Cardiology Research Analysis
May 2025 cardiology research featured randomized interventional evidence, pragmatic diagnostic protocol upgrades, and translational gene therapy. Extended head-to-carina CTA in acute stroke quintupled cardioaortic thrombus detection without delaying workflow, while epicardial substrate ablation reduced ventricular fibrillation in symptomatic Brugada syndrome. Finerenone’s benefit extended to heart failure with improved ejection fraction, supporting continued neurohormonal therapy after EF recove
Summary
May 2025 cardiology research featured randomized interventional evidence, pragmatic diagnostic protocol upgrades, and translational gene therapy. Extended head-to-carina CTA in acute stroke quintupled cardioaortic thrombus detection without delaying workflow, while epicardial substrate ablation reduced ventricular fibrillation in symptomatic Brugada syndrome. Finerenone’s benefit extended to heart failure with improved ejection fraction, supporting continued neurohormonal therapy after EF recovery. A PASMC-tropic AAV demonstrated prevention and reversal of PAH in rodents, and the first multicenter blinded RCT of FMT for hypertension showed safety but only transient BP effects, refocusing microbiome therapeutics toward defined consortia.
Selected Articles
1. Extended CT angiography versus standard CT angiography for the detection of cardioaortic thrombus in patients with ischaemic stroke and transient ischaemic attack (DAYLIGHT): a prospective, randomised, open-label, blinded end-point trial.
In acute code-stroke pathways, extending head-to-carina CTA at least 6 cm below the carina quintupled detection of cardioaortic thrombi (8.8% vs 1.7%) without delaying imaging completion, suggesting an immediately actionable protocol change to enable earlier anticoagulation decisions.
Impact: Demonstrates a low-friction imaging modification with high diagnostic yield and no workflow penalty, directly impacting secondary prevention of cardioembolism.
Clinical Implications: Stroke centers should consider adopting extended head-to-carina CTA to improve detection of cardioaortic thrombi and expedite anticoagulation decisions; formal outcome and cost-effectiveness evaluations are warranted.
Key Findings
- Extended CTA detected cardioaortic thrombus in 8.8% vs 1.7% (OR 5.70; p=0.002).
- No significant delay in time to CTA completion (median 21.0 vs 20.0 minutes; p=0.67).
- Prospective randomized design with blinded end-point assessment.
2. Fecal microbiota transplantation for hypertension: an exploratory, multicenter, randomized, blinded, placebo-controlled trial.
The first multicenter, double-blind RCT of oral FMT for hypertension (n=124) showed safety but no sustained BP reduction at 30 days, with an early week-1 SBP drop that waned; multi-omics revealed reproducible microbiome-metabolome shifts associated with BP changes.
Impact: Provides blinded randomized safety data and mechanistic insight that redirects development toward defined microbial consortia and metabolite-targeted strategies rather than whole-FMT.
Clinical Implications: Whole-FMT should not be adopted for routine BP control; future trials should enrich responders using baseline microbiome/metabolome signatures and test defined microbial therapeutics.
Key Findings
- Primary endpoint neutral at day 30 (office SBP change 6.28 vs 5.77 mmHg; p=0.62).
- Week-1 SBP reduction favored FMT by −4.34 mmHg (p=0.024) but was not sustained.
- Safety similar to placebo; taxa and metabolite shifts correlated with BP.
3. Brugada Syndrome Ablation for the Prevention of Ventricular Fibrillation Episodes (BRAVE).
A multicenter randomized trial in symptomatic Brugada syndrome with ICDs showed epicardial substrate ablation significantly reduced ventricular fibrillation over three years (HR 0.288), with high VF-free survival and low complications.
Impact: First randomized evidence that substrate-guided epicardial ablation reduces VF in Brugada syndrome, potentially shifting practice beyond ICD-only strategies.
Clinical Implications: Consider early referral to centers with epicardial expertise for mapping and ablation in symptomatic Brugada with recurrent VF or shocks; integrate ablation into shared decision-making alongside ICD therapy.
Key Findings
- Ablation reduced VF events vs control over 3 years (HR 0.288; P=0.0184).
- VF-free survival: 83% after single procedure; 90% after repeat ablation.
- Low complication rate (one hemopericardium without sequelae).
4. Finerenone in Heart Failure With Improved Ejection Fraction: The FINEARTS-HF Randomized Clinical Trial.
A prespecified subgroup analysis of FINEARTS-HF found finerenone reduced cardiovascular death and total worsening HF events consistently in patients with and without prior HFrEF; absolute risk reduction was larger in HFimpEF due to higher crude event rates.
Impact: Extends randomized benefit of an MRA to HFimpEF, informing ongoing therapy decisions after EF recovery in a growing clinical phenotype.
Clinical Implications: Clinicians should consider continuing or initiating finerenone in HFimpEF while monitoring for hypotension; guideline refinements for HFimpEF management may be warranted.
Key Findings
- Among 6001 patients with EF ≥40%, 273 had prior EF <40% (HFimpEF).
- Finerenone reduced CV death and total worsening HF events consistently across HFimpEF and non-HFimpEF (no interaction).
- Absolute risk reduction larger in HFimpEF (9.2 vs 2.5 per 100 patient-years); hypotension more frequent in HFimpEF.
5. A highly mobile adeno-associated virus targeting vascular smooth muscle cells for the treatment of pulmonary arterial hypertension.
Directed evolution produced a PASMC-tropic, highly mobile AAV enabling airway-to-vascular delivery; intratracheal FGF12 transgene delivery prevented PAH in mice and reversed established PAH in rats, demonstrating in vivo disease-modifying potential.
Impact: Addresses a key translational barrier by enabling cell-specific airway delivery to PASMCs and showing prevention and reversal of PAH in vivo across species.
Clinical Implications: If safety, biodistribution, and durability translate to large animals and humans, intratracheal PASMC-targeted AAV could shift PAH therapy from vasodilation to molecular correction of vascular remodeling.
Key Findings
- AAV variant with PASMC tropism and airway-to-vascular mobility via directed evolution.
- Intratracheal AAV-FGF12 prevented PAH in mice and reversed established PAH in rats.
- Demonstrated target-cell specificity and clinically feasible delivery route.