Daily Cardiology Research Analysis
Across cardiology, a prespecified analysis of the FINEARTS-HF trial shows finerenone reduces new-onset diabetes in HFpEF/HFmrEF patients without diabetes. A pragmatic randomized trial demonstrates smartphone photoplethysmography monitoring after cardiac surgery markedly increases detection of postoperative AF/AFL and prompts more evidence-based management. Translational proteomics identifies circulating FMOD and FBLN5 as candidate biomarkers of right ventricular dysfunction in HFrEF, independent
Summary
Across cardiology, a prespecified analysis of the FINEARTS-HF trial shows finerenone reduces new-onset diabetes in HFpEF/HFmrEF patients without diabetes. A pragmatic randomized trial demonstrates smartphone photoplethysmography monitoring after cardiac surgery markedly increases detection of postoperative AF/AFL and prompts more evidence-based management. Translational proteomics identifies circulating FMOD and FBLN5 as candidate biomarkers of right ventricular dysfunction in HFrEF, independent of left-sided parameters.
Research Themes
- Cardiorenal-metabolic therapy impacting diabetes incidence in heart failure
- Digital health for post-operative atrial arrhythmia detection and management
- Translational biomarkers for right ventricular dysfunction in HFrEF
Selected Articles
1. Finerenone and new-onset diabetes in heart failure: a prespecified analysis of the FINEARTS-HF trial.
In a prespecified analysis of FINEARTS-HF, finerenone reduced new-onset diabetes by 24% versus placebo in HFpEF/HFmrEF patients without diabetes (HR 0.76; median follow-up 31.3 months). Findings were consistent in competing risk and multiple sensitivity analyses, underscoring a metabolic benefit in addition to heart failure indications.
Impact: This is high-quality randomized evidence linking a heart failure therapy to a lower incidence of diabetes, bridging cardiology and endocrinology and potentially guiding drug selection in HFpEF/HFmrEF.
Clinical Implications: In HFpEF/HFmrEF without diabetes, finerenone may be favored when metabolic risk is a concern, offering potential diabetes prevention alongside standard HF management; monitor potassium and renal function per MR antagonist best practices.
Key Findings
- New-onset diabetes incidence was 3.0 vs 3.9 events per 100 person-years for finerenone vs placebo; HR 0.76 (95% CI 0.59–0.97).
- Competing risk analysis (death as competing event) confirmed benefit: subdistribution HR 0.75 (95% CI 0.59–0.96).
- Effects were consistent across sensitivity analyses, including definitions incorporating SGLT2i initiation or HbA1c-restricted criteria.
- Population: 3222 participants without diabetes at baseline from a 6001-patient RCT; median follow-up 31.3 months.
Methodological Strengths
- Randomized, double-blind, placebo-controlled design with concealed allocation
- Prespecified analysis with competing risk methods and multiple sensitivity analyses
Limitations
- Diabetes incidence was not the primary endpoint of the parent trial
- Generalizability limited to HFpEF/HFmrEF; background SGLT2i use and glycemic surveillance may vary by region/time
Future Directions: Prospective trials powered for diabetes prevention endpoints in HF populations and mechanistic studies on MR pathway effects on beta-cell/insulin sensitivity.
2. Improving atrial fibrillation or flutter detection and management by smartphone-based photoplethysmography rhythm monitoring following cardiac surgery: a pragmatic randomized trial.
Among 450 post-cardiac surgery patients, 6-week smartphone PPG monitoring increased AF/AFL detection (18.5% vs 1.9%) and quintupled evidence-based interventions (10.1% vs 2.4%). New arrhythmia detections were substantially higher with PPG (9.2% vs 0.5%), highlighting the utility of digital rhythm surveillance after discharge.
Impact: This pragmatic RCT supports a scalable, low-cost digital strategy to detect clinically actionable postoperative AF/AFL, potentially reshaping post-discharge monitoring and secondary prevention pathways.
Clinical Implications: Implement structured smartphone PPG checks for 6 weeks after cardiac surgery to identify AF/AFL early and prompt anticoagulation, cardioversion, or antiarrhythmic therapy as appropriate.
Key Findings
- AF/AFL detection: 18.5% with PPG monitoring vs 1.9% usual care (OR 11.8; 95% CI 4.2–33.3; P<0.001).
- New AF/AFL detections: 9.2% vs 0.5% (OR 21.3; 95% CI 2.9–166.7; P=0.003).
- AF management interventions: 10.1% vs 2.4% (OR 5.1; 95% CI 1.8–14.4; P=0.002).
Methodological Strengths
- Pragmatic randomized controlled design with independent physician adjudication of management interventions
- Clear, clinically relevant outcomes (OAC initiation, cardioversion, antiarrhythmic adjustments)
Limitations
- Open-label design and reliance on smartphone access/engagement may introduce selection and performance bias
- Short monitoring window (6 weeks) and no long-term clinical outcomes (e.g., stroke) reported
Future Directions: Evaluate long-term clinical outcomes (stroke, hospitalization), cost-effectiveness, and integration into perioperative care pathways; assess applicability in older and digitally underserved populations.
3. Biomarkers of RV Dysfunction in HFrEF Identified by Direct Tissue Proteomics: Extracellular Proteins Fibromodulin and Fibulin-5.
Direct myocardial proteomics identified FMOD and FBLN5 as upregulated in RVD; their plasma levels associated with RV function across assessment methods and with outcomes in an HFrEF cohort. These biomarkers were not associated with LV dysfunction or systemic comorbidities, highlighting RV-specific signal.
Impact: Provides mechanistically anchored, circulating candidates for RV dysfunction—an unmet need in HFrEF—with potential to improve risk stratification and clinical decision-making.
Clinical Implications: FMOD and FBLN5 could be developed for RV-focused risk stratification in HFrEF, complementing LV-centric metrics; validation and assay standardization are required before routine adoption.
Key Findings
- Tissue proteomics (RVD vs non-RVD, n=10 each) identified FMOD and FBLN5 as top upregulated ECM proteins in RV dysfunction.
- Plasma FMOD and FBLN5 levels were independently associated with RV function across assessment methods in HFrEF (validation cohort n=232).
- No association with LV dysfunction, cardiac index, BMI, diabetes, or kidney function, supporting RV specificity.
- Plasma levels of FMOD and FBLN5 were significantly associated with patient outcomes (details per study).
Methodological Strengths
- Discovery-to-validation pipeline integrating direct myocardial proteomics with circulating biomarker testing
- Multivariable analyses demonstrating independence from LV function and systemic confounders
Limitations
- Small discovery sample size (n=20 hearts) and observational validation design limit causal inference
- External validation in diverse populations and assay standardization are needed before clinical adoption
Future Directions: Prospective multicenter validation, threshold definition, incremental prognostic value over imaging/hemodynamics, and exploration of therapeutic modulation of FMOD/FBLN5 pathways.