Daily Cardiology Research Analysis
Across cardiology this cycle, an individual participant–level meta-analysis shows empagliflozin durably reduces acute and chronic kidney adverse outcomes irrespective of the initial eGFR dip or comorbidity profile. A population-based cohort reveals that co-occurring covert brain infarction and unrecognized myocardial infarction marks a subgroup with markedly elevated ASCVD risk. In the cath lab, a prospective study validates real-time vessel FFR as an accurate and faster alternative to wire-base
Summary
Across cardiology this cycle, an individual participant–level meta-analysis shows empagliflozin durably reduces acute and chronic kidney adverse outcomes irrespective of the initial eGFR dip or comorbidity profile. A population-based cohort reveals that co-occurring covert brain infarction and unrecognized myocardial infarction marks a subgroup with markedly elevated ASCVD risk. In the cath lab, a prospective study validates real-time vessel FFR as an accurate and faster alternative to wire-based FFR.
Research Themes
- SGLT2 inhibition confers kidney protection across diverse cardiometabolic populations
- Silent ischemia in brain and heart synergistically elevates future ASCVD risk
- Angiography-based functional physiology (vFFR) accelerates decision-making with high diagnostic accuracy
Selected Articles
1. Effects of empagliflozin on conventional and exploratory acute and chronic kidney outcomes: an individual participant-level meta-analysis.
Across four large randomized trials (n=23,340), empagliflozin reduced acute kidney injury (AKI) markers by 20% and AKI adverse events by 27%, lowered chronic kidney disease progression by 30% and kidney failure by 34%, and slowed chronic eGFR decline by 64%. Benefits were consistent irrespective of the size of the acute eGFR dip, diabetes or heart failure status, primary kidney disease, or albuminuria.
Impact: This IPD meta-analysis resolves a key safety concern by showing kidney benefits independent of the acute eGFR dip and across disease contexts, strengthening the case for broad SGLT2i use in cardiometabolic care.
Clinical Implications: Supports initiating empagliflozin in CKD and cardiometabolic populations without withholding due to expected acute eGFR dips, to prevent AKI, CKD progression, and kidney failure while slowing eGFR decline.
Key Findings
- Reduced AKI marker events by 20% and AKI adverse events by 27% versus placebo.
- Lowered CKD progression by 30% and kidney failure by 34%.
- Slowed chronic annual eGFR decline by 64%, consistent regardless of acute eGFR dip size.
- Benefits were consistent across diabetes status, heart failure status, primary kidney disease, and albuminuria.
Methodological Strengths
- Individual participant-level meta-analysis across four randomized controlled trials
- Robust subgroup analyses including predicted acute eGFR dip and key comorbidities
Limitations
- Heterogeneity in outcome definitions and follow-up across trials
- Trial populations may limit generalizability to unrepresented subgroups
Future Directions: Outcomes-based implementation studies to optimize SGLT2i initiation timing and integration with RAAS blockade/ARNI across CKD phenotypes, and mechanistic work on dip-independent renoprotection.
2. Risk of Cardiovascular Disease With Co-Occurring Covert Brain Infarction and Unrecognized Myocardial Infarction.
In 4,627 adults from the Rotterdam Study (mean follow-up 9.9 years), CBI and UMI were interrelated and each associated with higher ASCVD risk. Co-occurrence of CBI and UMI conferred the highest risk (HR 5.6; 95% CI 2.9–10.7) versus neither lesion. Among individuals with CBI, concomitant UMI tripled ASCVD risk compared with CBI alone.
Impact: Defines a readily identifiable, very high-risk subgroup using ECG and brain MRI findings, enabling intensified preventive therapy targeting ASCVD.
Clinical Implications: Patients with both CBI and UMI warrant aggressive risk factor control (statins, BP control), antithrombotic optimization, and close surveillance given markedly elevated ASCVD risk.
Key Findings
- CBI and UMI co-occurred more frequently than expected; CBI doubled the odds of UMI (OR 2.3).
- Co-occurring CBI+UMI yielded HR 5.6 (95% CI 2.9–10.7) for incident ASCVD versus neither lesion.
- Among 359 individuals with CBI, concomitant UMI increased ASCVD risk (HR 3.4; 95% CI 1.7–6.7) versus CBI alone.
Methodological Strengths
- Population-based prospective cohort with nearly 10-year mean follow-up
- Multivariable Cox models adjusting for cardiovascular risk factors
Limitations
- UMI detection relied on ECG, potentially underdetecting silent infarcts
- Observational design cannot eliminate residual confounding
Future Directions: Test whether intensified preventive regimens guided by combined CBI+UMI status reduce ASCVD events; refine imaging/ECG algorithms for silent ischemia detection.
3. VERMONT: Vessel Fractional Flow Reserve (vFFR) Assessment of Stenosis Severity: A Prospective Study.
In 209 patients with 225 intermediate lesions, real-time vFFR showed excellent diagnostic performance versus wire-based FFR (AUC 0.92; 90% sensitivity; 79% specificity; NPV 93%) with a low exclusion rate (8.9%). Computation was on average 13.9 minutes faster than wire-based FFR, with excellent interobserver agreement (r=0.97).
Impact: Demonstrates that angiography-based vFFR can accurately screen functionally significant lesions while saving procedural time, supporting scalable physiology-first strategies.
Clinical Implications: vFFR can triage intermediate lesions quickly with high NPV, potentially reducing wire-based FFR use, contrast, and procedure time while maintaining physiologic decision quality.
Key Findings
- AUC 0.92 with 90% sensitivity, 79% specificity, and 93% NPV versus FFR≤0.80 reference.
- Real-time vFFR was on average 13.9 minutes faster than wire-based FFR.
- Low exclusion rate (8.9%) and excellent interobserver agreement (r=0.97).
Methodological Strengths
- Prospective, blinded head-to-head comparison against wire-based FFR
- Comprehensive reporting of diagnostic metrics and workflow time
Limitations
- Single-center design may limit generalizability
- Lacked clinical outcomes to confirm management impact
Future Directions: Multicenter outcome-driven trials to test vFFR-guided strategy versus standard care, and cost-effectiveness analyses in diverse cath lab settings.