Daily Cardiology Research Analysis
A first-in-class randomized trial (STORM-PE) shows mechanical thrombectomy plus anticoagulation rapidly reverses RV strain vs anticoagulation alone in intermediate-high risk pulmonary embolism with comparable short-term safety. Long-term analyses from FOURIER support targeting very low LDL-C (<40 mg/dL) after ischemic stroke without a rise in hemorrhagic stroke. MESA trajectory data indicate that rising albuminuria independently predicts future heart failure, atrial fibrillation, and coronary ev
Summary
A first-in-class randomized trial (STORM-PE) shows mechanical thrombectomy plus anticoagulation rapidly reverses RV strain vs anticoagulation alone in intermediate-high risk pulmonary embolism with comparable short-term safety. Long-term analyses from FOURIER support targeting very low LDL-C (<40 mg/dL) after ischemic stroke without a rise in hemorrhagic stroke. MESA trajectory data indicate that rising albuminuria independently predicts future heart failure, atrial fibrillation, and coronary events, underscoring kidney–heart cross talk.
Research Themes
- Interventional management of submassive pulmonary embolism
- Ultra-low LDL cholesterol targets in secondary stroke prevention
- Albuminuria trajectories as cardiovascular risk stratifiers
Selected Articles
1. Randomized Controlled Trial of Mechanical Thrombectomy With Anticoagulation Versus Anticoagulation Alone for Acute Intermediate-High Risk Pulmonary Embolism: Primary Outcomes from the STORM-PE Trial.
In this first RCT of mechanical thrombectomy for intermediate-high risk PE, computer-assisted vacuum thrombectomy plus anticoagulation achieved a significantly greater reduction in RV/LV ratio at 48 hours versus anticoagulation alone, with earlier normalization of vital signs and similar 7-day major adverse event rates. Findings support rapid reperfusion to unload the RV in carefully selected, normotensive PE patients.
Impact: This is the first randomized evidence that mechanical thrombectomy improves a key imaging marker of RV strain in submassive PE with acceptable short-term safety, informing ongoing debates about escalation beyond anticoagulation.
Clinical Implications: When expertise and systems are available, mechanical thrombectomy can be considered for intermediate-high risk PE with RV strain to rapidly reverse RV overload while maintaining acceptable short-term safety; definitive trials powered for hard clinical outcomes are still needed.
Key Findings
- CAVT plus anticoagulation produced a larger 48-hour reduction in RV/LV ratio than anticoagulation alone (mean difference 0.27; 95% CI 0.12–0.43).
- Earlier normalization of vital signs was observed with CAVT versus anticoagulation alone.
- Seven-day major adverse event rates (clinical deterioration requiring rescue therapy, PE-related death, symptomatic recurrent PE, major bleeding) were comparable between groups.
Methodological Strengths
- Randomized, multicenter design with blinded core-lab imaging assessment
- Independent clinical events adjudication and predefined endpoints
Limitations
- Modest sample size (N=100) limits precision and subgroup analyses
- Primary endpoint was an imaging surrogate (RV/LV ratio) with short 48-hour horizon; limited hard outcomes and short safety follow-up (7 days)
Future Directions: Larger blinded RCTs powered for mortality, hemodynamic collapse, and quality-of-life endpoints should compare thrombectomy against anticoagulation and other reperfusion options (e.g., CDT), and refine selection criteria and timing.
2. Efficacy and Safety of Very Low Achieved LDL-Cholesterol in Patients with Prior Ischemic Stroke.
Across FOURIER and its open-label extension, patients with prior ischemic stroke who achieved very low LDL-C levels (including <40 mg/dL and even <20 mg/dL) had progressively lower risks of MACE and ischemic stroke without a clear increase in hemorrhagic stroke. These data support intensifying lipid lowering in secondary prevention after ischemic stroke.
Impact: Provides long-term, stroke-specific evidence that achieving ultra-low LDL-C confers benefit without an apparent hemorrhagic penalty, informing aggressive lipid targets in high-risk secondary prevention.
Clinical Implications: In ASCVD patients with prior ischemic stroke, clinicians should consider more intensive LDL-C lowering (e.g., PCSK9 inhibitors atop statins/ezetimibe) targeting <55 mg/dL and potentially <40 mg/dL when feasible, balancing cost and access.
Key Findings
- Among 5,291 prior-stroke patients, lower achieved LDL-C strata (including <40 mg/dL and <20 mg/dL) were associated with stepwise reductions in the primary composite endpoint.
- All stroke and ischemic stroke incidences decreased monotonically with lower achieved LDL-C.
- No clear increase in hemorrhagic stroke was observed at very low achieved LDL-C levels.
Methodological Strengths
- Large sample size with long-term follow-up across RCT and open-label extension
- Granular achieved LDL-C categorization with stroke-specific endpoints
Limitations
- Non-randomized comparison by achieved LDL-C introduces potential confounding (treatment adherence, baseline risk)
- Generalizability limited to trial-eligible ASCVD populations and PCSK9 inhibitor availability
Future Directions: Pragmatic trials or emulation studies testing LDL-C targets post-stroke, cost-effectiveness analyses of PCSK9 strategies, and safety surveillance for intracranial hemorrhage at ultra-low LDL levels.
3. Longitudinal Trajectories of Albuminuria and Risk of Subclinical and Clinical Heart Failure, Atrial Fibrillation, and Coronary Heart Disease: the MESA Study.
Using latent trajectory modeling in MESA, persistently moderate-to-high or rapidly rising UACR identified individuals with substantially higher risks of HF (notably HFpEF), AF, and CHD, independent of baseline UACR and even among those initially normoalbuminuric. Trajectories correlated with higher NT-proBNP, hs-TnT, and myocardial fibrosis by T1 mapping.
Impact: Shifts risk assessment from single UACR measurements to longitudinal trajectories, providing actionable insight for earlier prevention in normoalbuminuric individuals who develop progressive albuminuria.
Clinical Implications: Incorporate serial UACR monitoring into cardiovascular prevention, especially in multi-ethnic populations, to identify rising-risk phenotypes and intensify BP, RAAS, SGLT2i, and lifestyle interventions before overt disease.
Key Findings
- Three UACR trajectory classes were identified; the “sustained medium-to-high” (5-year) and “rapid rise” (10-year) groups (~8% each) had 1.5–3.7× higher risks of HF, AF, CHD, and HF/death composites.
- Associations persisted after adjustment for baseline UACR and even among baseline normoalbuminuric individuals.
- High-risk trajectories correlated with elevated NT-proBNP, hs-TnT, and increased native T1/ECV indicating myocardial fibrosis.
Methodological Strengths
- Large, multi-ethnic prospective cohort with latent class mixed modeling over 5- and 10-year windows
- Integration of biomarkers (NT-proBNP, hs-TnT) and myocardial T1 mapping to link trajectories with pathophysiology
Limitations
- Observational design with potential residual confounding and measurement variability in UACR
- Trajectory-based classifications may be sensitive to visit timing and missingness patterns
Future Directions: Test whether targeting rising UACR trajectories with RAAS/SGLT2i/intensive BP control reduces HFpEF/AF/CHD; evaluate cost-effectiveness of serial UACR monitoring in primary prevention.