This podcast delivers Dr. John Mandrola's summary and perspective on top news of the week that cardiologists can't miss. This podcast is intended for US health professionals only.
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Dr. John Mandrola discusses groundbreaking research, including a potential permanent genetic therapy for high LDL cholesterol and the sustained metabolic superiority of tirzepatide over semaglutide. The episode also delves into a subanalysis on PCSK9 inhibitors for post-PCI patients and new insights into arrhythmia patterns in cardiac amyloidosis from the EXCALIBUR study. Finally, Dr. Mandrola addresses a rebuttal to his critique of the recent complex lipid guidelines.
John Mandrola discusses the latest cardiology research, including the DECISION trial and meta-analysis on low-dose digoxin in heart failure, emphasizing its clinical meaningfulness despite not always reaching statistical significance, and the dangers of discontinuation. He introduces Retatrutide, a new GLP-1 drug showing powerful weight loss and broader cardiovascular benefits, potentially surpassing statins. The episode also explores the controversial, financially-driven early termination of the ANTHEM HFrEF vagal nerve stimulation trial, highlighting concerns about industry-sponsored science. Finally, Mandrola addresses new lipid guidelines, the significant statin nocebo effect, and the future role of GLP-1 drugs in prevention.
This episode reviews critical updates in cardiology, discussing findings from the positive Dig-RHD trial on digoxin's utility in heart failure and the Orbita-FIRE study's profound insights into angina physiology. It also covers new predictors for hypertrophic cardiomyopathy outcomes using CMR and expresses concerns about the increasing trend of TAVR in younger, lower-risk patients.
John Mandrola reviews feedback from DanGer Shock investigators regarding Impella support, delving into the complexities of as-treated analysis. He then explores the debate around immediate versus staged complete revascularization in STEMI patients, analyzing meta-analysis data and clinical considerations. The episode also critiques the commercialization and clinical utility of polygenic risk scores for cardiac conditions, questioning their incremental benefit. Finally, it highlights a randomized controlled trial that found quality improvement policies failed to improve patient outcomes, emphasizing the need for rigorous testing.
John Mandrola, MD, reviews critical cardiology updates, starting with optimal timing for quadruple therapy in HFrEF, including unexpected racial disparities. He critically analyzes the AVANT GUARD PFA trial, noting its high stroke rate and disappointing efficacy, and further highlights PFA safety concerns with the TIFFANY study. The episode also explores the TREAT-PVC trial, which revealed significant sham effects in reducing PVC burden and advocates for cautious intervention. Finally, Mandrola discusses NSTEMI care for frail elderly patients, recommending a conservative approach over an early invasive strategy.
John Mandrola reviews key cardiology developments, including the modest benefits of PCSK9 inhibitors in high-risk diabetes and conflicting data on AV node ablation for CRT. He also raises concerns about higher stroke rates with pulsed field ablation compared to thermal methods. Finally, the episode offers a strong critique of how industry interests and "therapeutic fashion" are influencing new electrophysiology training guidelines, particularly regarding left atrial appendage occlusion without robust evidence.
This week, John Mandrola dissects new cardiology research, including the underpowered SPIRIT-HF trial for heart failure with preserved ejection fraction and the ESSENCE imaging study of Olezarsen, a novel triglyceride-lowering drug with minimal plaque impact. He also highlights the successful SirPAD trial demonstrating benefits of sirolimus-coated balloons in peripheral artery disease. Finally, he praises the Ulysses trial for providing definitive evidence for ultrasound-guided femoral venous access in AFib ablations, advocating for its widespread adoption.
Dr. John Mandrola discusses several recent cardiology trials, including two imaging-guided PCI studies (Optimal and IVIS-CHIP) that found no benefit, challenging current guidelines. He also critiques the Ez-PAVE trial's findings on very low LDL targets, questioning the plausibility of its positive results. The episode introduces enlicitide, a new oral PCSK9 inhibitor showing strong LDL reduction, and covers the SMART-DECISION trial, which supports beta-blocker withdrawal in post-MI patients with preserved ejection fraction. A key theme is the "expiration date" of medical evidence.
John Mandrola provides a critical recap of five significant cardiology trials presented at ACC 2026. He meticulously dissects the Hi-PEITHO, PRO-TAVI, ORBITA-CTO, CHIPS-BCIS3, and CHAMPION AF studies, often presenting a contrarian view to the widely accepted "wins." The discussion highlights issues with composite endpoints, non-inferiority margins, industry sponsorship, and the premature adoption of medical devices, urging clinicians to look beyond top-line results and prioritize robust evidence in patient care.
This episode delves into crucial cardiology updates, starting with the long-term follow-up of the RECOVERY trial, questioning the "asymptomatic" status in early aortic valve replacement. It then examines major bleeding risks associated with left atrial appendage occlusion devices from the AMULET-IDE trial, highlighting patient factors over procedure. Finally, Dr. Mandrola provides an in-depth preview of significant trials at the ACC meeting, including those on high-risk PCI, LAAO expansion, CTO interventions, heart failure management, and lipid targets, offering critical commentary on their design and implications.
John Mandrola analyzes the recently published CLOSURE-AF trial, which found left atrial appendage closure was not non-inferior, and potentially inferior, to best medical therapy, highlighting concerns about high bleeding rates and procedural harm. He also scrutinizes the new ACC/AHA lipid treatment guidelines, arguing many Class I recommendations lack robust randomized controlled trial evidence, introducing complexity and potential conflicts of interest. The episode concludes with a skeptical preview of the upcoming CHAMPION AF trial and a call for simpler, evidence-based medical practice.
Dr. John Mandrola reviews key cardiology research, including the surprising findings on beta-blockers impairing exercise capacity in non-obstructive hypertrophic cardiomyopathy. He also delves into a head-to-head comparison of apixaban and rivaroxaban, highlighting differences in bleeding risk, particularly with loading doses. The episode further explores drug-drug interactions between diltiazem, metoprolol, and DOACs, and assesses the impressive accuracy and clinical utility of smartwatches for detecting atrial fibrillation post-ablation.
This episode covers critical topics in cardiology, starting with listener feedback on statin preferences and the role of physician trust. It then delves into the dangers of urgent AF ablations and the limited efficacy of AF ablation for stroke reduction, particularly when DOACs are used. The discussion also highlights variable accuracy in implantable loop recorders and concludes with insights into heart failure management in patients with advanced cancer, emphasizing quality of life.
John Mandrola discusses the complexities of CPR/DNR orders, highlighting the need for clearer language and updated guidelines based on patient preference and clinical benefit. He reviews a study revealing discrepancies between public and specialist perspectives on statin therapy, showing many patients require higher perceived risk reduction to accept treatment. The episode also delves into new oral GLP-1 RA trials, a study on spontaneous echo contrast impacting left atrial appendage closure outcomes, and expresses caution regarding the current enthusiasm for pulse field ablation despite its rapid adoption.
John Mandrola reviews the 6-year EVOLUT Low Risk trial data, raising concerns about reintervention rates and methodological issues in TAVR for low-risk patients, supported by recent meta-analyses. He then delves into the ethical complexities and poor documentation of unilateral Do-Not-Resuscitate orders in hospitals. The podcast also critiques the persistent, evidence-lacking use of targeted hypothermia post-cardiac arrest, while celebrating a new HFpEF device trial for its robust sham-controlled design. Finally, Mandrola explores the promising observational evidence for GLP-1 agents like semaglutide in treating atrial fibrillation, suggesting a significant future role.
This episode delves into various cardiology topics, including the debate between ticagrelor and prasugrel for post-stenting care, and a critical look at a new left atrial appendage closure device. It also provides a four-year follow-up on pulsed field ablation for AFib, discusses the controversial use of the term "provider" in healthcare, and critiques observational studies on coffee and dementia. Finally, the episode highlights the promising results of lifestyle interventions for AFib patients.
This week in cardiology addresses critical updates in cardiovascular care, beginning with issues in the PREVENT risk score and its underestimation of risk in young Black adults. It then highlights a promising new oral PCSK9 inhibitor for significant LDL-C reduction and a breakthrough factor XI inhibitor, Asundexian, showing efficacy in preventing recurrent ischemic stroke. The episode also re-examines statin side effects through a major meta-analysis, emphasizing the nocebo effect, and concludes by discussing the dramatic decline in heart attack mortality due to improved acute care, which recontextualizes the value of some preventive measures.
John Mandrola discusses the latest in cardiology, starting with listener feedback on TEE, ICE, and LGE in athletes. He then delves into the Beat Perox AFib trial, comparing PFA to RF ablation for AFib, highlighting PFA's speed but similar efficacy and safety. The episode also presents sobering reports of rare but life-threatening PFA complications, including delayed myocardial ischemia and atrial-esophageal fistulae. Finally, it reviews alarming US obesity statistics and the Tricorder trial, which evaluated an AI-enhanced stethoscope, revealing challenges in real-world implementation of new diagnostic technologies.
John Mandrola reviews key cardiology topics, starting with listener feedback on AF withdrawal and procedure credit. He delves into a study on TAVR and M-TEER procedural volume, emphasizing how higher operator experience correlates with better patient outcomes, and debates the implications for healthcare allocation. Another segment explores ventricular arrhythmia in older endurance athletes, linking it to myocardial fibrosis and cautioning against universal screening. Finally, Mandrola critically examines the use of 10-year versus 30-year risk assessment for statin prescription, arguing for a more pragmatic approach.
John Mandrola reviews significant cardiology topics, starting with listener insights on fish oil and AFib conversion agents. He delves into the "Withdraw AF" trial, examining the feasibility of withdrawing heart failure therapy after successful AF rhythm control, and then critiques the routine use of TEE before AF ablation, presenting new trial data on intracardiac echo (ICE). The episode concludes with a fascinating, complex percutaneous aorto-coronary bypass procedure and a broader reflection on innovation and end-of-life care in cardiology.
Dr. John Mandrola reviews recent cardiology studies, starting with the challenge of predicting coronary artery disease even with CCTA, highlighting its limited clinical value in reclassification. He then delves into the surprising connection between fish oil supplements and an increased risk of atrial fibrillation, advocating for whole fish over pills. The episode also covers the FDA's approval of etripamil, a novel nasal spray for SVT, and re-evaluates vernakalant for AFib conversion, considering its effectiveness against existing alternatives.
Dr. John Mandrola delves into four major cardiology topics: the limitations of risk scores in predicting first MIs and the "MI paradox"; the CELEBRATE trial of a new subcutaneous glycoprotein IIb/IIIA inhibitor and its controversial endpoint; the SURPASS-CVOT trial comparing tirzepatide and dulaglutide for cardiovascular outcomes in diabetes; and the crucial lesson from the FDA's removal of andexanet alfa due to problematic evidence and safety concerns. The discussion highlights the complexities of clinical trial interpretation and drug regulation.
John Mandrola analyzes an elegant study revealing distinct patterns and mechanisms of intra-procedural versus delayed AV block after TAVR, offering crucial insights for pacemaker implantation. He then discusses revascularization outcomes for women with severe chronic CAD, highlighting observational data suggesting CABG may be superior to PCI for this demographic. Finally, Mandrola critiques the utility of CTO PCI, arguing for stronger evidence before widespread adoption.
This episode reviews several cardiology trials, discussing the TARGET-FIRST trial on early aspirin discontinuation post-PCI and the RETREAT-FRAIL study's surprising insights into blood pressure medication reduction in frail elderly patients. It also delves into the ARTESiA sub-analysis comparing bleeding risks with aspirin versus apixaban, highlighting the safety of DOACs. Further topics include the high value of AEDs in public health and an update on the OCEANIC STROKE trial for Factor XI inhibitors.
John Mandrola, MD, addresses listener feedback regarding complete vs. culprit-only PCI in STEMI, the debate on drug class effects, and the nuances of cholesterol's role in atherosclerosis. He delves into new data from the CREST-2 trial, reshaping the approach to asymptomatic carotid artery disease, and presents compelling evidence from the Tuxedo-2 trial that favors prasugrel over ticagrelor for antiplatelet therapy. Finally, Dr. Mandrola reviews the DECAF trial, concluding that coffee consumption does not increase the risk of atrial fibrillation and should not be routinely restricted for patients.
Listener feedback on the PISCES trial, AHA news (including a big PCSK9i trial), beta-blockers post MI, LAAC, and post-AF ablation OAC use 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 Why I Believe Fish Oil's Big CV Benefit in Dialysis Patients https://www.medscape.com/viewarticle/why-i-believe-fish-oils-big-cv-ben...
Listener feedback on non-culprit PCI in STEMI, a major cardiac result in patients on hemodialysis, news on GLP-1 agonists, a dubious stroke trial, and an AHA preview 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 Meta-analysis of MI as a surrogate https://pubmed.ncbi.nlm.nih.gov/34694318/ Compare Acute Trial https:/...
Four pillars of cardiology today, stable coronary artery disease, severe aortic stenosis, the evaluation of chest pain, and best therapies 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 Stable CAD Complete vs culprit-only revascularization at time of STEMI iMODERN Trial https://www.nejm.org/doi/full/10.1056/NE...
The PREVENT score in hypertension, GLP-1 mechanism of action in cardiovascular disease, CAD type and statin benefit, and the problem with hospitalization endpoints in HF 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 Is the PREVENT Calculator Best for Determining CVD Risk? Insights From a Post Hoc Analysis of SPRINT Trial http...
Another knock against the antiplatelet/anticoagulant combo, polypills in HF, the physical exam of the future, and the problem of underpowered trials that even Bayesian analyses cannot rescue 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 Trends Study https://www.heartrhythmjournal.com/article/S1547-5271(11)00496-6/f...
