JACC Podcast

In the December 2024 issue of JACC, Dr. Valentin Fuster summarizes five pivotal clinical studies, including one on bleeding and mortality following revascularization for left main coronary artery disease, which highlights higher bleeding rates post-CABG compared to PCI. Other key articles explore the use of the MitraClip in treating moderate-to-severe functional mitral regurgitation, evaluating its impact on hospitalization and quality of life, as well as comparing aspirin monotherapy to no antiplatelet therapy in patients undergoing low-risk non-cardiac surgery, and testing a novel low-dose triple pill for hypertension.

In the December 10, 2024 JACC issue, a study from the EXCEL trial examines the link between bleeding complications and mortality in patients with left main coronary artery disease undergoing PCI or CABG. The findings highlight that while PCI showed lower rates of bleeding, both procedures had bleeding-related mortality risks, underscoring the need for strategies to minimize bleeding during and after revascularization.

In this episode, Dr. Valentin Fuster delves into the latest research surrounding the use of the mitral clip for patients with severe functional mitral regurgitation, comparing the results of three major trials: the French MITRA-FR trial, the American COAPT trial, and the Reshape HF 2 trial. While the COAPT and Reshape HF 2 trials show positive outcomes, especially in reducing hospitalizations and improving heart failure symptoms, the French trial saw no benefit, prompting debate over the influence of left ventricular volume and disease severity on treatment success, with expert opinions calling for further studies and individualized meta-analyses.

In this episode, Dr. Valentin Fuster delves into the latest research surrounding the use of the mitral clip for patients with severe functional mitral regurgitation, comparing the results of three major trials: the French MITRA-FR trial, the American COAPT trial, and the Reshape HF 2 trial. While the COAPT and Reshape HF 2 trials show positive outcomes, especially in reducing hospitalizations and improving heart failure symptoms, the French trial saw no benefit, prompting debate over the influence of left ventricular volume and disease severity on treatment success, with expert opinions calling for further studies and individualized meta-analyses.

In this episode, Dr. Valentin Fuster discusses the ASSURE DES trial, which compared aspirin monotherapy to withholding antiplatelet therapy in stable patients with drug-eluting stents undergoing non-cardiac surgery. The trial found no significant difference in major adverse outcomes between the two strategies, though minor bleeding was more common in the aspirin group, leading to a recommendation to continue aspirin therapy for most patients undergoing low-to-intermediate risk surgery, with exceptions for those at high bleeding risk.

In this podcast, Dr. Valentin Fuster discusses a groundbreaking study on the efficacy and safety of a novel low-dose triple combination pill for the initial treatment of hypertension. The study highlights how a single pill containing three blood pressure-lowering agents can significantly reduce blood pressure while improving patient adherence, offering a promising solution for hypertension management globally, especially in low-income settings.

In this podcast, Dr. Valentin Fuster summarizes the December 3rd, 2024 issue of JACC, highlighting four impactful studies that reshape our understanding of cardiovascular disease. From early cardiovascular risks in type 2 diabetes to innovative treatments for endocarditis, these studies emphasize the importance of early intervention, advanced diagnostics, and evolving treatment strategies in heart health.

This podcast discusses a significant study that reveals cardiovascular disease occurs up to 30 years before a type 2 diabetes diagnosis, emphasizing the importance of early intervention for those at risk. The findings suggest that addressing metabolic risk factors well before the clinical onset of diabetes could help prevent the rise of cardiovascular events, a growing global health concern.

In this podcast, Dr. Valentin Fuster discusses a study revealing that women with hypertensive disorders during pregnancy face a higher risk of early coronary artery disease and myocardial infarction. The findings emphasize the need for proactive cardiovascular monitoring and tailored prevention strategies, as these women are more susceptible to both obstructive and non-obstructive heart conditions later in life.

In this podcast, Dr. Valentin Fuster discusses a groundbreaking study on using artificial intelligence (AI) in electrocardiograms (ECGs) to assess left ventricular diastolic function and predict outcomes in patients with significant mitral regurgitation. The study demonstrates that AI-driven ECGs can offer comparable prognostic value to traditional echocardiography, identifying high-risk patients and potentially revolutionizing cardiovascular diagnostics, though challenges around sensitivity, specificity, and patient selection remain.

In this podcast, Dr. Valentin Fuster discusses a groundbreaking study published in JACC that examines the impact of the POET trial on the treatment of infective endocarditis. The study found that transitioning to oral antibiotic therapy after just 10 days of intravenous treatment reduced hospital stays by 8 days, without increasing mortality, and lowered relapse rates of bacteremia, suggesting a major shift toward oral antibiotics as a viable alternative to prolonged intravenous therapy.

In this podcast, Dr. Valentin Fuster introduces a state-of-the-art review on "Sudden Death in Obesity," exploring its mechanisms and management. Expert contributors from Cedars-Sinai Medical Center and Aalto University discuss key concepts, clinical characteristics, arrhythmia mechanisms, and therapeutic implications of this critical health issue.

JACC Associate Editor Theresa McDonagh, MBBCH  speaks with author Akshay S. Desai, MD, FACC about this paper on pulse pressure published in JACC and presented at AHA. In a pooled analysis of 16,950 patients with chronic HFmrEF or HFpEF enrolled from 4 global randomized clinical trials, a J-shaped relationship was observed between SBP and the risk of adverse CV events, with the lowest risk occurring at SBP values between 120 and 130 mmHg. A similar pattern was seen with PP, with the lowest risk found between 50 and 60 mmHg. Both higher SBP and higher PP independently predicted adverse CV events. Notably, PP remained a strong predictor of CV risk, independent of baseline SBP.

Join Dr. Harlan Krumholz and Dr. Milton Packer as they discuss the groundbreaking SUMMIT trial, a study poised to redefine treatment for heart failure with preserved ejection fraction (HFpEF) linked to obesity. Dive into the trial's unique methodology, compelling results, and transformative implications for patient care.

Harlan Krumholz, editor-in-chief of JACC, provides a wrap-up of the JACC papers at the AHA Scientific Sessions in Chicago in 2024. JACC's Obesity Revolution page features various trials to provide perspectives on obesity, including SUMMIT, LookAHEAD, and SELECT. Other studies featured include the DANGER trial; REALIZE-K; AMPLATZER; HELIOS-B; a study on sedentary behaviors from the UK Biobank; systolic pressure and blood pressure in patients with HFpEF; rural and urban differences in cardiovascular mortality from 2010-2022; and the association of hospital cardiologist integration with patient outcomes

JACC Associate Editor Michelle M. Kittleson, MD, PhD, FACC, interviews author Mikhail Kosiborod, MD, FACC about his REALIZE-K study published in JACC and presented at AHA. In participants with HFrEF and hyperkalemia, SZC led to large improvements in the percentage of participants with normokalemia while on optimal spironolactone dose, and reduced risk of hyperkalemia and down-titration/discontinuation of spironolactone. More participants had HF events with SZC than placebo; this difference was limited to those with very high NTproBNP levels.

JACC Associate Editor Marc P. Bonaca, MD, FACC, speaks with author Subodh Verma, MD, PhD, and A. Michael A. Lincoff, MD, FACC, about this brief report published in JACC and presented at AHA. Following CABG surgery there remains a markedly high risk of persistent ischemic events, heart failure, and mortality. Semaglutide consistently reduced all cardiovascular outcomes in this population.

JACC Associate Editor Neha J. Pagidipati, MD, FACC, speaks with author Christopher M. Kramer, MD, FACC about this substudy of the SUMMIT trial published in JACC and presented at AHA, demonstrating that tirzepatide therapy in obesity-related HFpEF led to reduced LV mass and paracardiac adipose tissue as compared to placebo and the change in LV mass paralleled weight loss. These physiologic changes may contribute to the reduction in heart failure events seen in the main SUMMIT trial.

JACC: Associate Editor Michelle M. Kittleson, MD, PhD, FACC, talks with authors Scott Solomon, MD, FACC and. Marianna Fontana, MD, about their study published in JACC and presented at AHA. Outpatient worsening heart failure (HF) (oral diuretic intensification or initiation) is simple to assess and has been shown to be prognostic of mortality in patients with ATTR-CM. In this pre-specified analysis of a contemporary ATTR-CM population, patients with outpatient worsening HF had an increased risk of all-cause mortality and CV events and all-cause mortality, as well as greater deterioration in assessments of functional capacity, health status, and quality of life. Vutrisiran significantly reduced the risk of outpatient worsening HF and the composite of outpatient worsening HF, all-cause mortality, and recurrent CV events compared with placebo.

JACC Deputy Editor Erica S. Spatz, MD, FACC, joins author Rishi Wadhera, MD, to discuss his paper on rural and urban differences in cardiovascular mortality in the United States, and the impact of the COVID-19 pandemic.

JACC Associate Editor Muthiah Vaduganathan, MD speaks with author Ambarish Pandey, MD about the LookAHEAD trial published in JACC and presented at AHA. Among adults with T2D and overweight/obesity in the Look Action for Health in Diabetes (AHEAD) trial, an intensive lifestyle intervention targeting weight loss led to sustained reductions in hs-cTnT at 1- and 4-year follow-up, and a rise in NT-proBNP at 1 year that attenuated at 4 years. After accounting for baseline biomarker levels and baseline and changes in risk factors, longitudinal increase in NT-proBNP was associated with higher risk of ASCVD and incident HF. In contrast, increase in hs-cTnT was significantly associated with ASCVD but not incident HF.

JACC: Associate Editor Celina Yong, MD, interviews author Jacob Eifer Møller, PhD about his DANGER SHOCK paper presented at AHA and published in JACC. The DanGer Shock trial demonstrated reduced mortality in patients with STEMI-related cardiogenic shock treated with a microaxial flow pump (mAFP). This secondary analysis assessed whether age affected survival benefits. Mortality increased incrementally with age, and age was independently associated with outcome. Spline analysis suggested that the risk of mortality was higher in the standard-care group for patients below 77 years, whereas patients aged 77 or older had a higher predicted risk in the mAFP group. Thus, elderly patients may not attain the same benefit from routine treatment with a mAFP as younger patients.

JACC Associate Editor Marc P. Bonaca, MD, FACC, has a discussion with author Sotirios Tsimikas, MD, FACC about this study on phospholipids presented at AHA and published in JACC. In MESA, both OxPL-apoB and Lp(a) were independently associated with prevalent AVC with a significant interaction between the two (p less than 0.01). OxPL-apoB and Lp(a) were associated with incident AVC at 9.5 years when evaluated independently (interaction p less than 0.01). The OxPL-apoB*Lp(a) interaction demonstrated higher odds of prevalent and incident AVC for OxPL-apoB with increasing Lp(a) levels. In the meta-analysis, both OxPL-apoB and Lp(a) were independently associated with faster increase in Vmax, but when evaluated together, only OxPL-apoB remained significant. OxPL-apoB is an independent predictor of the presence, incidence and progression of AVC and established AS and represents a novel therapeutic target for CAVD.

JACC Associate Editor Xiaoxi Yao, MPH, MS, PhD, FACC, interviews author Shaan Khurshid, MD and Ezimamaka Ajufo, MD, about their study on sedentary behavior presented at AHA and published in JACC. Beyond serving as a marker for insufficient physical activity, sedentary behavior may directly affect risk of future cardiovascular (CV) disease. In 89,530 UK biobank participants, greater accelerometer-measured sedentary time was associated with higher incidence of adverse CV events. Associations with sedentary time were particularly robust for HF and CV mortality, where risk inflected at approximately 10.6 hours/day and remained apparent even among individuals meeting guideline-recommended levels of moderate-to-vigorous physical activity. Future guidelines focused on sedentary behavior should emphasize the importance of avoiding excess sedentary behavior, even among individuals who are active.

JACC Associate Editor Seng Chan You, MD, and author Hiroki Ueyama, MD discuss this study presented at AHA and published in JACC. NCDR study finds a steady decline in P2Y12 inhibitor pretreatment for NSTE-ACS in the US, but significant variability persists among operators, institutions, and regions. This practice was not associated with any benefits but was linked to a longer length of stay among those undergoing CABG, underscoring the importance of maintaining efforts to integrate evidence into clinical practice.

JACC Associate Editor Jason H. Wasfy, MD, MPhil, FACC interviews author Vinay Kini, MD, FACC about this hospital integration study published in JACC and presented at AHA. Cardiologist employment by hospitals is increasing, but the impact on care quality is not well understood. The study identified cardiologists who cared for acute myocardial infarction or heart failure patients between 2008-2019. Outcomes were compared for patients treated by cardiologists who switched to hospital employment versus cardiologists who remained independent. The proportion of hospital-employed cardiologists increased from 26% in 2008 to 63% in 2019. The study found no differences in clinical outcomes (e.g., 30-day mortality) or most quality-of-care metrics between patients treated by hospital-employed versus independent cardiologists. The results do not support purported benefits of hospital employment on care quality.

JACC Deputy Editor Erica S. Spatz, MD, FACC, joins author Rishi Wadhera, MD, to discuss his paper on rural and urban differences in cardiovascular mortality in the United States, and the impact of the COVID-19 pandemic.

In the November 26, 2024 issue of JACC, Dr. Valentin Fuster highlights four pivotal studies in cardiovascular research. The first explores the independent roles of social determinants of health and polygenic risk scores in coronary heart disease, while the second assesses the impact of recurrent rejection on pediatric heart transplant outcomes. The third paper examines the effects of CSL 112 infusions on reducing ischemic events post-myocardial infarction, and the fourth investigates the interplay between pulmonary hypertension and heart failure with preserved ejection fraction. Each study advances our understanding of cardiovascular risk, treatment, and outcomes.

In this episode, Dr. Valentin Fuster discusses a groundbreaking study examining how both social determinants of health and polygenic risk scores independently contribute to the risk of coronary heart disease (CHD). The research highlights how factors like income, education, and food insecurity are linked to higher CHD risk, particularly among Black and Hispanic populations, while emphasizing the need to integrate both genetic and environmental factors for more accurate disease prevention models.

In this episode, a study on pediatric heart transplant recipients highlights the decreasing prevalence of recurrent rejection, yet finds that children who experience multiple rejection episodes face a significantly higher risk of graft loss. Notably, racial disparities were observed, with Black children showing poorer outcomes, suggesting the need for standardized care protocols and a focus on eliminating these inequities in future heart transplant practices.

In this episode, Dr. Valentin Fuster reviews an exploratory analysis from the 80s2 trial, which examined CSL 112's impact on ischemic events after acute myocardial infarction. While CSL 112 didn't significantly reduce cardiovascular death or stroke in the short term, the study found promising long-term benefits, suggesting that enhancing cholesterol efflux could be a valuable approach for reducing recurrent ischemic events in high-risk patients.

In this episode, Dr. Valentin Fuster reviews a recent study exploring the clinical overlap between heart failure with preserved ejection fraction (HFpEF) and Group 1 pulmonary hypertension. The study identifies a subset of patients with pulmonary hypertension who have a higher risk of heart failure and worse outcomes, emphasizing the need for further investigation into whether pulmonary hypertension therapies could improve prognosis in these patients.

In this episode, Dr. Valentin Fuster reviews a study on the impact of long-term drug treatment discontinuation in heart failure patients with reduced ejection fraction. He breaks down four pathways of drug withdrawal—ranging from immediate clinical worsening to long-term deterioration—emphasizing the importance of avoiding unnecessary interruptions in treatment to prevent significant health risks.

Join Harlan Krumholz, editor-in-chief of JACC, as he highlights groundbreaking cardiovascular science presented at this year's American Heart Association Scientific Sessions. From obesity-related heart failure to innovations in stroke prevention and disparities in care, this episode delves into pivotal studies shaping the future of cardiology and their real-world clinical implications.

In the November 19, 2024, issue of JACC, Dr. Valentin Fuster discusses four groundbreaking studies that could shape the future of cardiovascular care. Topics include the impact of atrial fibrillation screening on stroke prevention, risk factors in Brugada syndrome, new methods to reduce heart block after congenital heart disease surgery, and genetic insights into arrhythmogenic triggers of atrial fibrillation, alongside a review of a decade of leadless cardiac pacing technology.

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 Brugada Syndrome, exploring how non-modifiable risk factors—such as male sex, SCN 5A mutations, and polygenic risk scores—can predict life-threatening arrhythmic events in patients. The research, published in JACC (November 2024), offers new insights into personalized risk assessment for this inherited arrhythmia syndrome, though its clinical implications remain limited for now.

In this podcast, Dr. Valentin Fuster reviews a groundbreaking study on intraoperative conduction mapping to prevent postoperative atrioventricular block (AVB) in children with complex congenital heart disease. The study highlights how mapping the His bundle during surgery significantly reduces the need for pacemakers, particularly in high-risk populations like those with Heterotaxy syndrome and non-Transposed Great Arteries, offering a promising tool to improve long-term outcomes for these patients.

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 explores the evolution of leadless cardiac pacing over the past decade, highlighting its safety, efficacy, and growing role in treating heart patients. He reviews key advancements, including single and dual-chamber leadless pacemakers, ongoing innovations, and future developments, emphasizing their potential to replace traditional pacemakers and improve patient outcomes.

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 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.

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 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 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.