MD #cardiologo / #cardiologist at Hospital Marina Salud (Denia). Cardiology, learning & sharing! Interest in #Cardiomyopathies #Echofirst #FOAMed ❤️
Denia-Lima-Roma 🇪🇸🇵🇪🇮🇹
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🧩 HELIOS-B:
Vutrisiran’s treatment effect showed no significant interaction with baseline tafamidis use (Pinteraction=0.55). Reassuring consistency—but subgroup data do not prove that routine silencer + stabiliser combination is superior. esc365.escardio.org/presenta… #ESCCongress
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⏳ MAVA-LTE:
up to 5 years of mavacamten → sustained ↓LVOT gradients (−38.7 mmHg resting; −55.6 mmHg Valsalva); 97.4% reached Valsalva gradient ≤30 mmHg and 69.6% improved ≥1 NYHA class. Durable benefit, with continued LVEF monitoring. esc365.escardio.org/presenta… #ESCCongress
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🤖 One AI model, three tasks: automated HCM detection, phenotyping & LVOT gradient estimation from routine echo videos, with multinational external validation. Echo is moving → from visual interpretation to scalable quantitative phenotyping. esc365.escardio.org/presenta… #ESCCongress
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🫀 Do TTR silencers improve ATTR-CM outcomes—and does tafamidis matter? 🧵1/5
This JAMA meta-analysis of HELIOS-B + CARDIO-TTRansform (n=2,086) found benefit overall, but a crucial treatment interaction.
jamanetwork.com/journals/jam…
#ESCCongress #Amyloidosis #ATTR #CardioEd
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🧵4/5
Earlier disease may matter: benefit was greater at NT-proBNP ≤2,000 vs >2,000 pg/mL (interaction P=.007).
But only 2 trials were pooled, CV-event definitions differed, and subgroup analyses were not powered for combination therapy.
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🧵5/5
What the meta-analysis proves—and what it does not
Proven: silencing works.
Unproven: routine incremental benefit over tafamidis.
Unknown: deeper silencing or genome editing.
#ESCCongress
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🧵1/5 🫀 Can treating severe TR change prognosis—not just symptoms?
TRIC-I-HF randomized 360 high-risk patients: transcatheter repair + medical therapy improved the hierarchical outcome and reduced death/HF hospitalization.
doi.org/10.1056/NEJMoa260693…
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🧵4/5 The effect was not merely a QoL-driven win ratio: hierarchical win ratio 2.42 (95% CI 1.76–3.33), with more wins for death, HF hospitalization, & ≥15-point KCCQ improvement.
At 1 year, KCCQ improved by 11.2 vs 4.3 points.
Less TR, better functional status.
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🧵5/5 Practice-changing—for carefully selected patients at experienced centers.
⚠️ Open-label; anatomy preselected; 48/123 controls crossed over; only 20.5% reached 3 years. The 1-year signal is compelling; the apparent late mortality benefit needs maturation. #ESCCongress
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🔴“TAVI First: A New Sequencing Option”
🧵1/4 Which comes first in severe AS + CAD: TAVI or PCI? In TAVI PCI, TAVI-first was noninferior at 1 year: 22.2% vs 24.2% (RD −2.0%; 95% CI −7.4 to 3.4). A new option—not proof of superiority.
doi.org/10.1056/NEJMoa260692…
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🧵3/4 No efficacy signal separated the strategies:
Death 9.5% vs 9.5%;
MI 3.2% vs 3.8%;
Ischemia-driven revascularization 1.4% vs 2.1%.
Major bleeding was 6.6% vs 9.7% (RD −3.1%; 95% CI −6.8 to 0.5)—suggestive, not confirmatory.
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🧵4/4 Practice impact: timing can be individualized when both TAVI and PCI are planned.
Strength: randomized direct comparison.
Caveats: mITT noninferiority, broad composite, low SYNTAX score (median 10), 95% balloon-expandable valves, and no complex CAD. #ESCCongress
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