Hemodynamic Assessment for Diagnosis and Treatment Selection in HFpEF
Heart failure arises when the heart is unable to pump or fill with blood effectively. In the cardiac catheterization lab, we have the unique ability to directly measure the physiological abnormalities underlying this condition, making it the gold standard for diagnosing heart failure. While not every patient requires heart catheterization, it is often essential for those with heart failure with preserved ejection fraction (HFpEF). This is because noninvasive tests, which are commonly used, frequently fall short—providing false reassurance and leading to missed diagnoses. As a result, HFpEF remains underrecognized. And ultimately, a condition that goes unrecognized cannot be properly treated. In this interview, Drs. Matthew Martinez and Barry Borlaug discuss “Hemodynamic Assessment for Diagnosis and Treatment Selection in HFpEF.” Subscribe on Apple Podcasts | Subscribe to ACCEL
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Primary Results From the SOUL Randomized Trial
The SOUL trial demonstrated that in patients with type 2 diabetes (T2DM) and established atherosclerotic cardiovascular disease (ASCVD), chronic kidney disease (CKD), or both, treatment with oral semaglutide significantly reduced the risk of major adverse cardiovascular events (MACE) compared to placebo—without an increase in serious adverse events. These findings position oral semaglutide as a compelling option with cardiovascular benefits consistent with those seen in injectable GLP-1 receptor agonists. In this episode, Drs. Deepak L. Bhatt and Darren K. McGuire explore how the SOUL trial further strengthens the favorable risk-benefit profile of oral semaglutide for patients with T2DM and coexisting ASCVD and/or CKD, highlighting its potential to reshape cardiovascular risk management in this high-risk population. SUGGESTED MATERIALS McGuire DK, Marx N, Mulvagh SL, et al.; SOUL Study Group. Oral Semaglutide and Cardiovascular Outcomes in High-Risk Type 2 Diabetes. N Engl J Med. 2025 Mar 29. doi: 10.1056/NEJMoa2501006. Epub ahead of print. Subscribe on Apple Podcasts | Subscribe to ACCEL
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Clopidogrel Versus Aspirin For Long-term Maintenance Monotherapy In Patients With High Ischemic Risk After PCI
The SMART-CHOICE 3 trial demonstrated that clopidogrel monotherapy is more effective than aspirin monotherapy in reducing the risk of major adverse cardiac and cerebrovascular events in high-risk patients who completed standard dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI). Despite concerns that more potent antiplatelet agents may increase bleeding risk, the study found that clopidogrel significantly reduced ischemic events—including myocardial infarction and all-cause death—without increasing bleeding risk, making it a highly favorable option for long-term maintenance therapy. In this episode, Drs. Allen J. Taylor and Joo-Yong Hahn discuss the clinical implications of these findings and offer insights into selecting the optimal single antiplatelet regimen after PCI. SUGGESTED MATERIALS Choi H, Park H, Lee JY, et al. Efficacy and safety of clopidogrel versus aspirin monotherapy in patients at high risk of subsequent cardiovascular event after percutaneous coronary intervention (SMART-CHOICE 3): a randomised, open-label, multicentre trial. Lancet. 2025;405(10486):1252-63. doi: 10.1016/S0140-6736(25)00449-0. Koo BK, Kang J, Park KW, et al.; HOST-EXAM investigators. Aspirin versus clopidogrel for chronic maintenance monotherapy after percutaneous coronary intervention (HOST-EXAM): an investigator-initiated, prospective, randomised, open-label, multicentre trial. Lancet. 2021;397(10293):2487-2496. doi: 10.1016/S0140-6736(21)01063-1. Subscribe on Apple Podcasts | Subscribe to ACCEL
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Dapagliflozin in Patients Undergoing Transcatheter Aortic Valve Implantation
The DapaTAVI trial, conducted across 39 centers in Spain, is the first study to evaluate the use of sodium-glucose co-transporter-2 (SGLT-2) inhibitors, specifically dapagliflozin, in patients with heart failure undergoing transcatheter aortic valve implantation (TAVI). The trial found that patients who received dapagliflozin (10 mg daily) within 14 days of hospital discharge after TAVI experienced a 28% relative risk reduction in the composite outcome of all-cause mortality or worsening heart failure at one year, compared to those receiving standard care In this episode, Drs. Allen J. Taylor and Sergio Raposeiras Roubin discuss the safety and clinical benefits of initiating dapagliflozin—or other SGLT-2 inhibitors—in patients undergoing TAVI who are at risk for heart failure, emphasizing its potential to improve outcomes in this high-risk population. SUGGESTED MATERIALS Raposeiras-Roubin S, Amat-Santos IJ, Rossello X, et al.; the DapaTAVI Investigators. Dapagliflozin in patients undergoing transcatheter aortic-valve implantation. N Engl J Med 2025;392:1396-14. Doi: 10.1056/NEJMoa2500366 Subscribe on Apple Podcasts | Subscribe to ACCEL
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PRAGUE-25 Trial: Catheter Ablation Versus Antiarrhythmic Drugs With Risk Factor Modification for Treatment of AF
The PRAGUE-25 study evaluated the effectiveness of two treatment strategies in patients with both atrial fibrillation (AF) and obesity: catheter ablation versus lifestyle modification (including weight loss and increased physical activity) combined with antiarrhythmic drug therapy. While motivated patients who adhered to lifestyle changes experienced a reduction in AF episodes, the study found that catheter ablation was significantly more effective in achieving and maintaining sinus rhythm. In this episode, Drs. Joseph Marine and Pavel Osmancik discuss the trial’s findings, highlighting that catheter ablation outperformed lifestyle modification and medication in restoring and sustaining normal heart rhythm. SUGGESTED MATERIALS Osmancik P, Havránek Š, Bulková V, et al. Catheter ablation versus antiarrhythmic drugs with risk factor modification for treatment of atrial fibrillation: a protocol of a randomised controlled trial (PRAGUE-25 trial). BMJ Open. 2022 Jun 15;12(6):e056522. doi: 10.1136/bmjopen-2021-056522. Pathak RK, Middeldorp ME, Meredith M, Mehta AB, Mahajan R, Wong CX, Twomey D, Elliott AD, Kalman JM, Abhayaratna WP, Lau DH, Sanders P. Long-Term Effect of Goal-Directed Weight Management in an Atrial Fibrillation Cohort: A Long-Term Follow-Up Study (LEGACY). J Am Coll Cardiol. 2015 May 26;65(20):2159-69. doi: 10.1016/j.jacc.2015.03.002. Subscribe on Apple Podcasts | Subscribe to ACCEL
About ACCEL Lite: Featured ACCEL Interviews on Exciting CV Research
The American College of Cardiology offers select interviews and summaries of cardiology’s most interesting research areas from ACCEL’s renowned library, hosted by ACCEL Editor-in-Chief Alison L. Bailey, MD, FACC, FAACPVR.
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