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.
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.
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.