JACC This Week

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 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 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.

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 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 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.

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 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 discusses a study on the efficacy of semaglutide for treating obesity-related heart failure with preserved ejection fraction, highlighting that the drug significantly reduced body weight and improved heart failure symptoms in both men and women. Notably, women experienced greater weight loss than men, but this did not translate into better improvement in heart failure-related symptoms, underscoring complex sex-related differences in cardiovascular health.

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.