Daily Cardiology Research Analysis
A randomized trial (Tri.FR) shows that transcatheter edge-to-edge repair for severe tricuspid regurgitation yields large, durable gains in quality of life over optimal medical therapy alone. A prospective, blinded study links elevated CMR T1/T2 mapping values with biopsy-proven rejection and donor-derived cell-free DNA after heart transplant, supporting noninvasive rejection assessment. A 4,105-patient nationwide cohort defines age-adjusted NT-proBNP/BNP cutoffs for right ventricular dysfunction
Summary
A randomized trial (Tri.FR) shows that transcatheter edge-to-edge repair for severe tricuspid regurgitation yields large, durable gains in quality of life over optimal medical therapy alone. A prospective, blinded study links elevated CMR T1/T2 mapping values with biopsy-proven rejection and donor-derived cell-free DNA after heart transplant, supporting noninvasive rejection assessment. A 4,105-patient nationwide cohort defines age-adjusted NT-proBNP/BNP cutoffs for right ventricular dysfunction in acute pulmonary embolism, improving risk stratification.
Research Themes
- Structural heart intervention with patient-reported outcomes
- Noninvasive biomarkers and imaging for transplant rejection
- Age-adjusted biomarker thresholds for cardiopulmonary risk stratification
Selected Articles
1. Quality of life after transcatheter tricuspid valve repair: results from the Tri.FR trial.
In this randomized trial, adding T-TEER to medical therapy for severe symptomatic tricuspid regurgitation produced large and sustained gains in KCCQ and MLHF scores over 1 year versus medical therapy alone. Benefits spanned physical and emotional domains, with an average between-group KCCQ-OS improvement of +10.3 points.
Impact: This RCT provides high-quality evidence that T-TEER meaningfully improves patient-reported quality of life beyond medical therapy, supporting patient-centered outcomes in TR management.
Clinical Implications: For symptomatic severe TR, T-TEER should be considered to achieve clinically meaningful and durable quality-of-life improvements alongside medical therapy, informing shared decision-making and trial endpoints.
Key Findings
- KCCQ-OS increased by +17.0 at 6 weeks, +15.9 at 6 months, and +18.7 at 1 year in the T-TEER group.
- Between-group difference in KCCQ-OS favored T-TEER by +10.3 points (95% CI 5.6–15.0).
- MLHF total scores and both physical and emotional subscales improved significantly with T-TEER.
Methodological Strengths
- Randomized allocation to T-TEER + OMT vs OMT alone with longitudinal assessments.
- Use of validated patient-reported instruments (KCCQ, MLHF) and mixed-effects models.
Limitations
- Primary outcomes focused on patient-reported measures rather than hard clinical endpoints.
- Follow-up limited to 1 year; generalizability to different TR phenotypes and long-term outcomes remains to be established.
Future Directions: Evaluate long-term durability, hospitalization/mortality impacts, and identify subgroups most likely to benefit; integrate PROs with imaging and biomarker endpoints.
AIMS: In the Tri.FR trial, tricuspid transcatheter edge-to-edge repair (T-TEER) reduced severity of tricuspid regurgitation (TR) and improved the composite clinical score, driven by patient-reported outcomes. The purpose of this study was to describe the longitudinal impact of T-TEER on different dimensions and items of quality of life compared with guideline-directed medical treatment (OMT) alone. METHODS AND RESULTS: Patients were randomized to T-TEER +OMT (n = 152) or OMT alone (n = 148). Health status was assessed at baseline, 6 weeks, 6 months, and 1 year using the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the Minnesota Living with Heart Failure (MLHF) Questionnaire. Mixed effects linear regression analysed changes over time. Patients receiving T-TEER + OMT experienced a significant increase in KCCQ overall summary score (KCCQ-OS) at all time points: +17.0 points (95% confidence interval [CI] 13.1-21.5) at 6 weeks, +15.9 points (95% CI 11.2-20.6) at 6 months, and +18.7 points (95% CI 13.8-23.6) at 1 year. The mean between-group difference in KCCQ-OS was +10.3 points (95% CI 5.6-15.0) in favour of T-TEER + OMT, evident at 6 weeks and sustained for 1 year. Similarly, MLHF total scores improved significantly in the T-TEER group (mean between-group difference -8.61 points, 95% CI -12.6 to -4.6), including physical (-3.9, 95% CI -5.9 to -1.9) and emotional (-2.2, 95% CI -3.4 to -1.0) subscales. CONCLUSIONS: Compared with OMT alone, T-TEER resulted in substantial, multidimensional, and sustained improvements in patient-reported quality of life. These findings reinforce the value of T-TEER in managing severe symptomatic TR.
2. Cardiac magnetic resonance in heart transplant recipients: histological, clinical and cell-free DNA validation.
In a blinded prospective cohort of 58 heart transplant recipients (244 CMR scans), global T1 and T2 values declined over time post-transplant, reflecting recovery, but increased during acute rejection. T1/T2 mapping correlated with dd-cfDNA and T2 with impaired LV strain, supporting CMR mapping as a noninvasive marker of rejection.
Impact: Integrating CMR mapping with biopsy and dd-cfDNA validation provides robust, translational evidence for noninvasive rejection screening that could reduce reliance on endomyocardial biopsy.
Clinical Implications: CMR T1/T2 mapping, in conjunction with dd-cfDNA and clinical data, can inform surveillance strategies, identify episodes of acute rejection, and potentially decrease biopsy frequency in selected patients.
Key Findings
- Global T1 and T2 decreased over 24 months post-transplant, indicating recovery from early myocardial injury.
- During acute rejection, T1 significantly increased versus rejection-free studies in both pediatric and adult recipients.
- T1 and T2 were positively associated with dd-cfDNA; T2 correlated with worse LV global longitudinal strain.
Methodological Strengths
- Blinded prospective design with multimodal validation (biopsy, dd-cfDNA, strain).
- Segmental and global mapping across time enabling trajectory analyses.
Limitations
- Single-center sample with modest patient numbers.
- Thresholds for clinical decision-making and external validation cohorts are not established within this study.
Future Directions: Define actionable T1/T2 thresholds, validate in multicenter cohorts, and test biopsy-sparing algorithms combining CMR and dd-cfDNA.
AIMS: Cardiac magnetic resonance (CMR) presents a promising non-invasive method for evaluating acute rejection in heart transplant recipients. As indicators of myocardial injury, T1 and T2 mapping values are crucial for comprehending rejection patterns in heart transplants. This study aims to define CMR T1 and T2 mapping values in heart transplant patients both with and without acute rejection. METHODS AND RESULTS: In this blinded prospective study, we analysed CMR data from 244 scans of 58 paediatric and adult heart transplant recipients, 1-24 months post-transplant. Rejection status was defined by endomyocardial biopsy, clinical data, and donor-derived cell-free DNA (dd-cfDNA). Over the 24 months post-transplant, global T1 and T2 values decreased significantly (T1: β = -8.9/log(month), P < 0.001; T2: β = -0.5/log(month), P < 0.001) demonstrating the gradual recovery from transplant-related myocardial injury. During acute rejection, T1 values significantly increased compared to rejection-free studies in both children [estimates at 1 month post-transplant 1188 ms (95% CI: 1161-1215) vs. 1079 ms (95% CI: 1061-1097), P < 0.001] and adults [1087 ms (95% CI: 1045-1129) vs. 1016 ms (95% CI: 1005-1027), P = 0.007]. T1 and T2 values were positively associated with dd-cfDNA (P < 0.001 and P = 0.014, respectively), and T2 values with worse left ventricular global longitudinal strain (P < 0.001). CONCLUSION: We provide essential T1 and T2 mapping values across cardiac segments, as well as left ventricular myocardial strain, both with and without acute rejection. These findings establish a reliable foundation for non-invasive heart transplant rejection screening. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04311346.
3. Age-adjusted cut-off values of natriuretic peptides for right ventricular dysfunction in acute pulmonary embolism: Post-hoc analysis from CURES.
In 4,105 acute PE patients, optimal NT-proBNP and BNP thresholds for RVD showed strong discrimination, with age-adjusted cutoffs (e.g., NT-proBNP 356/526/647 pg/mL) improving performance. All thresholds had high negative predictive value (~0.9), and elevated NPs were associated with increased 30-day mortality.
Impact: Provides practical, age-specific NP thresholds for bedside RVD assessment in acute PE with strong NPV, supporting standardized risk stratification.
Clinical Implications: Use age-adjusted NT-proBNP/BNP cutoffs to refine identification of RVD and early risk stratification in acute PE pathways; low values can safely de-escalate imaging or monitoring in selected patients.
Key Findings
- Optimal NT-proBNP cutoff for RVD was 641 pg/mL overall (AUC 0.713); age-adjusted cutoffs were 356/526/647 pg/mL for <55/55–69/≥70 years.
- Optimal BNP cutoff was 194 pg/mL overall with age-adjusted cutoffs 83/146/200 pg/mL.
- All thresholds showed ~0.9 negative predictive value; elevated NPs predicted higher 30-day mortality.
Methodological Strengths
- Large prospective nationwide cohort with imaging-confirmed RVD endpoints.
- Age-stratified ROC analyses and mortality validation at 30 days.
Limitations
- Post-hoc analysis; external validation in non-Chinese populations is needed.
- Thresholds may vary with assay platforms and comorbidities.
Future Directions: Prospective validation and integration into PE pathways; evaluate cost-effectiveness and clinical impact of age-adjusted NP triage.
BACKGROUND: Cut-off values of natriuretic peptides [NPs, including B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP)] for right ventricular dysfunction (RVD) in acute pulmonary embolism (PE) are not standardized. METHODS: Patients with acute PE enrolled between 2016 and 2021 were selected from a large prospective nationwide cohort in China. Patients with available values of NPs were included. RVD was confirmed by echocardiography or computed tomography pulmonary angiography. We used receiver operating characteristic curves to determine optimal cut-off values. Kaplan-Meier curves and log-rank test were performed to show the association between NPs and 30-day all-cause mortality, stratified by these thresholds. RESULTS: A total of 4105 patients (median age, 65 years; 50.5 % male) were enrolled, with 743 (18.1 %) developing RVD. The optimal NT-proBNP threshold for RVD was identified as 641 pg/ml, yielding an area under the curve (AUC) of 0.713 (95 % CI 0.686-0.740). For individuals aged <55, 55-69, and ≥ 70 years, the cut-off values were 356 pg/ml, 526 pg/ml, and 647 pg/ml, with AUCs of 0.750, 0.712, and 0.689, respectively. The optimal cut-off value of BNP was 194 pg/ml, with an AUC of 0.679 (95 % CI 0.647-0.712). Age-adjusted thresholds were 83 pg/ml, 146 pg/ml, and 200 pg/ml, with AUCs of 0.705, 0.699, and 0.646, respectively. All thresholds demonstrated negative predictive value approximately 0.9 (range: 0.884-0.916). Elevated NPs based on thresholds for the rounded tens were associated with an increased risk of death within 30 days. CONCLUSIONS: Age-adjusted NP thresholds offer improved RVD detection. Physicians should emphasize the importance of NPs in acute PE.