Weekly Cardiology Research Analysis
This week’s cardiology literature highlights practical diagnostic refinements, novel translational mechanisms, and an extension of therapeutic benefit into a previously understudied HF phenotype. A randomized acute-stroke imaging trial showed that extending CTA below the carina markedly increases detection of cardioaortic thrombi without delaying workflow. The first multicenter blinded randomized trial of fecal microbiota transplantation for hypertension demonstrated safety and short-lived BP ef
Summary
This week’s cardiology literature highlights practical diagnostic refinements, novel translational mechanisms, and an extension of therapeutic benefit into a previously understudied HF phenotype. A randomized acute-stroke imaging trial showed that extending CTA below the carina markedly increases detection of cardioaortic thrombi without delaying workflow. The first multicenter blinded randomized trial of fecal microbiota transplantation for hypertension demonstrated safety and short-lived BP effects alongside reproducible microbiome–metabolome shifts. A prespecified analysis of FINEARTS‑HF indicates finerenone reduces cardiovascular events even in patients with heart failure and improved ejection fraction, supporting continued neurohormonal modulation after EF recovery.
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 this randomized DAYLIGHT trial of acute code-stroke patients, extending head‑to‑neck CTA at least 6 cm below the carina quintupled detection of cardioaortic thrombi (8.8% vs 1.7%) without meaningful delay in imaging completion times, suggesting a feasible change to acute stroke imaging protocols that could enable earlier anticoagulation decisions.
Impact: Demonstrates a simple, pragmatic imaging modification that substantially increases detection of actionable cardioaortic thrombi without workflow penalty — potentially changing acute stroke evaluation and secondary prevention pathways.
Clinical Implications: Consider adoption of extended head-to-carina CTA in acute stroke protocols to improve identification of cardioaortic thrombi and facilitate prompt anticoagulation decision-making; multicenter outcome and cost-effectiveness studies are the next step.
Key Findings
- Extended CTA detected cardioaortic thrombus in 8.8% vs 1.7% with standard CTA (OR 5.70; p=0.002).
- No significant delay in time to CTA completion (median 21.0 vs 20.0 minutes; p=0.67).
2. Fecal microbiota transplantation for hypertension: an exploratory, multicenter, randomized, blinded, placebo-controlled trial.
This first multicenter, double-blind RCT of oral FMT for hypertension (n=124) found the intervention to be safe but did not produce a sustained reduction in office systolic blood pressure at 30 days versus placebo; an early 1‑week SBP lowering was observed but waned. Multi-omics analyses identified reproducible taxa and metabolite shifts associated with BP changes, guiding future targeted microbial therapeutics.
Impact: Establishes safety and mechanism-level microbiome–metabolome correlates in a blinded RCT, reframing future microbial therapeutics toward defined consortia and metabolite-targeting strategies rather than whole-FMT for BP control.
Clinical Implications: Do not adopt whole-FMT for routine BP control; prioritize development and testing of defined microbial consortia or metabolite-targeted interventions, and use baseline microbiome/metabolome signatures to enrich responders in future trials.
Key Findings
- Primary endpoint neutral: mean office SBP change at day 30 similar (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 comparable to placebo; distinct taxa and metabolite shifts correlated with SBP.
3. Finerenone in Heart Failure With Improved Ejection Fraction: The FINEARTS-HF Randomized Clinical Trial.
A prespecified subgroup analysis within FINEARTS‑HF (n=6001 overall; 273 with prior EF <40%) shows finerenone reduced the composite of cardiovascular death and total worsening HF events consistently across patients with and without prior HFrEF. Because HFimpEF carried higher crude event rates, the absolute risk reduction with finerenone was larger in this subgroup, supporting continuation/ initiation of MRA therapy after EF recovery.
Impact: Extends high-quality randomized evidence for MRA (finerenone) benefit into HFimpEF, a clinically important and growing cohort often considered at lower ongoing risk after EF recovery; this supports therapeutic continuity beyond EF normalization.
Clinical Implications: In patients with prior HFrEF whose EF has improved, clinicians should consider continuing or initiating finerenone to reduce CV death and HF events while monitoring for hypotension; guideline alignment for HFimpEF management may be warranted.
Key Findings
- Among 6001 patients with EF ≥40%, 273 had prior EF <40% (HFimpEF); unadjusted event rates were higher in HFimpEF but adjusted risk similar.
- Finerenone reduced the composite of CV death and total worsening HF events consistently across HFimpEF and non-HFimpEF (no significant interaction).
- Absolute risk reduction was larger in HFimpEF (9.2 vs 2.5 per 100 patient‑years); hypotension was more common in HFimpEF with finerenone.