Cardiology Research Analysis
June’s cardiology literature converged on physiology-guided care, scalable AI diagnostics, and combination cardiorenal therapy. A national-scale dynamic model for PCI bleeding risk, a multicenter wearable-AI method to noninvasively estimate PCWP, and comprehensive AI echocardiography signal practical, near-term workflow changes. Simultaneous MR antagonism with SGLT2 inhibition (CONFIDENCE) and robust weight loss with a GLP‑1/glucagon dual agonist (mazdutide) highlight therapeutic advances with p
Summary
June’s cardiology literature converged on physiology-guided care, scalable AI diagnostics, and combination cardiorenal therapy. A national-scale dynamic model for PCI bleeding risk, a multicenter wearable-AI method to noninvasively estimate PCWP, and comprehensive AI echocardiography signal practical, near-term workflow changes. Simultaneous MR antagonism with SGLT2 inhibition (CONFIDENCE) and robust weight loss with a GLP‑1/glucagon dual agonist (mazdutide) highlight therapeutic advances with potential downstream cardiovascular benefit. Long-term randomized data for PET‑CFC–guided care (CENTURY) reinforce selective revascularization alongside intensified lifestyle and medical therapy.
Selected Articles
1. Towards a dynamic model to estimate evolving risk of major bleeding after percutaneous coronary intervention.
Using 2.87 million index PCIs from the NCDR CathPCI registry, tree-based machine learning models were trained to update bleeding risk at procedural decision points (access site, pre-PCI medications, closure device). Dynamic models improved AUROC from 0.812 (presentation-only) to 0.845 (all variables) and reclassified small subgroups into substantially higher-risk categories that static models would miss.
Impact: Operationalizes dynamic, point-of-care risk prediction at scale for PCI, demonstrating measurable gains over static tools and highlighting actionable reclassification at operator decision points.
Clinical Implications: Integrate dynamic bleeding risk updates into PCI workflows to inform access strategy, antithrombotic choices, and closure device selection; prioritize prospective implementation with clinician-facing decision support and monitoring for calibration drift.
Key Findings
- Training/validation on 2,868,808 index PCIs improved AUROC from 0.812 (presentation variables) to 0.845 (all variables).
- Dynamic reclassification identified small groups initially labeled low-risk who converted to moderate/high risk with substantially higher observed bleed rates (e.g., 12.5% in reclassified high-risk).
- Models aligned with procedural decision points (access site, pre-PCI meds, closure), enabling real-time guidance.
2. Noninvasive Pulmonary Capillary Wedge Pressure Estimation in Heart Failure Patients With the Use of Wearable Sensing and AI.
A multicenter prospective diagnostic study (n=310 HFrEF) evaluated a wearable that combines ECG, seismocardiography, and PPG with machine learning to estimate PCWP versus right heart catheterization. In the held-out test set, the model yielded an error of 1.04 ± 5.57 mmHg with limits of agreement −9.9 to 11.9 mmHg and consistent performance across sex, race, and BMI.
Impact: Shows clinically relevant accuracy for a noninvasive, scalable PCWP estimation method that could democratize hemodynamics-guided HF care without implants.
Clinical Implications: If validated in ambulatory/home settings and linked to outcome-directed titration algorithms, wearable PCWP could broaden hemodynamics-guided therapy adjustments and earlier decompensation detection, reducing hospitalizations.
Key Findings
- Multimodal wearable signals (ECG, SCG, PPG) with ML estimated PCWP versus RHC with an error of 1.04 ± 5.57 mmHg.
- Limits of agreement −9.9 to 11.9 mmHg; consistent performance across sex, race/ethnicity, and BMI categories.
- Prospective multicenter design with blinded core-lab adjudication and held-out testing supports methodological rigor.
3. Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes.
CONFIDENCE, a randomized trial, found that initial combination therapy with finerenone plus empagliflozin produced a 29–32% greater reduction in urinary albumin-to-creatinine ratio at 180 days compared with either agent alone among patients with CKD and type 2 diabetes, without new safety signals.
Impact: High-quality randomized evidence supporting simultaneous MR antagonism and SGLT2 inhibition to achieve superior antiproteinuric effects, potentially altering cardiorenal therapy sequencing.
Clinical Implications: Consider earlier initiation of finerenone plus an SGLT2 inhibitor in CKD with T2D to maximize antiproteinuric effect, with monitoring for hyperkalemia and renal function; hard-outcome data remain needed.
Key Findings
- Greater UACR reduction at day 180 vs finerenone alone (LS mean ratio 0.71; 95% CI 0.61–0.82).
- Greater UACR reduction at day 180 vs empagliflozin alone (LS mean ratio 0.68; 95% CI 0.59–0.79).
- No unexpected safety signals; hypotension, AKI, and hyperkalemia-related discontinuation were uncommon.
4. Once-Weekly Mazdutide in Chinese Adults with Obesity or Overweight.
A phase-3, double-blind randomized trial in 610 adults showed once-weekly mazdutide 4 mg and 6 mg produced mean weight reductions of −11.0% and −14.0% at 48 weeks, with broad cardiometabolic improvements and mainly mild-to-moderate gastrointestinal adverse events.
Impact: Demonstrates robust weight loss with a GLP‑1/glucagon dual agonist and cardiometabolic benefits that may translate into long-term CV risk reduction.
Clinical Implications: Mazdutide expands options for obesity management within cardiometabolic care; clinicians should monitor GI tolerability and await long-term CV outcome data for integration into practice.
Key Findings
- Mean weight change at 48 weeks: −11.00% (4 mg) and −14.01% (6 mg) vs +0.30% with placebo.
- High proportions achieved ≥5% and ≥15% weight loss; broad improvements in cardiometabolic measures.
- Adverse events predominantly mild-to-moderate GI symptoms with low discontinuation.
5. Optimal medical care and coronary flow capacity-guided myocardial revascularization vs usual care for chronic coronary artery disease: the CENTURY trial.
A randomized trial (n=1,028) comparing an integrated program (intensive lifestyle, goal-directed medical therapy, PET-derived coronary flow capacity to triage revascularization) vs usual care showed reduced 11-year all-cause death, death or MI, late revascularization, and MACE.
Impact: Provides long-term randomized evidence that physiology-guided comprehensive care with selective revascularization improves hard outcomes in chronic CAD.
Clinical Implications: Supports incorporating PET‑CFC into care pathways to prioritize aggressive lifestyle/medical therapy and reserve revascularization for severe physiologic impairment.
Key Findings
- Reduced 11-year all-cause mortality (4.7% vs 8.2%) and death/MI (7.0% vs 11.1%) with the comprehensive program.
- Lower late revascularization and MACE; early revascularization uncommon (5.4%).
- Intervention combined intensified lifestyle, goal-directed therapy, frequent follow-up, and PET‑CFC-guided selective revascularization.