Cardiology — Weekly Evidence Brief

Recent findings highlight advancements in heart failure diagnosis and management. Guideline-recommended medical therapy (GRMT) in heart failure with reduced ejection fraction (HFrEF) leads to significant improvements in left ventricular ejection fraction (LVEF) when initiated early and intensively 1. Peak oxygen uptake (VO2peak) is confirmed as a strong prognostic marker for all-cause mortality and hospitalizations in heart failure patients 2. Furthermore, cardiac magnetic resonance (CMR)-derived right ventricular longitudinal strain and left atrial reservoir strain show high diagnostic accuracy for early heart failure with preserved ejection fraction (HFpEF) 3. Research also points to distinct multi-organ inflammasome expression patterns in advanced heart failure, potentially opening new therapeutic avenues 4.

Improving cardiovascular risk stratification remains a key focus. While traditional risk scores are foundational, new evidence suggests that incorporating inflammation-related proteins significantly enhances the prediction of 10-year major adverse cardiovascular events 56. Elevated lipoprotein(a) is identified as an independent risk factor for incident atrial fibrillation, regardless of baseline inflammatory status 7. Additionally, the high-density lipoprotein cholesterol-modified triglyceride-glucose index (TyG/HDL-C ratio) serves as a robust independent predictor of short-term all-cause and cardiovascular mortality in acute decompensated heart failure patients, with an identified optimal range for metabolic management 8.

Tailored management strategies are emerging for specific patient populations. Early surgical intervention for asymptomatic patients with severe degenerative mitral regurgitation and preserved left ventricular function is associated with significantly better long-term cardiac and overall mortality outcomes compared to conventional treatment 9. For patients with atrial fibrillation and stable coronary artery disease, rivaroxaban monotherapy may reduce the risk of both major cardiovascular events and major bleeding across a broad age range, compared to dual antiplatelet therapy 10. Moreover, young adult cancer survivors face an elevated cardiovascular disease risk due to cardiometabolic factors, underscoring the critical need for integrated risk assessment and preventive strategies in their survivorship care 11.

New insights are also shedding light on specific cardiovascular conditions and therapeutic targets. Researchers have identified novel molecular targets, ITGAL and DUSP9, and computationally predicted several antifibrotic drug candidates for cardiac fibrosis, which could lead to new treatments for heart failure 1213. In diabetic cardiomyopathy, activated protein C has been shown to ameliorate cardiomyocyte senescence via a specific pathway, offering a potential innovative therapeutic approach 14. Conversely, a systematic review and meta-analysis found that mechanical circulatory support devices for infarct-related cardiogenic shock did not show a significant mortality benefit and were associated with increased risks such as major bleeding, stroke, and sepsis, suggesting current evidence does not support their routine use 15.

Further research enhances prognostic capabilities and refines management. For patients with coronary artery spasm, a lower first responsive dose of acetylcholine during testing is significantly associated with a higher long-term risk of major adverse cardiovascular events 16. Patients with type 2 diabetes experience impaired long-term cardiovascular outcomes after a myocardial infarction, with longer diabetes duration correlating with higher risk 17. In acute heart failure, while in-hospital mortality may be low across LVEF phenotypes, inflammatory markers and electrolyte imbalances predict mortality 18. Additionally, serial left ventricular global longitudinal strain (LV-GLS) measurements are superior to baseline HFA-ICOS scores in predicting cancer therapy-related cardiac dysfunction 19.