Weekly Cardiology Research Analysis
This week’s cardiology literature was dominated by high-quality randomized and translational work: finerenone showed a statistically significant reduction in new-onset diabetes in HFpEF/HFmrEF, biomarker-driven subphenotyping of cardiogenic shock revealed reproducible molecular classes that improve prognostication and suggest treatment heterogeneity, and an individual-patient pooled analysis clarified time-dependent risks of first-generation bioresorbable vascular scaffolds with excess early eve
Summary
This week’s cardiology literature was dominated by high-quality randomized and translational work: finerenone showed a statistically significant reduction in new-onset diabetes in HFpEF/HFmrEF, biomarker-driven subphenotyping of cardiogenic shock revealed reproducible molecular classes that improve prognostication and suggest treatment heterogeneity, and an individual-patient pooled analysis clarified time-dependent risks of first-generation bioresorbable vascular scaffolds with excess early events resolving after bioresorption. Across studies, AI-enabled imaging/ECG, digital monitoring, and long-term device durability emerged as actionable themes with near-term clinical implications.
Selected Articles
1. Finerenone and new-onset diabetes in heart failure: a prespecified analysis of the FINEARTS-HF trial.
In a prespecified analysis of FINEARTS-HF (non-diabetic subset n=3,222; median follow-up 31.3 months), finerenone reduced the hazard of new-onset diabetes by 24% versus placebo (HR 0.76; 95% CI 0.59–0.97), confirmed in competing-risk and sensitivity analyses, indicating a meaningful metabolic benefit in HFpEF/HFmrEF.
Impact: High-quality randomized evidence linking HF pharmacotherapy to diabetes prevention bridges cardiology and metabolic care and may influence drug selection in HFpEF/HFmrEF.
Clinical Implications: Consider finerenone when metabolic risk is a concern in HFpEF/HFmrEF patients without diabetes, while monitoring potassium and renal function per established protocols; its metabolic benefit supports broader consideration alongside HF endpoints.
Key Findings
- New-onset diabetes: 7.2% (finerenone) vs 9.1% (placebo) over median 31.3 months (HR 0.76; p=0.026).
- Benefit persisted in competing risk (death) analyses and multiple sensitivity definitions of diabetes.
- Population: non-diabetic subset n=3,222 from a larger randomized double-blind placebo-controlled trial (total n=6,001).
2. Identifying biomarker-driven subphenotypes of cardiogenic shock: analysis of prospective cohorts and randomized controlled trials.
Unsupervised clustering of plasma biomarkers across two prospective cohorts identified four reproducible cardiogenic shock subphenotypes (adaptive, non‑inflammatory, cardiopathic, inflammatory). The inflammatory and cardiopathic classes had the highest 28‑day mortality and subphenotype membership improved prognostic discrimination beyond SCAI staging; application to three RCTs suggested potential heterogeneity of treatment effect.
Impact: Operationalizes precision cardiology in shock by linking molecular phenotypes to outcomes and potential differential treatment effects—critical for trial design and personalized therapy.
Clinical Implications: Refine prognostication and trial stratification using subphenotype assignment; future phenotype‑guided trials may identify targeted therapeutic strategies for high‑risk inflammatory or cardiopathic patients.
Key Findings
- Four biomarker-defined subphenotypes were reproducible across cohorts.
- Inflammatory and cardiopathic subtypes had significantly higher 28‑day mortality and improved Harrell’s C-index beyond SCAI stages.
- A simplified classifier enabled assignment in three RCTs to explore treatment heterogeneity.
3. Early and Late Outcomes With the Absorb Bioresorbable Vascular Scaffold: Final Report From the ABSORB Clinical Trial Program.
Individual patient data pooled from five randomized trials (n=5,988) showed that Absorb bioresorbable vascular scaffold had higher target lesion failure and device thrombosis through 0–3 years, but no excess risk between 3–5 years; spline analyses suggest hazards dissipate after scaffold resorption, clarifying time‑dependent safety of first‑generation BVS.
Impact: Resolves a central controversy about BVS by demonstrating that excess events are concentrated in the pre‑resorption period, informing next‑generation scaffold development and follow-up/antithrombotic strategies.
Clinical Implications: Current practice should favor contemporary DES over first‑generation BVS, but findings support development of next‑generation resorbable scaffolds if early hazards can be mitigated; tailor antithrombotic and imaging surveillance to the bioresorption timeline.
Key Findings
- TLF higher with BVS versus EES through 0–5 years overall (15.9% vs 13.1%; HR 1.25).
- Device thrombosis markedly higher 0–3 years with BVS (2.0% vs 0.6%; HR 3.58) but not after resorption (3–5 years HR ~0.49 numerically).
- Time-varying analyses indicate excess risk is concentrated before scaffold bioresorption.