Daily Cardiology Research Analysis

INTRODUCTION: Sodium-glucose cotransporter-2 (SGLT2) inhibitors have shown significant reduction in cardiovascular mortality and heart failure hospitalization in patients with chronic heart failure. Despite their benefits in chronic heart failure, their use during episodes of acute decompensation remains under investigation. METHODS: A comprehensive literature search was performed using PubMed, Google Scholar, and ClinicalTrials.gov from database inception through September 3, 2025. The predefined endpoints were all-cause mortality, heart failure hospitalizations, and a composite of cardiovascular mortality or heart failure worsening. Outcomes were pooled using a random effects Mantel-Haenszel model. The DerSimonian and Laird method was used for estimation of τ RESULTS: A total of eight randomized controlled trials, encompassing 4,714 patients, were included in the analysis. Among patients hospitalized with decompensated heart failure, treatment with SGLT2 inhibitors compared with standard care only (control group) was associated with a significant decrease in all-cause mortality (RR 0.72; 95% CI, 0.58-0.90; P < 0.01; I² = 0%), and in the composite outcome of cardiovascular mortality or heart failure rehospitalization (RR 0.68; 95% CI, 0.53-0.86; P < 0.01; I² = 28%). However, no significant reduction was observed in heart failure rehospitalization as an isolated outcome (RR 0.92; 95% CI, 0.82-1.03; P = 0.16; I² = 0%). CONCLUSION: SGLT-2 inhibitors during hospitalization for acute decompensated heart failure is effective and led to decrease in all-cause mortality and a composite endpoint of cardiovascular mortality or heart failure hospitalizations.

BACKGROUND: Data on very long-term bioprosthesis durability after transcatheter aortic valve implantation (TAVI) are lacking. We sought to assess bioprosthetic valve durability beyond 10 years following TAVI with balloon-expandable valves. METHODS: We analyzed the data of a prospective single-center registry including consecutive patients undergoing TAVI with first-, second-, and third-generation balloon-expandable valves between 2007 and 2015 alive at one-year. The primary outcome was the valve-related long-term clinical efficacy according to VARC-3 consensus. Death was treated as a competing risk. RESULTS: Among the 431 patients included, the median follow-up was 5 years (interquartile range 3-8 years) for the overall population, and 10 years (interquartile range 8-12 years) for the survived patients, with the longest follow-up reaching 15 years. The overall 10-year mortality rate was 87%. At 10 years, the cumulative incidence of the composite endpoint of valve-related long-term clinical efficacy (bioprosthetic valve failure, stroke and bleeding secondary to antithrombotic used for valve-related concerns) was 29%. Conversely, 71% remained free from the composite outcome after accounting for death as a competing risk. The cumulative incidence of moderate or severe HVD was 17%. The independent factors associated with moderate or severe HVD were age (subdistribution hazard ratio (sHR) 0.96, confidence interval (CI) 95% 0.94-0.99, p=0.009), severe patient-prosthesis mismatch (sHR 5.26, 95% CI 1.44-19.2, p = 0.012), and the absence of anticoagulant therapy at discharge (sHR 1.96, CI 95% 1.12-3.45, p=0.018). Bioprosthetic valve failure occurred in 9.1% of the population, and aortic valve reintervention in 4.4%. Echocardiographic parameters of bioprosthesis hemodynamic performance showed a slight progressive deterioration over time, with an increase in mean transaortic gradient (+0.54 mmHg/year, 95% CI 0.44-0.65) and a corresponding decrease in effective orifice area (-0.016 cm CONCLUSIONS: These findings provide reassuring evidence supporting the very long-term durability of balloon-expandable valves after TAVI, although some signs of HVD were observed in about one fifth of patients. The protective effects of anticoagulation therapy on valve durability need further evaluation.

BACKGROUND: Patients with chronic coronary syndrome (CCS) often require long-term oral anticoagulation (OAC), most commonly for atrial fibrillation (AF). Evidence on the optimal antithrombotic strategy in this setting remains inconclusive, prompting this updated meta-analysis of randomized trials comparing OAC plus a single antiplatelet therapy (SAPT) with OAC monotherapy. METHODS: We systematically searched PubMed/MEDLINE, SciELO, Latindex, LILACS, the Cochrane Library, and ClinicalTrials.gov up to November 12, 2025. The primary efficacy endpoint was all-cause death, while secondary efficacy endpoints included cardiovascular death, acute myocardial infarction, ischemic stroke, and systemic embolism, each analyzed individually. Safety endpoints comprised major and clinically relevant non-major bleeding (International Society on Thrombosis and Hemostasis [ISTH] definition). RESULTS: Six randomized trials including 5,924 participants were analyzed. All-cause death did not differ significantly between OAC plus SAPT and OAC monotherapy (OR 1.31; 95%CI 0.89-1.92). Dual therapy was associated with an increased risk of cardiovascular death (OR 1.42; 95%CI 1.05-1.92), whereas rates of myocardial infarction (OR 0.98; 95%CI 0.60-1.57), ischemic stroke (OR 0.95; 95%CI 0.64-1.39), and systemic embolism (OR 1.00; 95%CI 0.20-4.95) were similar between groups. Safety outcomes were markedly worse with dual therapy, which significantly increased the risk of major bleeding (OR 2.20; 95%CI 1.51-3.22) and major or clinically relevant non-major bleeding (OR 2.30; 95%CI 1.72-3.06). CONCLUSIONS: In patients with CCS requiring long-term OAC, dual therapy (OAC plus SAPT) did not reduce all-cause death nor ischemic events compared with OAC alone but significantly increased major bleeding and cardiovascular death. PROSPERO Registration No.: CRD420251239917.