Renal denervation, the obesity paradox, JACC and the FINEARTS trial of finerenone in HFpEF, a setback for a PFA system, and coffee are the topics Jon Mandrola, MD, covers this week.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. RDN

• CMS https://www.cms.gov/medicare-coverage-database/view/ncacal-tracking-sheet.aspx?ncaid=318
• Messerli https://doi.org/10.1016/j.jacc.2024.09.1244
• Filippone https://doi.org/10.1016/j.amjmed.2023.05.010

II. Finerenone

• FINEHEARTS -HF NEJM https://www.nejm.org/doi/full/10.1056/NEJMoa2407107
• FIDELIO-DKD https://www.nejm.org/doi/full/10.1056/NEJMoa2025845
• FIGARO-DKD https://www.nejm.org/doi/full/10.1056/NEJMoa2110956
• Why Have We Not Been Able to Demonstrate Reduced Mortality in Patients With HFmrEF/HFpEF? https://doi.org/10.1016/j.jacc.2024.08.033
• Regional Variation TOPCAT https://www.ahajournals.org/doi/10.1161/circulationaha.114.013255
• Time from WHF Subanalysis https://doi.org/10.1016/j.jacc.2024.09.004
• REDEFINE - https://clinicaltrials.gov/study/NCT06008197
• Health status paper https://doi.org/10.1016/j.jacc.2024.09.023
• Obesity subanalysis https://doi.org/10.1016/j.jacc.2024.10.111
• Kidney outcomes https://www.sciencedirect.com/science/article/pii/S0735109724102525
• Kidney outcomes 2 https://doi.org/10.1016/j.jacc.2024.11.020
• Kaul editorial https://doi.org/10.1016/j.jacc.2024.11.024

III. PFA Setback

J&J Halts Varipulse Field Ablation for AFib

https://www.medscape.com/viewarticle/j-j-halts-varipulse-field-ablation-afib-2025a10000j8

IV. Coffee

Stop the Coffee Studies https://www.medscape.com/viewarticle/883709

• Coffee drinking timing and mortality in US adults 

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Alcohol and cancer, GLP-1 trial representativeness, diagnosing CAD, changing stroke rates in patients with AF, blanking periods after AF ablation are the topics John Mandrola, MD, covers this week.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. Surgeon General Causes Hoopla Regarding ETOH Warning

Dry January: Should Doctors Make It Year-Round?

https://www.medscape.com/viewarticle/dry-january-should-doctors-make-it-year-round-2025a100009t

• Surgeon General Warning https://www.hhs.gov/about/news/2025/01/03/us-surgeon-general-issues-new-advisory-link-alcohol-cancer-risk.html
• GBD 2016 Collaboration Lancet https://doi.org/10.1016/S0140-6736(18)31310-2
• RCT Voskobonik and colleagues https://www.nejm.org/doi/full/10.1056/NEJMoa1817591
• Marcus and colleagues; UCSF https://pubmed.ncbi.nlm.nih.gov/33516710/
• Review of ETOH AF https://doi.org/10.1016/j.jacc.2016.08.074

II. GLP-1 Agonists for Obesity –Trial vs Real World

• Generalizability of Trial Results https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2826335
• HRS Document ICD http://dx.doi.org/10.1016/j.hrthm.2014.03.041

III. Stress Testing and CAD Severity

• Reynolds and colleagues. Observational ISCHEMIA Sub-analysis https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.123.013743
• Foy Meta-analysis https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2655243
• ISCHEMIA https://www.nejm.org/doi/full/10.1056/NEJMoa1915922

IV. Changing Stroke Rates with AF

• Teppo and colleagues. Finnish Study https://doi.org/10.1016/j.jacep.2024.10.029
• Quinn and colleagues. https://www.ahajournals.org/doi/10.1161/circulationaha.116.024057

V. Patients’ Lives Don’t Pause for Blanking Periods

• Ruzieh and colleagues. https://doi.org/10.1016/j.ahjo.2024.100497

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Listener feedback, multiple studies in AF ablation,

a DANISH trial substudy of ICDs in NICM, and more data on eye complications of GLP-1 agonists 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. CCTA Feedback

• Foy meta-analysis https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2655243
• DANCAVAS https://www.nejm.org/doi/full/10.1056/NEJMoa2208681

II. Listener Feedback on my negative take of the OPTION Trial.

• Option trial https://www.nejm.org/doi/pdf/10.1056/NEJMoa2408308
• My Preview https://www.medscape.com/viewarticle/mandrola-previews-option-trial-most-worrisome-study-aha-2024-2024a1000kmz
• 4 Reasons to Question Percutaneous Left Atrial Appendage Closure After AF Ablation
• https://www.medscape.com/viewarticle/4-reasons-question-percutaneous-left-atrial-appendage-2024a1000l0u

III. AF Ablation 

PVI Add-Ons Provide Better Control of Persistent AF

https://www.medscape.com/viewarticle/pvi-add-ons-provide-better-control-persistent-af-2024a1000lcm

• VENUS https://jamanetwork.com/journals/jama/fullarticle/2772281
• PROMPT AF https://jamanetwork.com/journals/jama/fullarticle/2826710
• STAR AF 2 https://www.nejm.org/doi/full/10.1056/NEJMoa1408288
• CRRF-PeAF https://pmc.ncbi.nlm.nih.gov/articles/PMC9241129/
• CAVAC trial https://doi.org/10.1161/CIRCEP.124.012917
• CRRF-PeAF from multiple centers in Japan (not published)

IV. DANISH Trial Substudy

• Danish Trial Substudy https://www.ahajournals.org/doi/epdf/10.1161/CIRCULATIONAHA.124.071777
• Danish Main https://www.nejm.org/doi/full/10.1056/NEJMoa1608029
• MADIT-2 EF Substudy https://doi.org/10.1016/S0002-9149(01)01729-5
• SCD-HeFT subgroup https://www.nejm.org/doi/full/10.1056/NEJMoa043399
• Appraisal of ICD to Prevent SCD https://doi.org/10.1016/j.jacc.2008.05.058

V. Eye disease and GLP-1 Agonists

Jul 26, 2024 This Week in Cardiology Podcast

https://www.medscape.com/viewarticle/1001384

• Semaglutide vs No Semagutide and Eye Disease https://link.springer.com/epdf/10.1186/s40942-024-00620-x
• Semaglutide vs SGLT- Inhibitors and Eye Disease https://www.medrxiv.org/content/10.1101/2024.12.09.24318574v1.full-text

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US doc's pay, the ticagrelor controversy and new RCTs, clopidogrel beats ASA, holding antiplatelets for non-cardiac surgery, and Prof Cleland and ASA dogma are the topics John Mandrola, MD, covers this week.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. US Healthcare

Mandrola’s Top 10 Stories in 2024 https://www.medscape.com/viewarticle/mandrolas-top-10-stories-2024-2024a1000mxe?_gl=1*dcvmkh*_gcl_au*MTgzOTY2ODQ0Ni4xNzI5MjU4NjUz

• CMS Proposal

II. Ticagrelor Controversy

New Investigation Casts Doubt on Landmark Ticagrelor Trial

https://www.medscape.com/viewarticle/new-investigation-casts-doubt-landmark-ticagrelor-trial-2024a1000n1d

• Doshi Review https://www.bmj.com/content/387/bmj.q2550
• PLATO https://www.nejm.org/doi/full/10.1056/NEJMoa0904327
• ISAR REACT 5 https://www.nejm.org/doi/full/10.1056/NEJMoa1908973
• Bates Review https://www.ahajournals.org/doi/epub/10.1161/JAHA.123.031606
• Victor Serebuany and Dan Atar Editorial https://doi.org/10.1093/eurheartj/ehp545

III. New Ticagrelor vs Clopdiogrel trial

• Preprint: https://www.medrxiv.org/content/10.1101/2024.11.06.24316875v1.full-text

IV. Clopidogrel Better Than ASA Even in HBR

• Substudy Long-Term Aspirin vs Clopidogrel After Coronary Stenting by Bleeding Risk and Procedural Complexity
• HOST-EXAM 10.1016/S0140-6736(21)01063-1
• HOST-EXAM-Extended https://doi.org/10.1161/CIRCULATIONAHA.122.062770

V. ASA During Non-Cardiac Surgery

• ASSURE DES https://doi.org/10.1016/j.jacc.2024.08.024

VII. Professor Cleland on ASA for Secondary Prevention

• Cleland Editorial https//jamanetwork.com/journals/jamacardiology/article-abstract/2827201
• ASA Meta-analysis 10.1016/S0140-6736(09)60503-1
• AMIS https://jamanetwork.com/journals/jama/fullarticle/368745
• SAPAT 10.1016/0140-6736(92)92619-Q

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Tirzepatide vs semaglutide in obesity; GLP1a use is complicated; HF outcomes; the misuse of meta-analyses in HF; and a breakthrough in HF care are the topics John Mandrola, MD, covers this week.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

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I. SURMOUNT 5

• Clinicaltrials.gov https://clinicaltrials.gov/study/NCT05822830
• Press Release
•  

II. Access to GLP-1 Agonist Drugs

• CMS statement https://www.cms.gov/newsroom/press-releases/biden-harris-administration-announces-medicare-advantage-and-medicare-part-d-prescription-drug

III. SUMMIT TRIAL commentary

Has Tirzepatide Scaled the HFpEF/Obesity SUMMIT?

https://www.medscape.com/viewarticle/has-tirzepatide-scaled-hfpef-obesity-summit-2024a1000m2h

IV. Blank Spot in HF Evidence – All cause hospitalizations  

• Sayed and colleagues What Is Success in HF Trials? https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2827168
• EMPEROR-Preserved https://www.nejm.org/doi/full/10.1056/NEJMoa2107038
• Mayo Observational Study 10.1016/j.mayocp.2016.11.009
• DIG Trial https://jamanetwork.com/journals/jama/fullarticle/195990

V. Misuse of Meta-analysis by HF Community

• Lu and colleagues PARAGON/PARADIGM Meta-analysis https://jamanetwork.com/journals/jamacardiology/fullarticle/2823259
• Desai 2004 https://jamanetwork.com/journals/jama/fullarticle/199995
• PARADIGM HF https://www.nejm.org/doi/full/10.1056/NEJMoa1409077
• PARAGON HF https://www.nejm.org/doi/full/10.1056/NEJMoa1908655

VI Integration of Palliative Care Into HF Care

• Chuzi and colleagues Palliative Care in HF 10.1016/j.cardfail.2024.10.435
• Kotecha and colleagues Beta-blocker Metaanalysis 10.1016/S0140-6736(14)61373-8

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An AHA review: the OPTION, SUMMIT, VANISH 2, SARAH, and CLEAR 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:

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I. OPTION Trial

For AF, LAA Rivals Anticoagulants After Ablation

https://www.medscape.com/viewarticle/af-laa-rivals-anticoagulants-after-ablation-2024a1000l7n

4 Reasons to Question Percutaneous Left Atrial Appendage Closure After AF Ablation

https://www.medscape.com/viewarticle/4-reasons-question-percutaneous-left-atrial-appendage-2024a1000l0u

• OPTION in NEJM https://www.nejm.org/doi/full/10.1056/NEJMoa2408308

II. SUMMIT Trial

Tirzepatide Reduces Heart Failure Events in HFpEF With Obesity

https://www.medscape.com/viewarticle/tirzepatide-reduces-heart-failure-events-hfpef-obesity-2024a1000kx5

• SUMMIT in NEJM https://www.nejm.org/doi/full/10.1056/NEJMoa2410027

III. VANISH Trial

New Trial Result Pushes Past Antiarrhythmic Therapy After MI

https://www.medscape.com/viewarticle/new-trial-result-pushes-past-antiarrhythmic-therapy-after-mi-2024a1000l08

• VANISH 2 https://www.nejm.org/doi/full/10.1056/NEJMoa2409501
• VANISH 1 https://www.nejm.org/doi/full/10.1056/NEJMoa1513614

IV. Cardioprotection

Common Heart Failure Drugs Ease Heart Damage During Chemo https://www.medscape.com/viewarticle/common-heart-failure-drugs-ease-heart-damage-during-chemo-2024a1000l14

• Strain Imaging Review Article https://www.jacc.org/doi/10.1016/j.jcmg.2024.07.011

V. CLEAR trial

Spironolactone Shows Mixed Results in Acute MI

https://www.medscape.com/viewarticle/spironolactone-shows-mixed-results-acute-mi-2024a1000l41

Routine Colchicine or MRA Post-MI: No CLEAR Benefit

https://www.medscape.com/viewarticle/routine-colchicine-or-mra-post-mi-no-clear-benefit-2024a1000la2

• CLEAR-Spironolactone https://www.nejm.org/doi/full/10.1056/NEJMoa2405923
• CLEAR-Colchicine https://www.nejm.org/doi/full/10.1056/NEJMoa2405922

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Tirzepatide, AF screening, and an AHA preview, including VT ablation, LAAC at the time of AF ablation, BP targets, and GLP1 agonists in HF are the topics John Mandrola, MD, covers in today's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

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I. Tirzepatide

• SURMOUNT 1 – Three-year results https://www.nejm.org/doi/full/10.1056/NEJMoa2410819

II. AF Screening

• GUARD AF https://www.jacc.org/doi/10.1016/j.jacc.2024.08.019
• LOOP 10.1016/S0140-6736(21)01698-6
• STROKE STOP 10.1016/S0140-6736(21)01637-8

III. LAAC with AF ablation 

Mandrola Previews the OPTION Trial, the Most Worrisome Study at AHA 2024

https://www.medscape.com/viewarticle/mandrola-previews-option-trial-most-worrisome-study-aha-2024-2024a1000kmz

• The OPTION Trial Rationale https://doi.org/10.1016/j.ahj.2022.05.003

IV. Blood Pressure Targets

• BPROAD https://onlinelibrary.wiley.com/doi/10.1111/1753-0407.13411
• ACCORD - https://www.nejm.org/doi/full/10.1056/NEJMoa1001286

V. GLP1a for HFpEF

• SUMMIT at Clinicaltrials.gov https://clinicaltrials.gov/study/NCT04847557

VI. VT Ablation

• VANISH2 Rationale https://doi.org/10.1016/j.ahj.2024.04.009
• VANISH 1 https://www.nejm.org/doi/full/10.1056/NEJMoa1513614

VII. Spironolactone Results of CLEAR-SYNERGY 

Nov 08, 2024 This Week in Cardiology Podcast

https://www.medscape.com/viewarticle/1001865

'No Hint of Benefit' in Large Colchicine Trial

https://www.medscape.com/viewarticle/no-hint-benefit-large-colchicine-trial-2024a1000ko4

• CLEAR SYNERGY Rationale https://pubmed.ncbi.nlm.nih.gov/38936755/

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The EARLY TAVR trial, colchicine after MI, and the TRISCEND II trial of tricuspid valve replacement 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. Early TAVR

• EARLY TAVR https://www.acc.org/latest-in-cardiology/clinical-trials/2024/10/24/14/42/early-tavr
• Rationale https://doi.org/10.1016/j.ahj.2023.11.019
• AVATAR https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057639
• RECOVERY https://www.nejm.org/doi/full/10.1056/NEJMoa1912846
• FAME 2 https://www.nejm.org/doi/full/10.1056/NEJMoa1205361
• Rajkumar; Faith Healing in Unblinded Trials https://pubmed.ncbi.nlm.nih.gov/29530888/
• PARTNER 3 trial https://www.nejm.org/doi/full/10.1056/NEJMoa2307447
• 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

II. Colchicine

• Meta-analysis https://doi.org/10.1016/j.eclinm.2024.102835
• Clear-Synergy Rationale https://pubmed.ncbi.nlm.nih.gov/38936755/
• COLCOT (post MI) https://www.nejm.org/doi/full/10.1056/NEJMoa1912388
• LoDoCo (Chronic CAD) https://www.nejm.org/doi/full/10.1056/NEJMoa2021372
•  

III. TRISCEND II Trial

• TRISCEND II Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2401918

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Listener feedback on PFA and STEMI/NSTEMI paradigm, oral semaglutide, symptomatic vs asymptomatic AF, and the win-ratio 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:

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I. Listener Feedback

Oct 18, 2024 This Week in Cardiology Podcast

https://www.medscape.com/viewarticle/1001769

• Pulsed Field Ablation

https://www.hrsonline.org/guidance/safety-alerts/boston-scientific-cardiac-cryoablation-system

• STEMI/NSTEMI https://doi.org/10.1016/j.jacadv.2024.101314

II. Oral Semaglutide

• Press Release: https://www.novonordisk.com/content/nncorp/global/en/news-and-media/news-and-ir-materials/news-details.html?id=171480
• Rationale Paper SOUL trial

III. Symptomatic vs Asymptomatic AF

• Meta-analysis in EHJ
•  
• Meta-analysis of rate vs rhythm-control strategies https://doi.org/10.1016/j.jacep.2024.03.006

IV. The Win Ratio

• Pocock and colleagues https://doi.org/10.1093/eurheartj/ehae647

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Listener feedback on the c-statistic, atherosclerotic plaque imaging, WATCHMAN implant decisions in the US, and deprescribing 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:

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I.Listener Feedback

Oct 11, 2024 This Week in Cardiology Podcast

https://www.medscape.com/viewarticle/1001735

• Nancy Cook; C-statistic https://doi.org/10.1161/CIRCULATIONAHA.106.672402

II. Plaque Imaging

New Evidence That Plaque Buildup Shouldn't Be Ignored

https://www.medscape.com/viewarticle/new-evidence-plaque-buildup-shouldnt-be-ignored-2024a1000ihw

• Fuster and colleagues; Imaging vs CAC  

III. WATCHMAN Decisions

• Zeitler and colleagues. Long-term Outcomes

IV. Deprescribing

Cognitive Decline and Antihypertensive Use: New Data

https://www.medscape.com/viewarticle/cognitive-decline-and-antihypertensive-use-new-data-2024a1000isw?form=fpf

• Jing and colleagues.

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Reader feedback on cardiac devices and PFA, a new paradigm in the language of MI, sudden cardiac death, and measuring blood pressure 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

Sep 20, 2024 This Week in Cardiology Podcast

https://www.medscape.com/viewarticle/1001631

• Cardiac Devices

https://www.acpjournals.org/doi/10.7326/ANNALS-24-00724

• Impact of PFA on Intraluminal Esophageal Temperature https://onlinelibrary.wiley.com/doi/10.1111/jce.16096

II. Towards a New Classification of MI

• McLaren and colleagues; From STEMI to OMI https://doi.org/10.1016/j.jacadv.2024.101314

III. Sudden Death After MI.

• EHJ Paper; SCD After MI https://doi.org/10.1093/eurheartj/ehae326
• Barsheshet and colleagues; Risk Score to Predict Benefit of ICD https://doi.org/10.1016/j.jacc.2012.02.036
• Zegard and colleagues; Myocardial Fibrosis and SCD 10.1016/j.jacc.2020.10.046
• MADIT RIT https://www.nejm.org/doi/full/10.1056/NEJMoa1211107

IV. BP Readings

Poor Arm Position May Significantly Skew BP Readings

https://www.medscape.com/viewarticle/poor-arm-position-may-significantly-skew-bp-readings-2024a1000icv?form=fpf

• ARMS Crossover RCT

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