cardio Roland

Rare clinical presentations remind us how important careful diagnostic evaluation and multimodality imaging are in cardiology. This case report highlights the complexity of recognizing uncommon cardiac conditions and the value of a multidisciplinary approach. Published in European Heart Journal – Case Reports: ow.ly/rV5w50Ytfw5 #CardioTwitter #Cardiology #CardiacImaging #CaseReport #EHJCR #MedTwitter #EHJCaseReports @Phiso_de @TJ_Yeo @aayshacader @BoldiKovacsMD @SukritiBanthiya @ANazmiCalik @O_Azizy_MD @saramoscatelli7 @EHJCREiC #CardioX

Fluid restriction in patients with heart failure: a systematic review Studies on fluid restriction in patients with HF are scarce, and most of the available studies are at high risk of bias. Although power is lacking, there is no evidence indicating that fluid restriction affects mortality or HF hospitalisations, but there is a signal of harm in terms of thirst distress #Cardiology #MedTwitter #CardioTwitter #HeartHealth #Healthcare @mvaduganathan @HFA_President @hfcollaboratory @DrMarthaGulati @hvanspall @dranulala @dranulala @SJGreene_md @gcfmd heart.bmj.com/content/early/…

Fluid restriction in patients with heart failure: a systematic review heart.bmj.com/content/early/…

A Bayesian analysis of finerenone in heart failure with mildly reduced and preserved ejection fraction: a pre-specified analysis of FINEARTS-HF The non-steroidal MRA finerenone reduced the rate of cardiovascular death and total heart failure events under both frequentist and Bayesian inference methods. The probability of benefit exceeded 80% for both cardiovascular and all-cause mortality with finerenone #Cardiology #MedTwitter #CardioTwitter #HeartHealth #Healthcare @mvaduganathan @hfcollaboratory @gcfmd @ESC_Journals @escardio @ShelleyZieroth @AndrewJSauer @safchat academic.oup.com/ehjcvp/advance…

After the two recent meta-analyses published in The Lancet and NEJM, one could argue that the case is settled: following myocardial infarction, beta-blockers should be prescribed to patients with an LVEF <40%, may be considered in those with an LVEF of 40–49%, and in patients with an LVEF ≥50% only if there are other indications, such as hypertension, atrial fibrillation, or heart failure. The guidelines are partially misaligned with the emerging evidence and will most likely be updated in the near future.

ENCORE: One of JACC Heart Failure @JACCJournals most-read papers of 2025 — and the timing couldn’t be better. If you care about heart failure outcomes and the aldosterone–mineralocorticoid receptor axis, this state-of-the-art review is worth a spot on your reading list. Why now? We’re at an inflection point in the MRA space. Traditional steroidal MRAs (spironolactone/eplerenone) remain foundational in HFrEF with Class I, Level A evidence, yet real-world use is still strikingly low, often driven by concerns about hyperkalemia, kidney function, and endocrine side effects. Meanwhile, the evidence base for nonsteroidal MRAs (nsMRAs) has matured fast, especially for patients who live at the intersection of HFpEF/HFmrEF, CKD, and diabetes. What this review does: Clarifies the “why” behind class differences: nsMRAs lack a steroid nucleus and have different receptor selectivity, PK/PD, and heart–kidney tissue distribution, which may translate into a distinct efficacy/safety signature. Synthesizes the clinical trial landscape: from the established HFrEF benefit of sMRAs to the more mixed HFpEF story (including the well-known TOPCAT regional issues), and then the expanding outcomes data for nsMRAs. Frames what’s next (and what we still don’t know): head-to-head outcomes comparisons remain limited, and the pipeline (MR modulators, aldosterone synthase inhibitors) is evolving quickly. Why it matters clinically: For many of our patients with HF (especially those with CKD/diabetes), we’re constantly balancing: ---“Will they tolerate an MRA?” ---“Can we keep them on it safely?” ---“Which phenotype gets the most net benefit?” This review is a pragmatic map of that terrain and a useful way to align clinicians, pharmacists, and trialists around the next set of questions that actually matter at the bedside. If you’re following the MRA evolution across the EF spectrum, or designing trials/implementation strategies in this space, this is a worthwhile download for your files. doi.org/10.1016/j.jchf…

Routine fluid restriction in heart failure.

🫀⚡ Extreme CAC doesn’t automatically mean severe disease: photon-counting CCTA tells a more nuanced story REPOST b/c this is a change practice information. This 2026 JACC: Advances brief report addresses a long-standing dilemma in preventive cardiology: what do we really find when asymptomatic patients with extreme coronary artery calcium (CAC >1,000 AU) undergo coronary imaging? With photon-counting CT (PCCT), the answer is far less alarming than many assume  . 📊 Who was studied The authors evaluated 19 asymptomatic patients (mean age 64.5 years, 32% women) with a mean CAC of 1,510 AUand no prior CAD, MI, or revascularization. All underwent ultra–high-resolution PCCT coronary CTA (0.2 mm slices), interpreted using CAD-RADS 2.0. FFR-CT and invasive angiography were used selectively. 🔍 Key findings ✅ 100% of PCCT scans were diagnostic, despite extreme calcification 74% had no severe coronary stenosis CAD-RADS 2–3: 74% CAD-RADS 4: 21% CAD-RADS 5: 5% (1 patient) FFR-CT (n=7) was negative in all tested patients (FFR 0.80–0.93) Invasive angiography (n=4) confirmed: 1 true high-risk case → CABG No PCI performed in any patient 🧠 Why this matters Extreme CAC is a powerful risk marker, but it does not necessarily equate to: flow-limiting stenosis high-risk coronary anatomy need for invasive testing PCCT’s superior spatial resolution and reduced calcium blooming allow reliable lumen assessment where conventional CCTA often fails. ⚠️ Important caveats Small, retrospective series; no outcome data; highly selected population. This is not an endorsement of routine CCTA in asymptomatic patients—but it challenges the assumption that CAC >1,000 makes anatomic imaging futile. 🔮 Bottom line 📌 CAC defines risk. PCCT clarifies reality. In selected asymptomatic patients with extreme CAC, PCCT CCTA can safely exclude high-risk anatomy and reduce unnecessary downstream testing—turning fear-driven escalation into evidence-based reassurance.

7 questions to ask when evaluating a noninferiority trial: While most physicians are accustomed to evaluating randomized placebo-controlled studies, many are less familiar with the purpose and takeaway of noninferiority trials acrobat.adobe.com/id/urn:aaid:sc…

🎙️ @RoundsTable Listeners, More Top 5 Papers of 2025 infographics just dropped! 📊 💧 FRESH-UP (fluid intake in chronic HF) 🧬 ESSENCE (semaglutide for MASH) #MedTwitter #FOAMed #ClinicalTrials #MedEd

A man for the ages

What does CAC =0 mean in 2025 #AHA25 Fantastic talk by Dr. Laura Feindess

This may be the least surprising meta-analysis ever published. #aha25

💊 Tips & Tricks in Beta-Blockers 🔹 Nebivolol: most selective β1 → best for asthma/COPD 🔹 Bisoprolol/Metoprolol: best rate control 🔹 Nebivolol: lowest ED risk 🔹 Carvedilol/Nebivolol: best BP effect 📘 From my book: Tips and Tricks in Cardiology ✉️ Type “tips” if interested

Diuretic strategies in acute heart failure: a systematic review and network meta-analysis of randomized clinical trials FC and SNB improve surrogates of response to FB in AHF. SNB is also connoted by WRF and may induce hypokalaemia. The endpoints of diuretic RCTs should be revised and harmonized. @mvaduganathan @hvanspall @DrMarthaGulati @BiykemB @gcfmd @SJGreene_md @AndrewJSauer @AndrewJSauer @hfcollaboratory @ShelleyZieroth @Hragy @AnastasiaSMihai academic.oup.com/ehjcvp/advance…

@hvanspall @Medtronic @HFSA Interesting hypothesis, Harriette!

Press release @medtronic on our pivotal #ELEVATE-HFpEF RCT which will test the efficacy & safety of a personalized elevated pacing rate (based on LVEF & height) in #HFpEF 75 countries 2 patients enrolled already (AUS & US) Methods to be presented @HFSA news.medtronic.com/2025-09-15-Med…

Recently published: REDICAE trial. Stable HFrEF outpatients on GDMT were randomized to diuretic withdrawal vs maintenance. No significant differences were observed in dyspnea self-perception worsening HF or congestion @JACCJournals @Cardio_HURS @JovenesSec tinyurl.com/2cfw664e

#DIGIT_HF will change clinical practice for patients with #HFrEF ‼️ ⁦@ShelleyZieroth⁩ ⁦@DavidDuncker⁩ ⁦@escardio⁩ #ESCCongress2025 ⁦@YoungDgk⁩ ⁦@DGK_org⁩ ⁦@NEJM⁩

A significant breakthrough 🔥🍀 #Tirzepatide 👇 💉