This Week in Cardiology – Détails, épisodes et analyse

Feedback on ABYSS and beta-blockers, more ESC recap, including SHAM-PVI, FINEARTS-HF, and RESHAPE HF2 trials 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. Feedback on ABYSS

Setbacks After Stopping Beta-Blockers

https://www.medscape.com/viewarticle/setbacks-after-stopping-beta-blockers-2024a1000fv7

Beta-Blockers Post-MI? No for Me, Even After the ABYSS Trial

https://www.medscape.com/viewarticle/beta-blockers-post-mi-no-me-even-after-abyss-trial-2024a1000fva

• ABYSS trial https://www.nejm.org/doi/full/10.1056/NEJMoa2404204
• REDUCE AMI https://www.nejm.org/doi/full/10.1056/NEJMoa2401479
• QOL paper REDUCE AMI https://doi.org/10.1093/ehjcvp/pvae062
• Atenolol ED paper 10.1016/j.ehj.2003.08.016

II. SHAM-PVI

• JAMA SHAM-PVI paper https://jamanetwork.com/journals/jama/article-abstract/2823283
• Gupta QOL paper https://pubmed.ncbi.nlm.nih.gov/33952593/

III. FINEARTS HF

Finerenone Benefits Heart Failure With Preserved EF

https://www.medscape.com/viewarticle/finerenone-benefits-heart-failure-preserved-ef-2024a1000fza

Topline Finerenone Results Point to Advance in Heart Failure

https://www.medscape.com/viewarticle/topline-finerenone-results-point-advance-heart-failure-2024a1000fq2

• 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

IV. RESHAPE HF

TEER in Functional MR: Data Deluge, but No Easy Answers

https://www.medscape.com/viewarticle/teer-functional-mr-data-deluge-no-easy-answers-2024a1000fvg

• Mitra FR https://www.nejm.org/doi/full/10.1056/NEJMoa1805374
• COAPT https://www.nejm.org/doi/full/10.1056/NEJMoa1806640
• RESHAPE- HF2 https://www.nejm.org/doi/full/10.1056/NEJMoa2314328
• RESHAPE Subgroup paper https://doi.org/10.1016/j.jacc.2024.08.027

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From ESC: post-MI beta blockers, a new therapy for ATTR-CM, holding RASi before non-cardiac surgery, good news in HFpEF, and an ESC preview 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. ABYSS

• ABYSS trial https://www.nejm.org/doi/full/10.1056/NEJMoa2404204
• REDUCE AMI https://www.nejm.org/doi/full/10.1056/NEJMoa2401479

II. ATTR -CM HELIOS B

Positive Top Line Results for Vutrisiran in Cardiac Amyloidosis

https://www.medscape.com/viewarticle/positive-top-line-results-vutrisiran-cardiac-amyloidosis-2024a1000cjj

• HELIOS A https://www.tandfonline.com/doi/full/10.1080/13506129.2022.2091985
• HELIOS B https://www.nejm.org/doi/full/10.1056/NEJMoa2409134

III. STOP or NOT Trial

• Observational Study Showing Benefits of Holding RASi https://doi.org/10.1097/ALN.0000000000001404
• STOP or NOT Protocol Paper -- https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-019-3247-1
• JAMA STOP or NOT https://jamanetwork.com/journals/jama/fullarticle/2823118

IV. GLP1a in HFpEF

The GLP-1 Agonist Semaglutide in HFpEF Cleared a Low Bar https://www.medscape.com/viewarticle/995872

• STEP-HFpEF https://www.nejm.org/doi/full/10.1056/NEJMoa2306963
• STEP-HFpEF-DM https://www.nejm.org/doi/full/10.1056/NEJMoa2313917
• SELECT https://www.nejm.org/doi/full/10.1056/NEJMoa2307563
• FLOW https://www.nejm.org/doi/full/10.1056/NEJMoa2403347
• Lancet Meta-analysis https://doi.org/10.1016/S0140-6736(24)01643-X

V. ESC Preview

Mandrola's Five Big Trials to Look for at ESC 2024

https://www.medscape.com/viewarticle/mandrolas-five-big-trials-look-esc-2024-2024a1000fkt

Topline Finerenone Results Point to Advance in Heart Failure

https://www.medscape.com/viewarticle/topline-finerenone-results-point-advance-heart-failure-2024a1000fq2

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MRAs in HF with renal dysfunction, coronary autoregulation, the hubris of US doctors, NSTEMI in older patients, survival after STEMI, and new leaders at JACC 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 Listener Feedback

• Combined analysis (Matsumoto)

II Coronary artery autoregulation with increasing stenosis

• NEJM Paper https://www.nejm.org/doi/full/10.1056/NEJMc2402216

III RECOVER IV Trial

• Gregg Stone, MD Tweet https://x.com/GreggWStone/status/1803583552354742416
• DANGER-Shock Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2312572
• Impella Saves Lives in Cardiogenic Shock, but Patient Selection Key https://www.medscape.com/viewarticle/1000659

IV NSTEMI Elderly

• Main Paper
• Datamethods https://discourse.datamethods.org/t/random-vs-fixed-effects-meta-analysis/7361
• O’Fee Paper https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2785560

V MI Survival

Danish Paper https://doi.org/10.1016/j.jacc.2024.04.025

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AF screening; sodium, potassium, BP, and CV outcomes; drug prices; and cardio-respiratory fitness 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. AF Screening

- Using Wearable Devices to Detect AF Is 'Cost Effective' https://www.medscape.com/viewarticle/978861

- Cost-effectiveness of Screening for Atrial Fibrillation Using Wearable Devices https://jamanetwork.com/journals/jama-health-forum/fullarticle/2794835

- Screening for Atrial Fibrillation in Asymptomatic Older Adults https://www.nejm.org/doi/full/10.1056/NEJMclde2203726

II. Salt Substitutes

- More Evidence Salt Substitutes Lower Risk of CVD and Death https://www.medscape.com/viewarticle/978999

- Effects of salt substitutes on clinical outcomes: a systematic review and meta-analysis https://heart.bmj.com/content/early/2022/07/21/heartjnl-2022-321332

- Effect of Salt Substitution on Cardiovascular Events and Death https://www.nejm.org/doi/10.1056/NEJMoa2105675

- Settling the controversy of salt substitutes and stroke: sodium reduction or potassium increase? https://doi.org/10.1093/eurheartj/ehac160

- Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia https://www.nejm.org/doi/full/10.1056/nejmoa1812792

- Fractional Flow Reserve versus Angiography for Guiding Percutaneous Coronary Intervention https://www.nejm.org/doi/full/10.1056/nejmoa0807611

III. Drug Prices

- House Could Soon Give Biden Win on Medicare Drug Negotiations, Insulin Costs https://www.medscape.com/viewarticle/978988

IV. Fitness is Under-rated

- Cardiorespiratory Fitness Key to Longevity for All? https://www.medscape.com/viewarticle/978854

- Cardiorespiratory Fitness and Mortality Risk Across the Spectra of Age, Race, and Sex https://www.jacc.org/doi/full/10.1016/j.jacc.2022.05.031

- Cardiorespiratory fitness, obesity and left atrial function in patients with atrial fibrillation https://doi.org/10.1016/j.ijcha.2022.101083

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Hyperkalemia in heart failure, CV health in America, primary prevention ICDs, and a debate about posters at medical meetings 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. Hyperkalemia in Heart Failure

- DIAMOND: Adding Patiromer Helps Optimize HF Meds, Foils Hyperkalemia https://www.medscape.com/viewarticle/971616

- Patiromer for the management of hyperkalemia in heart failure with reduced ejection fraction: the DIAMOND trial https://doi.org/10.1093/eurheartj/ehac401

- Potassium Binders for Patients With Heart Failure? The Real Enlightenment of the DIAMOND Trial https://doi.org/10.1093/eurheartj/ehac399

- The Effect of Spironolactone on Morbidity and Mortality in Patients with Severe Heart Failure https://www.nejm.org/doi/full/10.1056/nejm199909023411001

- Eplerenone in Patients with Systolic Heart Failure and Mild Symptoms https://www.nejm.org/doi/full/10.1056/nejmoa1009492

- Evaluation of the efficacy and safety of RLY5016, a polymeric potassium binder, in a double-blind, placebo-controlled study in patients with chronic heart failure (the PEARL-HF) trial https://pubmed.ncbi.nlm.nih.gov/21208974/

II. CV Health in America

- ‘Staggering’ CVD Rise Projected in US, Especially in Minorities https://www.medscape.com/viewarticle/978366

- Cardiovascular Disease Projections in the United States Based on the 2020 Census Estimates https://www.jacc.org/doi/10.1016/j.jacc.2022.05.033

III. Primary Prevention ICDs in Modern Era

- Do ICDs Still ‘Work’ in Primary Prevention Given Today’s Recommended HF Meds? https://www.medscape.com/viewarticle/978254

- Guideline-Directed Medical Therapy and the Risk of Death in Primary Prevention Defibrillator Recipients https://doi.org/10.1016/j.jacep.2022.05.001

- 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

IV. Medical Meetings and Posters

- As Digital Posters Take Over, Traditionalists Push Back https://www.medscape.com/viewarticle/978384

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A big new HF and EP trial, doctors and probability, LV assist devices in cardiogenic shock, vitamin D, and exercise in PAD 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. Left vs Left RCT

Taking Cardiac Pacing From Boring to Super-Cool https://www.medscape.com/viewarticle/973615

Conduction-System Pacing Shines vs BiV Pacing for CRT in Early Studies https://www.medscape.com/viewarticle/974173

• Baylor led research awarded $31 Million for Resynchronization Therapy in Patients with Heart Failure https://www.bcm.edu/news/baylor-led-research-awarded-31-million-for-resynchronization-therapy-in-patients-with-heart-failure

II. Probability and Conjunction Fallacy

Is What You Call Probable...Impossible?

https://www.medscape.com/viewarticle/976451

• Analysis of Physicians’ Probability Estimates of a Medical Outcome Based on a Sequence of Events

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2793624

III. LV Assist Devices

Impella Pump for MI With Cardiogenic Shock Again Fares Poorly vs IABP in Study

https://www.medscape.com/viewarticle/977994

• Clinical Outcomes and Cost Associated With an Intravascular Microaxial Left Ventricular Assist Device vs Intra-aortic Balloon Pump in Patients Presenting With Acute Myocardial Infarction Complicated by Cardiogenic Shock

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2794390

• Intravascular Microaxial Left Ventricular Assist Device for Acute Myocardial Infarction With Cardiogenic Shock—A Call for Evidence of Benefit https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2794394

• Intra-aortic Balloon Pump Therapy for Acute Myocardial InfarctionA Meta-analysis https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2210888

IV. Vitamin D

Vitamin D Supplements Do Not Lower Risk of Fractures

https://www.medscape.com/viewarticle/978108

Why Is Vitamin D Hype So Impervious to Evidence? https://www.medscape.com/viewarticle/968682

• Supplemental Vitamin D and Incident Fractures in Midlife and Older Adults

https://www.nejm.org/doi/full/10.1056/NEJMoa2202106

V. Peripheral Artery Disease

For Patients With Peripheral Artery Disease, Pain Can Be Gain

https://www.medscape.com/viewarticle/978053

• Effects of Walking Exercise at a Pace With Versus Without Ischemic Leg Symptoms on Functional Performance Measures in People With Lower Extremity Peripheral Artery Disease: The LITE Randomized Clinical Trial

https://www.ahajournals.org/doi/10.1161/JAHA.121.025063

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Therapeutic fashion and conduction system pacing, early rhythm control in AF, statins in CKD, and salt intake in HF 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 – Therapeutic Fashion and Conduction System Pacing

- Medical Necessity vs Therapeutic Fashion: How Evidence-Based Is Your Field of Medicine? https://www.medscape.com/viewarticle/977358

- Conduction System Pacing Noninferior to Biventricular Pacing for HF With Wide QRS https://www.medscape.com/viewarticle/971740

- His Corrective Pacing or Biventricular Pacing for Cardiac Resynchronization in Heart Failure https://www.jacc.org/doi/full/10.1016/j.jacc.2019.04.026

II – Early Rhythm Control

- Benefit of Early Rhythm Control Questioned in Newly Diagnosed Atrial Fibrillation https://www.medscape.com/viewarticle/977584

- Presenting Pattern of Atrial Fibrillation and Outcomes of Early Rhythm Control Therapy https://doi.org/10.1016/j.jacc.2022.04.058

- Early Rhythm-Control Therapy in Patients with Atrial Fibrillation https://www.nejm.org/doi/full/10.1056/NEJMoa2019422

III – Statins and CKD

- Rosuvastatin Again Linked With Risks to Kidneys https://www.medscape.com/viewarticle/977646

- Association of Rosuvastatin Use with Risk of Hematuria and Proteinuria https://doi.org/10.1681/ASN.2022020135

- Atorvastatin in Patients with Type 2 Diabetes Mellitus Undergoing Hemodialysis https://www.nejm.org/doi/10.1056/NEJMoa043545

- Rosuvastatin and Cardiovascular Events in Patients Undergoing Hemodialysis https://www.nejm.org/doi/full/10.1056/nejmoa0810177

IV – Sodium and HF

- Overly Tight Sodium Restriction May Worsen HFpEF Outcomes https://www.medscape.com/viewarticle/977441

- Salt restriction and risk of adverse outcomes in heart failure with preserved ejection fraction https://heart.bmj.com/content/early/2022/06/07/heartjnl-2022-321167

- Spironolactone for Heart Failure with Preserved Ejection Fraction https://www.nejm.org/doi/full/10.1056/nejmoa1313731

- Reduction of dietary sodium to less than 100 mmol in heart failure (SODIUM-HF): an international, open-label, randomised, controlled trial https://doi.org/10.1016/S0140-6736(22)00369-5

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The LIFE study, multimorbidity and evidence translation, cardiac arrest and therapeutic fashion, diabetes and cardiology, and EP cuts are the topics John Mandrola, MD, tackles 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 – LIFE Study and Substudy

- LIFE: ARNI Does Not Best Valsartan in Advanced Heart Failure https://www.medscape.com/viewarticle/952681

- Tolerability of Sacubitril/Valsartan in Patients With Advanced Heart Failure: Analysis of the LIFE Trial Run-In https://www.jacc.org/doi/10.1016/j.jchf.2022.04.013

- Effect of Treatment With Sacubitril/Valsartan in Patients With Advanced Heart Failure and Reduced Ejection FractionA Randomized Clinical Trial https://jamanetwork.com/journals/jamacardiology/fullarticle/2785700

II – Early Angiography and Therapeutic Fashion

- Emergency Angiography for Cardiac Arrest Without ST Elevation? https://www.medscape.com/viewarticle/975434

- Emergency vs Delayed Coronary Angiogram in Survivors of Out-of-Hospital Cardiac ArrestResults of the Randomized, Multicentric EMERGE Trial https://jamanetwork.com/journals/jamacardiology/article-abstract/2793310

- Immediate Coronary Angiography in Survivors of Out-of-Hospital Cardiac Arrest https://www.nejm.org/doi/full/10.1056/NEJM199706053362302

- Coronary Angiography after Cardiac Arrest without ST-Segment Elevation https://www.nejm.org/doi/10.1056/NEJMoa1816897

- Randomized Pilot Clinical Trial of Early Coronary Angiography Versus No Early Coronary Angiography After Cardiac Arrest Without ST-Segment Elevation https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.049569

- Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation https://www.nejm.org/doi/10.1056/NEJMoa2101909

- Most healthcare interventions tested in Cochrane Reviews are not effective according to high quality evidence: a systematic review and meta-analysis https://www.jclinepi.com/article/S0895-4356(22)00100-7/fulltext

III – Diabetes and Cardiology

- Medicare Advantage Tied to Less Use of Pricey Diabetes Drugs https://www.medscape.com/viewarticle/977181

- Diabetes Care Among Older Adults Enrolled in Medicare Advantage Versus Traditional Medicare Fee-For-Service Plans: The Diabetes Collaborative Registry https://doi.org/10.2337/dc21-1178

IV – EP Cuts

- EP Ablation Rate Changes in 2022 Physician Fee Schedule https://www.acc.org/Latest-in-Cardiology/Articles/2021/11/18/01/44/EP-Ablation-Rate-Changes-in-2022-Physician-Fee-Schedule

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https://www.medscape.com/author/bob-harrington

Questions or feedback, please contact [email protected]

On this week’s podcast, John Mandrola, MD discusses fish oil, America’s heart health, pharmacists and prescribing and statins This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic

I - Fish Oil

- New Biomarker Data Add to Concerns Over REDUCE-IT Trial https://www.medscape.com/viewarticle/976490

- Effects of Randomized Treatment With Icosapent Ethyl and a Mineral Oil Comparator on Interleukin-1β, Interleukin-6, C-Reactive Protein, Oxidized Low-Density Lipoprotein Cholesterol, Homocysteine, Lipoprotein(a), and Lipoprotein-Associated Phospholipase A2: A REDUCE-IT Biomarker Substudy https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.059410

- Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia https://www.nejm.org/doi/full/10.1056/nejmoa1812792

- Effect of High-Dose Omega-3 Fatty Acids vs Corn Oil on Major Adverse Cardiovascular Events in Patients at High Cardiovascular RiskThe STRENGTH Randomized Clinical Trial https://jamanetwork.com/journals/jama/fullarticle/2773120

- Effect of icosapent ethyl on progression of coronary atherosclerosis in patients with elevated triglycerides on statin therapy: final results of the EVAPORATE trial https://academic.oup.com/eurheartj/article/41/40/3925/5898836

II - US Heart Health

- New AHA Checklist: Only 1 in 5 Adults Have Optimal Heart Health https://www.medscape.com/viewarticle/976519

- Life’s Essential 8: Updating and Enhancing the American Heart Association’s Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association https://www.ahajournals.org/doi/10.1161/CIR.0000000000001078

- Status of Cardiovascular Health in US Adults and Children Using the American Heart Association's New "Life's Essential 8" Metrics: Prevalence Estimates from the National Health and Nutrition Examination Survey (NHANES), 2013-2018 https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.060911

III - Pharmacist Prescribing

- Paxlovid Is Here: A Pharmacist's Prescribing Pearls https://www.medscape.com/viewarticle/973260

- Coronavirus (COVID-19) Update: FDA Authorizes Pharmacists to Prescribe Paxlovid with Certain Limitations https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-pharmacists-prescribe-paxlovid-certain-limitations

IV - Statin Eligibility

- New European Guidelines ‘Drastically’ Reduce Statin Eligibility https://www.medscape.com/viewarticle/976715

- Statin Eligibility for Primary Prevention of Cardiovascular Disease According to 2021 European Prevention Guidelines Compared With Other International Guidelines https://jamanetwork.com/journals/jamacardiology/article-abstract/2793729

- Time to Revisit Using 10-Year Risk to Guide Statin Therapy https://jamanetwork.com/journals/jamacardiology/article-abstract/2793732

- Mendelian randomization studies: using naturally randomized genetic data to fill evidence gaps https://doi.org/10.1097/mol.0000000000000247

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A non-significant but wonderful trial in AF, smoking and HF, vitamins, and pre-op risk screening 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 – DECAAF II Trial

DECAAF II: AF, Fibrosis Ablation Technique Falls Short, but Signs of Hope

https://www.medscape.com/viewarticle/957469

• Effect of MRI-Guided Fibrosis Ablation vs Conventional Catheter Ablation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial Fibrillation https://jamanetwork.com/journals/jama/article-abstract/2793452

• Association of Atrial Tissue Fibrosis Identified by Delayed Enhancement MRI and Atrial Fibrillation Catheter Ablation

https://jamanetwork.com/journals/jama/fullarticle/1820433

II – Smoking and HF

Cigarettes Linked to HF With Preserved or Reduced EF https://www.medscape.com/viewarticle/976066?src=

• Cigarette Smoking, Cessation, and Risk of Heart Failure With Preserved and Reduced Ejection Fraction https://www.jacc.org/doi/full/10.1016/j.jacc.2022.03.377

III – Vitamins

Evidence Still Lacking That Vitamins Prevent CVD, Cancer: USPSTF https://www.medscape.com/viewarticle/975965

• Vitamin, Mineral, and Multivitamin Supplementation to Prevent Cardiovascular Disease and Cancer: US Preventive Services Task Force Recommendation Statement https://jamanetwork.com/journals/jama/fullarticle/2793446

IV – Pre-Op Risk

Add Atrial Fibrillation to Pre-Noncardiac Surgery Risk Evaluation: New Support

https://www.medscape.com/viewarticle/975926

• Preoperative Atrial Fibrillation and Cardiovascular Outcomes After Noncardiac Surgery

https://doi.org/10.1016/j.jacc.2022.04.021

• Patterns and Determinants of Low-Value Preoperative Testing in Michigan

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2779744

• Coronary-Artery Revascularization before Elective Major Vascular Surgery

https://www.nejm.org/doi/full/10.1056/nejmoa041905

• Stress testing before abdominal aortic aneurysm repair does not lead to a reduction in perioperative cardiac events https://doi.org/10.1016/j.jvs.2021.02.032

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Questions or feedback, please contact

[email protected]