Daily Cardiology Research Analysis
Three studies advance cardiovascular care across intervention, prevention, and diagnostics. A multicenter RCT (EBC MAIN) supports stepwise provisional stenting as the default for true left main bifurcations. A large cluster trial subgroup shows potassium-enriched salt substitution reduces recurrent stroke and mortality post-stroke, and an AI pipeline robustly detects and scores transthyretin cardiac amyloidosis across multi-tracer, multi-center scintigraphy datasets.
Summary
Three studies advance cardiovascular care across intervention, prevention, and diagnostics. A multicenter RCT (EBC MAIN) supports stepwise provisional stenting as the default for true left main bifurcations. A large cluster trial subgroup shows potassium-enriched salt substitution reduces recurrent stroke and mortality post-stroke, and an AI pipeline robustly detects and scores transthyretin cardiac amyloidosis across multi-tracer, multi-center scintigraphy datasets.
Research Themes
- Left main bifurcation PCI strategy optimization
- Population-level sodium/potassium substitution for secondary prevention
- AI-enabled diagnosis of transthyretin cardiac amyloidosis
Selected Articles
1. Stepwise Provisional Versus Systematic Dual-Stent Strategies for Treatment of True Left Main Coronary Bifurcation Lesions.
In this multicenter RCT of 467 patients with true unprotected left main bifurcation lesions, stepwise provisional stenting achieved similar 3-year major adverse cardiovascular events compared with systematic upfront dual stenting but significantly reduced target lesion revascularization. Findings support stepwise provisional as the default strategy for noncomplex left main bifurcation PCI.
Impact: Provides randomized, adjudicated, 3-year evidence to guide a high-stakes interventional decision in left main bifurcation PCI, influencing default strategy selection.
Clinical Implications: Adopt stepwise provisional stenting as the default for noncomplex true left main bifurcations, reserving dual-stent techniques for bailout or clearly complex side branch disease.
Key Findings
- No significant difference in 3-year MACE between stepwise provisional and systematic dual-stent strategies.
- Target lesion revascularization was significantly lower with stepwise provisional strategy.
- Events were independently adjudicated; analyses followed intention-to-treat.
Methodological Strengths
- Randomized, multicenter, parallel-group design with independent event adjudication
- Intention-to-treat analysis with 3-year follow-up
Limitations
- Open-label design may introduce procedural or operator bias
- European-only enrollment may limit generalizability to other healthcare settings
Future Directions: Head-to-head evaluations stratified by bifurcation complexity and physiological assessment, cost-effectiveness analyses, and operator learning curve effects.
2. Salt Substitution and Recurrent Stroke and Death: A Randomized Clinical Trial.
In a prespecified subgroup of 15,249 stroke survivors within the SSaSS cluster RCT, a 75% NaCl/25% KCl salt substitute reduced recurrent stroke (RR 0.86) and all-cause mortality (RR 0.88) over a median 61.2 months, with a −2.05 mm Hg systolic BP difference and no excess hyperkalemia. Benefits were larger for hemorrhagic stroke and stroke-related deaths.
Impact: Demonstrates a scalable, low-cost dietary intervention that reduces recurrent stroke and mortality in a large high-risk population, reinforcing population sodium reduction strategies with direct clinical outcomes.
Clinical Implications: Recommend potassium-enriched salt substitutes for secondary prevention in appropriate post-stroke patients, with potassium monitoring in those with chronic kidney disease or on RAAS inhibitors.
Key Findings
- Recurrent stroke reduced with salt substitute vs regular salt (RR 0.86; 95% CI 0.77–0.95; P=.005).
- All-cause mortality reduced (RR 0.88; 95% CI 0.82–0.96; P=.003), with larger effects on stroke-related deaths.
- No increase in hyperkalemia (RR 1.01; 95% CI 0.74–1.38; P=.96); systolic BP decreased by −2.05 mm Hg.
Methodological Strengths
- Prespecified subgroup of a large, cluster-randomized clinical trial with long follow-up
- Objective clinical endpoints and blood pressure measurements
Limitations
- Open-label cluster design may allow behavioral spillover or measurement biases
- Subgroup analysis within a larger trial; generalizability outside rural China requires caution
Future Directions: Implementation studies in diverse health systems, potassium safety in CKD, and cost-effectiveness analyses for scale-up.
3. Artificial intelligence-based cardiac transthyretin amyloidosis detection and scoring in scintigraphy imaging: multi-tracer, multi-scanner, and multi-center development and evaluation study.
A fully automated deep-learning pipeline trained and tested across six datasets (12 cameras) detected and scored ATTR-CM on whole-body scintigraphy with high performance, achieving external AUCs up to 1.00 for detection and up to 0.96 for scoring. Explainability maps focused on clinically relevant cardiac areas, supporting model validity and potential for earlier diagnosis.
Impact: Introduces a generalizable, explainable AI diagnostic pipeline across tracers and scanners for ATTR-CM—an underdiagnosed, prognostically critical cardiomyopathy—supporting scalable deployment.
Clinical Implications: AI-assisted screening of total-body scintigraphy could flag probable ATTR-CM for confirmatory evaluation, standardize Perugini-like scoring across centers, and reduce diagnostic delays.
Key Findings
- Internal test performance exceeded AUC 0.95 and F1 0.90 for both detection and scoring.
- External validation achieved detection AUCs of 0.93, 0.95, and 1.00; scoring AUCs of 0.95, 0.83, and 0.96.
- Explainability (Grad-CAM/saliency) highlighted clinically relevant cardiac regions; prospective flagging identified additional possible cases.
Methodological Strengths
- Multi-center, multi-tracer, multi-scanner development with external validation
- Use of explainability methods (Grad-CAM/saliency) to support clinical plausibility
Limitations
- Retrospective datasets with incomplete reference standards; limited biopsy confirmation
- Generalizability to unseen tracers/cameras and prospective workflow integration requires testing
Future Directions: Prospective, multi-center clinical utility studies; harmonization across acquisition protocols; head-to-head comparisons with expert readers and hybrid AI-human workflows.