. More on Imaging and CT FFR Symptoms Don’t Always Indicate the Severity of Coronary Artery Disease https://www.medscape.com/viewarticle/symptoms-dont-always-indicate-severity-coronary-artery-2025a1000ge6 ADVANCE Registry Protocol https://www.journalofcardiovascularct.com/article/S1934-5925(16)30288-X/abstract Research Letter JACC CV Imaging  https:

Listener feedback on cardiac sarcoidosis, SA node ablation, surgical AF ablation, chronic kidney disease protection, and recruiting for clinical trials 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 EHJ paper Mathijssen et al https://doi.org/10.1093/eurheartj/ehaf338 Nordenswan et al https://www.ahajournals.org/doi/full/10.1161/CIRCEP.117.006145#tab-contributors II IST HR Case Reports https://doi.org/10.1016/j.hrcr.2025.05.017 Lakkireddy et al https://doi.org/10.1016/j.hrthm.2021.07.010 III Survival After Surgical AF ablation during CABG McClure et al https://doi.org/10.1093/europace/eux336 Schaffer et al https://doi.org/10.1016/j.athoracsur.2025.03.044 IV Finerenone with Empagliflozin in CKD and DM The Confidence Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2410659 V Recruiting for Important Trials and the Stature of

Listener feedback on cardiac sarcoidosis, out-of-hospital cardiac arrest, less is more when it comes to post-stent antiplatelets, lipoprotein(a), and atrial fibrillation in HFpEF 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 Listener Feedback Mathijssen https://doi.org/10.1093/eurheartj/ehaf338 Poyhonen https://doi.org/10.1161/CIRCEP.124.013239 II News in out of hospital cardiac arrest AHA Press Release https://newsroom.heart.org/news/nfl-safety-justin-reid-expands-cpr-education-for-youth-through-summer-program Chan et al https://www.ahajournals.org/doi/abs/10.1161/CIRCOUTCOMES.124.011799 III Post-Stent Antiplatelet 4D ACS trial https://eurointervention.pcronline.com/article/one-month-dual-antiplatelet-therapy-followed-by-prasugrel-monotherapy-at-a-reduced-dose-the-4d-acs-randomised-trial IV Lp(a) and the new PREVENT equation for Predicting cardiac

Listener feedback, CRT vs CSP, important clues on the ECG, beta-blocker interruption after myocardial infarction, novel approaches to LDL-C lowering, and ICD decisions in cardiac sarcoidosis 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 II CRT vs CSP – CONSYST-CRT • Trial JACC EP https://doi.org/10.1016/j.jacep.2025.03.024 III The Important QRS • Kewcharoen et al https://www.ahajournals.org/doi/10.1161/CIRCEP.125.013809 IV ABYSS Trial of BB Interruption after MI Continues to be Mis-interpreted • ABYSS Main https://www.nejm.org/doi/full/10.1056/NEJMoa2404204 • ABYSS substudy https://doi.org/10.1093/eurheartj/ehaf170 • REDUCE AMI https://www.nejm.org/doi/full/10.1056/NEJMoa2401479 V Oral PCSK9i and the PURSUIT Trial • Koren et al https://www.jacc.org/doi/10.1016/j.jacc.2025.03.499 • Editorial https://doi.org/10.1016/j.jacc.2025.03.

Listener feedback on sports “disqualification,” big digoxin news, Brugada syndrome, another positive finerenone study, and unblinded transcatheter trials 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 Listener Feedback JACC EP Paper https://www.jacc.org/doi/10.1016/j.jacep.2025.03.013 II Digoxin News DIGIT HF Baseline Characteristics paper https://doi.org/10.1002/ejhf.3679 DIGIT HF Rationale paper https://pmc.ncbi.nlm.nih.gov/articles/PMC6607489/ Dig trial https://www.nejm.org/doi/full/10.1056/NEJM199702203360801 DECISION trial https://onlinelibrary.wiley.com/doi/full/10.1002/ejhf.3428 Ziff et al BMJ meta-analysis https://www.bmj.com/content/351/bmj.h4451 III Brugada Syndrome Gomes et al https://doi.org/10.1093/europace/euaf091 IV Another Finerenone Substudy Published FINEARTS-HF trial substudy, Bhatt, A et al https://doi.org/10.1016/j.cardfail.2025

The BedMed trial of nighttime BP meds, SURMOUNT-5, Troponin URL, gene tests in patients with no disease, and guideline-directed medical therapy for 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 Timing of BP Meds – The BedMed RCT MAPEC https://doi.org/10.3109/07420528.2010.510230 Hygia https://doi.org/10.1093/eurheartj/ehz754 Turgeon et al https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.121.16501 TIME trial https://doi.org/10.1016/S0140-6736(22)01786-X BedMed https://jamanetwork.com/journals/jama/fullarticle/2833860 Time Antihypertensives Taken Doesn't Matter: New Trials https://www.medscape.com/viewarticle/time-antihypertensives-taken-doesnt-matter-new-trials-2024a1000g3z Timing of BP Dosing Doesn't Matter: BedMed and BedMed-Frail https://www.medscape.com/viewarticle/timing-blood-pressure-dosing-doesnt-matter-again-bedmed-and-2024a1000

The controversial KETO-CTA study, tough decisions in subclinical AF, and another potentially huge benefit for GLP-1 agonist drugs 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 The KETO-CTA Study JACC Advances Paper: https://www.jacc.org/doi/10.1016/j.jacadv.2025.101686 Meta-analysis https://doi.org/10.1016/j.ajcnut.2024.01.009 II Subclinical AF – Anticoagulate or Not? Anticoagulation in Subclinical AF May Offer Little Benefit https://www.medscape.com/viewarticle/anticoagulation-subclinical-af-may-offer-little-benefit-2025a1000b31 Treat AFib ‘Diagnosed’ by Smartwatch https://www.medscape.com/viewarticle/treat-afib-diagnosed-smartwatch-2025a1000avp JAMA NO paper https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2833437 NOAH https://www.nejm.org/doi/full/10.1056/NEJMoa2303062 ARTESIA https://www.nejm.org/doi/full/10.1056/NEJMoa2310234 McIntyr

The FDA approval of TAVR for asymptomatic AS, digital health, subcutaneous vs transvenous ICD, and cryptogenic stroke in young adults are discussed by John Mandrola, MD. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I  FDA announces approval for TAVR in pts with asymptomatic AS Edwards Press Release https://www.edwards.com/newsroom/news/2025-05-01-edwards-tavr-receives-fda-approval-for-patients-with-asymptomatic-severe-aortic-stenosis Transcatheter Aortic-Valve Replacement for Asymptomatic Severe Aortic Stenosis (EARLY TAVR) https://www.nejm.org/doi/full/10.1056/NEJMoa2405880 EARLY TAVR: A Positive Trial That Fails to Inform Clinical Decisions https://www.medscape.com/viewarticle/early-tavr-positive-trial-fails-inform-clinical-decisions-2024a1000kec Asymptomatic Aortic Stenosis: 'Time to Act' or Not So Fast? https://www.medscape.com/viewarticle/asymptomatic-aortic-stenosis-time-act-or-not-so-fast-2025a10005o9 II P

AI and ECGs, novel ways to treat hypertension, combined lipid-lowering therapy after myocardial infarction, PFA and silent stroke, a move toward accountability in AF ablation, and pacing issues in TTVR 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 Help with ECGs in the ED AI Shows Promise for Rapid NSTEMI Diagnosis https://www.medscape.com/viewarticle/ai-shows-promise-rapid-nstemi-diagnosis-2025a10009pw Buscher et al https://doi.org/10.1093/eurheartj/ehaf254 II A Novel way to Treat HTN A Pacemaker to Control BP Gets FDA Breakthrough Designation https://www.medscape.com/viewarticle/pacemaker-control-bp-gets-fda-breakthrough-designation-2025a10009t3 JAHA paper https://www.ahajournals.org/doi/10.1161/JAHA.120.020492 Backbeat https://clinicaltrials.gov/study/NCT06059638 III Type of PFA may matter for Silent Cerebral Lesions Paper https://www.ah

The FAME 3 trial 5-year results, TAVR at 5 years, pacers after TAVR, and mavacamten not a wonder drug 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 FAME 3 at Five Years Stents as Good as Surgery for Triple-Vessel Disease https://www.medscape.com/viewarticle/noninvasive-stents-good-surgery-triple-vessel-disease-2025a10007l4 Main trial NEJM https://www.nejm.org/doi/full/10.1056/NEJMoa2112299 Circulation 3-years https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.065770 5-year results Lancet 10.1016/S0140-6736(25)00505-7 https://linkinghub.elsevier.com/retrieve/pii/S0140673625005057 II TAVR in Low-Risk Patients at 5 years 5-Year TAVR, Surgery Outcomes Similar in Low-Risk Patients https://www.medscape.com/viewarticle/5-year-tavr-surgery-outcomes-similar-low-risk-patients-2025a10007zl EVOLUT Low-Risk 5 years https://www.jacc.org/doi/10.1016/

The TAP-IT, STRIDE, FreshUP, and SINGLE SHOT CHAMPION trials 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 TAP IT  TAP IT trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.073521 II STRIDE LANCET Ref 10.1016/S0140-6736(25)00509-4 SUMMIT HF https://www.nejm.org/doi/full/10.1056/NEJMoa2410027 III FRESH UP No Need to Restrict Fluids in Stable Heart Failure https://www.medscape.com/viewarticle/no-need-restrict-fluids-stable-heart-failure-2025a10008bu Nature (Trial) https://www.nature.com/articles/s41591-025-03628-4 SODIUM HF https://pubmed.ncbi.nlm.nih.gov/35381194/ IV PFA for AF ablation SINGLE SHOT CHAMPION https://www.nejm.org/doi/full/10.1056/NEJMoa2502280 ADVENT https://www.nejm.org/doi/full/10.1056/NEJMoa2307291 Foy et al https://pmc.ncbi.nlm.nih.gov/articles/PMC11852674/ MANIFEST REDO Study https://doi.org/10.1093/europace/euaf012 You m

Trials from the 2025 American College of Cardiology scientific sessions, including the WARRIOR, PROTECT TAVI, DAPATAVI, and SOUL are reviewed by John Mandrola, MD This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I Thank you Comments II WARRIOR Women’s IschemiA TRial to Reduce Events In Non-ObstRuctive CAD Keep Fighting INOCA After Neutral WARRIOR Trial https://www.medscape.com/viewarticle/keep-fighting-inoca-after-neutral-warrior-trial-2025a10007uf III Cerebral Embolic Protection in TAVI PROTECT TAVI https://www.nejm.org/doi/full/10.1056/NEJMoa2415120 PROTECTED TAVR https://www.nejm.org/doi/full/10.1056/NEJMoa2204961 Instrumental Variables in Randomized Trials https://evidence.nejm.org/doi/10.1056/EVIDctw2400204 IV  DAPATAVI SGLT2 Inhibitors Progressing to New Standard After TAVI https://www.medscape.com/viewarticle/sglt2-inhibitors-progressing-new-standard-after-tavi-2025a100081y Dapagliflozin in Patients Under

Stopping oral anticoagulation after AF ablation, the core problem with paradoxes like the smoker’s paradox, chronic total occlusion PCI, and an ACC/EHRA preview 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 Oral Anticoagulation after Successful AF Ablation Iwawakie et al https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2831851 OCEAN protocol paper https://doi.org/10.1016/j.ahj.2017.12.007 II Smoker’s Paradox Presch et al https://www.jacc.org/doi/10.1016/j.jcin.2024.12.028 Gupta et al https://doi.org/10.1161/JAHA.116.003370 III CTO PCI Main sub-analysis paper Bangalore et al https://doi.org/10.1016/j.jacc.2025.01.029 DECISION CTO https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.031313 Main EURO CTO trial https://doi.org/10.1093/eurheartj/ehy220 3-year MACE of EURO CTO https://eurointervention.pcronline.com/article/three-year-outc

A large trial in cardiac pacing finally published, PVCs and cardiomyopathy, cannabis, CV risk and the danger of observational studies, and the tale of two disparate statin trials 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 BioPace Trial Trial manuscript https://doi.org/10.1093/europace/euaf029 II Another Belief Challenged in EP this week—PVCs and CM ‘ UC Paper https://doi.org/10.1016/j.jacep.2025.01.004 JACC Review https://doi.org/10.1016/j.jacc.2024.03.416 Lee et al https://heart.bmj.com/content/105/18/1408 III Cannabis and CV Risk Cannabis and MACE in JACC Advances: https://www.jacc.org/doi/10.1016/j.jacadv.2025.101698 Zeraatkar –Grilling the data https://doi.org/10.1016/j.jclinepi.2024.111278 PLOS-1 10.1371/journal.pone.0199705 IV Cardio-oncology Jacc Onc Substdy https://www.jacc.org/doi/10.1016/j.jaccao.2024.11.008 Editorial https://w

Listener feedback, resistant hypertension, K-binders for MRA use in heart failure, nutritional epidemiology, and a positive study for vitamin D 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 Califf editorial https://www.jacc.org/doi/10.1016/j.jaccas.2020.01.003 II Resistant HTN Positive Topline Results for Lorundrostat in Hypertension https://www.medscape.com/viewarticle/positive-topline-results-lorundrostat-hypertension-2025a100062e III K-Binding REALIZE K Trial https://doi.org/10.1016/j.jacc.2024.11.014 Packer Editorial https://doi.org/10.1016/j.jacc.2025.01.011 Diamond Trial EHJ https://doi.org/10.1093/eurheartj/ehac401 REALIZE K Commentary https://www.medscape.com/viewarticle/realize-k-new-potassium-binder-help-keep-spiro-board-2024a1000m2c IV Butter vs Plant-based Oils and Mortality JAMA-IM Study https://jamanetwork.c

Listener feedback on asymptomatic aortic stenosis (AS), transcatheter aortic valve replacement (TAVR) vs surgical aortic valve replacement (SAVR), coronary artery calcium (CAC), and revascularization for patients with ischemic LV dysfunction are discussed by John Mandrola, MD, in today'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 Aortic Valve Intervention for Asymptomatic AS Asymptomatic Aortic Stenosis: “Time to Act” or Not So Fast? https://www.medscape.com/viewarticle/asymptomatic-aortic-stenosis-time-act-or-not-so-fast-2025a10005o9 EARLY TAVR: A Positive Trial That Fails to Inform Clinical Decisions https://www.medscape.com/viewarticle/early-tavr-positive-trial-fails-inform-clinical-decisions-2024a1000kec Reddy et al: https://doi.org/10.1016/j.jacc.2024.12.031 Wallach editorial https://doi.org/10.1016/j.jacc.2025.01.020 Guerrero https://www.tctmd.com/slide/tavr-young-patients-current-treatment-pa

The treatment of asymptomatic aortic stenosis, the move to composite endpoints in trials, IFR vs FFR and high-frequency low tidal volume ventilation for AF ablation are the topics John Mandrola, MD, discusses in today'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 Aortic valve intervention for Asymptomatic AS Lindman editorial https://jamanetwork.com/journals/jamacardiology/fullarticle/2829881 Trends https://pmc.ncbi.nlm.nih.gov/articles/PMC11308430/ Podcast EARLY TAVR Nov 8, 2024 This Week in Cardiology Podcast https://www.medscape.com/viewarticle/1001865 Faith Healing and Subtraction Anxiety https://www.ahajournals.org/doi/10.1161/circoutcomes.118.004665 Early TAVR trial https://www.nejm.org/doi/10.1056/NEJMoa2405880 EVOLVED https://jamanetwork.com/journals/jama/fullarticle/2825540 AVATAR https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057639 II Trial Endpoints Shepshelovich https://jaman

Blanking period after AF ablation, periprocedural MI after PCI in non-STEMI, predicting AF after ischemic stroke, and the proper standards for mitral valve repair in primary mitral regurgitation are the topics John Mandrola, MD, discusses in today’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 blanking period CIRCA DOSE Research letter https://www.ahajournals.org/doi/10.1161/CIRCEP.124.013232 Circa-Dose https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.119.042622 COMPARE CRYO  https://doi.org/10.1016/j.jacep.2024.03.021 Mohanty et al  10.1016/j.hrthm.2024.08.011 Ruzieh, Foy, Mandrola Patients’ Lives Don’t Pause for Blanking Periods https://doi.org/10.1016/j.ahjo.2024.100497 II Periprocedural MI and Future events Circulation paper https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.070729 III AI to detect AF related stroke eClinical Medicine Paper  https://www.thelancet.com/journals/ec