Daily Cardiology Research Analysis
Long-term interventional strategy and measurement standardization dominated today’s cardiology literature. An individual patient data analysis of randomized trials shows that upfront double-kissing crush two-stent techniques reduce 6-year target lesion failure versus provisional stenting in true bifurcations. New corrected PISA thresholds markedly improve grading accuracy for secondary tricuspid regurgitation, and a territory-wide cohort reveals a rising incidence and shifting risk profile of he
Summary
Long-term interventional strategy and measurement standardization dominated today’s cardiology literature. An individual patient data analysis of randomized trials shows that upfront double-kissing crush two-stent techniques reduce 6-year target lesion failure versus provisional stenting in true bifurcations. New corrected PISA thresholds markedly improve grading accuracy for secondary tricuspid regurgitation, and a territory-wide cohort reveals a rising incidence and shifting risk profile of heart failure in younger adults.
Research Themes
- Coronary bifurcation PCI strategy and long-term outcomes
- Echocardiographic quantification standards for tricuspid regurgitation
- Epidemiology and risk trends of heart failure in younger adults
Selected Articles
1. Double-kissing crush versus provisional stenting in patients with true coronary artery bifurcation lesions: a pooled individual patient-level analysis of randomised trials (DKCRUSH X trial).
Across four randomized trials (n=1,573), upfront two-stent techniques—particularly DK crush—reduced 6-year target lesion failure compared with provisional stenting (18.2% vs 24.7%; HR 0.71, 95% CI 0.57-0.89). Heterogeneity was negligible (τ²=0.00), supporting durable efficacy, especially in complex bifurcations.
Impact: Provides high-level, long-term evidence to guide stenting strategy selection in true bifurcation lesions, potentially shifting practice toward DK crush in complex anatomy.
Clinical Implications: For true bifurcations, operators should consider upfront DK crush when anatomy is complex, given the 6-year reduction in TLF vs provisional stenting. Training and procedural planning should reflect the technique’s superiority in selected lesions.
Key Findings
- Upfront two-stent strategy reduced 6-year TLF vs provisional stenting (18.2% vs 24.7%; HR 0.71, 95% CI 0.57-0.89).
- Low between-trial heterogeneity (τ²=0.00) supports robustness of the effect.
- Benefit was most notable for DK crush and in complex bifurcation anatomy.
Methodological Strengths
- Individual patient data meta-analysis of randomized trials with centrally adjudicated endpoints
- Long-term (6-year) follow-up enabling durable efficacy assessment
Limitations
- Reporting truncation of heterogeneity metric (I²) in abstract and potential variability in operator expertise across trials
- Generalizability may be limited to true bifurcation lesions treated with contemporary DES and experienced centers
Future Directions: Head-to-head trials comparing DK crush with other two-stent techniques under contemporary imaging guidance; implementation studies on training, procedural efficiency, and cost-effectiveness.
2. Refining tricuspid regurgitation severity assessment with new corrected proximal isovelocity surface area threshold values.
In 213 patients with isolated secondary tricuspid regurgitation, corrected PISA thresholds (EROA <0.22/0.22–0.46/>0.46 cm²; RegVol <18/18–42/>42 mL) achieved high accuracy against 3D echo–derived regurgitant fraction (99% EROA, 94% RegVol), significantly outperforming conventional PISA metrics.
Impact: Provides actionable, empirically derived thresholds for corrected PISA that align with volumetric reference standards, likely to standardize TR severity grading and downstream clinical decisions.
Clinical Implications: Echocardiography labs should incorporate corrected PISA thresholds into reporting for secondary TR to reduce misclassification and to guide timing of intervention and follow-up.
Key Findings
- New corrected PISA thresholds: EROA <0.22/0.22–0.46/>0.46 cm² and RegVol <18/18–42/>42 mL mapped to mild/moderate/severe STR.
- Accuracy against 3D volumetric regurgitant fraction was 99% (EROA) and 94% (RegVol), higher than conventional PISA (EROA 90%, RegVol 41%).
- Study utilized 3D echocardiography stroke volume–based regurgitant fraction as reference standard.
Methodological Strengths
- Use of 3D echocardiography volumetric regurgitant fraction as an independent reference standard
- Direct comparison of corrected vs conventional PISA with predefined accuracy metrics
Limitations
- Single-cohort observational design; external validation in broader STR populations is needed
- Focused on isolated secondary TR; applicability to mixed or primary TR requires study
Future Directions: Prospective multicenter validation, integration with 3D/4D flow and vena contracta area, and outcome-based thresholds linked to intervention timing.
3. Temporal trends in incidence, clinical characteristics and outcomes among young adults with heart failure: a territory-wide study from 2014 to 2023 on 19,537 patients.
In a territory-wide cohort of 19,537 adults <65 years, standardized incidence of heart failure rose by 20% from 2014 to 2023, with a risk profile shift toward obesity, cardiomyopathy, and lower socioeconomic status, and an increase in HFrEF. Despite improved GDMT uptake, 1-year mortality reductions were modest.
Impact: Defines a pressing epidemiologic shift in heart failure among younger adults with direct implications for prevention, resource allocation, and targeted guideline implementation.
Clinical Implications: Programs should prioritize upstream prevention (obesity, cardiomyopathy detection), equitable GDMT access, and earlier HFrEF screening in younger adults; health systems should adapt capacity planning for rising young HF burden.
Key Findings
- Standardized incidence of HF in adults <65 years increased by 20% (IRR 1.20, 95% CI 1.13-1.27) over 2014–2023.
- Risk factor profile shifted toward obesity, cardiomyopathy, lower socioeconomic status, and ages 45–65; rise in HFrEF subtype.
- Despite improved GDMT uptake, 1-year all-cause mortality showed only modest reductions.
Methodological Strengths
- Territory-wide administrative dataset with age-sex standardization over a 10-year window
- Multivariable modeling and period comparisons to characterize shifts in risk and outcomes
Limitations
- Administrative data subject to coding errors and residual confounding
- Generalizability beyond the studied health system may be limited
Future Directions: Mechanistic studies on early-onset HFrEF drivers, interventions addressing obesity and social determinants, and implementation trials to optimize GDMT in younger HF populations.