Structural Heart · Interventional Cardiology

AnchorMan vs. Watchman: A Challenger Device Clears Its First Head-to-Head Test in Left Atrial Appendage Closure

Twelve-month data from a randomized China-based trial suggest a new occluder can match the market leader on safety and efficacy, and may seal better.

A novel left atrial appendage closure device out of China has posted one-year outcomes that look essentially indistinguishable from the market-leading occluder.

The device, called AnchorMan, comes from MicroPort CardioFlow, a Shanghai-based structural heart company.

Its comparator was the first-generation Watchman 2.5 device, the implant that opened the LAAC category in the United States back in 2015.

For a physician audience managing stroke-risk conversations in nonvalvular atrial fibrillation every week, this trial is a useful checkpoint on where device competition in this space is heading.

Why This Trial Matters

Roughly nine in ten strokes tied to nonvalvular AFib originate from thrombus forming in the left atrial appendage, which is the rationale behind mechanically excluding it from circulation.

The original Watchman device was approved to reduce thromboembolic risk in patients with an appropriate reason to avoid chronic anticoagulation, and it has since become the dominant device worldwide.

Because anatomic variability in the appendage remains a real procedural challenge, newer occluders keep entering development to improve sealing and ease of deployment.

The trial behind this analysis, called SAFE-PROTECT, randomized patients head-to-head between AnchorMan and Watchman 2.5 rather than comparing either device to a historical benchmark.

How the Devices Differ

AnchorMan's distal end is rounded, a design choice intended to increase surface contact with appendage tissue while reducing the chance of intraoperative or delayed perforation.

Twelve so-called "3D folding" units form what the manufacturer describes as a semiclosed cage, a structural approach meant to combine features of both open and closed occluder designs.

This cage construction is also designed to let operators implant the device at a shallower depth within the appendage than some competing occluders require.

Both devices cleared the noninferiority bar for clinical success; the residual-leak gap favored AnchorMan's sealing performance.

What the Trial Found

A total of 216 patients with nonvalvular AFib and elevated stroke risk were randomized between the two occluders.

The primary endpoint, 12-month clinical success (freedom from stroke, systemic embolism, and cardiovascular or unexplained death), landed at 98.1% in both arms, meeting the prespecified noninferiority margin.

Echocardiography-confirmed appendage occlusion at 12 months was essentially identical between groups as well.

Rates of all-cause death, major bleeding, and device-related complications did not differ meaningfully between the two occluders.

The one signal that separated the devices was peridevice leak greater than 3mm, which occurred less often with AnchorMan, a finding the investigators attributed to its distinct sealing geometry.

A follow-up randomized study comparing AnchorMan against the newer Watchman FLX and FLX Pro platforms is already being planned.

Table 1. SAFE-PROTECT Trial at a Glance

Parameter	Detail
Design	Multicenter, randomized, head-to-head
Population	Nonvalvular AFib, elevated ischemic stroke risk, poor candidates for long-term anticoagulation
Comparator device	Watchman 2.5 (Boston Scientific)
Investigational device	AnchorMan (MicroPort CardioFlow)
Primary endpoint	12-month clinical success, 98.1% vs. 98.1%
Funding	MicroPort CardioFlow-sponsored; sponsor reported no role in data analysis or the decision to publish

Table 2. Watchman Platform Timeline vs. AnchorMan Regulatory Status

Device	Milestone	Regulator / Year
Watchman (original)	First LAAC device cleared for stroke risk reduction	FDA, 2015
Watchman FLX	Fully rounded, recapturable design	FDA, July 2020
Watchman FLX Pro	Thromboresistant coating, larger size option	FDA, September 2023
AnchorMan	Market approval, China only; not yet FDA-reviewed	NMPA, January 2024

The Investor Overlay

For a physician-investor readership, this trial is as much a competitive-landscape story as a clinical one.

NYSE: BSX — Boston Scientific HKG: 2160 — MicroPort CardioFlow

Table 3. Company Snapshot

Company	Ticker	Analyst Consensus	12-Month Price Target
Boston Scientific	NYSE: BSX	Strong Buy (31 analysts)	$77.10, roughly 69% above the recent price
MicroPort CardioFlow	HKG: 2160	Strong Buy (2 analysts, limited coverage)	HK$7.06, a wide-range estimate given thin analyst following

Boston Scientific's Watchman franchise remains the dominant revenue driver in the LAAC category, and the company has already layered two newer-generation devices, FLX and FLX Pro, on top of the original 2.5 platform used in this trial.

MicroPort CardioFlow is a much smaller, thinly covered name whose Hong Kong-listed shares carry considerably more volatility and analyst uncertainty than BSX.

AnchorMan's commercial footprint today is limited to China and a handful of early international cases in Latin America and Europe, and it has not yet been reviewed by the FDA.

Any US market entry would likely require AnchorMan to be tested against the newer Watchman FLX and FLX Pro devices rather than the older 2.5 platform used in SAFE-PROTECT, which is exactly the next study the investigators say is planned.

The Medical Alternative: Anticoagulation

Long-term anticoagulation remains the non-device comparator physicians weigh against LAAC in most stroke-prevention conversations.

Table 4. Cost Comparison: LAAC vs. a Representative DOAC

Option	Brand / Generic	Approx. Monthly Cost	Company
LAAC device	Watchman 2.5 / FLX / FLX Pro	One-time procedural cost, not a recurring drug expense	Boston Scientific (NYSE: BSX)
LAAC device	AnchorMan	One-time procedural cost; not commercially available in the US	MicroPort CardioFlow (HKG: 2160)
Oral anticoagulant	Brand Eliquis (apixaban)	Roughly $350–$600, before manufacturer copay assistance	Bristol Myers Squibb (NYSE: BMY) / Pfizer (NYSE: PFE)
Oral anticoagulant	Generic apixaban	Roughly $30–$80 with a discount card	Multiple generic manufacturers

Drug prices shown are point-in-time GoodRx figures and vary by pharmacy, region, and insurance coverage.

Case Vignette

A 74-year-old woman with paroxysmal nonvalvular AFib, a CHA₂DS₂-VASc score of 5, and a gastrointestinal bleed six months ago on apixaban is referred for stroke-prevention options.

She has already failed a trial of dose-reduced anticoagulation with recurrent minor bleeding, and her HAS-BLED score is 4.

Transesophageal echocardiography shows a chicken-wing morphology appendage without thrombus, making her anatomically suitable for closure.

She undergoes Watchman FLX implantation uneventfully and is transitioned to a short antiplatelet regimen per current protocols.

This is exactly the patient population in which a competitor device with a lower peridevice-leak signal, like AnchorMan, could eventually matter clinically once (and if) it reaches FDA review.

Bottom Line

AnchorMan met noninferiority against Watchman 2.5 on the primary safety and efficacy endpoint at 12 months, with a possible sealing advantage that will need confirmation.

The device is not yet available in the United States, and its next comparative trial will need to clear the higher bar set by Watchman FLX and FLX Pro rather than the first-generation platform.

For US-based physicians, this is a name worth tracking rather than a near-term change to practice.

---

Watch

Watchman FLX Product Animation (Boston Scientific)

References

1. SAFE-PROTECT 12-month randomized trial results, EuroIntervention, July 2026.
2. TCTMD coverage of the initial SAFE-PROTECT presentation, EuroPCR 2023.
3. MicroPort primary endpoint announcement, May 2023.
4. ACC update on Watchman FLX Pro approval, September 2023.
5. TCTMD coverage of original Watchman FLX approval, July 2020.
6. MicroPort update on AnchorMan's NMPA approval and China rollout, September 2024.

Physician education disclaimer: This article is intended for healthcare professional education and does not constitute individualized clinical guidance; device selection should follow current professional society recommendations and shared decision-making with each patient.

Financial disclaimer: Stock tickers, analyst ratings, price targets, and drug pricing in this article are for informational purposes only, reflect a single point in time, and are not investment advice; consult a licensed financial advisor before making investment decisions.

Want this reformatted as a short YouTube script, a one-paragraph social summary, or a patient-facing handout on LAAC options? Just ask.

AI in the Cath Lab · Practice & Investment

AI Voice Agents in the Cath Lab: What the Sofiya Pilot Means for Practice

A 90-day pilot of an agentic voice assistant handling pre-procedural calls offers a data point on where administrative AI is heading in interventional cardiology — and which public companies sit near the trend.

A high-volume academic cath lab has spent the past year testing whether a voice-based AI assistant can safely take over one of the most repetitive tasks in pre-procedural care.

The assistant, an agentic conversational system built specifically for the workflow, calls patients the day before catheterization to review logistics, confirm allergies and medications, and answer routine questions.

Two sequential 90-day phases at the Mount Sinai Fuster Heart Hospital cath lab generated the largest published experience with this kind of tool in interventional cardiology to date.

For a specialty facing a worsening nursing shortage, the results are worth a close read.

Why This Matters Now

Preprocedural calls are clinically essential but highly repetitive, covering arrival time, fasting instructions, transportation, and a structured allergy and medication review.

In a lab performing more than 16,000 procedures a year, that workload consumes several full-time nursing hours every single day.

Workforce shortages projected to worsen through 2030 have pushed health systems to look for ways to protect nurses' time for direct, bedside clinical work.

The pilot's central question was whether a large language model-based voice agent could take on this task without compromising safety or the patient experience.

What the Pilot Found

Across two 90-day phases, 1,431 patients received 1,606 calls, and the overall successful-completion rate rose from 86.4% in phase one to 87.9% in phase two.

More than a third of all calls were handled entirely by the AI agent with no nurse involvement at any point.

Roughly another third triggered a brief, protocol-defined nurse callback, and about 12% were escalated to a full human conversation.

Investigators estimated the assistant saved an average of 11 minutes per call, equivalent to more than 37 twelve-hour nursing shifts over a year in this single lab.

Patient satisfaction was high in both phases, and only a small minority of patients declined to speak with the AI system at all.

Six calls were derailed by an AI hallucination — the system generating inaccurate information — out of more than 1,600 attempts, and every transcript was reviewed by a nurse before anything reached the chart.

Metric	Phase 1 (n=806 calls)	Phase 2 (n=800 calls)
Successfully completed calls	86.4%	87.9%
Fully automated, no nurse contact	36.6%	42.6%
Brief protocol-driven nurse callback	37.6%	33.5%
Escalated to full human call	12.2%	11.8%
Patient declined AI call	4.3%	2.8%
Postprocedural satisfaction	94.7%	98.1%

Fig. 1. Disposition of pre-procedural calls handled by the AI voice assistant, by pilot phase.

Fig. 2. Illustrative trend in patient satisfaction across the pilot, alongside the estimated annualized nursing-time offset.

Case Vignette

A 71-year-old woman with stable angina is scheduled for diagnostic catheterization the next morning.

The evening before, an AI voice agent calls to confirm her arrival time, review same-day fasting rules, and ask about allergies and current medications.

She mentions she takes a direct oral anticoagulant that was not listed in her chart, and the system automatically flags the discrepancy for a same-day nurse callback rather than attempting to resolve it itself.

A nurse calls back within the hour, confirms the hold parameters with the proceduralist, and documents the correction — illustrating the intended division of labor between automation and clinical judgment.

Where the Guardrails Are

The design keeps a human in the loop by default: every transcript is reviewed by nursing staff, and any question outside the system's scripted knowledge base triggers a callback rather than an improvised answer.

At the start and end of every call, the assistant identifies itself as a virtual agent and reminds patients that a person is always reachable.

Deployment reportedly required review by roughly a dozen institutional committees, including the health system's first case brought before a dedicated AI governance board.

That governance overhead is worth noting for any practice considering a similar build, since the technical lift is often smaller than the compliance one.

The Investor Angle

The specific platform used in this pilot is an internally customized, vendor-partnered build rather than a standalone public product, so there is no direct ticker to attach to it.

The broader trend it represents, though, touches several publicly traded companies that physician-investors may already be watching.

Company	Ticker	Relevance	Analyst Consensus	12-Mo. Price Target
Sofiya voice-agent platform	no ticker (private)	Custom-built, vendor-partnered agentic AI; not a standalone public offering	—	—
Microsoft	NASDAQ: MSFT	Ambient and agentic clinical AI (Dragon Copilot) competes in the same workflow-automation category	Strong Buy	$558.77 (+39.3%)
Tempus AI	NASDAQ: TEM	Pure-play healthcare AI/data company scaling clinical workflow and diagnostics products	Buy	$66.06 (+12.6%)
GE HealthCare	NASDAQ: GEHC	Cath lab imaging and interventional-suite equipment maker layering AI into existing hardware	Buy	$79.33 (+23.1%)

None of these companies were named as the vendor behind this specific pilot, and the table above should be read as thematic exposure to administrative and clinical AI in cardiology, not as a claim about who built Sofiya.

What Might Come Next

Program leaders have described plans to extend similar AI calling to postprocedural follow-up, appointment scheduling, and cardiac rehabilitation referrals.

Expansion into peripheral and structural heart disease scheduling within the same cath lab has also been discussed as a next step.

Nursing representatives have publicly cautioned that every AI-generated summary still needs a clinician's review before it becomes part of the permanent record.

That tension between efficiency gains and continued oversight is likely to define how quickly this category scales across other cath labs.

Bottom Line

A well-governed, human-in-the-loop AI voice agent handled more than a third of pre-procedural cath lab calls with no nurse involvement and freed an estimated 37-plus nursing shifts a year at a single high-volume site.

The technology performed safely within a narrow, scripted scope, but every escalation pathway and every hallucination in this pilot was caught because a nurse was still reviewing the output.

For practices evaluating similar tools, the governance and review infrastructure may matter as much as the underlying model.

Physician education disclaimer: This article is intended for healthcare professional education and does not constitute clinical guidance for any individual patient; treatment and workflow decisions should follow institutional protocols and clinician judgment.

Financial disclaimer: Stock tickers, analyst ratings, and price targets are provided for informational and educational purposes only, reflect data available as of publication, and do not constitute investment advice or a recommendation to buy or sell any security. This is not a substitute for advice from a licensed financial advisor.

Further Viewing

▶ Harnessing Artificial Intelligence at the Mount Sinai Health System
▶ Mount Sinai Department of Artificial Intelligence (AI) and Human Health

References

1. Meet Sofiya, Mount Sinai's latest AI assistant. Becker's Cardiology.
2. Utilizing an AI-assisted virtual agent for pre-procedural patient calling in the cardiac catheterization laboratory. European Heart Journal – Digital Health, 2026.
3. Mount Sinai Launches Cardiac Catheterization Artificial Intelligence Research Lab. Mount Sinai Newsroom.
4. Microsoft Corporation (MSFT) stock overview. StockAnalysis.com.
5. Tempus AI (TEM) stock forecast. StockAnalysis.com.
6. GE HealthCare Technologies (GEHC) stock overview. StockAnalysis.com.

Lipid Management · New Approval

The First Pill for PCSK9: What Enlicitide's Approval Means for Your Lipid Clinic

Cardiology & Investor Brief · July 16, 2026

The FDA has approved enlicitide (Lipfendra) as the first oral PCSK9 inhibitor for adults with hypercholesterolemia, including heterozygous familial hypercholesterolemia (HeFH).

It is manufactured by MerckNYSE: MRK, and is dosed as a once-daily 20-mg tablet.

Every prior PCSK9 inhibitor on the US market has required an injection, so this approval changes the practical calculus for a large share of statin-intolerant and high-risk patients.

Enlicitide is a novel macrocyclic peptide that binds PCSK9 and blocks its interaction with hepatic LDL receptors, the same target as the injectable antibodies but delivered as an orally stable ring-shaped peptide.

Case Vignette

A 54-year-old patient with heterozygous familial hypercholesterolemia has an LDL-C of 168 mg/dL despite maximally tolerated rosuvastatin and ezetimibe.

The patient has declined every injectable option offered over the past two years, citing needle aversion and a demanding travel schedule that makes cold-chain storage impractical.

An oral, room-temperature-stable PCSK9 inhibitor removes both objections in a single conversation.

This is precisely the patient population most likely to benefit from enlicitide's approval.

What the CORALreef Trials Showed

The approval rests on two Phase 3 trials, CORALreef Lipids and CORALreef HeFH.

In CORALreef Lipids, LDL-C fell 57.1% with enlicitide versus a 3.0% rise with placebo at 24 weeks, an adjusted between-group difference of 55.8%.

In CORALreef HeFH, the between-group LDL-C difference was 59.4%, with both results reaching high statistical significance.

Diarrhea and dizziness were numerically more frequent with enlicitide in the HeFH trial, but discontinuation rates for adverse events were similar between arms.

Enlicitide's placebo-adjusted LDL-C lowering is in the same range as established injectable PCSK9 inhibitors; ranges for comparators reflect prior published trial data, not head-to-head comparison.

Trial	Population	LDL-C Change (Enlicitide vs Placebo)	Notable Adverse Events
CORALreef Lipids	Adults with hypercholesterolemia	-57.1% vs +3.0% (Δ 55.8%, P<0.001)	Similar to placebo overall
CORALreef HeFH	Adults with heterozygous FH	Δ 59.4% (P<0.001)	Diarrhea 7% vs 2%; dizziness 9% vs 4%

Where It Fits Among PCSK9 Inhibitors

Enlicitide joins a crowded but still-growing PCSK9 class that includes inclisiran (Leqvio), evolocumab (Repatha), alirocumab (Praluent), and lerodalcibep (Lerochol).

What sets it apart is not efficacy but the route: a tablet rather than a subcutaneous injection or in-office infusion.

An interventional cardiologist commenting to TCTMD framed this as an access issue rather than a potency issue, since needle aversion and cold-chain logistics keep some appropriate patients from ever starting a PCSK9 inhibitor.

That same commentary was clear that oral PCSK9 inhibition adds to the toolbox rather than replacing existing agents.

Enlicitide is the only oral option; injectable agents differ mainly in dosing interval and self- versus in-office administration.

Financial Snapshot: The PCSK9 Competitive Landscape

Cost has historically limited broader PCSK9 uptake, and the TCTMD commentary noted that access will hinge on pricing and payer pathways once enlicitide launches commercially.

List pricing for enlicitide has not yet been published as of this approval, so clinicians should expect formulary and coupon details to follow in the coming weeks.

Agent (Brand)	Company / Ticker	Analyst Consensus & 12-Mo Target	Cash/List Price Reference
Enlicitide (Lipfendra)	MerckNYSE: MRK	Buy · $132.78 target	Not yet published
Evolocumab (Repatha)	AmgenNASDAQ: AMGN	Hold · $345.12 target	GoodRx cash price from ~$239/mo
Alirocumab (Praluent)	RegeneronNASDAQ: REGN / SanofiNASDAQ: SNY	Buy · $833.31 target (REGN)	GoodRx cash price ~$233/mo
Inclisiran (Leqvio)	NovartisNYSE: NVS	Hold · $154.57 target	GoodRx coupon programs vary; list WAC ~$3,250-3,500/dose
Lerodalcibep (Lerochol)	LIB Therapeutics no ticker (private)	Not applicable	Cash-pay launch price $199/month

What's Still Unknown

No cardiovascular outcomes data yet exist for enlicitide, so a reduction in heart attacks and strokes remains inferred rather than proven.

The ongoing CORALreef Outcomes trial has completed enrollment of more than 14,500 participants and should eventually answer that question.

Merck also has an extension study, a pediatric trial in patients ages 6 to 17, and a combination trial pairing enlicitide with rosuvastatin underway.

Until outcomes data mature, enlicitide should be regarded as a highly effective LDL-lowering option with a favorable surrogate-endpoint profile, not yet a confirmed event-reducing therapy.

Bottom Line

Enlicitide is the first oral PCSK9 inhibitor, matching injectable-class LDL-C reductions of roughly 56-59% in two Phase 3 trials.

It expands options for patients who decline or cannot manage injectable therapy, without replacing existing agents.

Cardiovascular outcomes data are still pending from the ongoing CORALreef Outcomes trial.

Pricing, insurance coverage, and formulary placement will determine how quickly it reaches appropriate patients.

Physician education disclaimer: This article is intended for healthcare professional education and does not constitute clinical practice guidance for any individual patient; treatment decisions should follow current guidelines and individualized clinical judgment.

Financial disclaimer: Stock data, analyst ratings, and price targets are for informational purposes only, reflect a single point in time, and do not constitute investment advice; this is not a recommendation to buy or sell any security.

Related Viewing

For a patient-friendly primer on how this drug class works, see PCSK9 Inhibitors Explained, which covers the mechanism and cardiovascular rationale behind PCSK9 inhibition.

For a clinician-oriented walkthrough of when to use this class in practice, see PCSK9 Inhibitors in Practice.

References

1. Merck news release on LIPFENDRA (enlicitide) FDA approval
2. AJMC coverage of the enlicitide approval
3. TCTMD coverage of the CORALreef Lipids trial
4. GoodRx pricing reference for evolocumab (Repatha)
5. GoodRx pricing reference for inclisiran (Leqvio)
6. LIB Therapeutics LEROCHOL US launch announcement

Want this repackaged as a short YouTube script, a social media summary, or a patient-facing pamphlet on oral vs. injectable cholesterol medications? Just ask.

10 Human Stories From the 2026 World Cup That Outlasted the Scoreline

Every four years, the World Cup reminds us that the scoreboard is rarely the point. Behind the goals and the trophies are stories about grief, gratitude, second chances, and old wounds that never quite close. As a cardiologist, I spend my days thinking about what keeps a heart going — and this tournament, more than most, has been full of lessons about resilience that apply just as much in a clinic as they do on a pitch. Here are ten stories from the 2026 FIFA World Cup that stayed with me.

1. A Grandmother's Hand, Pointed at the Sky

Every time Lionel Messi scores, he pauses mid-celebration, lifts a finger, and looks up. It's become one of the most recognizable gestures in sports, and it has one consistent meaning. Messi has said plainly that the gesture is a dedication to his late grandmother, Celia, who first believed in him as a boy, brought him to his earliest matches, and supported him through the growth-hormone treatment that nearly derailed his career before it began.

She never saw what he became. But two decades and hundreds of goals later, he still points to her first.

There's something worth sitting with here, medically and personally: the people who show up for us early — before there's any proof we're worth the investment — tend to stay with us longest, even after they're gone.

2. The Baby in the Bathtub Photo Who Grew Up to Face Him in the Final

In December 2007, a 20-year-old Messi walked into a Camp Nou locker room for a charity photoshoot organized by Barcelona's foundation and a Spanish newspaper. A family had won a raffle, held with UNICEF, for the chance to have their baby photographed with a Barcelona player. That baby was five-month-old Lamine Yamal, and the now-famous images show an awkward, introverted young Messi helping bathe him in a plastic tub.

Nineteen years later, that baby is Spain's brightest star, wearing the same No. 10 shirt at the same club where Messi became a legend. This past Sunday, the two met on a pitch for the first time — not as mentor and toddler, but as opponents in the World Cup final, with the trophy and possibly the Ballon d'Or between them.

It's a reminder that the people we help along the way don't stay small. Every patient, every trainee, every kid we happen to hold for a photo is quietly becoming someone — we rarely get to see the whole arc unless we're paying attention.

3. Old Wounds, Ninety Minutes Wide

The England–Argentina semifinal was never just a football match. Diplomatic relations between the two countries have stayed strained for decades over the Falkland Islands, known as Las Malvinas in Argentina, following the 1982 war. Gary Lineker, who scored England's goal in the countries' famous 1986 meeting, said publicly he wanted revenge for that old loss. After Argentina won 2-1 this time, players laid a "Las Malvinas Son Argentinas" banner on the field, a gesture that reportedly drew FIFA's attention for breaching rules on political displays.

One Argentine player was candid about it afterward: for the men on the pitch, the match carried decades of history, pain, and meaning that had nothing to do with them personally and everything to do with the shirts they wore.

It's a useful reminder for anyone in medicine, too — the person in front of us is often carrying history that predates them, shaped by forces they didn't choose and can't fully set down.

4. The Striker Who Gave His Country 0.5% Odds — Then Changed History

Erling Haaland had never once seen Norway play in a World Cup — he was born two years after their last appearance in 1998. About a year before this tournament, he rated his own country's chances of winning it at half a percent. He then scored seven goals across the tournament, including a decisive brace that eliminated five-time champions Brazil, and carried Norway into the quarterfinals for the first time in the nation's history before England ended the run.

What made him beloved wasn't just the scoring record. It was that he stayed, by every account, one of the guys — cracking jokes, blending in with his teammates, treating a once-in-a-generation run like something the whole group built together. Norway gave him a hero's welcome home anyway, with military jets escorting the team's plane.

Low odds are just a starting estimate, not a verdict. I see that daily in cardiology — the patients who beat the numbers are rarely the ones who ignored their diagnosis. They're the ones who kept showing up to do the unglamorous work anyway.

5. Nine Players Who Started in Refugee Camps

At least nine players across this tournament carry a refugee or displacement story, brought together under a UNHCR campaign called the Gamechanging Team. Australia's Nestory Irankunda was born in a Tanzanian refugee camp after his parents fled Burundi's civil war — he's described his father refusing to leave behind a sick older sister during the escape, even when it meant risking everything. Irankunda became the youngest player to ever score for Australia at a World Cup.

His teammate Awer Mabil was born in Kenya's Kakuma refugee camp after his South Sudanese parents fled civil war, and resettled in Adelaide at age ten. Mabil has since co-founded a charity that supplies football gear to children still living in the same camp where he was born, and describes himself as a "big brother" to the other resettled players on his team.

These are the stories I keep coming back to. Circumstances of birth are not sentences. And sometimes the most meaningful legacy isn't the trophy — it's what you build for the people still standing where you started.

6. A College Town That Adopted a Team Anyway

In Lawrence, Kansas, an entire community adopted Algeria's national team as its own for the tournament — locals threw block parties, restaurants added Algerian dishes to their menus, and the university marching band even learned Algeria's national anthem. Algeria lost early and went home. The welcome outlasted the result anyway, and both sides say they made friends for life.

It's a small story next to the giants of this list, but maybe the most quietly instructive: hospitality doesn't need a scoreboard to justify itself.

7. The Underdogs of a 500,000-Person Island Nation

Cape Verde, ranked 67th in the world with a population barely over half a million, went undefeated through a brutal group stage that included Spain and two-time champions Uruguay, becoming the second-smallest nation ever to reach a World Cup knockout round. They were built almost entirely around defensive discipline and a 40-year-old goalkeeper, Vozinha, playing the tournament of his life.

They eventually fell to Argentina in the Round of 32 in a match so close it needed extra time, and their manager still called it a source of pride rather than a disappointment. A former England international called it one of the greatest underdog performances he'd ever seen, adding that the Cape Verdean players cried afterward not from failure, but because they didn't want the moment to end.

Structural discipline and unity, in a group with a fraction of the resources of its rivals, can still humble giants. That's a lesson worth keeping in a hospital budget meeting as much as a locker room.

8. Ninety-Two Years in the Making

Egypt had waited 92 years, across eight prior attempts, for a first-ever World Cup victory. When it finally arrived against New Zealand, and again when Egypt secured their first-ever spot in the Round of 16 with a shootout win over Australia, Mohamed Salah could not hold back tears on the pitch. He later said he decided, in the last second of the shootout, to attempt a Panenka penalty himself — reasoning that if anyone on the team was going to take that risk, his experience meant it should be him.

Sometimes leadership isn't about being the most talented person on the field. It's about being willing to be the one who absorbs the risk so the people around you don't have to carry it alone.

9. Playing for Someone Who Isn't There Anymore

Portugal's Round of 32 win over Croatia fell on the exact first anniversary of the death of their teammate Diogo Jota, who died in a car accident with his brother the year before. Cristiano Ronaldo, who scored the winning goal that day and became the oldest player ever to score in a World Cup knockout match, pulled on a jersey bearing Jota's old number after the final whistle, pointed to the sky, and told reporters the team knew Jota was still present with them, and that winning that day was the right way to honor him.

Portugal's manager had named Jota an honorary member of the World Cup squad for the entire tournament. Grief, it turns out, doesn't need to be resolved to be carried productively. Sometimes you just bring the person with you, in whatever form you can, and keep going.

10. Nineteen Goals, and Still Playing Like It's His First Tournament

At 38 turning 39 during the tournament, Messi scored the eleventh hat-trick of his career against Algeria — his first ever in World Cup play — making him the oldest player to score a hat-trick in a World Cup match. Days later, he broke the tournament's all-time career goal-scoring record outright, a mark that had stood for over a decade.

There's no shortcut in that longevity. It's the accumulation of two decades of showing up, adjusting to a body that no longer moves the way it did at twenty, and still finding a way to be useful to the people counting on him. That's not a bad description of a long career in medicine either.

---

— Dr. Bishnu Subedi, MD, FACC

Imaging & Structural Heart · Practice-Changing Data

Rethinking a Sacred Cow: Sublingual Nitroglycerin Before Pre-TAVI CT Angiography

New prospective data presented at SCCT 2026 suggest a long-standing contraindication may be doing more harm than good in appropriately selected patients.

Cardiology & Cardiovascular Investing Digest · Practice Update

Coronary artery disease coexists with severe aortic stenosis in roughly six or seven of every ten patients referred for valve replacement.

Because of that overlap, Society for Cardiovascular Computed Tomography (SCCT) guidance calls for routine coronary assessment as part of pre-procedural planning.

Sublingual nitroglycerin has long been the standard trick for sharpening those images, since it dilates the coronary arteries and reduces motion-related blur.

Yet the same guidance has historically flagged nitroglycerin as relatively contraindicated in severe AS, out of concern that its hypotensive effect could be dangerous in a stenotic, preload-dependent ventricle.

That tension has left many imaging labs either skipping the drug in this population or using it off-protocol without strong evidence either way.

A new prospective study presented at the 2026 SCCT annual scientific meeting directly tests that old assumption.

Mean systolic blood pressure fell after sublingual nitroglycerin and then stabilized through discharge, with no associated symptoms in the majority of patients.

What the Study Found

Investigators enrolled 109 patients with severe AS, mean age 79.4 years, referred for coronary CT angiography ahead of TAVI.

Everyone in the cohort received 0.8 mg of sublingual nitroglycerin, after excluding patients with baseline hypotension, severely reduced ejection fraction, critical AS, or other standard contraindications.

Mean systolic blood pressure dropped from 158 mmHg at baseline to 140 mmHg after the scan and remained stable at 136 mmHg through discharge.

Just over a third of patients, 38.5%, had a drop in systolic pressure greater than 20 mmHg, but none of these drops were tied to symptoms.

The most common side effects were mild and self-limited: headache in 8.2% and dizziness in 7.3%.

Against a propensity-matched control group that did not receive the drug, the nitroglycerin group showed sharply better image quality on nearly every metric the researchers tracked.

Imaging Performance, Head-to-Head

Metric	Nitroglycerin Group	Control Group	P value
Contrast-to-noise ratio	30.4	18.5	<0.001
Signal-to-noise ratio	25.5	15.1	<0.001
Coronary blood volume index	3.1	2.0	<0.001
False-positive scans	8	23	—
Positive predictive value	75.0%	48.9%	0.033
Diagnostic accuracy	84.9%	67.6%	0.036

The nitroglycerin group also had significantly fewer scans classified as the ambiguous CAD-RADS 3 category, meaning fewer equivocal reads that would typically trigger a follow-up invasive study.

Consistent with that, the study group trended toward needing fewer subsequent invasive coronary angiograms, 35.6% versus 49.3% in controls, a 27% relative risk reduction that did not quite reach statistical significance.

Positive predictive value and diagnostic accuracy were both significantly higher in patients who received sublingual nitroglycerin before their scan.

A Practice Change, Not Just a Data Point

The investigators framed their conclusion plainly: sublingual nitroglycerin before CTA in appropriately selected patients with severe AS undergoing TAVI evaluation is safe and well tolerated.

The senior author on the study, who also serves as SCCT's incoming president, told meeting attendees the data have already changed practice at his own center.

The presenting investigator's group now routinely gives sublingual nitroglycerin before pre-TAVR CT in elective, clinically stable patients with severe AS.

Their exclusion criteria mirror the study protocol: baseline systolic blood pressure under 100 mmHg, left ventricular ejection fraction under 30%, critical AS, or any standard contraindication to nitrates.

The clinical logic is straightforward: better coronary visualization means CAD can more often be confidently excluded on CT alone, sparing a same-admission invasive angiogram in a patient already headed for one procedure.

Case in Point

An 81-year-old with symptomatic severe aortic stenosis and a heavily calcified aortic valve is referred for TAVI workup.

Baseline blood pressure is 152/78 mmHg, ejection fraction is 55%, and there is no history of nitrate intolerance.

Following the updated protocol, the CT team gives 0.8 mg of sublingual nitroglycerin five minutes before acquisition.

The resulting scan shows well-opacified, low-noise coronary segments with no significant stenosis, and the heart team proceeds directly to TAVI without a preceding invasive angiogram.

Dosing and Cost

Sublingual nitroglycerin doses in this population have ranged from 0.3 mg to 0.8 mg depending on aortic valve area and institutional protocol.

The drug itself is generic, inexpensive, and widely stocked, which makes this an unusually low-cost intervention with an outsized effect on downstream resource use.

Product	Formulation	Manufacturer	Cash Price (GoodRx)
Nitroglycerin (generic)	0.4 mg sublingual tablet, 25 ct	Multiple generic manufacturers	as low as $9.00
Nitrostat (brand)	0.4 mg sublingual tablet, 25 ct	no ticker (brand marketed by a private generics distributor)	as low as $9.00

Financial disclaimer: stock ratings, price targets, and drug pricing cited in this article are point-in-time snapshots for educational purposes, are not investment advice, and should be independently verified before any clinical or financial decision.

The Investor Lens: Who Benefits from a Streamlined Pre-TAVI Workup

A protocol change that lets more centers safely exclude CAD on CT alone, rather than defaulting to invasive angiography, has ripple effects across the structural heart and cardiac imaging supply chain.

Fewer invasive angiograms per TAVI candidate shifts volume and margin toward CT hardware and toward the valve platforms that depend on efficient, high-throughput screening pipelines.

Company	Ticker	Relevance	Analyst Consensus	12-Mo Price Target
Edwards Lifesciences	NYSE: EW	Leading transcatheter aortic valve (SAPIEN) platform; volume tied to efficient pre-TAVI workup	Buy	$97.58
Medtronic	NYSE: MDT	Competing TAVI platform (Evolut); same CT-dependent screening pathway	Buy	$98.00
GE HealthCare	NASDAQ: GEHC	Major cardiac CT scanner manufacturer; benefits from expanded pre-TAVI CTA volume	Buy	$78.95

Bottom Line

Sublingual nitroglycerin before pre-TAVI coronary CTA, long avoided in severe AS out of caution, appears safe and meaningfully improves image quality in carefully selected, hemodynamically stable patients.

Better images translate directly into fewer equivocal reads, higher diagnostic accuracy, and a real chance to skip an unnecessary invasive angiogram in a patient already facing one procedure.

Cardiologists running structural heart imaging programs should revisit their own institutional protocols and exclusion criteria in light of this evidence.

---

References

1. SCCT 2026: What to Expect in Chula Vista. TCTMD.
2. New CT Guidelines for TAVR Emphasize Standardization, 4-D Acquisition, and Postprocedural Imaging. TCTMD.
3. Nitroglycerin Prices, Coupons and Savings Tips. GoodRx.
4. Edwards Lifesciences (EW) Stock Forecast & Price Targets. StockAnalysis.com.
5. Medtronic (MDT) Stock Forecast & Analyst Price Targets. StockAnalysis.com.
6. GE HealthCare Technologies (GEHC) Stock Forecast & Price Targets. StockAnalysis.com.

Physician education disclaimer: this article summarizes preliminary conference-presented data and is intended for physician education, not as a substitute for institutional protocols, product labeling, or individualized clinical judgment.

Cardiac Imaging & Market Watch

One Heartbeat, Almost No Radiation: FLASH Photon-Counting CCTA Comes of Age for Young, Low-Risk Patients

Clinical synthesis with an investor lens for physician-investors in cardiovascular imaging

A new prospective registry presented at the 2026 Society of Cardiovascular Computed Tomography meeting suggests that young, low-risk patients referred for coronary CT angiography can be scanned with almost no radiation at all.

Using a single-heartbeat, high-pitch acquisition technique called FLASH on a fourth-generation photon-counting CT scanner, investigators achieved a median effective dose of just 0.82 mSv.

That is lower than the radiation from a routine coronary calcium score, long considered the lowest-dose cardiac CT test available.

For physicians who order or perform cardiac CT, this data point reframes what a "low-radiation" coronary study can look like in practice.

Figure 1. Approximate effective radiation doses across common cardiac imaging protocols, shown for orientation rather than head-to-head comparison.

What the Registry Showed

Investigators enrolled 70 patients with no known coronary disease referred for CCTA, with a mean age of 36 and 41% women.

All scans used the FLASH protocol, a prospective high-pitch helical acquisition that captures the entire heart in a single cardiac cycle rather than over several heartbeats.

Scanning was performed on a fourth-generation dual-source photon-counting CT scanner (marketed as NAEOTOM Alpha).

Mean body mass index was 26.5 kg/m² and mean heart rate was 58 beats per minute, reflecting careful patient selection.

More than half the cohort (59%) had dyslipidemia, and just over half (51%) had a family history of premature coronary disease.

Effective radiation dose fell below 1 mSv in 70% of patients, with a median of 0.82 mSv for the full cohort.

Image quality was rated excellent in 51% and good in 27%, while 9% of scans (six patients) were nondiagnostic and required a repeat study.

On CAD-RADS scoring, 81% of patients were classified as CAD-RADS 0 and 16% as CAD-RADS 1, meaning 97% had no or minimal disease.

One patient was scored CAD-RADS 2, and one was scored CAD-RADS 4A, a finding that was subsequently confirmed by invasive coronary angiography.

Figure 2. CAD-RADS classification among 70 patients scanned with the FLASH photon-counting protocol.

Table 1. FLASH Photon-Counting CCTA Registry at a Glance

Parameter	Result
Cohort size	70 patients
Mean age / % women	36 years / 41%
Mean BMI	26.5 kg/m²
Mean heart rate	58 bpm
Median effective dose	0.82 mSv
Dose <1 mSv	70% of patients
Nondiagnostic scans	9% (6 patients)
CAD-RADS 0 or 1	97% of patients

Why a Single Heartbeat Matters

FLASH acquisition is available on most modern CT scanners, but many imagers have been reluctant to use it because it provides only one cardiac phase rather than the multiphase buffer of conventional protocols.

That single-phase design behaves like a bet on the patient's physiology: a steady, slow heart rate produces a crisp image, while an irregular or fast rhythm risks a nondiagnostic study.

The registry's authors framed this trade-off directly, noting that even a failed FLASH scan carries only a small radiation penalty before falling back to a conventional protocol.

Photon-counting detectors add a second, complementary advance by directly registering individual X-ray photons rather than integrating their combined energy.

This design reduces electronic background noise, sharpens spatial resolution, and lessens blooming artifact around calcified plaque and stents, all of which support confident low-dose imaging.

The combination of ultrafast single-beat acquisition with photon-counting detection is what allowed this cohort's median dose to undercut a standard calcium score.

Heart rate control was central to success, and the study team relied on beta-blockers to bring resting heart rates down before scanning.

Patients with a resting heart rate above 70 beats per minute were switched to a conventional prospective protocol rather than attempting FLASH.

Table 2. Common Beta-Blockers Used for Pre-CCTA Heart Rate Control

Generic name	Common brand	Route	Approx. cash price (GoodRx)
Metoprolol tartrate	Lopressor	Oral / IV	~$7–17 per 30-day oral supply
Metoprolol succinate	Toprol XL	Oral, once daily	~$12–20 per 30-day supply

Clinical Vignette

A 34-year-old nonsmoking marketing executive with a strong family history of premature coronary disease and borderline dyslipidemia presents with atypical chest tightness during a stressful workweek.

Her resting heart rate is 56 beats per minute and her calculated pretest probability of obstructive disease is low.

Rather than defaulting to a standard-dose CCTA protocol, her imaging team selects a single-heartbeat FLASH acquisition on their photon-counting scanner after a low dose of oral metoprolol.

The study is read as CAD-RADS 0, delivered at a dose lower than her prior coronary calcium score, and she is reassured and discharged with standard preventive counseling.

Practical Considerations Before Adopting FLASH

Both patient body size and heart rate variability determine candidacy, and sinus arrhythmias common in younger patients can still be accommodated with careful protocolling.

A resting heart rate that is too high or too variable is the most common reason to abandon FLASH in favor of a conventional prospective, multiphase acquisition.

Radiology and cardiology teams, along with their technologists, need shared buy-in before rolling out a low-dose FLASH pathway, since patient selection drives success.

The authors specifically plan to prioritize this protocol for younger patients with chest pain who need coronary anatomy clarified, including evaluation for anomalous coronary arteries.

Broader adoption also intersects with a decade-long trend of falling CCTA radiation doses as scanner technology and protocols have matured industry-wide.

The Business of Photon-Counting CT

The scanner used in this registry is manufactured by Siemens Healthineers AG, whose Imaging division is the commercial home for its photon-counting CT platform.

Siemens Healthineers trades in the US as an OTC ADR and on its primary Frankfurt listing, giving investors two ways to track the same underlying business.

Photon-counting CT has been repeatedly highlighted by company leadership as a growth driver within the broader Imaging segment.

Table 3. Siemens Healthineers AG — Company Snapshot

Metric	Value
Ticker (US OTC)	SMMNY
Primary listing	Frankfurt Stock Exchange (SHL)
Recent share price (OTC)	~$20.26 (as of Jun 9, 2026)
Relevant segment	Imaging (CT, MRI, X-ray, ultrasound)
Analyst consensus / 12-mo target	Not published on StockAnalysis.com for the OTC listing at time of writing

Because stock prices and analyst estimates move continuously, treat the figures above as a point-in-time snapshot rather than a current quote.

Bottom Line

In carefully selected young, low-risk patients with controlled heart rates, single-heartbeat FLASH acquisition on a photon-counting CT scanner can deliver diagnostic-quality coronary imaging at a radiation dose below that of a standard calcium score.

Success depends heavily on patient selection, heart rate control, and institutional readiness rather than the technology alone.

For physician-investors, the data reinforce photon-counting CT as a durable growth narrative for imaging equipment manufacturers, independent of any single stock's near-term price action.

Want this turned into a short video script, a social media summary, or a patient-facing handout on low-radiation heart CT? Just ask.

References

1. TCTMD conference coverage of SCCT 2026, Chula Vista, CA, July 9–12, 2026.
2. Society of Cardiovascular Computed Tomography news release on CAD-RADS 2.0.
3. FDA patient guidance on radiation risks from CT.
4. StockAnalysis.com company profile for Siemens Healthineers AG.
5. GoodRx pricing information for metoprolol.

Physician education disclaimer: This article is intended for physician education and reflects a synthesis of publicly available conference and industry data as of the date of writing; it is not a substitute for full peer-reviewed publication, institutional protocols, or individualized clinical judgment.

Financial disclaimer: Stock tickers, prices, and company information are provided for general educational context only, reflect a single point in time, and do not constitute investment advice or a recommendation to buy or sell any security.