30-Second Takeaway
- Bisoprolol worsened exercise capacity and patient-reported health status in nonobstructive HCM, while verapamil was neutral for exercise but improved NT-proBNP and strain.
- Intravascular imaging guidance during complex PCI yielded durable 5-year reductions in cardiac death, MI, and target-vessel revascularization versus angiography alone.
- Nearly half of Swedish HFrEF patients received potentially inappropriate drugs, with higher mortality, more HF events, and lower GDMT use.
Week ending March 7, 2026
New data on HCM symptom drugs, complex PCI guidance, HF prescribing quality, and cardiometabolic risk reduction
Bisoprolol harms peak VO2 and health status in nonobstructive HCM; verapamil neutral on exercise
In a triple-crossover RCT of 32 nonobstructive HCM patients, bisoprolol reduced peak VO2 versus both verapamil and placebo. Bisoprolol substantially lowered peak heart rate but worsened KCCQ score, increased NT-proBNP, and enlarged left atrial volume versus placebo. Verapamil reduced NT-proBNP and improved global longitudinal strain compared with placebo but did not improve peak VO2 or NYHA class. These short-term data challenge empiric beta-blocker use for symptom relief in nonobstructive HCM and suggest careful individualization of rate-slowing therapy.
Imaging-guided PCI improves 5-year outcomes in complex coronary disease
Among 1,639 patients with complex coronary lesions, intravascular imaging–guided PCI lowered the composite of cardiac death, target-vessel MI, or TVR versus angiography guidance. Event rates were 10.5% with imaging versus 14.9% with angiography over 5.3 years (HR 0.68; 95% CI 0.51-0.91). Cardiac death or target-vessel MI, TVR, and definite stent thrombosis were all numerically lower with imaging guidance. Procedural safety was similar between groups, supporting routine intravascular imaging use for complex PCI where feasible.
Potentially inappropriate prescribing is common in HFrEF and linked to worse outcomes
In the Swedish HF Registry, 47% of 50,348 HFrEF patients received at least one potentially inappropriate prescription by ESC PIP-HFrEF criteria. Neuroleptics, systemic steroids, and NSAIDs were the most frequent potentially inappropriate agents, often reflecting multimorbidity such as rheumatoid arthritis, depression, COPD, or gout. Any PIP was independently associated with higher 3-year risks of HF death, all-cause and cardiovascular death, and first and recurrent HF hospitalizations. Patients with PIP were less likely to receive GDMT, underscoring deprescribing and medication reconciliation as HF quality-improvement priorities.
Higher aldosterone–renin ratio predicts AF and stroke in older adults without baseline CVD
In 3,477 ARIC participants free of HF, MI, stroke, and AF, higher aldosterone–renin ratio (ARR) predicted adverse events over 9 years. Each ARR doubling increased risk of the composite of HF hospitalization, AF, stroke, MI, or death (aHR 1.04; 95% CI 1.01-1.08). Higher ARR was independently associated with ischemic stroke (aHR 1.13) and AF (aHR 1.10), but not HF hospitalization or MI. Findings support a spectrum of subclinical primary aldosteronism contributing to AF and stroke risk in older hypertensive populations.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.