This Week In Cardiology

Two great stories of translation science leading to beneficial drugs in terrible diseases of the heart and the Sisyphean task of predicting the need for pacing after TAVI 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 Sotatercept HYPERION Trial https://www.nejm.org/doi/10.1056/NEJMoa2508170 ZENITH Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2415160 Evidence report on treatment for PAH https://icer.org/news-insights/press-releases/icer-publishes-final-evidence-report-on-treatment-for-pulmonary-arterial-hypertension/ PAH Sotatercept Editorial https://www.nejm.org/doi/full/10.1056/NEJMe2503944 II Acoramidis and ATTR Cardiomyopathy ATTRIBUTE-CM Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2305434?logout=true ATTRIBUTE-CM Analysis - Substudy https://www.jacc.org/doi/10.1016/j.jacc.2025.09.013 Tafamadis Trial https://www.nejm.org/doi/full/1

A bold trial in valvular heart disease, a CV prevention trial whose message is humility, VTE dogma challenged, more news on oral GLP-1 agonists, and a few public service announcements 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 DOUBLE-CHOICE: Minimalist Approach to TAVI May Be as Good as Standard of Care https://www.medscape.com/viewarticle/double-choice-minimalist-approach-tavi-may-be-good-standard-2025a1000pp7 Patient & Physician Perspectives on CV Risk https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.124.011837 II KP Vaccinate Trial KP Vaccinate Trial https://evidence.nejm.org/doi/full/10.1056/EVIDoa2500208 IAMI trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057042 Increasing Flu Vaccinations in Patients With Chronic Disease https://jamanetwork.com/journals/jama/fullarticle/2824956 MI FREEE Trial https://www.nejm.

More trials at ESC, including PARACHUTE HF, DAPA ACT HF-TIMI 68, AMALFI, and a super-interesting modeling study of when to start oral anticoagulants in AF, 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 PARACHUTE HF First Evidence of Treatment Benefit in Chagas Heart Failure https://www.medscape.com/viewarticle/first-evidence-treatment-benefit-chagas-heart-failure-2025a1000oem PARACHUTE-HF https://www.jacc.org/doi/10.1016/j.jchf.2024.05.021 II SGLT2i Early Initiation — DAPA ACT HF-TIMI 68 Trial Trial Data Support In-Hospital Initiation of SGLT2 Inhibitors for Heart Failure https://www.medscape.com/viewarticle/trial-data-support-hospital-initiation-sglt2-inhibitors-2025a1000o5q DAPA ACT HF-TIMI 68 https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.125.076575 III AMALFI Trial of AF Screening Remote ECG Screening Ups Atrial Fibrillation

More from ESC including: Valvular HD guidelines, a new drug class for HTN, myosin inhibition in HCM, vericiguat, and digoxin are the topic 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 New European Valvular Heart Disease Guidelines 2025 ESC/EACTS Guidelines for the management of valvular heart disease  https://doi.org/10.1093/eurheartj/ehaf194 Debate: Does Asymptomatic Aortic Stenosis Warrant Early Intervention? https://exp.medscape.com/debates/does-asymptomatic-aortic-stenosis-warrant-early-intervention/ Surgical Ablation of Atrial Fibrillation during Mitral-Valve Surgery https://www.nejm.org/doi/full/10.1056/NEJMoa1500528 Surgical ablation of atrial fibrillation: a systematic review and meta-analysis https://doi.org/10.1093/europace/eux336 II  New Drug for Resistant HTN Baxdrostat: A 'Game Changer' for Hypertension? https://www.medscape.com/viewarticle/baxdrostat-game-changer-h

The big beta-blocker story from ESC, dual pathway therapy with aspirin and OAC, stopping OAC after successful AF ablation, and DANCAVAS II trial are the topics John Mandrola, MD, discusses on 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 This Week in Cardiology Podcast – August 29 https://www.medscape.com/viewarticle/1002877 II The Big Beta-blocker Story from ESC Beta-Blockers Post-MI: A Clear Clinical Message https://www.medscape.com/viewarticle/beta-blockers-post-mi-clear-clinical-message-2025a1000mz0 REBOOT https://www.nejm.org/doi/full/10.1056/NEJMoa2504735 BETAMI-DANBLOCK https://www.nejm.org/doi/abs/10.1056/NEJMoa2505985 REDUCE AMI https://www.nejm.org/doi/10.1056/NEJMoa2401479 CAPITAL RCT https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0199347 Post Hoc Analysis From REBOOT Trial https://eurointervention.pcronline.com/article/effect-of-beta-blocker-

CAC 0 takes a gut punch, ICD therapies cannot be surrogates for benefit, and two important trials from ESC 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 CAC 0 LDL-C and CVD Risk With CAC Score 0 https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehaf497/8228645 II ICD Therapies Contemporary ICD Benefit https://www.jacc.org/doi/10.1016/j.jacep.2025.06.028 PROFID Trial https://profid-project.eu/profid-ehra-trial/ MADIT-RIT Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1211107 Declining Risk of Sudden Death in HF https://www.nejm.org/doi/full/10.1056/NEJMoa1609758 III Digit-HF DIGIT-HF Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2415471 Digoxin–Mortality: Comparison in the DIG trial https://academic.oup.com/eurheartj/article/40/40/3336/5520008 IV POTCAST POTCAST trial https://www.nejm.org/doi/full/10.1056/NEJMoa

John Mandrola discusses conduction system pacing vs standard pacing, withdrawing HF meds when AF is corrected and patient selection in LAAO. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I Conduction System Pacing CSPACE trial https://doi.org/10.1016/j.jacc.2025.06.043 BLOCK HF trial https://www.nejm.org/doi/full/10.1056/NEJMoa1210356 BioPace trial https://doi.org/10.1093/europace/euaf029 II  Withdrawing Meds After AF Corrected WITHDRAW AF https://doi.org/10.1093/eurheartj/ehaf563 TRED HF https://pubmed.ncbi.nlm.nih.gov/30429050/ III Patient Selection in Left Atrial Appendage Occlusion Long-Term Outcomes Following LAAO in Medicare Beneficiaries: Outcomes From the National Cardiovascular Data Registry https://www.ahajournals.org/doi/10.1161/JAHA.124.039780 ESC Preview IV HTN Guidelines New Blood Pressure Guidelines: 4 Things I Like and 2 Concerns https://www.medscape.com/viewarticle/new-blood-pressure-guidelin

Big new hypertension guidelines, ultraprocessed foods, coronary sinus reduction and evidence-based medicine, and more news on pulsed field ablation for atrial fibrillation 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 HTN Guidelines BP Meds Should Begin Promptly, New ACC/AHA Guidelines Say https://www.medscape.com/viewarticle/bp-meds-should-begin-promptly-new-acc-aha-guidelines-say-2025a1000lms Guideline for Management of High Blood Pressure https://www.ahajournals.org/doi/10.1161/CIR.0000000000001356 BPROAD trial https://www.nejm.org/doi/full/10.1056/NEJMoa2412006 Trial Score Framework https://pmc.ncbi.nlm.nih.gov/articles/PMC6459598/ II UltraProcessed Foods AHA statement on Ultraprocessed Foods and Cardiometabolic Health https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000001365 III Refractory Angina and the Coronary Sinus Reducer

Listener feedback on SURPASS CVOT, AF ablation and the limits of meta-analyses, a Watchman alert from FDA, and oral anticoagulation choices in elderly patients are discussed by John Mandola, 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 SURPASS CVOT This Week in Cardiology Podcast, August 1 https://www.medscape.com/viewarticle/1002781 Mounjaro Appears More Heart Protective Than Trulicity in Trial Of Eli Lilly Diabetes Drugs https://www.medscape.com/s/viewarticle/mounjaro-proves-more-heart-protective-than-trulicity-trial-2025a1000kct II Catheter and Surgical AF ablation Catheter and Surgical Ablation for AF: Meta-Analysis https://www.acpjournals.org/doi/10.7326/ANNALS-25-00253 III Watchman Air Embolism Alerts Looming Pay Cut to LAAO Triggers Objection From Card Groups https://www.medscape.com/viewarticle/looming-pay-cut-laao-triggers-objection-card-groups-2025a1000l0j FDA Alert

Exercise and CV outcomes, aldosterone modulation, AI for ECG reading, GLP-1 comparisons, end-of-life decisions, and another well-meaning policy that caused harm in veterans 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 Exercise and CV outcomes II Aldosterone Modulation in Cardio-Kidney Disease Aldosterone and Aldosterone Modulation https://doi.org/10.1016/j.jacc.2025.06.012 Randomized Aldactone Evaluation Study https://www.nejm.org/doi/full/10.1056/NEJM199909023411001 III AI vs MD ECG-Reading for Cath Lab Activation Accuracy of Cath Lab Activation Decisions https://doi.org/10.1016/j.ajem.2025.07.061 IV Tirzepatide vs Dulaglutide - SURPASS CVOT Study Eli Lilly Press Release https://investor.lilly.com/news-releases/news-release-details/lillys-mounjaro-tirzepatide-gipglp-1-dual-agonist-demonstrated REWIND Study 10.1016/S0140-6736(19)31149-3 External Lin

The VENTOUX study of endurance athletes, the 10,000 step myth was not busted, rate vs rhythm control for AF, and GLP1 drugs and 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 Endurance Athletes and Arrhythmia (again) VENTOUX trial https://www.ahajournals.org/doi/10.1161/CIRCIMAGING.125.018470 II Daily Step Count and Health — no myths were busted. Lancet Public Health: https://doi.org/10.1016/S2468-2667(25)00164-1 III Rate vs Rhythm Control of AF Medscape: Everyone Deserves a Shot at the American Dream: Sinus Rhythm https://www.medscape.com/viewarticle/everyone-deserves-shot-american-dream-sinus-rhythm-2025a1000jle This Week in Cardiology, July 11, 2025 https://www.medscape.com/viewarticle/1002704 AFFIRM trial https://www.nejm.org/doi/full/10.1056/NEJMoa021328 AFFIRM substudy https://jamanetwork.com/journals/jamainternal

Finerenone, what not to consider when choosing treatment of AS, brain health after atrial fibrillation ablation, early rhythm control for AF, and Watchman reimbursement cuts 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 Finerenone FDA Widens Indication of Finerenone for Heart Failure Patients https://www.medscape.com/viewarticle/fda-widens-indication-finerenone-heart-failure-patients-2025a1000ive FDA finerenone approval https://bayer2019tf.q4web.com/news/news-details/2025/U-S--FDA-Approves-KERENDIA-finerenone-to-Treat-Patients-With-Heart-Failure-With-Left-Ventricular-Ejection-Fraction-40-Following-Priority-Review/default.aspx FINEARTS-HF trial https://www.nejm.org/doi/full/10.1056/NEJMoa2407107 II Choosing TAVI or Surgical AVR Carbon Emission when treating AS EHJ study https://doi.org/10.1093/eurheartj/ehaf379 III Brain Lesions and Visual Migraine Af

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