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.
BACKGROUND: Data on the effect of mineralocorticoid receptor antagonist therapy on HbA METHODS: In this randomised, double-blind, placebo-controlled trial, 6001 participants with heart failure with New York Heart Association functional class II-IV, left ventricular ejection fraction 40% or higher, evidence of structural heart disease, and elevated N-terminal pro-B-type natriuretic peptide levels were randomly assigned to finerenone or placebo, administered orally. Randomisation was performed with concealed allocation. The primary outcome of the trial was the composite of cardiovascular death and total (first and recurrent) heart failure events (ie, heart failure hospitalisation or urgent heart failure visit). In the present analysis, participants with diabetes at baseline (investigator-reported history of diabetes or baseline HbA FINDINGS: Between Sept 14, 2020, and Jan 10, 2023, 6001 participants were recruited and randomly assigned to finerenone or placebo. 3222 (53·7%) participants did not have diabetes at baseline and comprised the study population. During a median duration of follow-up of 31·3 months (IQR 21·5-36·3), 115 (7·2%) participants in the finerenone group and 147 (9·1%) in the placebo group developed new-onset diabetes, corresponding to a rate of 3·0 events per 100 person-years (95% CI 2·5-3·6) in the finerenone group and 3·9 events per 100 person-years (3·3-4·6) in the placebo group. Compared with placebo, finerenone significantly reduced the hazard of new-onset diabetes by 24% (hazard ratio [HR] 0·76 [95% CI 0·59-0·97], p=0·026). Fine-Gray competing risk analysis, accounting for the competing risk of death, yielded a similar finding (subdistribution HR 0·75 [0·59-0·96], p=0·024). Results were similar in sensitivity analyses, in which the definition of new-onset diabetes was expanded to include initiation of SGLT2 inhibitor treatment with diabetes as indication, restricted to HbA INTERPRETATION: In participants with heart failure with mildly reduced or preserved ejection fraction without diabetes, oral finerenone reduced the hazard of new-onset diabetes, representing a meaningful additional clinical benefit of this treatment in these individuals. FUNDING: Bayer.
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.
AIMS: Atrial fibrillation (AF) and atrial flutter (AFL) after cardiac surgery are common and associated with adverse outcomes. The increased risk related to AF or AFL may extend beyond discharge. This study aims to determine whether photoplethysmography (PPG)-based smartphone monitoring to detect AF or AFL after hospital discharge following cardiac surgery improves AF management. METHODS AND RESULTS: The intervention group performed 1 min rhythm checks three times daily using a smartphone-based PPG application during 6 weeks after hospitalization for cardiac surgery. The primary outcome involved AF management interventions by independent physicians, including initiation of oral anticoagulation (OAC), direct cardioversion, and up-titration or initiation of antiarrhythmic drugs. The study included 450 patients [mean (SD) age, 64.1 (9.2) years; 96 women (21.3%); 130 patients with AF history (28.9%); median (IQR) CHA2DS2-VASc score, 2 (1-3)], of whom 238 were randomized to PPG-based monitoring and 212 to usual care. AF/AFL was detected with PPG or electrocardiography in 44 patients (18.5%) in the monitoring group and 4 patients (1.9%) in the usual care group (OR 11.8; 95% CI, 4.2-33.3; P < 0.001); these were new detections in, respectively, 22 patients (9.2%) and 1 patient (0.5%) (OR 21.3; 95% CI, 2.9-166.7; P = 0.003). AF management interventions occurred in 24 patients (10.1%) in the monitoring group compared to 5 patients (2.4%) in the usual care group [odds ratio (OR), 5.1; 95% CI, 1.8-14.4; P = 0.002]. CONCLUSION: In unselected patients discharged home following cardiac surgery, PPG-based smartphone monitoring revealed significantly more AF/AFL which led to significantly more optimization of AF management.
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.
BACKGROUND: Right ventricular dysfunction (RVD) is common in patients with heart failure with reduced ejection fraction, and it is associated with poor prognosis. However, no biomarker reflecting RVD is available for routine clinical use. METHODS: Proteomic analysis of myocardium from the left ventricle and right ventricle (RV) of patients with heart failure with reduced ejection fraction with (n=10) and without RVD (n=10) who underwent heart transplantation was performed. Concentrations of 2 ECM (extracellular matrix) proteins with the highest myocardial upregulation in RVD, FMOD (fibromodulin) and FBLN5 (fibulin-5), were assayed in the blood and tested in a separate cohort of patients with heart failure with reduced ejection fraction (n=232) to test for the association of the 2 proteins with RV function and long-term outcomes. RESULTS: Multivariable linear regression revealed that plasma concentrations of both FMOD and FBLN5 were significantly associated with RV function regardless of the RV function assessment method. No association of FMOD or FBLN5 with left ventricular dysfunction, cardiac index, body mass index, diabetes status, or kidney function was found. Plasma levels of FMOD and FBLN5 were significantly associated with patient outcomes ( CONCLUSIONS: Our study proposes that circulating levels of FMOD and FBLN5 may serve as new biomarkers of RVD in patients with heart failure with reduced ejection fraction.