Daily Cardiology Research Analysis
Three impactful cardiology studies stood out today: a randomized trial showing perioperative empagliflozin reduced acute kidney injury after on-pump CABG in patients with type 2 diabetes; a prespecified analysis from FINEARTS-HF demonstrating finerenone benefits across NYHA functional classes in HF with mildly reduced or preserved EF; and an EHJ cohort revealing persistent ventricular arrhythmic risk in mitral valve prolapse patients with mitral annular disjunction even after surgical correction
Summary
Three impactful cardiology studies stood out today: a randomized trial showing perioperative empagliflozin reduced acute kidney injury after on-pump CABG in patients with type 2 diabetes; a prespecified analysis from FINEARTS-HF demonstrating finerenone benefits across NYHA functional classes in HF with mildly reduced or preserved EF; and an EHJ cohort revealing persistent ventricular arrhythmic risk in mitral valve prolapse patients with mitral annular disjunction even after surgical correction.
Research Themes
- Perioperative cardiorenal protection using SGLT2 inhibitors
- Mineralocorticoid receptor modulation in HFpEF/HFmrEF
- Arrhythmic risk stratification in mitral valve prolapse and mitral annular disjunction
Selected Articles
1. Empagliflozin in Patients With Type 2 Diabetes Undergoing On-Pump CABG: The POST-CABGDM Randomized Clinical Trial.
In a pragmatic randomized trial of 145 T2DM patients undergoing on-pump CABG, perioperative empagliflozin reduced postoperative AKI (22.5% vs 39.1%; RR 0.57) without increasing adverse events. Atrial fibrillation and type 5 MI rates were similar, and all three deaths occurred in the control group.
Impact: This is the first randomized evidence suggesting SGLT2 inhibitor preoperative use can reduce AKI after on-pump CABG, potentially shifting perioperative renal protection strategies.
Clinical Implications: Consider perioperative empagliflozin in T2DM patients scheduled for on-pump CABG to lower AKI risk, with attention to stopping 72 hours pre-op and monitoring standard safety parameters.
Key Findings
- Postoperative AKI reduced with empagliflozin: 22.5% vs 39.1% (RR 0.57; 95% CI 0.34-0.96; P=0.03).
- No excess in postoperative atrial fibrillation (15.4% vs 13.5%) or type 5 MI (1.4% vs 4.1%).
- No significant differences in safety events; all three deaths occurred in the control arm.
Methodological Strengths
- Randomized, pragmatic design with blinded outcome adjudication.
- Clear, clinically relevant primary endpoint (AKI within 7 days) with established criteria.
Limitations
- Single-center, open-label design with modest sample size (N=145).
- Short follow-up focused on AKI; longer-term renal and cardiovascular outcomes not assessed.
Future Directions: Multicenter, double-blind RCTs powered for renal and cardiovascular outcomes should validate perioperative SGLT2 strategies and define optimal timing and patient selection.
2. Finerenone and New York Heart Association Functional Class in Heart Failure: The FINEARTS-HF Trial.
In this prespecified analysis of FINEARTS-HF including 6,000 patients with HFmrEF/HFpEF, finerenone reduced cardiovascular death and total HF events and improved health status irrespective of baseline NYHA functional class. Patients with NYHA III/IV had higher event rates than NYHA II.
Impact: Supports broad applicability of finerenone across symptom severity in HFmrEF/HFpEF, informing clinical decision-making and guideline adoption.
Clinical Implications: Finerenone can be considered across NYHA II–IV in HFmrEF/HFpEF to reduce HF events and improve health status, with risk stratification acknowledging higher baseline risk in NYHA III/IV.
Key Findings
- Baseline NYHA III/IV vs II was associated with higher cardiovascular death and total HF events (adjusted rate ratio 1.28; 95% CI 1.11–1.46).
- Finerenone reduced the primary composite outcome irrespective of baseline NYHA functional class.
- Finerenone improved patient-reported health status across NYHA strata.
Methodological Strengths
- Prespecified subgroup analysis within a large randomized, placebo-controlled trial.
- Robust assessment including both clinical outcomes and patient-reported health status.
Limitations
- Subgroup analysis; the trial was not primarily powered for interactions across NYHA classes.
- Follow-up duration not specified in the abstract; details required from the main trial for temporal context.
Future Directions: Examine finerenone’s efficacy across other clinically relevant strata (e.g., etiology, comorbid CKD) and assess long-term mortality and hospitalization benefits in pragmatic settings.
3. Mitral annular disjunction and mitral valve prolapse: long-term risk of ventricular arrhythmias after surgery.
Among 599 MVP patients undergoing mitral surgery, 16% had preoperative MAD (median 8 mm). Despite surgical correction of MAD, these patients had a threefold higher long-term risk of ventricular arrhythmias (adjusted HR 3.33) over a median 5.4-year follow-up.
Impact: Defines persistent arrhythmic risk in MVP with MAD after surgical correction, informing long-term surveillance and risk stratification strategies.
Clinical Implications: Patients with MVP and preoperative MAD warrant intensified long-term rhythm surveillance and consideration of arrhythmic risk mitigation (e.g., ambulatory monitoring, EP evaluation) even after successful mitral surgery.
Key Findings
- Preoperative MAD present in 16% of surgical MVP cohort; median MAD length 8.0 mm (IQR 5.0–10.0).
- MAD associated with younger age, female sex, and Barlow’s disease.
- Adjusted hazard ratio for long-term ventricular arrhythmias was 3.33 (95% CI 1.37–8.08) despite surgical correction.
Methodological Strengths
- Relatively large surgical cohort with systematic echocardiographic measurement of true MAD pre- and post-operatively.
- Long median follow-up (5.4 years) with clinically adjudicated arrhythmic outcomes from records.
Limitations
- Single-center, retrospective observational design with potential residual confounding.
- Arrhythmia ascertainment relies on clinical encounters and records, possibly underdetecting asymptomatic events.
Future Directions: Prospective, multicenter studies integrating continuous rhythm monitoring and tissue/strain imaging may refine arrhythmic risk models and guide preventive strategies (e.g., ICD consideration) in MVP with MAD.