JACC This Week

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.

In this insightful discussion from the October 1, 2024 issue of JACC, researchers reveal that triglyceride-rich lipoprotein (TRL) remnants are significantly more atherogenic than LDL cholesterol, suggesting a need for updated risk assessment strategies. The study advocates for a shift towards evaluating lipoproteins on a per-particle basis, which could revolutionize the diagnosis and treatment of lipid disorders by focusing on the functional activity of these particles.

In this episode, Dr. Valentin Fuster discusses a comprehensive review on the challenges and considerations of using implantable cardiography devices in patients with advanced chronic kidney disease and heart failure. Highlighting key findings from Dr. Cecilia Barca's research, he explores the nuanced interplay between these conditions and device efficacy, emphasizing the need for tailored patient evaluations and future studies to improve outcomes.

In this episode, Dr. Valentin Fuster discusses groundbreaking research on the interplay between cardiovascular risk factors and chronic kidney disease (CKD) progression among Chinese adults. Highlighting a study that reveals how effective management of hypertension, cholesterol, and blood glucose can significantly reduce the risks of cardiovascular events and mortality in CKD patients, the conversation emphasizes the crucial need for targeted treatment strategies to improve patient outcomes.

In this episode, Dr. Valentin Foster highlights a groundbreaking study published in the October 2024 issue of JACC, which explores how patiromer facilitates the effective use of angiotensin inhibitors and mineralocorticoid antagonists in heart failure patients at risk of hyperkalemia. Authored by Dr. Bertram Pete and colleagues, the research demonstrates that patiromer not only helps achieve optimal medication doses but also improves potassium management, ultimately enhancing patient outcomes in this high-risk population.

In the October 2024 issue of JACC, Dr. Valentin Fuster highlights five diverse studies addressing key topics in cardiovascular health, from surgical outcomes for congenital anomalies to the impact of patiromer on heart failure therapies. The episode underscores the importance of managing cardiovascular risk factors in chronic kidney disease and explores new insights into lipid profiles, revealing that triglyceride-rich lipoproteins may pose greater cardiovascular risks than previously understood.

In this episode, Dr. Valentin Fuster reviews a pivotal document on Social Determinants of Health (SDOH) in cardiology, highlighting their critical role in shaping health outcomes. He outlines ten key insights, emphasizing the need for standardized definitions and integration of SDOH into electronic health records to promote equitable healthcare and improve patient outcomes.

In this episode, Dr. Valentin Fuster highlights a groundbreaking study on surgical outcomes for complete vascular rings, revealing that 95% of children experience complete symptom resolution after comprehensive surgical interventions. The discussion emphasizes the evolution of surgical techniques at Boston Children's Hospital and the potential for fetal diagnosis to alter the natural history of this congenital anomaly.

Dr. Kaitlyn McGraw discusses her study on the relationship between urinary trace metal levels and coronary artery calcification, highlighting the role of environmental exposures in cardiovascular disease risk. The research reveals significant associations between elevated levels of metals like cadmium, tungsten, and uranium with the progression of calcification, comparable to traditional risk factors such as smoking and diabetes. Dr. McGraw emphasizes the need for integrating environmental factors into cardiovascular risk assessments and suggests policy changes to better regulate metal exposure in the population. Moderated by Khurram Nasir, MBBS, FACC.

In this episode, Dr. Valentin Fuster highlights key studies from the September 24, 2024 issue of JACC, featuring groundbreaking research on the impact of cold temperatures on myocardial infarctions, the nuanced recovery process in Takotsubo syndrome, and evolving trends in the condition. Also discussed are novel insights into predicting long-term outcomes for recurrent pericarditis and the influence of obstructive sleep apnea on cardiovascular health.

In the September 24, 2024 issue of JACC, Dr. Ben Lee Nay and colleagues reveal that short-term exposures to lower temperatures and cold spells significantly increase the risk of myocardial infarction hospitalizations in Sweden. This nationwide study, utilizing advanced machine learning techniques, underscores the pressing need to address both extreme cold and heat in climate change mitigation efforts to better protect cardiovascular health.

In the September 24, 2024, issue of JACC, Dr. Abdullah Yashin Yaprak and his team at Cleveland Clinic unveil a groundbreaking risk prediction model for recurrent pericarditis using machine learning. Their study, analyzing data from 365 patients, offers a novel tool to stratify patients based on their likelihood of achieving clinical remission, showcasing the promising intersection of AI and personalized medicine in cardiology.

In this episode, Dr. Valentin Fuster dives into a comprehensive review of obstructive sleep apnea, exploring its complex interactions with cardiovascular disease and discussing its multifaceted treatment options. The podcast unpacks how sleep apnea exacerbates cardiovascular conditions through biological pathways, examines the impact of various therapies, and considers future directions for research and clinical practice.

In the September 24, 2024, JACC issue, Dr. Valentin Fuster presents the latest expert consensus on heart failure management, updating the 2019 guidelines with ten key changes. Highlights include a strong emphasis on SGLT inhibitors throughout hospitalization and a refined approach to managing heart failure patients, ensuring timely adjustments in therapy and improved patient care strategies.

In the September 24, 2024 issue of JACC, Dr. Manuel Almendro Odelia and Dr. Ivan Nunet Hill present groundbreaking research on Takotsubo syndrome, revealing that delayed recovery of left ventricular function significantly worsens both short and long-term survival. The study, based on data from the extensive RITACCO registry, identifies key predictors of slow recovery and underscores the need for closer follow-up in affected patients, challenging traditional treatment approaches and highlighting the evolving understanding of this complex condition.

In the September 24, 2024 issue of JACC, Dr. Valentin Fuster explores a pivotal study on Takotsubo Syndrome, revealing significant shifts in patient demographics, trigger types, and outcomes over nearly two decades. The research highlights an increase in physical triggers and short-term mortality, reflecting a more complex and severe understanding of the condition than previously recognized.

In the September 17, 2024 issue of JACC, Valentin Fuster discusses a study on sotagliflozin, a dual SGLT1 and SGLT2 inhibitor, which shows modest improvements in health status among patients with worsening heart failure. While the study highlights sotagliflozin's benefits, it also points out gaps in understanding its full impact and emphasizes the need to optimize current treatments and explore future interventions.

In this episode of JACC, Valentin Fuster examines genotype-guided antiplatelet therapy, emphasizing its potential to tailor treatments based on genetic variants for improved patient outcomes. While promising, the approach faces challenges like testing delays and variable patient responses that need addressing for broader implementation.

In this September 17, 2024 JACC issue, Dr. Zhi Jian Zhang and colleagues unveil a groundbreaking study on pulmonary arterial hypertension (PAH) that identifies plasma IgG fucosylation and glycan traits as promising prognostic markers. This research not only enhances survival predictions beyond current models but also opens intriguing possibilities for future therapeutic targets in PAH.

In the September 17, 2024 issue of JACC, Dr. Jai Quan Song and colleagues explore whether the DPP-4 inhibitor, abrogating, can slow the progression of aortic valvular calcification. Although the primary endpoint was not met, the study's promising secondary results and ongoing research into related therapies suggest potential future breakthroughs in medical treatment for aortic stenosis.

In this episode, Dr. Valentin Fuster reviews a groundbreaking study comparing metabolic surgery to traditional care for patients with obesity and obstructive sleep apnea. The research shows that metabolic surgery significantly lowers the risk of major cardiovascular events and mortality, highlighting the need for a multifaceted approach to treating these interlinked conditions.

In this episode, Valentin Fuster reviews the September 17, 2024, JACC issue, highlighting pivotal studies on metabolic surgery's impact on cardiovascular risk in obstructive sleep apnea patients, and the potential of DPP-4 inhibitors in aortic valve calcification. He also discusses the benefits of Sitagliptin for heart failure and the prognostic value of plasma immunoglobulins in pulmonary arterial hypertension, closing with a look at genotype-guided antiplatelet therapy.

Dr. Marcus Anker, presenting at ESC, discussed the RESHAPE HF2 trial's findings on transcatheter edge-to-edge repair for secondary mitral regurgitation, published in JACC with Aakriti Gupta, MD, FACC, JACC Executive Associate Editor.

Xiaoxi Yao, MPH, MS, PhD, FACC, JACC Associate Editor, interviews Renato Lopes, MD, PhD, FACC, author of the GUARD-AF trial published in JACC and presented at ESC Congress 2024.

Michelle M. Kittleson, MD, PhD, FACC, JACC Associate Editor and John A. Spertus, MD, MPH, FACC discuss the evaluation of the cardiac myosin inhibitor, aficamten, on patient-reported health status in patients with symptomatic obstructive hypertrophic cardiomyopathy (HCM) as part of the SEQUOIA trial. The study utilized the Kansas City Cardiomyopathy Questionnaire (KCCQ) Overall Summary Score (OSS) and the Seattle Angina Questionnaire to assess the broader impact of the disease and treatment on patients' lives, emphasizing symptoms, function, and quality of life. The findings highlight the significance of these tools in capturing meaningful patient outcomes, beyond traditional physiological measures, which can guide clinicians in counseling HCM patients about treatment expectations. The rapid decline in health status after discontinuation of aficamten underscores its potential importance in managing HCM.

Michelle M. Kittleson, MD, PhD, FACC, JACC Associate Editor and John A. Spertus, MD, MPH, FACC discuss the evaluation of the cardiac myosin inhibitor, aficamten, on patient-reported health status in patients with symptomatic obstructive hypertrophic cardiomyopathy (HCM) as part of the SEQUOIA trial. The study utilized the Kansas City Cardiomyopathy Questionnaire (KCCQ) Overall Summary Score (OSS) and the Seattle Angina Questionnaire to assess the broader impact of the disease and treatment on patients' lives, emphasizing symptoms, function, and quality of life. The findings highlight the significance of these tools in capturing meaningful patient outcomes, beyond traditional physiological measures, which can guide clinicians in counseling HCM patients about treatment expectations. The rapid decline in health status after discontinuation of aficamten underscores its potential importance in managing HCM.

In the September 10, 2024, JACC issue, Dr. Valentin Fuster discusses a pivotal study on cardiogenic shock, revealing that early and frequent reassessment within the first 24 hours is crucial for predicting patient outcomes. The study underscores the critical nature of early intervention and highlights the rapid progression seen in many patients, emphasizing the need for timely and continuous monitoring to improve survival rates.

In the September 10, 2024, issue of JACC, Dr. Valentin Fuster highlights groundbreaking research on lipid exposure in early adulthood and its link to later cardiovascular events, the importance of early and serial assessments in cardiogenic shock, and the impact of triglyceride levels on cardiovascular outcomes with alirocumab. He also discusses the association between postnatal opioid exposure and neurodevelopmental outcomes in infants undergoing cardiac surgery, alongside a brief update on the long-term benefits of Mercantor in obstructive hypertrophic cardiomyopathy.

In the September 10, 2024, issue of JACC, the study by Dr. Doron Seeker and colleagues investigates alirocumab's impact on cardiovascular outcomes related to triglyceride levels. Despite effectively lowering LDL cholesterol, alirocumab did not show significant clinical benefit through triglyceride reduction, suggesting that its efficacy may be limited in addressing cardiovascular risk associated with elevated triglycerides.

In this September 10th, 2024 issue of Jack, Dr. Michael Ogburn's study highlights a troubling association between high postnatal opioid exposure and poorer neurodevelopmental outcomes in infants who have undergone cardiac surgery. Despite careful adjustments for confounding factors, increased opioid use was linked to significant deficits in cognitive, language, and motor skills, emphasizing the need for stricter protocols and alternative pain management strategies in pediatric cardiac care.

In the September 10, 2024, JACC issue, Dr. Valentin Fuster highlights a pivotal study showing that a single cholesterol measurement in young adults can predict future cardiovascular risk with remarkable accuracy. He underscores the need for early lipid screening and novel long-acting treatments to improve long-term cardiovascular health, stressing that early intervention is crucial for preventing future heart disease.

Rasha K. Al-Lamee, MD, PhD, JACC Deputy Editor and Navin K. Kapur MD discuss the work from the Cardiogenic Shock Working Group, which is an academic research consortium comprising ~40 hospitals in the U.S. and internationally.

Aakriti Gupta, MD, FACC, JACC Executive Associate Editor, and Stefan D. Anker, MD, discuss the insights from the RESHAPE-HF2 trial - an eight-year study on the efficacy of transcatheter edge-to-edge repair for mitral valve regurgitation in patients with heart failure.

Khurram Nasir, MBBS, FACC, JACC Associate Editor and Tor Biering-Sorenson, MD, MPH, PhD, discuss the importance of influenza vaccines for patients with chronic kidney disease (CKD), particularly in the context of the DANFLU-1 study.

Neha J. Pagidipati, MD, FACC, JACC Associate Editor and Subodh Verma MD, PhD explore a secondary analysis of the SELECT trial, a landmark study investigating the cardiovascular benefits of semaglutide in people with obesity or overweight without diabetes.

Neha J. Pagidipati, MD, FACC, JACC Associate Editor and Mikhail Kosiborod, MD, FACC discuss an exciting secondary analysis of the STEP-HFpEF program, shedding light on the groundbreaking findings related to heart failure and obesity.

Harlan Krumholz, MD, FACC, JACC Editor-in-Chief, and Benjamin M. Scirica, MD, MPH, FACC, discuss the surprising benefits of semaglutide beyond weight loss and cardiovascular health from the SELECT trial, which investigated the effects of semaglutide on COVID-19 outcomes and non-cardiovascular deaths in patients with obesity and cardiovascular disease.

Neha J. Pagidipati, MD, FACC, JACC Associate Editor, and Richard Pratley, MD, discuss insights from the FLOW trial – revealing that semaglutide reduced heart failure events and cardiovascular death by approximately 27%, both in patients with and without prior heart failure.

In this episode, Dr. Valentin Fuster reviews five pivotal studies from September 2024, focusing on antithrombotic strategies and diabetes treatments. Key insights include the efficacy of dual antithrombotic therapy over triple therapy, the benefits of anticoagulation alone post-left atrial appendage occlusion, and the superior cardiovascular outcomes of SGLT2 inhibitors and GLP-1 receptor agonists in diabetes management.

In the September 3, 2024, issue of JACC, Dr. Valentin Fuster introduces a pivotal study on Brugada syndrome in children and adolescents. This research, led by Dr. Marco Berganti and colleagues, demonstrates how continuous monitoring with implanted loop recorders provides critical insights into arrhythmias and syncope in young patients, highlighting the potential for future AI-driven personalized care in this complex condition.

In the September 3rd, 2024 issue of JACC, a new scientific statement delves into antithrombotic strategies for peripheral artery disease (PAD), highlighting the challenges and advancements in treatment. The review emphasizes that while traditional therapies like aspirin and clopidogrel remain crucial, combining aspirin with low-dose rivaroxaban offers a promising approach for reducing major adverse events and limb outcomes, despite an increased bleeding risk.

Dr. Valentin Fuster discusses the Augustus trial's groundbreaking findings on antithrombotic strategies for atrial fibrillation patients post-acute coronary syndrome or PCI. The study reveals that a regimen of apixaban and a P2Y12 inhibitor—without aspirin—offers superior safety and efficacy, challenging traditional triple therapy approaches.

In the September 3, 2024, issue of JACC, Dr. Samuel Reinhart and team find that using direct oral anticoagulants alone is associated with fewer adverse events compared to combining them with aspirin after left atrial appendage occlusion. Their large-scale study suggests this streamlined approach might be optimal, though further randomized trials are needed to address limitations and refine long-term antithrombotic strategies.

In the September 3, 2024, JACC issue, a major study evaluates the cardiovascular outcomes of second-line antihyperglycemic agents in type 2 diabetes, comparing SGLT2 inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors, and sulfonylureas. The research reveals that SGLT2 inhibitors and GLP-1 receptor agonists offer superior cardiovascular protection over the other agents, highlighting their importance for patients with cardiovascular conditions.

In this episode, Dr. Valentin Fuster explores findings from the Phase 2 OCEAN-LDO trial assessing the off-treatment effects of the RNA-based drug alpcisiran on lipoprotein(a) [Lp(a)] levels. The study found that high doses of alpcisiran reduced Lp(a) levels by up to 95% during treatment, with a sustained reduction of 27-76% persisting up to 96 weeks after discontinuation, and no new safety concerns emerged.

Dr. Valentin Fuster evaluates a deep learning model designed to predict left and right ventricular dysfunction and dilation in congenital heart disease patients using ECG and CMR data. The research demonstrated that AI ECG can reliably identify significant cardiovascular issues, though future work should focus on refining thresholds and validating the model across diverse populations and healthcare settings.

In this episode, Dr. Valentin Fuster covers four original papers focusing on cardiovascular disease. Highlights include the effectiveness of semaglutide in reducing weight and improving heart failure symptoms, long-lasting effects of OPASAN on lipoprotein(a) levels, the impact of low-dose rivaroxaban plus aspirin on fragile patients post-revascularization, and the promising use of AI-based ECG for predicting biventricular dysfunction in congenital heart disease.

Dr. Valentin Fuster discusses a study on the effects of low-dose rivaroxaban combined with aspirin in fragile patients after lower extremity revascularization, focusing on the balance between efficacy and safety. It highlights that while frailty increases the risk of adverse outcomes, rivaroxaban reduces ischemic events but also raises bleeding risks, regardless of frailty status. The editorial emphasizes that frailty should not preclude the use of combined antithrombotic therapy, advocating for personalized treatment approaches.

In this episode, Dr. Valentin Fuster provides an overview of a scientific statement on structural cardiac interventions in heart failure. It details advances in percutaneous therapies for ventricular reshaping, valvular heart disease interventions, and tricuspid valve issues, while also highlighting gaps in current treatments and areas for future research.

Dr. Valentin Fuster discusses the treatment and diagnosis of transcatheter aortic valve thrombosis, focusing on its manifestations, diagnostic techniques using multi-slice computed tomography, and a proposed treatment algorithm. It highlights the difference between subclinical and clinical thrombosis and provides a detailed approach to managing both, including antiplatelet and anticoagulant therapies.