Daily Cardiology Research Analysis
Three impactful cardiology studies stood out: a large cohort showed serum peroxiredoxin‑4 predicts incident heart failure across phenotypes; a national registry analysis refined risk‑stratified selection between open vs endovascular AAA repair; and a CTA radiomics framework detected transthyretin amyloid cardiomyopathy in severe aortic stenosis from routine scans. Together, they advance prognosis, treatment selection, and noninvasive diagnosis.
Summary
Three impactful cardiology studies stood out: a large cohort showed serum peroxiredoxin‑4 predicts incident heart failure across phenotypes; a national registry analysis refined risk‑stratified selection between open vs endovascular AAA repair; and a CTA radiomics framework detected transthyretin amyloid cardiomyopathy in severe aortic stenosis from routine scans. Together, they advance prognosis, treatment selection, and noninvasive diagnosis.
Research Themes
- Biomarkers for heart failure risk prediction
- Risk-stratified management of aortic aneurysm
- AI/radiomics for myocardial tissue characterization
Selected Articles
1. Computed tomography-derived myocardial radiomics for detection of transthyretin amyloidosis in patients with severe aortic stenosis.
In 589 severe aortic stenosis patients, CT-based myocardial radiomics stratified clinical phenotypes and enabled detection of transthyretin amyloid cardiomyopathy from standard CTA. A radiomic extracellular volume surrogate correlated with reference ECV, supporting tissue characterization without additional imaging.
Impact: Radiomics leveraging routine CTA could enable opportunistic screening for cardiac amyloidosis in a high-risk valve population, potentially expediting diagnosis and treatment.
Clinical Implications: In severe aortic stenosis, CTA radiomics may serve as a gatekeeper to identify patients warranting confirmatory amyloid testing (e.g., bone scintigraphy, CMR, biopsy) and timely initiation of disease-modifying therapy.
Key Findings
- Myocardial radiomics extracted from standard CTA stratified patients into clusters with distinct clinical profiles.
- A radiomic-derived extracellular volume surrogate showed correlation with reference ECV, supporting myocardial tissue characterization.
- Radiomics enabled detection of transthyretin amyloid cardiomyopathy among patients with severe aortic stenosis using routine CTA.
Methodological Strengths
- Relatively large sample (n=589) with a unified CTA workflow
- Use of both unsupervised clustering and model-based radiomic ECV estimation
Limitations
- Retrospective design with potential selection bias
- External validation and prospective clinical impact assessment are needed
Future Directions: Prospective multicenter validation, standardized radiomic pipelines, and clinical utility trials integrating radiomics-triggered amyloid workups in TAVR pathways.
BACKGROUND: We explored the value of myocardial radiomics by computed tomography angiography (CTA) for detection of transthyretin amyloidosis cardiomyopathy (ATTR-CM). METHODS: The study included 589 patients with aortic stenosis and CTA datasets. Radiomics were extracted from LV myocardium. Arm 1 ( RESULTS: In Arm 1, unsupervised clustering of patients based on radiomics was associated with significant differences in patients' clinical profile among clusters. In Arm 2, we constructed a radiomic-based ECV (correlation with ECV CONCLUSIONS: We present a radiomic method for myocardial tissue characterisation in patients with severe aortic stenosis which enables ATTR-CM detection from standard CTA scans.
2. Peroxiredoxin-4, a marker of systemic oxidative stress, is associated with incident heart failure.
In 8199 community participants followed for a median 12.6 years, higher circulating peroxiredoxin-4 independently predicted incident heart failure (HR 1.22 per SD). Associations were observed for both HFpEF and HFrEF, supporting peroxiredoxin-4 as a systemic oxidative stress biomarker relevant to HF pathogenesis.
Impact: Establishes a scalable oxidative stress biomarker for primary prevention and risk stratification across HF phenotypes.
Clinical Implications: Prx4 could augment HF risk models to identify at-risk individuals for early lifestyle or medical interventions and to enrich preventive trials, pending assay standardization and validation.
Key Findings
- Peroxiredoxin-4 predicted incident heart failure independent of traditional risk factors (HR 1.22 per SD).
- Associations were present for both HFpEF (HR 1.27) and HFrEF (HR 1.19) without significant subtype differences.
- Large community-based cohort with long-term follow-up supports generalizability.
Methodological Strengths
- Prospective community-based cohort with median 12.6-year follow-up
- Multivariable adjustment for comprehensive cardiometabolic covariates
Limitations
- Observational design; residual confounding cannot be excluded
- Single-country cohort may limit external generalizability to diverse populations
Future Directions: Standardize Prx4 assays, assess incremental value over natriuretic peptides, and test biomarker-guided prevention strategies in diverse populations.
AIMS: Oxidative stress is known to be involved in the pathophysiology of heart failure (HF). To assess oxidative stress, direct quantification of reactive oxygen species would be ideal but this is not feasible due to their short half-lives. Antioxidant enzymes such as peroxiredoxins, produced as a direct response to oxidative stress, mirror the process and can be more easily quantified. The aim of this study was to examine whether circulating peroxiredoxin-4 (Prx4), a marker of systemic oxidative stress, associates with incident HF and its subtypes. METHODS AND RESULTS: We included a total of 8199 individuals from the Prevention of REnal and Vascular End-stage Disease (PREVEND) community-based cohort (mean age: 49.8 years; 50.1% women). During a median follow-up of 12.6 years, 349 (4.3%) HF events occurred of which 118 (33.8%) had HF with preserved ejection fraction. In a Cox proportional hazards model adjusting for age, sex, smoking, diabetes, hypertension, obesity, total and high-density lipoprotein cholesterol, cholesterol-lowering medication and renal disease, Prx4 was significantly associated with incident HF (hazard ratio [HR] per 1 standard deviation increase in log-Prx4: 1.22; 95% confidence interval [CI] 1.09-1.36; p < 0.001). Among HF subtypes, Prx4 remained associated with incident HF with preserved (HR 1.27; 95% CI 1.05-1.53) as well as reduced ejection fraction (HR 1.19; 95% CI 1.04-1.37), with no significant difference between the subtypes (p = 0.64). CONCLUSION: Circulating Prx4 associates with the risk of developing HF, both with preserved and reduced ejection fraction. Future studies should examine whether Prx4 can serve as a real-time marker of oxidative stress status.
3. Risk Stratification and Treatment Selection in Patients With Asymptomatic Abdominal Aortic Aneurysms.
In 6891 Danish patients undergoing elective AAA repair with median 8.28-year follow-up, OSR had higher perioperative mortality but conferred longer restricted mean survival in low-risk patients; EVAR favored survival in moderate-to-high-risk patients. Secondary AAA rupture and cancer incidence were similar.
Impact: Provides risk-stratified evidence to personalize AAA repair modality, moving beyond a one-size-fits-all approach.
Clinical Implications: Use simple clinical variables (age, eGFR, COPD) to stratify patients: consider OSR for low-risk patients with longer life expectancy; prefer EVAR in moderate-to-high-risk patients to optimize survival while acknowledging perioperative risks.
Key Findings
- OSR had higher perioperative mortality across all risk strata.
- Low-risk patients realized a 10-month longer restricted mean survival (15 years) with OSR vs EVAR.
- Moderate-to-high-risk patients had a 9-month survival advantage with EVAR (after 12.5 years); rupture and cancer rates were similar.
Methodological Strengths
- Nationwide registry with large sample size and long follow-up
- Inverse probability weighting to balance comorbidities across treatment arms
Limitations
- Retrospective observational design with potential residual confounding
- Risk score derived from limited variables; anatomical complexity not fully captured
Future Directions: Prospective validation of risk tools incorporating anatomy and frailty; decision-aid trials comparing OSR vs EVAR by risk category.
IMPORTANCE: Open surgical repair (OSR) should be prioritized for patients with asymptomatic abdominal aortic aneurysm (AAA) and long life expectancy, whereas endovascular repair (EVAR) is preferred for patients with suitable anatomy and life expectancy less than 2 to 3 years. However, life expectancy estimation and risk stratification are not well established. OBJECTIVE: To evaluate risk-stratified survival differences between OSR and EVAR following elective AAA treatment. DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from Danish national health registries. Patients older than 60 years undergoing elective AAA repair between 2004 and 2023 were categorized into 4 risk groups according to age, estimated glomerular filtration rate, and chronic obstructive pulmonary disease. Follow-up was until March 31, 2024. EXPOSURE: OSR or EVAR for AAA. MAIN OUTCOMES AND MEASURES: The primary outcome was overall survival. Secondary outcomes were incidence of AAA rupture and new cancer diagnosis. Comorbidities were balanced using inverse probability weighting. Kaplan-Meier estimators were generated for both treatments and the 4 risk score groups. RESULTS: Of 6891 identified patients, 5757 (83.4%) were men. Women were older (median [IQR] age, 75.4 [70.9-79.3] vs 74.5 [70.5-78.5] years), more often had chronic obstructive pulmonary disease (156 women [13.6%] vs 512 men [8.9%]), and had lower estimated glomerular filtration rate (median [IQR], 68.4 [54.2-80.4] vs 70.4 [56.5-82.4] mL/min/1.73 m2) compared with men. The median follow-up was 8.28 years (95% CI, 8.10-8.50 years). OSR was associated with higher perioperative mortality in all risk groups. In low-risk patients, OSR was associated with a 10-month (95% CI, 2.2-18.3 months; P = .02) longer mean survival time restricted at 15 years compared with EVAR. In moderate-to-high-risk patients, OSR was associated with a 9-month (95% CI, 1.9-16.9 months; P = .008) shorter mean survival time restricted after 12.5 years compared with EVAR. No difference in mean survival time was seen in low-to-moderate-risk and high-risk patients at the study end. No differences in 10-year incidence of secondary AAA ruptures (OSR, 2.6% [95% CI, 1.9%-3.4%] vs EVAR, 2.2% [95% CI, 1.7%-2.7%]; P = .34) or solid malignant tumor (OSR, 18.6% [95% CI, 16.7%-20.5%] vs EVAR, 20.5% [95% CI, 18.9%-22.1%]; P = .35) were detected. CONCLUSIONS AND RELEVANCE: In this cohort study of 6891 patients with AAA, OSR was associated with higher perioperative mortality in all risk groups, but with longer mean survival only in low-risk patients. Conversely, EVAR was associated with longer mean survival in moderate-to-high-risk patients. These findings highlight the potential benefits of risk stratification when planning AAA treatment.