Daily Cardiology Research Analysis
A pooled randomized analysis in Lancet shows that high-dose influenza vaccine reduces influenza/pneumonia and cardiorespiratory hospitalizations in older adults. A large echocardiography cohort identifies a U-shaped link between left ventricular ejection fraction and worsening heart failure, highlighting risk at supranormal EF. An individual patient-level meta-analysis finds suture-based ProGlide superior to plug-based MANTA for large-bore vascular closure after TAVI, lowering vascular and bleed
Summary
A pooled randomized analysis in Lancet shows that high-dose influenza vaccine reduces influenza/pneumonia and cardiorespiratory hospitalizations in older adults. A large echocardiography cohort identifies a U-shaped link between left ventricular ejection fraction and worsening heart failure, highlighting risk at supranormal EF. An individual patient-level meta-analysis finds suture-based ProGlide superior to plug-based MANTA for large-bore vascular closure after TAVI, lowering vascular and bleeding complications.
Research Themes
- Vaccination strategies to reduce cardiopulmonary hospitalizations in older adults
- Risk stratification across the full spectrum of left ventricular ejection fraction
- Optimization of large-bore vascular closure in transcatheter interventions
Selected Articles
1. Effectiveness of high-dose influenza vaccine against hospitalisations in older adults (FLUNITY-HD): an individual-level pooled analysis.
Across 466,320 randomized participants, high-dose influenza vaccine reduced hospitalisation for influenza or pneumonia versus standard dose (relative vaccine effectiveness 8.8%). It also reduced cardiorespiratory, laboratory-confirmed influenza, and all-cause hospitalisations, with similar all-cause mortality and serious adverse events.
Impact: This prespecified pooled analysis of two harmonized randomized trials provides robust evidence that high-dose influenza vaccination confers superior protection against severe clinical outcomes in older adults, informing vaccine policy.
Clinical Implications: Preferential use of high-dose inactivated influenza vaccine in older adults may reduce influenza/pneumonia and cardiorespiratory hospitalizations without increasing serious adverse events, and should be considered in immunization programs.
Key Findings
- Primary endpoint: hospitalisation for influenza or pneumonia was lower with HD-IIV vs SD-IIV (rVE 8.8%, 95% CI 1.7–15.5; one-sided p=0.0082).
- Secondary endpoints: reductions with HD-IIV in cardiorespiratory hospitalisation (rVE 6.3%), laboratory-confirmed influenza hospitalisation (rVE 31.9%), and all-cause hospitalisation (rVE 2.2%).
- All-cause mortality and serious adverse events were similar between groups.
Methodological Strengths
- Prespecified individual-level pooled analysis of two harmonized randomized trials with >460,000 participants.
- Registry-linked outcomes and hierarchical testing of clinically relevant endpoints.
Limitations
- Geographic scope limited to Denmark and Galicia (Spain), potentially affecting generalizability.
- No mortality benefit demonstrated; potential confounding by circulating strains across seasons.
Future Directions: Head-to-head cost-effectiveness analyses and implementation studies across diverse health systems; evaluation in very old, frail, or multimorbid populations and in coadministration settings.
2. A U-shaped relationship between left ventricular ejection fraction and risk of worsening heart failure.
In 93,694 adults, LVEF showed a U-shaped association with the composite of all-cause death or worsening heart failure, with lowest risk at 60–70% and increased risk when LVEF was ≥70%. The pattern held across age, sex, and comorbid subgroups and for both incident and recurrent HF events.
Impact: This large cohort extends the U-shaped paradigm of LVEF from mortality to worsening HF, identifying supranormal EF (≥70%) as a high-risk phenotype that may warrant tailored monitoring and management.
Clinical Implications: Patients with supranormal LVEF may merit closer surveillance and targeted evaluation for diastolic dysfunction, hypertrophy, or infiltrative disease despite preserved or high EF.
Key Findings
- U-shaped association between LVEF and composite of all-cause mortality or worsening HF, with nadir at 60–70%.
- Supranormal LVEF (≥70%) associated with higher risk for the composite (aHR 1.12) and for worsening HF (aHR 1.13).
- Findings consistent across age, sex, hypertension, diabetes subgroups, and for incident and recurrent HF events.
Methodological Strengths
- Very large single-center cohort with granular 5% LVEF categories.
- Long median follow-up (8.3 years) with multiple clinically relevant outcomes.
Limitations
- Observational design from a tertiary center; residual confounding and referral bias are possible.
- Lack of detailed phenotyping (e.g., strain, biomarkers) to elucidate mechanisms at high EF.
Future Directions: Prospective, multiethnic validation with mechanistic profiling (imaging, biomarkers) to define drivers of risk at supranormal EF and to test tailored management strategies.
3. Suture-based versus plug-based closure for large-bore arterial access: an individual patient-level meta-analysis of randomised trials.
Pooling individual data from two randomized TAVI trials (n=722), suture-based ProGlide reduced VARC-3 access-site vascular complications versus plug-based MANTA (OR 0.54) and lowered bleeding (OR 0.41). Need for endovascular stenting or vascular surgery was also lower with ProGlide (OR 0.22).
Impact: Access-site complications are a major driver of morbidity in large-bore interventions. This IPD meta-analysis provides comparative randomized evidence to guide device selection.
Clinical Implications: For transfemoral TAVI requiring large-bore access, suture-based closure with ProGlide should be favored to minimize vascular and bleeding complications and reinterventions.
Key Findings
- ProGlide reduced access site-related vascular complications vs MANTA (OR 0.54, 95% CI 0.35–0.82).
- Access site-related bleeding events were lower with ProGlide (OR 0.41, 95% CI 0.18–0.94).
- ProGlide reduced need for endovascular stenting or vascular surgery (OR 0.22, 95% CI 0.06–0.79); no subgroup favored MANTA.
Methodological Strengths
- Individual patient-level meta-analysis of randomized trials with standardized VARC-3 outcomes.
- Prespecified subgroup analyses to explore effect modifiers.
Limitations
- Only two randomized trials and 722 patients; external validity beyond TAVI populations may be limited.
- Operator experience and device learning curves could influence outcomes but are difficult to fully standardize.
Future Directions: Head-to-head randomized trials across broader anatomies and access sizes; cost-effectiveness analyses; training and standardization strategies to optimize closure outcomes.