Weekly Cardiology Research Analysis
This week’s cardiology literature highlights advances across device innovation, cardiometabolic therapeutics, and cross-disciplinary risk modification. A randomized trial of a fully biodegradable PFO closure device demonstrated noninferior closure with echocardiographic disappearance by 24 months. Individual participant-level evidence consolidated broad kidney protection by empagliflozin across eGFR-dip profiles, and a phase-3 CETP inhibitor substudy (obicetrapib) revealed unexpected attenuation
Summary
This week’s cardiology literature highlights advances across device innovation, cardiometabolic therapeutics, and cross-disciplinary risk modification. A randomized trial of a fully biodegradable PFO closure device demonstrated noninferior closure with echocardiographic disappearance by 24 months. Individual participant-level evidence consolidated broad kidney protection by empagliflozin across eGFR-dip profiles, and a phase-3 CETP inhibitor substudy (obicetrapib) revealed unexpected attenuation of Alzheimer’s biomarkers in ASCVD patients—most pronounced in APOE4 carriers—suggesting lipid-targeted interventions may intersect neurodegeneration risk management.
Selected Articles
1. Transcatheter Closure of Patent Foramen Ovale With a Novel Biodegradable Device: A Prospective, Multicenter, Randomized Controlled Clinical Trial.
In a multicenter randomized noninferiority trial (n=190), a fully biodegradable PFO closure device achieved comparable 6-month closure rates to a nitinol device (90.6% vs 91.5%) without device-related thrombosis or erosion; the device’s echocardiographic signal diminished within a year and disappeared by 24 months.
Impact: First randomized head-to-head evidence that a biodegradable structural heart device can match standard nitinol devices on efficacy and safety while eliminating long-term foreign material, representing a potential paradigm shift for structural interventions.
Clinical Implications: May enable selection of PFO closure devices that avoid permanent implants, reduce late imaging artefacts and theoretical long-term device risks; procedural vigilance remains necessary for rare intraprocedural device deformation.
Key Findings
- 6-month closure success: 90.63% (biodegradable) vs 91.49% (nitinol); noninferiority margin met.
- No deaths, device thrombosis, embolism, or erosion observed during follow-up.
- Echocardiographic signal of biodegradable device diminished within 1 year and disappeared by 24 months.
2. Effects of empagliflozin on conventional and exploratory acute and chronic kidney outcomes: an individual participant-level meta-analysis.
An IPD meta-analysis of four randomized trials (n=23,340) found empagliflozin reduced AKI markers and events (~20–27%), lowered CKD progression by ~30%, reduced kidney failure by ~34%, and markedly slowed chronic eGFR decline; benefits were consistent regardless of acute eGFR dip size or comorbidity profile.
Impact: Resolves a major implementation concern by showing renoprotective effects of empagliflozin are robust despite initial eGFR dips and across diverse cardiometabolic contexts, strengthening rationale for broader use.
Clinical Implications: Supports initiating empagliflozin in CKD and cardiometabolic patients without withholding for expected acute eGFR dips; reinforces SGLT2i benefits for AKI prevention, CKD progression slowing, and kidney-failure risk reduction.
Key Findings
- AKI marker events reduced by ~20% and AKI adverse events by ~27% vs placebo.
- CKD progression lowered ~30% and kidney failure reduced ~34%.
- Chronic eGFR decline slowed substantially (~64% relative change) and effects were consistent irrespective of acute eGFR dip size, diabetes/HF status, primary kidney disease, or albuminuria.
3. Effect of obicetrapib, a potent cholesteryl ester transfer protein inhibitor, on p-tau217 levels in patients with cardiovascular disease.
A prespecified substudy of the phase-3 BROADWAY trial (n=1535 ASCVD participants) reported that obicetrapib significantly attenuated 12-month increases in plasma p-tau217 and related AD biomarkers, with the largest biomarker reductions in APOE4 carriers and APOE4/E4 individuals, suggesting CETP inhibition may modulate Alzheimer’s-related pathology in a cardiology population.
Impact: First demonstration in a cardiovascular trial population that an oral CETP inhibitor can reduce amyloid- and tau-related plasma biomarkers—particularly in APOE4 carriers—bridging lipid pharmacology and neurodegeneration prevention strategies.
Clinical Implications: Not yet practice-changing, but supports biomarker-directed prevention trials and consideration of APOE genotype–stratified approaches; clinicians should monitor for forthcoming outcome trials to determine cognitive benefit.
Key Findings
- Obicetrapib attenuated 12-month p-tau217 increases vs placebo (adjusted mean 2.09% vs 4.94%; P=0.025).
- APOE4/E4 participants had a placebo-adjusted 20.48% treatment difference in p-tau217 (7.81% decrease vs 12.67% increase; P=0.010).
- Secondary biomarkers (p-tau217/Aβ42:40, GFAP, NfL) showed consistent positive trends and correlated with drug exposure (r = -0.64).