News
AI QCT Coronary Plaque Features More Predictive in Women: CONFIRM2 Registry
Key Points:
- Women are underdiagnosed and undertreated for CAD, despite higher prevalence of non-obstructive CAD, leading to worse outcomes
- Using AI-enhanced assessment of coronary artery plaque characteristics, investigators suggest better evaluation of CAD risk compared to traditional risk scores
- The CONFIRM2 registry study analyzed symptomatic patients with no prior CAD to assess for evidence of CAD with plaque characterization
- Despite a higher prevalence of plaque in men, women demonstrated incrementally higher rates of elevated risk plaque characteristics, which the study investigators suggest should be considered in future guidelines
AI-Quantitative CT Coronary Plaque Features Indicate Higher Relative CV Risk in Women: CONFIRM2 Registry
Key Takeaways:
- AI-based quantitative coronary plaque assessments significantly improve risk prediction for cardiovascular events in women compared to traditional clinical risk scores.
- Although women had lower absolute plaque burden, the same incremental increase in plaque conferred substantially higher relative risk for adverse cardiovascular outcomes compared to men, highlighting the importance of sex-specific risk evaluation and potential intensification of preventive therapy in women.
First-in-Human Gene Therapy (TN-201) Shows Promising Results in MYBPC3-Associated HCM
Key Takeaways:
- TN-201, a first-in-class gene therapy, was well tolerated and showed stable cardiac gene expression, improved biomarkers, and symptom relief in patients with severe MYBPC3-associated hypertrophic cardiomyopathy.
- All treated patients improved from symptomatic NYHA class II/III at baseline to asymptomatic class I after TN-201 therapy, highlighting the potential clinical impact of gene replacement strategies in this challenging condition.
Artificial Intelligence Enables Novices to Perform Diagnostic-Quality Echocardiography: HeartFocus Study
Key Takeaways:
- AI-guided echocardiography enables novice users to obtain diagnostic-quality cardiac images comparable to expert sonographers, achieving perfect diagnostic-quality rates (100%) for primary cardiac parameters.
- AI-assisted echocardiography shows rapid adoption by novice users, potentially broadening access to critical diagnostic imaging, especially in underserved or resource-constrained healthcare environments.
Survival After Sudden Cardiac Arrest Improves in Young Athletes, but Racial Disparities Persist
Key Takeaways:
- Survival from sudden cardiac arrest among young competitive athletes increased significantly from 38% to 66% over the last decade, driven by enhanced emergency preparedness and improved access to CPR and AEDs.
- Persistent racial disparities remain a critical concern, with Black athletes having significantly lower survival rates (43%) compared to White athletes (68%), emphasizing the need for equitable emergency response resources and strategies across all athletic environments.
ALPACA Trial – Lepodisiran Significantly Reduces Lipoprotein(a) in Phase II Trial
Key Points
- Elevated lipoprotein(a) is associated with incident atherosclerotic cardiovascular disease and aortic stenosis
- The ALPACA trial randomized 320 patients with a serum lipoprotein(a) concentration ≥175 nmol/L in 1:2:2:2:2 ratio to receive lepodisiran 16 mg (baseline and 180 days), lepodisiran 96 mg (baseline and 180 days), lepodisiran 400 mg (baseline and 180 days), lepodisiran 400mg at baseline followed by placebo at 180 days, or placebo at both timepoints
- The placebo-adjusted time-averaged change in lipoprotein(a) from day 60 to day 180 was 94% for the pooled lepodisiran groups.
TRILUMINATE– Transcatheter edge-to-edge repair reduces TR severity and HF Hospitalizations
Key Points
- The TRILUMINATE Pivotal trial previously reported that transcatheter edge-to-edge repair (TEER) improved quality-of-life compared to medical therapy alone for severe, symptomatic tricuspid regurgitation. The trial did not observe a benefit in mortality or heart failure hospitalization at 1-year but differences may emerge with longer follow-up.
- In this 2-year pre-specified analysis, TEER significantly decreased the annualized rate of heart failure hospitalizations through 2 years compared to the control arm (0.19 vs 0.26 events/patient year, p=0.02). No difference in all-cause mortality was observed.
PURSUIT Trial – Dose Dependent Reduction in LDL-C with AZD0780, Oral PCSK9 inhibitor
Key Points
- The majority of ASCVD patients fail to achieve guideline endorsed LDL targets
- The PURSUIT trial randomized 428 patients in a 1:1:1:1 ratio to receive oral AZD0780 1, 3, 10, or 30mg, or matching placebo for 12 weeks.
- AZD0780 demonstrated robust, dose-dependent reductions in LDL-C with a favorable safety and tolerability profile supporting further development of this once daily, oral treatment.
Comparison Of Angiography-Derived FFR to IVUS in PCI: FLAVOUR II
Key Points:
- In the FLAVOUR II trial, 1839 patients with angiographically-significant coronary artery disease were randomized to receive angiography-derived fractional flow reserve (AngioFFR) guided vs. intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI).
- Fewer patients in the AngioFFR-guided group underwent PCI compared to the IVUS-guided group (73.9% vs. 83.1%; p<0.001).
- AngioFFR-guided PCI was found to be non-inferior to IVUS-guided PCI for the primary outcome, a composite of death, myocardial infarction or revascularization at 12 months.
No Difference with Mobile Integrated Health vs A Transitions Of Care Coordinator in HF: MIGHTy-Heart
Key Points:
- In the MIGHT-y Heart Trial, 2,003 patients who were hospitalized for heart failure across 11 hospitals in New York City were randomized to receive post-discharge follow-up via a mobile integrated health (MIH) platform versus transitions of care coordinators (TOCC).
- Although there was no significant difference in health status at 30 days between the MIH vs. TOCC arms overall, younger patients in the MIH arm had a 4.5 point higher health status score than younger patients in the TOCC arm.
- There was no significant difference in 30-day all cause hospitalizations between in the MIH vs. TOCC arms overall, but women in the MIH arm were 30% less likely to have an all-cause readmission than women in the TOCC arm.
Electronic Provider Notification Significantly Improved Quality of Care Delivered for Severe AS: DETECT AS
Key Points:
- In the DETECT AS trial, 285 providers for 939 patients with severe aortic stenosis were randomized to receive an electronic provider notification (EPN) notifying the provider of the AHA/ACC guidelines for management vs. usual care.
- At one year, the rates of the primary outcome, aortic valve replacement within one year, were 48.2% in the EPN arm versus 37.2% in the usual care arm (OR: 1.62, 95% CI: 1.13-2.32).
- The impact of the EPN on rates of aortic valve replacement was greatest in patients >80 years of age, in women, and in patients who underwent echocardiogram in the inpatient setting.
Routine Cerebral Embolic Protection Did Not Reduce Incidence of Peri-procedural Stroke in TAVI: BHF PROTECT-TAVI
Key Points:
- Stroke remains one of the most feared complications of transcatheter aortic valve implantation (TAVI), prompting interest in cerebral embolic protection (CEP) devices.
- The BHF PROTECT-TAVI trial studied the routine use of the Sentinel CEP device amongst 7,635 patients across 33 UK centers. The results showed that the routine use of the CEP device did not significantly reduce clinical stroke rates (2.1% vs. 2.2%) or improve outcomes across subgroups.
- The investigators findings do not support routine CEP use, though selective strategies for high-risk patients may still warrant study.
TAVR with Trilogy System Safe and Effective for Aortic Regurgitation: Updated Results from ALIGN-AR
Key Points:
- Transcatheter aortic valve replacement for aortic valve disease has largely focused on those with aortic stenosis. In pure, native-valve aortic regurgitation, there remains a paucity of options beyond surgical correction or medical management.
- The ALIGN-AR trial evaluated the JenaValve Trilogy, a dedicated transcatheter heart valve for treating moderate to severe, symptomatic aortic regurgitation (AR), in 500 high surgical risk patients.
- At one year, the all-cause mortality rate was 8.1%, significantly outperforming the prespecified non-inferiority goal of 25%. Device success was 96.4%, with excellent hemodynamic performance and low rates of regurgitation.
- This findings support the JenaValve Trilogy as a safe and effective treatment for symptomatic, moderate to severe AR and provide strong evidence for expanding transcatheter therapies beyond aortic stenosis.
Evolut Low Risk Trial: TAVR Non-inferior to Surgical AR at 5 Years in Low-Risk Patient With Severe AS
Key Points:
- In the initial Evolut Low Risk Trial, patients with severe aortic stenosis who were at low surgical risk had noninferior outcomes with TAVR using a self-expanding valve compared to surgery, based on the composite endpoint of death or disabling stroke at 24 months.
- Long-term data on TAVR performance in low-risk patients remain limited, making extended follow-up crucial for guiding treatment decisions.
- At five years, patients with severe aortic stenosis at low surgical risk who underwent Evolut TAVR had similar rates of death, disabling stroke, and re interventions compared to those undergoing surgical aortic valve replacement (SAVR).
- TAVR demonstrated comparable improvements in symptoms and functional class while offering the advantage of faster recovery.
ALLEPRE: Fully Nursing-Led Heart Health Counseling Program Reduces CV Outcomes After ACS
Key Points
- Nurses are increasingly responsible for cardiovascular risk management, but randomized data supporting this approach is lacking, especially for secondary prevention.
- ALLEPRE randomized 2060 hospitalized patients in Italy with ACS to a nurse-coordinated prevention program (NCPP), which included a visit with a trained nurse before discharge and 8 additional post-discharge visits over 2 years, or standard of care. Nurses provided education and counseling on CV risk factors, lifestyle, and medications adherence, and referred patients to a multidisciplinary teams for risk factor optimization when indicated.
- The NCCP led to a significant 30% reduction in the primary composite MACE endpoint of CV death, non-fatal MI, and non-fatal ischemic stroke, driven primary by a reduction in MI. The NCCP was also associated with improvements in BMI, exercise levels, and medication adherence.
- A structured, nursing-led program to promote secondary prevention can lead to lower MACE among high-risk patients following an ACS hospitalization.
HERZCHECK: A New Paradigm for Assessing Patients at Risk for Heart Failure
Key Points:
- Individuals in rural areas have a particularly high prevalence of both clinical and subclinical heart failure (HF).
- Early detection of individuals at risk of progression to symptomatic HF may reduce occurrence and healthcare burden.
- Global longitudinal strain (GLS) is a recommended parameter to identify individuals at risk.
- In HERZCHECK, a GLS-based screening strategy was utilized to detect subclinical heart failure in rural areas.
- HERZCHECK demonstrated that subclinical HF affects approximately one-fourth of the rural at-risk population and GLS-based risk screening identified these individuals approximately 7 years earlier than standard of care.
FAIR-HF2 Trial: IV Iron Improves Quality of Life But Not CV Events in Heart Failure
Key Points:
- Iron deficiency is common in patients with heart failure with reduced ejection fraction (HFrEF) and is associated with worse outcomes.
- The FAIR-HF2 trial assessed the impact of intravenous iron supplementation on cardiovascular outcomes and quality of life in iron-deficient HFrEF patients.
- Intravenous iron failed to meet its primary endpoints of cardiovascular death or heart failure hospitalization, but it significantly improved quality of life, particularly in the first year of treatment.
- A meta-analysis incorporating over 7,000 patients confirmed a benefit of intravenous iron supplementation in HFrEF, supporting current guideline recommendations.
Pre-Op Digifab Before CABG Prevents Post-Op AKI In Patients At High Risk
KEY POINTS:
- Ouabain, a cardiac glycoside that is structurally similar to digoxin, has been shown to impair renal function in animal models. This finding suggests that Digifab, which binds to ouabain receptors, may help prevent AKI
- Digifab, an antidote for digoxin toxicity, was associated with a lower incidence of AKI in patients with high levels of endogenous ouabain undergoing CABG, but did not significantly impact eGFR
The EquiOx Study: Pulse Oximeter Performance Varies by Skin Pigment
Key Points:
- Small retrospective studies of critically ill adults have shown pulse oximetry levels different by race
- No large prospective study has shown possible difference in pulse oximetry among darker skinned individuals
- The EquiOx study found that among critically ill adults, there were higher rates of overestimated pulse oximetry among darker skinned individuals
- This is the first large study to demonstrate findings of pulse oximetry bias, and future studies may benefit from expansion to other relevant populations
Lorundrostat is Effective and Safe in Patients with Uncontrolled Hypertension : ADVANCE-HTN Trial
Key Points:
- Hypertension (HTN), a major risk factor for cardiovascular disease, remains uncontrolled in many groups
- Lorundostat is an aldosterone synthase inhibitor, a novel anti-hypertensive agent that has shown some efficacy and safety in HTN treatment
- The ADVANCE-HTN trial was a multicenter randomized controlled trial evaluating the blood pressure lowering effect of lorundostat in uncontrolled and resistant HTN, finding an additional 8 mmHg decrease in 24-hour SBP compared to placebo
- This trial suggests that novel anti-hypertensive agents, particularly targeting aldosterone production, may be beneficial in HTN treatment and possibly cardiovascular risk reduction
