Highlights from “This Week in Cardiology” – April 25 & May 2, 2025:
Highlights from “This Week in Cardiology” – April 25 & May 2, 2025:
Source: This Week in Cardiology, Medscape podcast :
1. AI and ECG Interpretation in the Emergency Department (ED)
Source: European Heart Journal, ACC 2025 late-breaker
Date: April 25, 2025
• AI model trained on 200,000 ED ECGs showed excellent performance in diagnosing NSTEMI:
• AUROC = 0.91 (vs clinician ECG reading = 0.65; vs troponin = 0.71).
• Negative predictive value: 99.92%.
• External validation in Germany yielded AUROC of 0.81.
• AI is promising for early decision-making, but troponin still outperforms AI in some contexts.
• Open-source and explainable model.
• Mandrola’s comment: AI won’t replace clinicians—history and patient interaction remain irreplaceable.
2. AVIM Pacemaker Therapy for Hypertension
Source: JAHA (2021), FDA Breakthrough Designation
Date: April 25, 2025
• FDA designated Orchestra BioMed’s AVIM therapy as a Breakthrough Device.
• AVIM modulates autonomic tone via atrioventricular delay changes.
• Phase 2 trial showed BP reduction of 8 mmHg.
• Larger BACKBEAT trial underway.
• Mandrola’s view: Promising but early; needs safety validation.
3. Early Ezetimibe After MI – SWEDEHEART Observational Study
Source: JACC
Date: April 25, 2025
• Compared early, late, and no ezetimibe post-MI in >35,000 patients.
• MACE: 1.8 (early) vs 2.8 (late) vs 4.0 (none) per 100 pt-yrs.
• Adjusted HR (no ezetimibe vs early): 1.29.
• NNT = 53 (early vs none).
• Comment: Marginal benefit; shared decision-making advised. Adherence remains key.
4. Pulsed Field Ablation and Silent Strokes
Source: Circulation: EP
Date: April 25, 2025
• Study of 16 patients showed significant difference in MRI-detected brain lesions:
• J&J PFA catheter: 85% incidence, avg 13 lesions.
• Medtronic catheter: 22%, avg 2 lesions.
• Concern: Potential cognitive impact; more comparative data needed.
5. AF Ablation – Heart Rhythm Society White Paper
Source: Heart Rhythm (pre-release)
Date: April 25, 2025
• Calls for creation of Centers of Excellence for AF Ablation with standards for:
• Procedural quality, multidisciplinary teams, QI, and transparency.
• Mandrola’s take: Long overdue—calls AF ablation the “Wild West” in the US.
6. Pacing Challenges in TTVR
Source: Heart Rhythm
Date: April 25, 2025
• Study of 73 TTVR patients from Emory:
• 21 had preexisting pacemakers; 14 had leads jailed.
• 21% of jailed lead patients had complications; 1 fatal infection.
• Message: Multidisciplinary planning is essential before TTVR.
7. FDA Approval of TAVR for Asymptomatic AS – EARLY TAVR Trial
Source: FDA; NEJM; Podcast Review
Date: May 2, 2025
• TAVR approved for asymptomatic severe AS based on EARLY TAVR trial.
• Primary endpoint driven by unplanned hospitalization (21% vs 42%).
• No significant difference in death or stroke.
• Mandrola: Strong criticism—trial bias, endpoint manipulation, absence of surgical arm.
8. PPG to Identify Source of Tachycardia
Source: Computer Methods and Programs in Biomedicine
Date: May 2, 2025
• ML study using wristband-derived PPG distinguished VT from SVT with high accuracy.
• Up to 97% accurate with patient-specific adaptation.
• Implication: Early proof of concept; potential for consumer-grade arrhythmia monitoring.
9. PRAETORIAN-XL Trial – Subcutaneous ICD
Source: HRS 2025; Circulation
Date: May 2, 2025
• Extended follow-up of original PRAETORIAN trial (8 years).
• No significant difference in overall complications.
• SICD had fewer lead-related issues but higher need for pacing switches.
• Mandrola: Critiques design flaws, endpoint selection bias, and SICD marketing influence.
10. Cryptogenic Stroke in Young Adults and Migraine
Source: Stroke (Journal)
Date: May 2, 2025
• Finnish case-control study (500 patients, median age 41):
• With PFO: nontraditional risk factors (esp. migraine with aura) dominate (PAR 50%).
• Without PFO: traditional risk factors dominate (PAR 65%).
• Insight: Need to evaluate migraines and non-traditional factors in young strokes.
