JACC This Week

In this episode, Dr. Valentin Fuster discusses the Garter AF trial, which evaluates the impact of screening for undiagnosed atrial fibrillation (AF) in older adults using a 14-day ECG monitor to reduce stroke risk. While the study found a marginal increase in AF diagnoses, it suggests that AI could play a crucial role in identifying high-risk patients who would benefit most from such screenings, highlighting the need for a more targeted approach in future trials.

In this episode, Dr. Valentin Fuster discusses a groundbreaking study on the embryological origins of atrial fibrillation triggers, which could help refine treatment strategies for the condition. The research highlights how genetic factors linked to specific atrial regions, like the sinus venosus and primitive atrium, influence arrhythmia recurrence after ablation, potentially paving the way for more personalized, effective treatments.

In this episode, Dr. Valentin Fuster reviews two pivotal phase three trials from China assessing the efficacy of the new monoclonal antibody, Katisha, for treating non-familial hypercholesterolemia. With significant reductions in LDL cholesterol and a long-acting, flexible dosing regimen, these studies promise a novel therapeutic option for patients struggling with cholesterol management and adherence to traditional treatments.

In this episode, Dr. Valentin Fuster delves into the transformative potential of artificial intelligence (AI) in cardiovascular clinical trials, guided by a comprehensive review from leading experts. Highlighting both innovative applications and regulatory challenges, the discussion emphasizes AI's role in trial design, patient recruitment, and data analysis, while cautioning against risks like bias and data privacy concerns.

In this episode, Dr. Valentin Fuster highlights the groundbreaking studies featured in the November 12, 2024 issue of the JACC, focusing on the emerging role of proteomics in understanding heart failure and hypertrophic cardiomyopathy. He discusses key findings on SGLT2 inhibitors, the efficacy of complete revascularization in myocardial infarction patients, and novel treatments for hypercholesterolemia, emphasizing the transformative potential of these insights for cardiovascular care.

In this episode, Dr. Valentin Fuster discusses a pivotal study on revascularization strategies in older patients with myocardial infarction, comparing complete versus culprit-only approaches. The findings suggest that physiology-guided complete revascularization significantly reduces adverse outcomes in both STEMI and non-STEMI patients, emphasizing its potential benefits across a diverse patient population.

In this episode, Dr. Valentin Fuster reviews two pivotal phase three trials from China assessing the efficacy of the new monoclonal antibody, Katisha, for treating non-familial hypercholesterolemia. With significant reductions in LDL cholesterol and a long-acting, flexible dosing regimen, these studies promise a novel therapeutic option for patients struggling with cholesterol management and adherence to traditional treatments.

In this episode, Dr. Valentin Fuster discusses groundbreaking research on hypertrophic cardiomyopathy (HCM), revealing dysregulated signaling pathways through comprehensive proteomic profiling of human myocardial tissue. The study identifies novel therapeutic targets, including the Ras MAPK pathway and the ubiquitin-proteasome system, while emphasizing the need for further exploration beyond obstructive cases to better understand the disease's molecular mechanisms.

In this episode, Dr. Valentin Fuster discusses groundbreaking research on SGLT2 inhibitors and their impact on heart failure, highlighting the validation of mechanistic proteomic signatures from a major clinical trial. The study reveals how empagliflozin influences over 2,000 proteins, promoting autophagy, enhancing mitochondrial health, and normalizing kidney function, offering new insights into therapeutic strategies for heart failure management.

Author Robert W. Yeh, MD, FACC, and JACC Associate Editor Celina M. Yong, MD, FACC, discuss the results of the TARGET-IV NA trial. In the trial, 1720 patients with stable or acute coronary syndromes were randomized to undergo PCI with a BP-SES or any commonly used 2nd generation DES. At 12 months, BP-SES was non-inferior to control DES for the primary endpoint of Target Lesion Failure (cardiac death, target vessel-related myocardial infarction (MI), or ischemia-driven target lesion revascularization) which occurred in 3.4% of the BP-SES arm versus 3.3% in the control arm; p-value for non-inferiority. Secondary endpoints were also similar between groups.

In this episode of JACC, Author Suzanne Arnold, MD and JACC Associate Editor Dennis T. Ko, MD, discusses groundbreaking findings from the Tricatin-2 trial, the first clinical study on transcatheter tricuspid valve replacement. The results reveal significant improvements in quality of life for patients, particularly those with severe tricuspid regurgitation, highlighting the transformative potential of this procedure compared to traditional medical therapy.

Author Shao-Liang Chen, MD, FACC, and JACC Associate Editor Celina M. Yong, MD, FACC, discuss patients with simple and true coronary bifurcation lesions undergoing provisional stenting. Main vessel stenting with a DCB for the compromised side branch resulted in a lower 1-year rate of the composite outcome compared with an NCB intervention for the side branch. The high rates of periprocedural myocardial infarction, which occurred early and did not lead to revascularization, are of unclear clinical significance.

Author Nicolas M. Van Mieghem, MD, PhD, FACC, and JACC: Executive Associate Editor Aakriti Gupta, MD, FACC, discuss the TAVR UNLOAD trial, which focused on patients with moderate aortic stenosis (AS) and reduced ejection fraction (HFrEF). The trial found no significant difference in the primary endpoint (composite of mortality, stroke, and hospitalizations) between the TAVR and clinical surveillance groups. However, patients who underwent TAVR showed a significant improvement in quality of life at one year. The conversation highlighted the need for individualized treatment approaches, emphasizing patient selection, while also considering trial limitations, including slow enrollment and study size.

In this episode, Dr. Valentin Fuster explores groundbreaking research on hypertrophic cardiomyopathy, focusing on the effects of the drug aficamten on cardiac structure and function. Highlighting significant findings from the Sequoia HCM trial, the discussion underscores the potential of aficamten to induce favorable cardiac remodeling and improve patient outcomes, signaling a transformative era in the management of this condition.

In this episode, Dr. Valentin Fuster introduces a dedicated focus on hypertrophic cardiomyopathy, featuring a pivotal study by Dr. Martin Maron and Dr. lacopo Olivotto on the impact of aficamptin. This pre-specified sub-analysis from the SEQUOIA HCM trial aims to comprehensively evaluate the drug's effects on various aspects of disease burden, enhancing our understanding of its clinical efficacy.

In this episode, Dr. Valentin Fuster highlights the Forest HCM study, which focuses on the withdrawal of standard care medications in patients with obstructive hypertrophic cardiomyopathy receiving afficantin. The study shows promising results: nearly half of the patients who attempted to reduce or stop their medications did so successfully, with significant improvements in functional class and symptoms. While the findings suggest that afficantin may allow for the reduction of traditional therapies, caution is advised, as not all patients may benefit equally.

In this episode, Dr. Valentin Fuster dives into a pivotal study on hypertrophic cardiomyopathy, focusing on the challenges of identifying at-risk relatives when genetic variants are not found in 60% of families. With insights into the disease's autosomal dominant inheritance and incomplete penetrance, this discussion highlights the complexities of family screening and the need for innovative approaches in managing this condition.

In this episode, Dr. Valentin Fuster delves into the latest research on hypertrophic cardiomyopathy, highlighting the significant health status improvements achieved with the new cardiac myosin inhibitor, Aficamten, compared to placebo. The findings from the Sequoia HCM study reveal that Aficamten markedly enhances patients' quality of life and alleviates symptoms like chest pain and shortness of breath, paving the way for more effective treatments in this challenging condition.

In the November 5, 2024 issue of JACC, Dr. Valentin Fuster summarizes the November 5, 2024 issue of the JACC, which focuses exclusively on hypertrophic cardiomyopathy (HCM). Highlighting six original research papers, the discussion emphasizes the groundbreaking impact of the cardiac myosin inhibitor Aficamten on health outcomes, symptom burden, and cardiac structure in patients with obstructive HCM, while also exploring genetic screening implications for affected families.

In this episode, Dr. Valentin Fuster delves into a groundbreaking study on the effects of the cardiac myosin inhibitor, Aficamten, on patients with obstructive hypertrophic cardiomyopathy. The findings reveal significant improvements in echocardiographic measures of cardiac function, despite a mild and reversible decrease in left ventricular ejection fraction, highlighting the need for long-term safety evaluations of this promising treatment.

Author Joerg Hausleiter, MD and Executive Associate Editor Aakriti Gupta, MD, FACC. discuss the TAVR UNLOAD trial, which focused on patients with moderate aortic stenosis (AS) and reduced ejection fraction (HFrEF). The trial found no significant difference in the primary endpoint (composite of mortality, stroke, and hospitalizations) between the TAVR and clinical surveillance groups. However, patients who underwent TAVR showed a significant improvement in quality of life at one year. The conversation highlighted the need for individualized treatment approaches, emphasizing patient selection, while also considering trial limitations, including slow enrollment and study size.

JACC Associate Editor Celina M. Yong, MD, FACC, and JACC: Case Reports Editor in Chief Gilbert H. L. Tang, MD, MSc, MBA, FACC, discuss this paper published in JACC and presented at TCT. TRILUMINATE Pivotal is the first randomized, controlled trial evaluating transcatheter edge-to-edge repair (T-TEER) for severe tricuspid regurgitation (TR). Adaptive design randomized 572 subjects in the primary or subsequent cohorts. Subjects were elderly with atrial fibrillation and prior HFH. Primary endpoint was met at 1 year with a larger win ratio for T-TEER driven by KCCQ improvement with no significant differences in mortality and tricuspid valve surgery or HFH.

In this episode, Dr. Valentin Fuster reviews the Ironman trial, which studied the effects of intravenous iron on patients with heart failure and iron deficiency. While intravenous iron improved symptoms and reduced recurrent hospitalizations, it did not significantly impact first-time hospitalizations or mortality rates, suggesting the need for further research into its broader clinical benefits.

In this episode, Dr. Zhuo Chen and his team explore how AI-driven analysis of neighborhood satellite imagery can reveal links between the built environment and cardiovascular risk. Their findings suggest that while AI can predict adverse cardiovascular events, the influence of social determinants, particularly socioeconomic status, plays a critical role in this relationship, underscoring the need for further research into these complex interactions.

In the October 29, 2024 issue of JACC, Dr. Valentin Fuster explores groundbreaking studies on heart failure treatments, including the impact of sacubitril-valsartan on hypotension, the benefits of intravenous iron for reducing hospitalizations, the prognostic value of platelet FCγRIIA in post-myocardial infarction patients, and innovative AI assessments of environmental factors influencing cardiovascular risk.

In this episode, Dr. David J. Schneider research identifies platelet FCγRIIA (PFCG) as a key biomarker for cardiovascular risk post-myocardial infarction. In an 800-patient study, higher PFCG levels were linked to increased risks of myocardial infarction, stroke, and death, indicating its potential for guiding personalized antiplatelet therapy, pending further validation.

In this episode, Dr. Valentin Foster introduces a vital review on aspirin hypersensitivity in patients with atherosclerotic cardiovascular disease, led by Dr. Mattia Galli and Dr. Dominick J. Angiolillo. The discussion spans the history, epidemiology, and mechanisms of aspirin hypersensitivity, alongside strategies for management and practical recommendations for healthcare providers.

In this episode, researchers explore how asymptomatic versus symptomatic hypertension affects heart failure patients on sacubitril valsartan, finding that both types are linked to worse outcomes, but the drug's benefits remain strong, suggesting clinicians should avoid stopping treatment based solely on blood pressure.

In this episode, Dr. Valentin Foster explores the October issue of JACC, which highlights obesity and the potential benefits of glucagon-like peptide receptor agonists, particularly semaglutide, in treating heart failure. He delves into the FLOW trial, revealing how semaglutide significantly reduced heart failure events and cardiovascular death in patients with type 2 diabetes and chronic kidney disease, while also addressing the study's limitations and the need for improved diagnostic criteria in future research.

In this episode, Dr. Valentin Foster explores the October 2024 issue of JACC, highlighting the significant benefits of semaglutide, particularly for individuals with obesity and cardiovascular disease. He focuses on findings from the SELECT trial, which demonstrate that semaglutide reduces overall and cardiovascular mortality, as well as COVID-19 related deaths, emphasizing the need for continued innovative research in addressing health challenges.

In this episode, Dr. Valentin Fuster discusses a pivotal study on inflammation's role in obesity-related heart failure with preserved ejection fraction, highlighting findings from the STEP heart failure program. The research reveals that semaglutide improves heart failure symptoms and reduces inflammation across varying baseline CRP levels, suggesting cardiovascular benefits that extend beyond weight loss alone.

In this episode, Dr. Valentin Fuster summarizes the pivotal October 2024 issue of the JACC Journal, focusing on the intersection of obesity and cardiology. Key discussions include the revolutionary impact of anti-obesity medications like semaglutide on heart health, the intricate relationship between obesity and heart failure with preserved ejection fraction, and the urgent need for equitable access to these therapies for improved cardiovascular outcomes.

In this episode, Dr. Valentin Foster highlights the October 2024 issue of JACC, which delves into the benefits of semaglutide for obesity-related heart failure with preserved ejection fraction. A key study presented shows that semaglutide significantly improves heart failure symptoms and physical limitations, particularly in patients with a history of atrial fibrillation, underscoring its efficacy beyond mere weight loss.

In the October 22, 2024 issue of JACC, a podcast explores the promising benefits of semaglutide, a glucagon-like peptide receptor agonist, in treating obesity-related heart failure. The episode discusses key findings from original research, highlighting how semaglutide improves cardiac structure and function, attenuates adverse remodeling, and showcases the dual mechanisms—both weight-related and independent—behind these effects.

Dr. Sardari Nia's trial on digital cardiac counseling, presented at EACTS and published in JACC, is a randomized study of 394 patients. It investigated the impact of telemedicine-based prehabilitation to reduce modifiable risk factors in patients awaiting elective cardiac surgery. The results demonstrated a significant 35% reduction in major adverse events, particularly rehospitalizations, highlighting the safety and effectiveness of prehabilitation in improving patient outcomes. This trial also emphasizes empowering patients to take control of their health before surgery, potentially benefiting healthcare on a larger scale.

In the October 15, 2024, issue of JACC, Dr. Valentin Fuster highlights a crucial study revealing that the prevalence of diagnosed atrial fibrillation in the U.S. has surged to at least 10.5 million adults, driven by factors like aging, obesity, and diabetes. With a call for improved prevention and treatment strategies, experts stress the urgent need for public health initiatives to tackle this growing burden on the healthcare system.

In this episode, Dr. Valentin Fuster summarizes the October 2024 issue of the JACC Journal, highlighting four pivotal studies on atrial fibrillation, anticoagulation strategies in STEMI, heart failure risk assessment, and the impact of urinary metal levels on coronary artery calcification. Emphasizing the increasing prevalence of atrial fibrillation and the critical role of biomarkers, he underscores the urgent need for enhanced prevention strategies and public health actions regarding environmental metal exposure.

In this episode, Dr. Valentin Fuster discusses a pivotal study comparing bivalirudin and heparin anticoagulation in STEMI patients undergoing primary PCI, highlighting that bivalirudin may reduce cardiac mortality and bleeding without increasing thrombotic events. While the findings challenge previous guidelines favoring heparin, limitations in the research prompt caution about immediate changes to clinical practice, emphasizing the need for further exploration of bivalirudin's role in diverse patient populations.

In this insightful episode of JACC, Dr. Valentin Fuster summarizes groundbreaking international clinical practice guidelines for acute pulmonary embolism, authored by Dr. Marco Suin and colleagues. The discussion delves into key aspects such as diagnosis, risk stratification, immediate anticoagulation, and advanced therapies, highlighting the challenges and recommendations that can ultimately guide clinicians in managing this critical condition.

In the October 15, 2024 issue of JACC, a study led by Dr. Paul Haller investigates the use of biomarkers—NT-proBNP, high-sensitive cardiac troponin T, and GDF-15—to assess heart failure risk in patients with atrial fibrillation. The findings reveal that these biomarkers significantly enhance risk stratification, suggesting their potential to identify patients at varying risks for heart failure and improve clinical management.

In this episode, Dr. Valentin Fuster discusses a groundbreaking study linking urinary metal levels, particularly non-essential metals like cadmium and uranium, to coronary artery calcification, highlighting their potential role in cardiovascular disease. The findings underscore the urgent need for public health initiatives to address environmental metal exposure, as they could significantly mitigate cardiovascular risks and health disparities.

Michelle M Kittleson, MD, FACC, JACC Associate Editor, speaks with author Muthiah Vaduganathan, MD on his accepted paper concerning the FINEARTS trial published in JACC.

Akshay S. Desai, MD, FACC presents his accepted HFSA presentation concerning the FINEARTS trial published in JACC, with commentary by Theresa McDonagh, MBBCH, JACC Associate Editor.

In this episode, Dr. Valentin Fuster discusses groundbreaking research on the impact of subclinical atherosclerosis on mortality, revealing insights from a 15-year study. He emphasizes the limitations of traditional cardiovascular risk prediction tools, like the Framingham Risk Score, and calls for deeper exploration of individual risk factors for better long-term outcomes.

In the October 8, 2024 issue of JACC, a pivotal study explores the prognostic implications of various diagnostic criteria for myocarditis, comparing the European Society of Cardiology and the late-luis criteria. The findings reveal that while most patients can be diagnosed using ESC criteria, the combination of both sets enhances risk stratification, emphasizing the need for collaboration between clinical cardiologists and imaging specialists in managing suspected myocarditis cases.

In the October 8, 2024, issue of JACC, Dr. Casper Bonison and colleagues present a study on the risks of ischemic stroke recurrence after PFO closure, revealing that while the four-year risk remains higher than the general population, it mirrors clinical trial findings. They emphasize the importance of careful patient selection and the need for further research into closure techniques and associated stroke risk factors.

In this episode, Dr. Valentin Fuster introduces a crucial consensus document on Critical Care Cardiology training, highlighting insights from leading experts at the University of Minnesota and Harvard. With the field rapidly expanding and 20% of incoming cardiology fellows expressing interest in this specialty, the panel outlines key recommendations for enhancing training programs to meet evolving demands.

In this episode, Dr. Valentin Fuster discusses a groundbreaking study that evaluates the role of myocardial fibrosis in predicting sudden cardiac death and ventricular arrhythmias in patients with non-ischemic cardiomyopathy. The findings suggest that assessing fibrosis through advanced imaging techniques offers a more accurate risk stratification than the traditional reliance on left ventricular ejection fraction, ultimately refining treatment approaches for at-risk patients.

In this episode, Dr. Valentin Fuster highlights groundbreaking research from the October 8, 2024 issue of JACC. Key studies delve into the evolving diagnostic criteria for myocarditis, the prognostic value of subclinical atherosclerosis, the arrhythmic risks in non-ischemic cardiomyopathy, and the implications of PFO closure on ischemic stroke risk, underscoring the importance of advanced imaging techniques and clinical criteria in modern cardiovascular care.

In this episode, experts discuss a crucial 2024 document outlining appropriate use criteria for multimodality imaging in cardiovascular evaluation before non-emergent non-cardiac surgery, addressing the rising annual surgeries and associated cardiac risks. They delve into balancing the necessity of imaging with cost-effectiveness while exploring the potential of artificial intelligence to enhance future evaluations.