AlbaLopez

R2 de Cardiología 🫀

[AlbaLopez @lacukiiAlba]

Oficialmente R1 de Cardiología en casita (HGUCR) 🏡 🫀

[CardioTeca @cardioteca]

Solo finerenona redujo las hospitalizaciones en insuficiencia cardiaca con FEVI preservada: metaanálisis en red

Un metaanálisis en red bayesiano de 8 estudios aleatorizados, con 10.644 pacientes con insuficiencia cardiaca y FEVI preservada, compara finerenona, espironolactona y eplerenona frente a placebo. Solo finerenona redujo la hospitalización por insuficiencia cardiaca; ninguno de los tres fármacos redujo la muerte cardiovascular y los tres duplicaron la hiperpotasemia.

https://t.co/2JOPbOhMtG

🫀 En 8 estudios aleatorizados con 10.644 pacientes, finerenona redujo la hospitalización por insuficiencia cardiaca frente a placebo con un riesgo relativo de 0,84; espironolactona quedó en 0,86 sin alcanzar significación y eplerenona, también en 0,86.
📉 Ninguno de los tres redujo la muerte cardiovascular.
🧪 Los tres duplicaron la hiperpotasemia frente a placebo, con riesgos relativos de 2,06 a 2,17 y sin diferencias entre ellos.
⚖️ Comparadas entre sí, finerenona y espironolactona salen iguales: riesgo relativo de 0,97 con un intervalo creíble del 95% de 0,80 a 1,19.

[Martín Negreira @NegreiraMartin]

📳 Aquí va 🧵 con el resumen de los que para mí son los principales estudios relacionados con las arritmias ⚡⚡ presentados en el reciente #ESCcongress 🫀

📍Dejo enlaces a las publicaciones de los estudios

Let's go

👇🏻👇🏻👇🏻

[Andrew J Sauer MD @AndrewJSauer]

I’m sorry but how does @escardio give MRA (without differentiating sMRA from nsMRA) a Class I for HFpEF?

Where is the evidence for steroidal MRA?

And even if we base on nsMRA, we have one study (FINEARTS-HF) and we somehow end up with a Class I?

Make it make sense.

[Felipe Díez del Hoyo @Felipediezhoyo]

📌 Este estudio de nombre impronunciable (TRIC-I-HF-DZHK24) es muy rompedor 🚨 #ESCCongress 🇩🇪

🎯 La terapia borde-a-borde tricúspide ⬇️ ☠️ e ingresos 🏥 por ICC en pacientes con IT severa sintomática

🆕 Una ⬇️ de un 60% de eventos 🫀. NNT de 4 para ☠️ -ingreso 🏥 Wow 🥶

[Vladyslav Kavalerchyk 🇺🇦 🇩🇪 @echo_stepbystep]

TOPCAT: spironolactone failed its primary endpoint in HFpEF. FINEARTS-HF: finerenone reduced HF events. So is “MRA therapy for HFpEF” really the right concept? Different drugs, different patients, different phenotypes. HFpEF needs precision medicine—not EF-based medicine #ESC2026

[Hany Ragy @Hragy]

CABG if EF below 35% do not listen to Salman! 🥰 #ESCCongress @realarainMD

[Sarah Moharem Elgamal, MBBCh, MSc, PhD👩🏻‍⚕️🫀 @Sarah_Moharem]

🫀 ESC HEART FAILURE GUIDELINES 2026 — WHAT HAS CHANGED?

The new ESC HF Guidelines bring major changes in classification, treatment, decompensation, devices and precision phenotyping.

🔹 1 | New HF classification
➡️ HFrEF: LVEF <50%
➡️ HFpEF: LVEF ≥50%
The previous HFmrEF category is removed.

🔹 2 | “Acute HF” → “Decompensated HF (DHF)”
Management focuses on identifying the trigger and rapidly assessing congestion, perfusion, BP, renal function and oxygenation.

🔹 3 | Smarter decongestion
IV loop diuretics remain first-line.
If response is inadequate, consider sequential nephron blockade with IV acetazolamide or oral hydrochlorothiazide.

Early urinary sodium assessment may help guide diuretic escalation.

🔹 4 | Treat before discharge
Once stabilized, initiate/optimize foundational therapy—including in-hospital SGLT2 inhibitor initiation.

After discharge, aim for rapid optimization, with uptitration generally every 1–2 weeks when tolerated.

🔹 5 | MRA therapy expands
MRAs now have a broader role across the EF spectrum, including selected patients with HFpEF.

And if EF improves?
➡️ Continue foundational therapy.

🔹 6 | HFpEF becomes increasingly treatable
Beyond SGLT2 inhibitors, treatment now includes broader use of MRAs and selected RAAS inhibition, alongside phenotype-driven management of comorbidities.

🔹 7 | CRT: refined selection and timing
CRT remains Class I A for symptomatic HFrEF with:
➡️ LVEF ≤35%
➡️ sinus rhythm
➡️ LBBB
➡️ QRS ≥150 ms
despite optimal foundational therapy.

In this strong electrical phenotype, CRT planning may begin alongside initiation of foundational therapy, with reassessment before implantation.

⚠️ Evidence remains insufficient to recommend conduction-system pacing as an alternative to CRT in HFrEF.

🔹 8 | ICD: more individualized
Primary prevention:
➡️ Ischaemic HFrEF, LVEF ≤35% → Class I
➡️ Non-ischaemic HFrEF, LVEF ≤35% → Class IIa

Consider competing mortality, comorbidities, frailty, life expectancy and patient preference.

🔹 9 | Obesity becomes a treatment target
In selected symptomatic HF with LVEF ≥45% and BMI ≥30 kg/m², semaglutide or tirzepatide should be considered to improve weight, symptoms, exercise capacity and QoL.

🔹 10 | Precision imaging & aetiology
The focus moves beyond EF toward identifying why the patient has HF, with greater roles for CMR, CT, nuclear imaging and genetic testing.

ATTR-CM therapy also expands to tafamidis, acoramidis and vutrisiran.

🔹 11 | Mitral TEER & haemodynamic monitoring
Mitral TEER receives a Class I recommendation in appropriately selected HFrEF with severe secondary MR despite optimized therapy/CRT.

Pulmonary artery pressure-guided monitoring is strengthened to Class IIa in selected high-risk patients.

📌 The ESC HF 2026 message:

Diagnose earlier → phenotype better → decongest effectively → start treatment early → titrate rapidly → personalize devices and interventions → prevent the next decompensation.

💡 HF management is becoming less about treating an EF number—and more about treating the individual patient’s phenotype, aetiology, haemodynamics and comorbidities.

#ESCCongress #HeartFailure #Cardiology #HFrEF #HFpEF #CRT #SGLT2i #CardiacImaging

[Álex Maceín @AlexMacein]

🫀🔥Nuevas guías de IC también presentadas en el #ESCCongress

Acaba de cambiar bastante el manejo de la insuficiencia cardiaca... vamos con las principales novedades que no podemos pasar por alto!

🆕 ¡No te pierdas los tuits 5 y 8 del hilo! 🔝

👇1/13🧵

[European Society of Cardiology @escardio]

Tailored Treatment of Myocardial diseases, Endocarditis and Atrial Fibrillation - HOTLINE 1 👇

#ESCCongress

[Vanessavillavicencio @elba_vanessa]

🚨 NUEVA GUÍA ESC 2026 + ERA

Corazón y riñón ya no pueden evaluarse por separado.

La nueva guía sobre enfermedad cardiovascular y enfermedad renal crónica deja recomendaciones que pueden cambiar nuestra práctica clínica.

🧵 Les resumo las más importantes 👇

[Álex Maceín @AlexMacein]

🔥Ya está aquí el primer ensayo clínico aleatorizado que compara ACOD Vs no anticoagular en pacientes con FA y un único factor de riesgo tromboembólico no relacionado con el sexo (CHA₂DS₂-VA=1)

💡Ensayo SINGLE-AF (presentado hoy en #ESCCongress y publicado en @NEJM)

👇1/8🧵

[MD Kemal Karaagac @kemalkaraaa1]

🖋️Clopidogrel monotherapy is associated with a lower incidence of adverse clinical outcomes;🫀death, MI, ischemic stroke, and major bleeding; compared with ASA monotherapy in patients who underwent PCI.

[Felipe Díez del Hoyo @Felipediezhoyo]

📌 Habemus nuevas GPC de ICC (2026) en #ESCCongress

🎯 Aquí mi resumen de los ppales mensajes y novedades 🆕 👇👇

[Julian P Villacastin @jvillacastin]

Varón de 50 años que acude a urgencias por palpitaciones. Se realiza el primer electrocardiograma (izda) y deciden infundir 150 mg de flecainida. A los 30 minutos se repite el ECG (dcha). Que te parece?