Daily Cardiology Research Analysis

BACKGROUND: Glucagon like peptide-1 receptor agonist (GLP-1RA) use in individuals with high atherosclerotic cardiovascular disease (ASCVD) risk reduces major adverse cardiovascular events (MACE). However, its clinical impact, in terms of numbers needed to treat (NNT), efficacy and safety profile in reducing the risk of myocardial infarction (MI) and the individual ASCVD constituents remain unclear. METHODS: Electronic databases, Medline and Embase were reviewed for randomized trials from inception to 29 May 2025. Risk-reduction effect of GLP-1RA were pooled using pairwise meta-analysis with random-effects model. The primary outcome was MI, and secondary outcomes were the individual ASCVD constituents. RESULTS: 109,846 patients from 25 unique studies were included. Over a follow-up duration of 3.48 ± 1.51 (1.55 to 5.47) years, GLP-1RA reduced the risk of total MI (RR: 0.86, p < 0.01), with numbers needed to benefit (NNTB) of 207 to prevent one event of MI. Higher body mass index was associated with greater MI risk reduction (β: -0.09, p = 0.03) in GLP-1RA users. GLP-1RA reduced cardiovascular mortality (RR: 0.87, p < 0.01, NNTB 170), MACE (RR: 0.87, p < 0.01, NNTB 67) and stroke (RR: 0.88, p < 0.01, NNTB 335) compared to placebo. GLP-1RA commonly resulted in gastrointestinal side-effects amongst other systems (RR: 1.55, p  < 0.01, NNTH 9). CONCLUSION: GLP-1RA reduced the risk of MI, stroke, cardiovascular mortality and MACE in a broad range of patients with and without T2DM and/or prior ASCVD, supporting its role in ASCVD prevention, especially in the cohort with high BMI. TRIAL REGISTRATION: Open Science Framework ( https://doi.org/10.17605/OSF.IO/7VXN5 ).

BACKGROUND: New-onset heart failure with reduced ejection fraction (HFrEF) requires further diagnostic evaluation to determine its underlying cause. Despite the potential of cardiac magnetic resonance (CMR) imaging to identify ischemic and nonischemic causes, percutaneous invasive coronary angiography (CATH) remains the preferred tool for diagnosing ischemic cardiomyopathy (ICM). OBJECTIVES: This study aimed to determine whether a CMR-first strategy could diagnose ICM as effectively as CATH (primary endpoint) and potentially reduce the number of invasive procedures (secondary endpoint). METHODS: In this multicenter 2-armed diagnostic trial (Magnetic Resonance Imaging vs Invasive Coronary Angiography as First-Line Diagnostic Modality in New-Onset Heart Failure), 229 adults with new-onset HFrEF were randomized to undergo CMR or CATH first and the other modality second. Separate expert panels evaluated both modalities, blinded to each other's results. The cardiologist-in-charge was blinded to the panel results and served as the reference standard. RESULTS: A total of 203 patients (mean age: 62 ± 14 years, 28% women) had evaluable pairs of diagnostic modalities (108 CATH-first). For diagnosing ICM, the panels considered CATH to be sufficient in 100% (105/105) and CMR in 80% (76/95; P < 0.001). Compared with the reference, sensitivity for diagnosing ICM was high for both (CATH 91%, CMR 90%; P = 1.00), but CMR had lower specificity (98% vs 74%; P < 0.001). According to the CMR panel, 48% (46/95) of CATH procedures could have been avoided with a CMR-first strategy, dropping to 45% when excluding patients who underwent coronary interventions. CONCLUSIONS: Although CATH was superior for diagnosing ICM, CMR showed similar sensitivity and could significantly reduce CATH procedures without increasing the risk of missing critical coronary interventions. Longitudinal studies are needed to assess whether a CMR-first strategy confers prognostic benefit. (Magnetic Resonance Imaging vs Invasive Coronary Angiography as First-Line Diagnostic Modality in New-Onset Heart Failure; ISRCTN16515058).

BACKGROUND: Following the Fontan procedure, patients with single ventricle physiology are at high risk of diastolic dysfunction (DD) and elevated end-diastolic pressure (EDP). OBJECTIVE: This study aims to determine (1) the optimal EDP threshold correlated with adverse outcomes post-Fontan and (2) the clinical and imaging predictors of DD. METHODS: The study included patients from the Fontan Outcome Registry using CMR Examinations (FORCE) who underwent cardiac catheterization and cardiac magnetic resonance (CMR) within a 2-year window. The composite outcome was defined as all-cause mortality, sustained atrial or ventricular arrhythmia, plastic bronchitis, protein-losing enteropathy, or listing for transplantation. The EDP cutoff was determined using the lowest Brier score from Cox proportional hazard models. RESULTS: The study included 861 patients (mean age 16.4 ± 9.3 years). Mean EDP was 9.0 ± 3.5 mm Hg, with DD defined at an optimal EDP threshold >13 mm Hg. Patients were followed for a median of 3.6 years after catheterization. By univariable analysis patients with DD were more likely to have Fontan associated liver disease (40% vs 29%, P = .03) and kidney disease (19% vs 6%, P < .001). In multivariable analyses, DD was associated with the composite outcome (HR 3.37, 95% CI: 2.03-5.59, P < .001). Ninety-seven patients (11.3%) had DD. Multivariable analysis demonstrated that older age at catheterization, greater body mass index (BMI), nonleft ventricular morphology, and higher ventricular end-diastolic volume (EDV) were associated with DD. CONCLUSION: DD, defined as an EDP >13 mm Hg, is linked to over 3-fold higher risk of adverse outcomes. Risk factors for DD include older age, higher BMI, nonleft ventricular morphology, and larger EDV. The presence of risk factors may warrant screening catheterization to identify DD and modify care accordingly.