This Week in Cardiology

Sep 12 2025 This Week in Cardiology

19 snips
Sep 12, 2025
In this discussion, the latest European guidelines on valvular heart disease take center stage. The conversation dives into the debate around treating asymptomatic aortic stenosis and unpacks the complexities of surgical interventions. A breakthrough drug, Baxdrostat, is scrutinized for its potential to revolutionize treatment for resistant hypertension. Additionally, recent trials on myosin inhibitors offer fresh hope for patients battling hypertrophic cardiomyopathy and heart failure, showcasing new therapies that challenge traditional approaches.
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ANECDOTE

Correction From Copenhagen

  • Mandrola corrected an earlier error: the Dan Block reboot trial randomized 8,000 patients, not 4,000.
  • He also relays Professor Eva Prescott's point that beta blockers may still help patients with EF 40–49% despite modest absolute benefit.
ADVICE

Stop Routine Add-On Surgical AF Ablation

  • Avoid routine surgical AF ablation add-ons without robust RCT evidence and randomized data.
  • Mandrola would stop the add-on billing code unless patients enroll in trials to prevent unproven overuse.
INSIGHT

Aldosterone Synthase Inhibitors Lower BP Well

  • Baxdrostat (aldosterone synthase inhibitor) lowered systolic BP by ~9–10 mmHg versus placebo in resistant hypertension trials.
  • Mandrola cautions many trial patients were not on MRAs, so incremental benefit over cheap spironolactone may be smaller and hyperkalemia is a concern.
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