Research Feed

Generated at: 2026-03-30 22:40:42 UTC
# Cardiology News Multilevel Outline - March 30, 2026

## Top Stories / Major Trials
### ACC.26 Late-Breaking Clinical Trials (March 28-30, New Orleans)
- **HI-PEITHO**: Ultrasound-facilitated catheter-directed thrombolysis (EKOS system) + anticoagulation superior to anticoagulation alone in intermediate-high-risk PE (4% vs 10.3% primary composite endpoint at 7 days; 61% reduction; no increase in major bleeding). Practice impact: Shifts paradigm for intermediate-risk PE management.
- **VESALIUS-CV (subgroup)**: Evolocumab (PCSK9i) reduced first MACE by 31% (HR 0.69) in high-risk diabetes without prior MI/stroke (LDL-C drop to 52 mg/dL). Reinforces early aggressive lipid lowering in primary prevention.
- **CHIP-BCIS3**: Elective LV unloading with Impella microaxial pump in high-risk PCI (severe LV dysfunction) did NOT improve outcomes (win ratio 0.85 favoring standard care; higher all-cause mortality HR 1.54, CV death HR 1.91). Safety signal tempers routine use.
- **STEMI-DTU**: Impella unloading + delayed PCI in anterior STEMI without shock failed to reduce infarct size; longer ischemic times noted.
- **ALL-RISE**: AI-based FFRangio noninferior to wire-based FFR for PCI guidance (7% MACE at 1 year; shorter procedure time). Enables wire-free physiology assessment.
- **FAST-III**: vFFR (angiography-derived) noninferior to wire FFR (7.5% MACE at 1 year; faster procedures). Advances noninvasive FFR adoption.
- **CHAMPION-AF (3-year)**: LAA closure (WATCHMAN FLX) vs DOACs in high-stroke-risk AF; questions first-line LAAO role (full results emerging).
- Other: HOST-EXAM (clopidogrel > aspirin post-DAPT in stable CAD at 10 years); ORBITA-CTO; PRO-TAVI (defer PCI in TAVI? noninferior).

## Guideline & Consensus Updates
### 2026 ACC/AHA Multisociety Dyslipidemia Guideline (March release)
- Replaces 2018 cholesterol guideline; focuses on atherogenic lipoproteins (LDL-C, non-HDL-C, apoB, Lp(a)).
- **Key changes**: Use PREVENT equations (vs PCE) for 10/30-year risk from age 30-79; universal Lp(a) testing once in adulthood (≥125 nmol/L or 50 mg/dL elevates risk 1.4x); selective CAC scoring for risk reclassification (men ≥40, women ≥45 borderline/intermediate risk).
- **LDL-C goals restored**: <55 mg/dL very high-risk ASCVD; <70 mg/dL high-risk; <100 mg/dL moderate risk/CAC>0.
- Earlier intervention: Statins from age 30 in FH or LDL≥160 mg/dL; lifestyle primordial prevention.
- Expanded therapies: Bempedoic acid, inclisiran, PCSK9i, apoC3 inhibitors for TG.
- Practice impact: Lifetime risk focus; CAC/Lp(a) personalize therapy; lower targets accelerate combo LLT.
### Other
- 2026 ACC/AHA PAD Performance/Quality Measures: New metrics for BP/DM/antithrombotics, foot care, lipid novel agents.
- 2026 ACC/AHA Expert Consensus: TTVI operator/institutional requirements.

## Device & Procedural News
- **FDA Approvals**: JenaValve Trilogy THV (first for symptomatic severe aortic regurgitation, high surgical risk; March 18).
- Philips IntraSight Plus (interventional guidance platform).
- Medtronic OmniaSecure (LBB pacing).
- Stereotaxis MAGiC (robotic ablation catheter).
- **Trials**: PRO-TAVI (TAVI w/o routine PCI noninferior); PROTECT (Emboliner vs Sentinel cerebral protection in TAVR).
- Advances: AI FFR (ALL-RISE/FAST-III); caution on routine Impella high-risk PCI.

## New Drugs & Therapeutics
- **Pipeline/Updates**: Mavacamten Phase 3 success in adolescent oHCM; olpasiran (Lp(a) lowering) ongoing.
- HF: Non-steroidal MRAs, incretins for HFmrEF/HFpEF; digitalis revalidated in HFrEF.
- Anticipated 2026: Oral GLP-1s (orforglipron), high-dose semaglutide, baxdrostat (resistant HTN), Awiqli (weekly insulin).
- Q4 2025 carryover: Aficamten, sotatercept, plozasiran for CV conditions.

## Imaging & Diagnostics
- **AI Advances**: Automated echo for congenital HD; multi-modality for MINOCA; AI-ECG (AccurKardia, HeartSciences); AI TAVR planning.
- Symposia: ASPC Virtual Imaging (April 25; multimodality for prevention).
- Nuclear/CT/MRI: High-res for plaque/subclinical athero; predictive non-invasive (CCTA, AI-MRI).

## Practice-Changing Insights
- **Interventional**: Noninvasive FFR ready for prime time; reserve mechanical support for true shock; catheter-directed Rx now standard intermediate PE.
- **Prevention**: Dyslipidemia guidelines mandate earlier/more aggressive Rx (PREVENT+CAC+Lp(a)); universal screening.
- **Structural/EP**: LAAO maturing but not yet first-line; new THVs expand AR options; LBB pacing/TAVI cerebral protection evolving.
- **HF/CV Risk**: Incretins/PCSK9i expand primary prevention; gene therapies on horizon.

## Appended Sections: New Updates & Corrections
- ACC.26 ongoing (as of March 30); LBCT results fresh (e.g., HI-PEITHO/CHIP-BCIS3 published NEJM). Monitor for full CHAMPION-AF/HOST-EXAM details.
- No major corrections noted; Dyslipidemia guideline modular for rapid annual updates.
- Emerging: AI ethics/integration in imaging; Lp(a)/apoB as routine risk enhancers.