Daily Cardiology Research Analysis
A randomized trial in acute stroke (DAYLIGHT) shows that extending CT angiography below the carina quintupled detection of cardioaortic thrombi without delaying imaging. The first multicenter, blinded RCT of fecal microbiota transplantation for hypertension demonstrated safety but an unsustained blood pressure effect alongside microbiome–metabolome shifts. A systematic review/meta-analysis suggests managing systolic blood pressure to <130 mmHg in HFpEF lowers heart failure hospitalizations, with
Summary
A randomized trial in acute stroke (DAYLIGHT) shows that extending CT angiography below the carina quintupled detection of cardioaortic thrombi without delaying imaging. The first multicenter, blinded RCT of fecal microbiota transplantation for hypertension demonstrated safety but an unsustained blood pressure effect alongside microbiome–metabolome shifts. A systematic review/meta-analysis suggests managing systolic blood pressure to <130 mmHg in HFpEF lowers heart failure hospitalizations, with increased hypotension risk but no signal for renal harm.
Research Themes
- Imaging optimization to uncover cardioembolic sources in acute stroke
- Microbiome-based interventions and cardiometabolic regulation
- Blood pressure targets in HFpEF and clinical outcomes
Selected Articles
1. Extended CT angiography versus standard CT angiography for the detection of cardioaortic thrombus in patients with ischaemic stroke and transient ischaemic attack (DAYLIGHT): a prospective, randomised, open-label, blinded end-point trial.
In the DAYLIGHT randomized trial, extending CTA at least 6 cm below the carina increased detection of cardioaortic thrombi from 1.7% to 8.8% without prolonging imaging time. The design was single-centre, open-label with blinded endpoint adjudication and included 465 patients with ischaemic stroke/TIA.
Impact: This RCT demonstrates a practical imaging change that substantially increases detection of actionable thrombi without workflow penalty, potentially enabling earlier anticoagulation and secondary prevention.
Clinical Implications: Acute stroke protocols could consider extended CTA to improve detection of cardioaortic thrombi and inform early anticoagulation decisions; outcome and cost-effectiveness studies are warranted.
Key Findings
- Extended CTA detected cardioaortic thrombi in 8.8% vs 1.7% with standard CTA (OR 5.70, 95% CI 1.92–16.96; p=0.002).
- No significant delay in imaging: median time to CTA completion 21.0 vs 20.0 minutes (p=0.67).
- Randomized 830 patients; modified ITT analysis included 465 with ischaemic stroke/TIA after excluding stroke mimics.
Methodological Strengths
- Prospective randomized design with blinded endpoint adjudication and trial registration.
- Direct workflow metric assessment showing non-inferiority in imaging time.
Limitations
- Single-centre study; generalizability needs multicentre validation.
- Primary outcome was diagnostic yield; impact on recurrent stroke and clinical outcomes remains untested.
Future Directions: Multicentre pragmatic trials assessing whether extended CTA-guided management reduces recurrent stroke; radiation/contrast risk–benefit analyses and cost-effectiveness; subgroup analyses (e.g., renal dysfunction).
2. Fecal microbiota transplantation for hypertension: an exploratory, multicenter, randomized, blinded, placebo-controlled trial.
In this multicenter, randomized, blinded, placebo-controlled trial (n=124), FMT was safe but did not significantly reduce office SBP at 30 days versus placebo, despite an early 1-week between-arm reduction of −4.34 mmHg that was not sustained. FMT induced reproducible shifts in specific microbial taxa and plasma metabolites that correlated with SBP.
Impact: This is the first blinded RCT testing FMT for hypertension, establishing safety and delineating microbiome–metabolome correlates, which reframes future microbial therapeutics toward targeted consortia rather than whole-FMT.
Clinical Implications: FMT capsules should not be used for routine hypertension control; future clinical studies should focus on defined microbial consortia with metabolite-targeted, BP-modulating properties and biomarker-guided engraftment.
Key Findings
- Primary endpoint was neutral: mean SBP change at day 30 was similar (6.28 vs 5.77 mmHg; p=0.62).
- Early effect: week-1 SBP reduction favored FMT by −4.34 mmHg (95% CI −8.1 to −0.58; p=0.024) but waned despite repeat dosing.
- Safety comparable to placebo (AEs 20.6% vs 14.8%; p=0.39) with significant shifts in taxa (e.g., Parabacteroides merdae↑, Eggerthella lenta↓) and metabolites correlating with SBP.
Methodological Strengths
- Multicentre, randomized, double-blind, placebo-controlled design with ITT analysis.
- Integrated multi-omics (microbiome and metabolome) linking taxa and metabolites to BP.
Limitations
- Short follow-up (primary at 30 days; safety to 3 months) and relatively young cohort (mean age 43).
- Whole-FMT approach may dilute specific BP-modulating effects; engraftment not ensured.
Future Directions: Test defined microbial consortia with mechanistic metabolites (e.g., amino acid pathways), optimize dosing/engraftment, and enrich responders via baseline microbiome/metabolome signatures in longer trials.
3. Systolic blood pressure lower than 130 mmHg in heart failure with preserved ejection fraction: a systematic review and meta-analysis of clinical outcomes.
Across six RCTs where intervention groups achieved SBP <130 mmHg, HF hospitalizations were reduced (RR 0.80, p=0.005) with a trend toward lower all-cause mortality, at the expense of more hypotension but no increase in renal dysfunction or serious adverse events.
Impact: This synthesis aligns BP targets with improved outcomes in HFpEF and informs forthcoming guidelines, despite indirectness from interventions not exclusively targeting SBP <130 mmHg.
Clinical Implications: In HFpEF, manage SBP to <130 mmHg when tolerated, with vigilant monitoring for hypotension, while anticipating no excess renal or serious adverse events based on current evidence.
Key Findings
- Achieving SBP <130 mmHg reduced HF hospitalizations (RR 0.80, 95% CI 0.69–0.93; p=0.005).
- Trend toward lower all-cause mortality (RR 0.74, 95% CI 0.53–1.04; p=0.083).
- Hypotension increased (RR 1.35, 95% CI 1.03–1.79; p=0.03) without increases in renal dysfunction or serious adverse events.
Methodological Strengths
- PRISMA-consistent systematic search including RCTs with ≥6-month follow-up.
- Consistent direction of effects across heterogeneous interventions achieving SBP <130 mmHg.
Limitations
- Indirectness: no RCTs that randomized patients specifically to SBP <130 mmHg as the primary intervention.
- Potential heterogeneity in populations, interventions, and BP measurement protocols.
Future Directions: Conduct pragmatic RCTs targeting SBP <130 mmHg with standardized BP protocols in HFpEF, including frailty and orthostatic hypotension assessments, and evaluate patient-centred outcomes.