This Week in Cardiology – Highlights
This Week in Cardiology – Highlights
Source: Medscape – Podcast.
Date: September 12, 2025 :
1. Beta-Blockers (DANBLOCK/REBOOT)
• Benefit seen in LVEF 40–49% (≈25% relative risk reduction).
• Still cheap, safe, and supported by evidence.
2. ESC 2025 Valvular Guidelines
• CCTA before valve surgery = Class I, B (but weak evidence).
• Asymptomatic severe AS: early TAVR Class IIa (bias concerns).
• TAVR in younger patients: long-term durability uncertain.
• TEER in TR: Class IIa, risk of overuse.
• Surgical AF ablation: evidence weak, guidelines oversimplify.
3. Baxdrostat (Resistant HTN)
• ↓ SBP by ~15 mmHg vs ~6 mmHg placebo.
• Hyperkalemia noted; few patients on spironolactone.
• Comment : Nearly no patients on spironolactone; unclear added value vs cheap MRAs.
• May be promising, but not “game changing.”
4. Myosin Inhibitors in HCM
• Obstructive HCM (MAPLE): aficamten improved VO₂, NYHA, LVOT, BNP.
• Non-obstructive HCM (ODYSSEY): no benefit; strong placebo effect.
• Effective only in obstructive HCM; cost and long-term safety remain concerns.
5. Vericiguat
• VICTOR trial: no significant benefit in ambulatory HFrEF.
• Meta-analysis (VICTOR + VICTORIA): small effect (HR 0.91).
• No meaningful role beyond 4 pillars of GDMT.
6. Digoxin (RATE AF substudy)
• In AF (mean age 75): digoxin improved EF, lowered NT-proBNP, fewer adverse events than β-blockers.
• May be as good or better than β-blockers for rate control in AF + HFpEF.
Takeaway:
• Old drugs (BBs, digoxin) still matter.
• New drugs (baxdrostat, myosin inhibitors, vericiguat) interesting but need caution.
• ESC 2025 guidelines criticized for overstating weak evidence.
