Key Points

• Recaticimab effectiveness demonstrated dosage-dependent response indicating versatility in treatment options.
• Sustained reduction in LDL-C levels throughout the 48-week study period as well as favorable outcomes observed in additional lipid variables.

Continue reading →

Key Points:

• The prevalence of obesity, and AF is increasing substantially and are inextricably linked.
• Patients with obesity show less response to single-DCCV due to chest wall impedance
• This trial compared dual-DCCV to single-DCCV among patients with BMI ≥ 35 in ability to attain sinus rhythm in a patient refractory to initial DCCV
• Dual-DCCV showed significantly lower rates of failure compared to single-DCCV, suggesting its utility for AF refractory to DCCV in obese patients

Continue reading →

Key Points:

• • The use of an artificial intelligence electrocardiogram (AI-ECG) support tool in the evaluation of patient ECGs was associated with a reduction in the door to coronary angiography time (43.3 minutes vs. 52.3 minutes) in patients who presented with an ECG concerning for ST-elevation myocardial infarction (STEMI).
  • The AI-ECG support tool has a high positive predictive value of 88.0 (81.8-94.1) and high negative predictive value of 99.9 (99.9-100.0).
  • AI technology helped to reduce the treatment waiting time for patients with STEMI from about 52 minutes to 43 minutes.

Continue reading →

Key Points:

• Previous studies have investigated the use of direct oral anticoagulants (DOACs) instead of warfarin for reduction of stroke risk in AF, but the risk of clinically significant bleeding remains.
• Abelacimab is a novel Factor XI inhibitor that may be useful in reducing thromboembolic events while also being less likely to cause major bleeding.
• Patients were assigned to rivaroxaban  20 mg/ day or two different doses of abelacimab, 150mg SC monthly and 90mg SC monthly. The primary endpoint was major or clinically relevant non-major bleeding.
• The trial was stopped premature due to significant reduction in bleeding with 74% reduction in major bleeding and 93% reduction in GI bleeding on abelacimab 150mg SC versus rivaroxaban.

Continue reading →

Key Points:

• Out of all patients who undergo a CCTA, the highest number of cardiac events occurs in patients without obstructive CAD. 
• In patients with non-obstructive CAD on CCTA, the use of a novel AI tool to quantify coronary inflammation results in accurate predictions of patients’ ten-year risk of cardiac mortality and MACE. 
• In this study, patients with non-obstructive CAD on CCTA who have an inflammation score that is above the 75th percentile have an ~ 20 times higher risk of dying from a cardiac event over the next ten years.
• The AI risk model used in this study results in the reclassification of the risk profile of ~ 40% of patients and was found to lead to changes in clinical management in roughly half the patients.

Continue reading →

Key Points

• This randomized trial of 11255 patients in China with established CVD or at least 2 CVD risk factors but without a significantly reduced ejection fraction or advanced kidney disease (mean age ~65 years, 100% Asian, baseline SBP 147, 39% with diabetes, 27 % with stroke) found that a blood pressure target of <120 led to a 12% reduction in major vascular events, 39% reduction in cardiovascular mortality, and 21% reduction in all-cause mortality compared to a blood pressure target of <140.
• This was the first major randomized trial to show benefit of aggressive blood pressure in those with prior stroke, diabetes, or Asian ancestry.  

Continue reading →

Key Points

• The REPRIEVE trial recently demonstrated that pitavastatin reduced major adverse cardiovascular events by 35% among individuals with HIV at low-moderate risk predicted risk for cardiovascular disease. However, little is known regarding the mechanism of benefit. 
• The mechanistic sub-study of REPRIEVE enrolled 804 participants from the overall trial from 31 U.S. sites and randomized them to daily pitavastatin at a dose of 4mg or placebo. 
• At 2 years follow-up, pitavastatin reduced non-calcified plaque volume by 7% relative to placebo and reduced the risk of plaque progression by 33%.  

Continue reading →

Key Points

• This pre-specific subanalysis of NOAH-AFNET 6 found that those with long lasting atrial high rate episodes >24 hours were more likely to develop atrial fibrillation (AF); there was no significant interaction found between the duration of the longest AHRE and the efficacy and safety of oral anticoagulation.

Continue reading →

Key Points

• This randomized trial of 4012 patients (median age ~77, mean CHA2DS2VASC ~4, ~65% male) with an implanted pacemaker, defibrillator, or cardiac monitor with subclinical atrial fibrillation (SCAF) found that apixaban significant reduced stroke and systemic embolism compared with aspirin.
• Major bleeding was higher in the anticoagulation group in both on treatment and intention to treat analyses, but rates of fatal bleeding and symptomatic intracranial hemorrhage were similar and numerically fewer in the apixaban arm.

Continue reading →

Key Points:

• There are currently no approved targeted therapies for the reduction of Lp(a).
• In this Phase I study, a novel siRNA therapy (lepodisiran) was tested in escalating doses and compared to placebo in 48 patients. Lp(a) concentrations and safety events were examined for 48 weeks.
• Single-dose lepodisiran administration resulted in up to 94% reduction in Lp(a) at 48 weeks and was generally well-tolerated, supporting further development of this therapy.

Continue reading →

Key Points:

• Since the advent of novel HeartMate 3 LVAD technology with lower thrombotic risk, the clinical utility of continuing to add aspirin to the antithrombotic strategy has not been established.
• In the ARIES-HM3 study, an aspirin exclusion strategy (ie, Vitamin K antagonist [VKA] + placebo) was compared with the typical dual VKA/ASA therapy in patients with a HeartMate 3 LVAD. The primary endpoint was survival free of any non-surgical major hemocompatibility related adverse event one year post implant.
• Aspirin avoidance resulted in fewer bleeding events and hospitalizations for bleeding complications without any concurrent increase in thrombosis or mortality.

Continue reading →

Key Points:

• Out-of-pocket costs for GDMT in HFrEF have risen substantially with the advent of novel effective therapies. However, there is limited information regarding the utility of comprehensive cost disclosure in informing patient and clinician decision-making regarding prescribing GDMT.
• The POCKET-COST-HF study was a stepped-wedge cluster randomized trial examining the utility of a tailored, comprehensive cost disclosure intervention on a primary endpoint of cost-informed decision-making, ascertained by transcription of audio recordings of a clinic visit for HF.
• Comprehensive cost disclosure resulted in a higher proportion of encounters in which cost of medication was discussed, with further studies needed to inform the potential impact on medication prescribing and implementation strategies. 

Continue reading →

Key Points:

• Daily sodium intake remains high (on average ~3,500 mg/day), despite recommendations from the AHA and WHO to limit sodium intake to around 2,000 mg/day. 
• Salt-sensitivity to BP (SSBP) is an emerging concept supporting the notion that both normotensive and hypertensive individuals can have BP responses to their dietary sodium concentration. 
• The CARDIA-SSBP trial was a prospective, multicenter, randomized cross-over study that enrolled 228 participants to 1 week of either a high sodium diet (with up to 2,200 mg of sodium added/day) or a low sodium diet (with standardized meals containing 500 mg of sodium added/day), followed by another week crossing over to the other diet. At baseline and at the end of each week of diet, 24-hr ABPM and 24-hr urine collections were performed. 
• The low-sodium diet resulted in a significant reduction in median SBP of 6 mm Hg, which was similar to the average effect that would be observed with 12.5 mg of hydrochlorothiazide. On the other hand, further increases in daily sodium intake did not result in any significant increase in BP in this cohort – most likely as the baseline diets were already saturated in sodium.
• In conclusion, these data support that clinically meaningful lowering of BP through dietary sodium reduction can be achieved safely and rapidly within 1 week, with a magnitude comparable with that of a common first-line antihypertensive medication.

Continue reading →

Key Points

• This was the first randomized trial to evaluate the safety and efficacy of everolimus and low-dose tacrolimus in pediatric heart transplant recipients.
• The open-label trial demonstrated that this combination is safe compared to standard dose tacrolimus and mycophenolate mofetil but was not associated with a lower burden of coronary allograft vasculopathy, rejection, and chronic kidney disease.
• TEAMMATE was limited by lower event rates than expected and challenges related to protocol adherence due to the COVID19 pandemic.

Continue reading →

Key points:

• PCI is often performed for chronic stable angina, but current evidence is unclear to what extent the benefit is physiologic vs placebo
• This trial compared PCI with placebo-procedure in stable angina patients not on antianginal therapy with primary outcome of angina symptom assessment
• PCI was significantly associated with decreased angina symptoms measured by an angina symptom score compared to placebo

Continue reading →

Key Points:

• Intensive blood pressure (BP) lowering intervention was tested on hypertensive patients in rural China.
• In this four year blood pressure intervention program in rural China,  the intervention, led by non-physician community health-care providers, significantly reduced systolic blood pressure and the risk of all-cause dementia.
• Serious adverse events were less frequent in the intervention group, indicating the safety of the approach.

Continue reading →

Key Points

• Anemia is common among individuals with acute myocardial infarction, however, transfusion thresholds and targets remain uncertain.
• The MINT trial randomized 3,506 patients with acute myocardial and anemia (hemoglobin concentration < 10 g/dL) to a restrictive transfusion strategy (transfusion permitted if hemoglobin was less than 8 g/dL or in the event of anginal symptoms despite medications) or a liberal strategy (transfusion when hemoglobin was less than 10 g/dL).
• At 30-days the primary endpoint of all-cause death or recurrent myocardial infarction was not statistically different between the two strategies. 

Continue reading →

Key Points 

• This trial of patients with acute myocardial infarction (AMI) and impaired left ventricular (LV) systolic function found that dapagliflozin significantly improved clinical and cardiometabolic outcomes compared with placebo. 
• There was no significant difference in clinical events rates, which were low in both groups. 
• The innovative registry-based clinical trial design helped facilitate efficient patient recruitment and outcomes ascertainment.  

  Continue reading →

Key Points:

• While myocarditis is an inflammatory condition, there have not yet been trials demonstrating the benefit of anti-inflammatory therapies in the treatment of acute myocarditis.
• In the ARAMIS study, subcutaneous anakinra was compared with placebo in patients with acute myocarditis diagnosed on CMR presenting with chest pain and troponin elevation. The primary endpoint was number of days alive free from myocarditis complications.
• Anakinra use did not result in a significant change in number of days free from myocarditis complications but was well-tolerated and safe.

Continue reading →

Key Points:

• Diuretic requirement Is a major contributor to hospital length-of-stay for HF admissions, but the optimal strategy of diuretic optimization has not yet been established. Spot urinary sodium measurement and subsequent natriuresis-guided diuretic adjustment may refine diuretic dosage in the setting of insufficient diuretic response.
• In the PUSH-AHF study, natriuresis-guided therapy was compared with standard of care in patients hospitalized with acute HF. The two primary endpoints were a) natriuresis over 24 hours and b) first occurrence of all-cause mortality or heart failure rehospitalization after 180 days.
• Natriuresis-guided therapy resulted in significantly increased natriuresis over 24 hours without a significant difference in time to all-cause mortality or heart failure rehospitalization.

The duration of acute HF hospitalization is often driven by diuresis requirement, but the optimal strategy of in-hospital diuresis has not yet been established. For those with insufficient diuretic response, assessment of urinary sodium may help monitor diuretic response and guide further therapy. In a breaking presentation at the 2023 ESC Congress today, Dr. Jozine ter Maaten (University Medical Centre Groningen ) and her team presented their study: “PUSH-AHF: Natriuresis guided therapy in acute heart failure.”

The PUSH-AHF trial (NCT04606927) was a randomized, open-label single-center trial of adult patients with a primary inpatient diagnosis of acute heart failure with an intravenous diuretic requirement that compared natriuresis-guided therapy with standard of care diuresis. Natriuresis-guided therapy was dictated by spot urinary sodium measurements; a spot sodium <70 mmol/L indicated insufficient response and resulted in diuretic therapy adjustment.  Key exclusion criteria were non-cardiac dyspnea or severe renal impairment requiring dialysis. The two primary outcomes were total natriuresis after 24 hours and first occurrence of all-cause mortality or heart failure rehospitalization after 180 days.

A total of 310 patients were 1:1 randomized to either natriuresis-guided therapy or standard of care. The median age was 74, and 45% were women. Participants receiving natriuresis-guided therapy had a significant increase in natriuresis at 24 hours (409±178 vs 345±202 mmol, p=0.0061).  However, there were no significant differences in time to all-cause mortality or heart failure rehospitalization after 180 days (HR 0.92, 95% CI 0.62-1.38, p=0.698). The secondary endpoints of 48-hour natriuresis and both 24- and 48-hour diuresis were all increased in the intervention arm (all p<0.02). There was no difference in hospital length-of-stay between the two groups. Natriuresis-guided therapy was safe and well-tolerated.

When discussing the clinical implications of the study at the ESC Congress press conference, Dr. ter Maaten stated: “The results of the PUSH-AHF trial are directly implementable to improve decongestive treatment as spot urinary sodium values are easy to obtain, inexpensive and widely available…natriuresis guided therapy was safe and is a first step to a personalized treatment approach in patients with acute heart failure.”