Daily Cardiology Research Analysis
Three studies advance cardiovascular imaging and intervention: an RCT shows an accelerated, stress-only CMR protocol matches standard CMR accuracy while saving >20 minutes per scan; a post hoc analysis of FAVOR III China reveals that online QFR reclassifies flawed angiography-based PCI plans and aligns treatment with physiology; and a 20,094-patient TAVR registry delineates sex-specific outcomes, with severe PPM linked to mortality in men but not women after adjustment.
Summary
Three studies advance cardiovascular imaging and intervention: an RCT shows an accelerated, stress-only CMR protocol matches standard CMR accuracy while saving >20 minutes per scan; a post hoc analysis of FAVOR III China reveals that online QFR reclassifies flawed angiography-based PCI plans and aligns treatment with physiology; and a 20,094-patient TAVR registry delineates sex-specific outcomes, with severe PPM linked to mortality in men but not women after adjustment.
Research Themes
- Accelerated cardiovascular MRI for efficient CAD diagnostics
- Physiology-guided PCI using QFR to correct angiography-based plans
- Sex-specific hemodynamics and outcomes after TAVR
Selected Articles
1. Accelerated stress CMR for the detection of significant coronary artery disease: a prospective randomized diagnostic accuracy study.
In a randomized diagnostic accuracy study (n=150), an accelerated, stress-only CMR protocol achieved non-inferior per-vessel accuracy versus standard stress-rest CMR, while reducing scan time by over 20 minutes. Per-patient accuracy was high (88.6%), with sensitivity 84.2% and specificity 93.2%, and the accelerated protocol was better tolerated.
Impact: Demonstrates a time-efficient, patient-friendly CMR pathway with preserved diagnostic accuracy, potentially increasing access and throughput without compromising quality.
Clinical Implications: Centers can adopt accelerated stress-only CMR to streamline CAD workups, reduce scanner time, and improve patient experience while maintaining diagnostic performance; protocols and training should standardize free-breathing accelerated sequences.
Key Findings
- Accelerated stress-only CMR achieved non-inferior per-vessel diagnostic accuracy within a pre-specified 5% margin compared with standard stress-rest CMR.
- Mean scan duration was 19±5 minutes, saving approximately 24 minutes per scan (p<0.001) versus the standard protocol.
- Per-patient accuracy was 88.6% with sensitivity 84.2% and specificity 93.2% on consensus read.
- Patients tolerated the accelerated protocol better, supporting real-world feasibility.
Methodological Strengths
- Prospective randomized, within-patient comparison with randomized scan order.
- Physiologic reference standard (FFR ≤0.80 or QFR when FFR unavailable) and blinded dual-reader assessment.
Limitations
- Single-country study with 150 complete cases may limit generalizability.
- Non-inferiority margin selection (5%) and qualitative read may influence sensitivity to subtle ischemia.
Future Directions: Multicenter pragmatic trials and cost-effectiveness analyses to validate accelerated stress-only CMR across vendors and populations, and to define optimal integration with CT-first strategies.
2. Rationales Behind Physiology-Guided Revascularization: Diagnostic Impact of Quantitative Flow Ratio in the FAVOR III China Trial.
In 3,768 patients from FAVOR III China, about 30% of angiography-based prerandomization PCI plans were physiologically nonconcordant. Online QFR reclassified 23.6% of cases versus 4.6% with angiography guidance, achieving 92.3% postrandomization physiological concordance and showing an interaction with 2-year MACE, indicating that QFR benefits stem from shifting flawed plans toward physiology-concordant decisions.
Impact: Provides mechanistic evidence explaining improved outcomes with physiology-guided PCI by demonstrating substantial reclassification of angiography-based plans toward physiologic concordance.
Clinical Implications: Routine integration of QFR can correct angiography-only plans in roughly one-quarter of patients, prioritizing ischemia-driven PCI and potentially reducing unnecessary interventions.
Key Findings
- Approximately 30% of prerandomization angiography-based PCI plans were physiologically nonconcordant by offline QFR assessment.
- Online QFR reclassified 23.6% of patients versus 4.6% with angiographic guidance, markedly increasing postrandomization physiological concordance (92.3% vs 67.2%).
- A significant interaction existed between prerandomization concordance and randomized allocation for 2-year MACE.
- Older age, multivessel disease, LCx/RCA involvement, and lower SYNTAX scores predicted prerandomization physiological nonconcordance.
Methodological Strengths
- Large multicenter randomized trial dataset with predeclared treatment plans and core-lab offline QFR adjudication.
- Physiology-concordance framework links diagnostic reclassification to clinical outcomes over 2 years.
Limitations
- Post hoc analysis; not randomized to reclassification strategy per se.
- Potential residual confounding and reliance on offline QFR adjudication for prerandomization plans.
Future Directions: Prospective trials testing QFR-first strategies versus angiography-first in diverse settings, and implementation studies evaluating workflow, cost, and outcomes.
3. Sex differences in hemodynamics and outcomes after transcatheter aortic valve replacement.
In 20,094 TAVR patients, women were older and more symptomatic yet had better survival than men with comparable postprocedural hemodynamics. Severe prosthesis-patient mismatch (PPM) was associated with increased mortality in men, but after multivariable adjustment PPM was not linked to survival in either sex.
Impact: Defines sex-specific risk patterns after TAVR at scale, informing tailored procedural planning and follow-up strategies beyond prosthesis hemodynamics alone.
Clinical Implications: TAVR programs should consider sex-specific factors (e.g., valve choice, PPM thresholds, comorbidity profiles) and recognize that severe PPM confers greater risk in men; comprehensive risk adjustment is essential for prognostication.
Key Findings
- Women comprised 49.1% and were older and more symptomatic, with greater use of self-expanding valves.
- Post-TAVR indexed effective orifice area was slightly larger in women; overall postprocedural hemodynamics were comparable by sex.
- Women showed better 5-year survival than men.
- Severe prosthesis-patient mismatch was associated with mortality in men, but after adjustment PPM was not associated with survival in either sex.
Methodological Strengths
- Very large international registry with 5-year outcomes and standardized hemodynamic definitions (VARC-3).
- Multivariable and logistic regression analyses to identify predictors and adjust confounders.
Limitations
- Observational design with potential residual confounding and selection biases.
- Device-era and practice pattern heterogeneity across centers may influence findings.
Future Directions: Prospective studies to test sex-tailored TAVR strategies (valve selection, sizing, access) and to integrate frailty and low-flow states into risk models.