Cardiology — Weekly Evidence Brief

Patients with heart failure with preserved ejection fraction (HFpEF) and an implanted pacemaker exhibit more severe bi-ventricular and bi-atrial dysfunction, impaired exercise capacity, and a higher risk of heart failure hospitalization or death 1. Similarly, the presence of moderate to severe tricuspid regurgitation in patients with exercise HFpEF is associated with worse cardiac reserve and an increased 5-year risk of heart failure hospitalization or death 2. However, novel therapeutic options are emerging: GLP-1 receptor agonists (GLP-1 RAs) significantly reduce the risk of incident atrial fibrillation in patients with HFpEF and HFmrEF, offering benefits beyond weight and blood pressure reduction 3. Furthermore, a synergistic association between fasting plasma glucose (FPG) and high-density lipoprotein cholesterol (HDL-C) levels influences 30-day mortality in acute decompensated heart failure (ADHF) patients, suggesting optimal metabolic ranges for improved outcomes 4.

Patients presenting with ST-elevation myocardial infarction (STEMI) who already have a cardiac device (pacemaker, ICD, CRT) are at higher risk for adverse outcomes, including delayed reperfusion and increased all-cause mortality up to 5 years post-event 5. In patients with newly diagnosed heart failure with reduced ejection fraction (HFrEF) and LVEF 35%, rapid initiation and optimization of guideline-directed medical therapy (GDMT), particularly ARNI and SGLT2i, is associated with significant LVEF improvement within the first three months. This supports the continued appropriateness of the conventional three-month window for implantable cardioverter-defibrillator (ICD) decision-making 6. For amyloid transthyretin cardiomyopathy (ATTR-CM) patients undergoing cardiac resynchronization therapy (CRT), early improvement in left ventricular ejection fraction predicts significantly longer survival, despite overall shorter survival compared to controls 7.

Coronary artery disease (CAD) rates are rising globally, with molecular imaging offering new avenues for understanding pathogenesis, risk assessment, and personalized therapies 89. A high burden of standard modifiable cardiovascular risk factors (SMuRFs), particularly smoking and hypercholesterolemia, is prevalent in very young myocardial infarction (MI) patients ( 35 years), correlating with greater CAD severity and worse post-index outcomes 10. In older patients ( 75 years) with established atherosclerotic cardiovascular disease (ASCVD), inflammation, as assessed by high-sensitivity CRP (hsCRP 2 mg/l), is a stronger predictor of major adverse cardiovascular events (MACE) than lipoprotein(a), highlighting potential benefits from targeted anti-inflammatory strategies 11. Importantly, comprehensive control of multiple risk factors in cancer survivors demonstrates a graded inverse association with heart failure risk, with at least five controlled factors leading to a 24% lower risk compared to minimal control 12.

Residual congestion at discharge following acute heart failure (ADHF) is a significant predictor of increased 180-day mortality, with both intravascular and tissue congestion independently linked to worse outcomes, emphasizing the need for thorough decongestion 13. In acute myocardial infarction (MI), dapagliflozin improves survival and cardiac function by inhibiting Wnt/ b-catenin-driven fibroblast activation and reducing oxidative stress in cardiomyocytes 14. The counter-regulatory angiotensin II type 2 receptor (AT2R) axis in the diabetic heart represents a compelling therapeutic target, with AT2R activation demonstrating cardioprotection by attenuating pathological cardiac remodeling, fibrosis, and hypertrophy 15. Furthermore, noninvasive myocardial work parameters, such as the Global Work Index (GWI) and Global Constructive Work (GCW), offer superior diagnostic and prognostic utility for identifying post-interventional left ventricular (LV) dysfunction and clinical events in primary mitral regurgitation compared to LVEF alone 16.