Daily Cardiology Research Analysis
Three impactful cardiology studies stand out today. Early catheter-based therapy for acute pulmonary embolism was associated with lower 90-day mortality in a large national cohort. Cascade screening for familial hypercholesterolaemia led to markedly earlier statin initiation and fewer cardiovascular events, and pre-LVAD hemolysis during Impella support predicted more hemocompatibility-related adverse events after durable LVAD implantation.
Summary
Three impactful cardiology studies stand out today. Early catheter-based therapy for acute pulmonary embolism was associated with lower 90-day mortality in a large national cohort. Cascade screening for familial hypercholesterolaemia led to markedly earlier statin initiation and fewer cardiovascular events, and pre-LVAD hemolysis during Impella support predicted more hemocompatibility-related adverse events after durable LVAD implantation.
Research Themes
- Timing of catheter-based reperfusion in acute pulmonary embolism
- Preventive cardiology via cascade genetic screening
- Hemocompatibility and outcomes in mechanical circulatory support
Selected Articles
1. Early versus delayed catheter-based therapies in patients hospitalised with acute pulmonary embolism.
In a national retrospective cohort of 12,137 PE patients undergoing catheter-based therapy, initiating CBT within 1 day of admission was associated with lower 90-day mortality for both intermediate- and high-risk PE and reduced readmissions in intermediate-risk PE. Propensity score weighting and Cox models were applied to mitigate confounding.
Impact: This large real-world analysis directly addresses the critical question of when to revascularize acute PE and suggests a survival advantage with early intervention.
Clinical Implications: PE response teams and interventional programs should consider streamlining pathways to offer catheter-based therapy within 24 hours when indicated, while awaiting prospective randomized trials to confirm causality.
Key Findings
- Early CBT (≤1 day) lowered 90-day mortality in intermediate-risk PE (HR 0.55, 95% CI 0.46-0.66).
- Early CBT also reduced 90-day mortality in high-risk PE (HR 0.89, 95% CI 0.80-0.99).
- All-cause readmissions at 90 days were lower with early CBT in intermediate-risk PE (HR 0.86, 95% CI 0.78-0.95); a nonsignificant trend was seen in high-risk PE (HR 0.84, 95% CI 0.69-1.05).
Methodological Strengths
- Large national cohort (n=12,137) with risk stratification.
- Use of propensity score weighting and Cox models to mitigate confounding.
Limitations
- Retrospective observational design with potential residual confounding and selection bias.
- Administrative database may lack granular anatomical/physiologic data and be subject to coding inaccuracies.
Future Directions: Prospective randomized trials should test early versus delayed CBT, incorporating imaging, hemodynamic, and bleeding endpoints, and evaluating system-level implementation strategies.
BACKGROUND: Acute pulmonary embolism (PE) is a common cause of cardiovascular morbidity and mortality. Catheter-based therapies (CBT) are emerging technologies that provide reperfusion for patients with PE. However, the optimal timing of these interventions from initial presentation is unknown. AIMS: This study aimed to determine whether the timing of CBT affects outcomes among patients with acute PE managed with CBT. METHODS: This was a retrospective cohort study of patients with PE who underwent CBT and were included in the Nationwide Readmissions Database between January 2017 and December 2020. Patients who underwent early CBT (≤1 day from admission) were compared with those who underwent delayed CBT (>1 day). The primary outcome was death at 90 days, and secondary outcomes included 90-day readmissions. Propensity scores were estimated using logistic regression, and propensity score weighting (PSW) was utilised to compare outcomes between early and delayed CBT. Cox proportional hazards modelling was used to estimate the risk of primary and readmission outcomes. RESULTS: A total of 12,137 patients were included: 1,992 (16.4%) had high-risk PE, and 1,856 (15.3%) were treated with delayed CBT. After PSW, early CBT was associated with a lower risk of 90-day death in both intermediate-risk (hazard ratio [HR] 0.55, 95% confidence interval [CI]: 0.46-0.66) and high-risk (HR 0.89, 95% CI: 0.80-0.99) PE. Early CBT was associated with lower rates of all-cause readmission in patients with intermediate-risk PE (HR 0.86, 95% CI: 0.78-0.95) and in those with high-risk PE (HR 0.84, 95% CI: 0.69-1.05). CONCLUSIONS: Among patients with intermediate- or high-risk PE, early CBT was associated with a lower risk of 90-day death and readmission. A further prospective study on the optimal timing for reperfusion using CBT is needed.
2. Impact of Hemolysis During Microaxial Flow Pump Support on Early Outcomes After Durable Left Ventricular Assist Device Implantation.
Among 311 patients bridged with Impella to durable LVAD, hemolysis occurred in 40.8% and was independently associated with a higher risk of early hemocompatibility-related adverse events after LVAD implantation. Use of Impella 2.5/CP versus 5.0/5.5 independently predicted pre-LVAD hemolysis.
Impact: Identifying hemolysis as a modifiable risk signal prior to LVAD implantation highlights actionable device-selection and management strategies to reduce post-implant hemocompatibility events.
Clinical Implications: Preferential use of larger-bore Impella (5.0/5.5) when feasible, vigilant hemolysis monitoring, and preemptive mitigation may lower post-LVAD stroke/bleeding risk; integration into MCS care pathways is warranted.
Key Findings
- Pre-LVAD hemolysis occurred in 40.8% of Impella-bridged patients.
- Use of Impella 2.5/CP vs 5.0/5.5 independently predicted hemolysis (adjusted HR 2.68, 95% CI 1.04-6.94).
- Hemolysis independently associated with higher early post-LVAD HRAEs (adjusted HR 1.62, 95% CI 1.02-2.58), driven by hemorrhagic stroke and GI bleeding.
- Temporary RVAD was more often required in hemolysis patients (28.3% vs 16.8%; p=0.012), without mortality difference.
Methodological Strengths
- Consecutive cohort with predefined biochemical hemolysis criteria.
- Multivariable analyses to identify independent predictors and outcomes.
Limitations
- Retrospective design with potential residual confounding and center/device practice variability.
- Early outcomes focused; long-term hemocompatibility and survival not assessed.
Future Directions: Prospective studies should test hemolysis-targeted protocols (device selection, pump speed management, anticoagulation) and evaluate long-term thrombohemorrhagic outcomes post-LVAD.
The impact of hemolysis during microaxial flow pump (mAFP; Impella, Danvers, Massachusetts, US) support on early outcomes after durable left ventricular assist device (d-LVAD) implantation is unknown. Three hundred and eleven consecutive patients undergoing d-LVAD implantation after mAFP support (Impella 5.0/5.5 72.3%) were retrospectively included. The incidence and predictors of hemolysis (plasma-free hemoglobin >20 mg/dl or lactic dehydrogenase (LDH) >2.5-fold the upper reference limit) before d-LVAD implantation were assessed, along with its impact on early post-d-LVAD outcomes. The primary outcome was a composite of hemocompatibility-related adverse events (HRAEs: stroke/gastrointestinal bleeding/pump thrombosis). Hemolysis occurred in 40.8%. Impella 2.5/CP versus 5.0/5.5 was the single independent predictor of hemolysis (adj-hazard ratio [HR] = 2.68, 95% confidence interval [CI] = 1.04-6.94, p = 0.031). Post-d-LVAD HRAEs occurred more frequently among patients with hemolysis (31.9% vs. 20.6%; p = 0.041), mainly driven by hemorrhagic stroke and gastrointestinal bleeding. At multivariate analysis, hemolysis remained independently associated with HRAEs (adj-HR = 1.62, 95% CI = 1.02-2.58; p = 0.041). Patients with hemolysis were more likely to need a temporary right ventricular assist device following d-LVAD implantation (28.3% vs. 16.8%; p = 0.012), with no difference in mortality (23.6% vs. 21.2%; p = 0.355). In conclusion, among patients undergoing d-LVAD implantation with mAFP bridge, hemolysis is common, occurs more frequently among patients supported with Impella 2.5/CP, and is an independent predictor of post-d-LVAD HRAEs.
3. Cascade screening in familial hypercholesterolaemia is associated with earlier statin initiation and fewer cardiovascular events than opportunistic screening.
In a molecularly confirmed HeFH registry (n=3,232), cascade screening was associated with statin initiation 14 years earlier and a 51% lower prevalence of ASCVD events compared with opportunistic identification. Age at statin initiation appears to mediate much of the benefit.
Impact: Provides strong real-world evidence that systematic family-based identification accelerates preventive therapy and reduces events, informing public health policy and guideline implementation.
Clinical Implications: Health systems should prioritize FH cascade screening programs to identify relatives early, initiate statins in adolescence/early adulthood when indicated, and thereby reduce lifetime ASCVD burden.
Key Findings
- Cascade screening cases started statins 14 years earlier than index cases (median 18.1 vs 31.8 years; P<0.001).
- Cardiovascular events prior to first visit were lower with cascade screening (8.3% vs 26.5%; P<0.001).
- Cascade screening was associated with 51% fewer ASCVD events in multivariable models; in age/sex-matched analysis, age at statin initiation remained the key factor.
Methodological Strengths
- Large national registry with molecular confirmation of HeFH.
- Use of multivariable regression and matched sub-analyses to address confounding.
Limitations
- Retrospective design with potential residual confounding and selection bias between index and cascade cases.
- Event assessment focused on pre-first-visit prevalence; prospective incidence and treatment adherence effects are not detailed.
Future Directions: Implement and evaluate population-level cascade screening pathways with outcomes-based metrics, including long-term ASCVD incidence, adherence, and cost-effectiveness.
AIMS: The aim of this study is to assess whether the family cascade screening strategy for identifying patients with heterozygous familial hypercholesterolaemia (HeFH) is associated with a reduction in cardiovascular events compared with opportunistic screening strategies. METHODS AND RESULTS: We retrospectively included 3232 patients, from the French FH registry, REFERCHOL, with a molecular diagnosis. We compared patients according to their screening strategy for HeFH: index cases (opportunistic screening) and cascade screening cases (patients diagnosed by cascade screening) on clinical and biological characteristics. We first compared patients according to screening modality using χ² and Student's t-tests and performed multivariate logistic regression to assess the association between screening strategy and the risk of cardiovascular events. We finally performed the same tests in an age- and sex-matched subpopulation. Compared with index cases (2106 patients), cascade screening cases (1126 patients) started statin use 14 years earlier [18.1 (interquartile range 12.5-29.1) years vs. 31.8 (19.7-42.4) years, P < 0.001] and 8.3% had a cardiovascular event prior to the first visit, vs. 26.5% in the index cases group (P < 0.001). In multivariate logistic regression, the cascade screening was independently associated with 51% less atherosclerotic cardiovascular disease (ASCVD) than the opportunistic screening. Age at statin initiation was also associated with ASCVD, with a higher adjusted odd ratio for higher age categories. In an age- and sex-matched analysis, cascade screening was no longer associated with ASCVD, but age at statin initiation remained. CONCLUSION: The cascade screening strategy for familial hypercholesterolaemia is associated with 51% fewer cardiovascular events in genetically confirmed heFH probably due to an earlier age at treatment initiation. Familial hypercholesterolaemia is a genetic disorder characterized by high plasma concentrations of LDL-cholesterol leading to a high or very high risk of atherosclerotic cardiovascular events during life. The first person in a family diagnosed with familial hypercholesterolaemia (mainly by measuring blood cholesterol) is called index case. Practitioners then use cascade screening to detect the disease in relatives of the index case. The aim of this article is to assess whether the cascade screening strategy for familial hypercholesterolemia is associated with less cardiovascular events compared with opportunistic screening. We compared the prevalence of cardiovascular events in patients with heterozygous familial hypercholesterolemia according to method of screening for the disease. We recruited 2106 index cases and 1126 cascade screening cases. Cascade screening cases started statins 14 years earlier (18.1 years vs. 31.8 years, P < 0.001) than index cases. In the cascade screening group, 8.3% had a cardiovascular event before the first visit, compared with 26.5% in the index case group (P < 0.001). Age at statin initiation was also associated with ASCVD, with a higher OR for higher age categories. In an age- and sex-matched analysis, cascade screening was no longer associated with ASCVD, but age at statin initiation remained.