John P Erwin III, MD on a question from his compassionate colleague.

Cardiology Testing

Two Cardiac Troponins Don’t Tell the Same Story

There might be a bigger difference between the types of cardiac troponin assays, after a recent JACC analysis found that the type of troponin could help us better understand the kind of damage occurring after a heart attack.

• Cardiac troponin I and troponin T are currently used interchangeably in clinical practice with guidelines assuming they reflect identical myocardial damage. 
• Currently, most practices measure one type or the other but not both.
• Early studies have suggested that the cTnI/cTnT ratio may differ between acute necrotic versus chronic or non-necrotic myocardial injury, but that was uncertain till now.

As part of a multicohort validation, researchers examined 9.7k patients who were marked as having no known, chronic, or acute cardiac disease, and then measured their hs-cTnI and hs-cTnT concentrations to see what cTnI/cTnT ratio could tell them about the injury type.

• The cTnI/cTnT ratio proved highest in acute cardiac disease (2.06).
• This was approximately 4-fold greater than the ratio found in patients with chronic disease (0.66) and no known cardiac disease (0.50).
• Incorporating the cTnI/cTnT ratio alongside individual troponin values made it easier to tell between type 1 and type 2 acute myocardial infarction (AUC: 0.73 vs 0.70).

Experimental cardiomyocyte models were also used to replicate the clinical findings, with researchers discovering that mild nonlethal injury produced cTnT-dominant release, while lethal injury led to cTnI-dominant release.

Given that current practice assumes cTnI and cTnT reflect identical pathophysiology, these findings could challenge single-troponin measurement strategies and guideline recommendations that treat the biomarkers as interchangeable.

• The good news is that implementing this information would require minimal additional cost, since physicians can measure both troponins rather than choosing one.
• The ratio’s ability to distinguish type 1 from type 2 MI could also help guide decision-making about invasive coronary angiography versus medical management.

The Takeaway

It seems like a method for better classifying and triaging cardiac damage was under our noses the whole time. On the bright side, thanks to this study, physicians will no longer have to scratch their heads on which assay to use, since the answer is both.

Making the Leap to Outsource Post-Processing

Interested in how to outsource cardiac image post-processing, but not sure where to start? PIA walks you through how to assess and compare vendors, understand pricing models and payment options, and outline your requirements to identify vendors who meet your clinical needs. 

Identify and Treat Cardiovascular Disease

Complex care pathways make getting patients to the next step a challenge. See how Tempus Next, an AI enabled care pathway platform, helps providers identify and reduce under treatment in cardiovascular disease by adding an intelligent layer onto their routinely generated EHR data.

What Every Cardiologist Needs to Watch for in Heart Failure

Patients with preserved (HFpEF) or mildly reduced ejection fraction (HFmrEF) face a high risk of hospitalization for heart failure and cardiovascular death, even with guideline-directed medical treatment. Hear from Bayer’s Dr. Alanna Morris-Simon as she shares common heart failure signs to look out for.

The Wire

• A Path to Xenotransplantation: Two decades after its first ISHLT report, cardiac xenotransplantation (animal hearts in humans) has evolved from a theory to an actual clinical experience with two human heart recipients. While both cases ultimately ended in graft failure due to antibody rejection and other complications, they provided a vital roadmap for the field. The current ISHLT consensus now emphasizes that future success will need refined gene-editing of pigs hearts, better immunosuppression protocols (focusing on CD40/CD40L pathway blockade), and preventing animal-borne infections.

• Echo AI Aids Cardiac Amyloidosis Detection: Us2.ai’s echocardiography AI solution helped clinicians diagnose cardiac amyloidosis in a new Circulation study. In 5.8k patients, Us2.ai-generated measurements were added to an established multiparametric echo scoring system, producing sensitivity of 75% and specificity of 82%. In a separate test, a more automated model called Us2.ca was tested on single-view echo videos, achieving sensitivity of 97% and specificity of 96%. Both techniques could be integrated into clinical practice for automated cardiac amyloidosis screening.

• CagriSema vs. Tirzepatide: Novo Nordisk announced new weight loss results from the REDEFINE 4 Phase 3 trial that compared its CagriSema combo drug (a 2.4mg formula of cagrilintide/semaglutide) to Eli Lilly’s 15mg tirzepatide dose. Among the study’s 809 people with obesity, CagriSema achieved 23% weight loss at 84 weeks versus 25.5% with tirzepatide, failing to meet the non-inferiority primary endpoint. Novo plans on higher dose trials to see if it can meet non-inferiority cutoffs.

• GSK’s PAH Play: GSK announced it will acquire 35Pharma, gaining the rights to its HS235 molecule, a potentially best-in-class activin signaling inhibitor for cardiopulmonary diseases. HS235 has already completed Phase 1 trials with studies starting in pulmonary arterial hypertension and pulmonary hypertension due to heart failure with preserved ejection fraction. The investigational medicine is designed with enhanced selectivity to reduce bleeding risk compared to existing therapies while offering metabolic benefits including fat-selective weight loss, lean mass preservation, and improved insulin sensitivity.

• A New Pharma Spinoff: Atrium Therapeutics launched as a spinout from Avidity Biosciences four months after Novartis acquired Avidity for $12B. Atrium will now focus on developing RNA medicines for rare heart conditions using technology that delivers drugs to cardiac muscle tissue. The company will start with $270M in funding and two preclinical programs for PRKAG2 syndrome and PLN cardiomyopathy, plus two undisclosed research targets. The cardiac-focused work was originally excluded from the Novartis acquisition, which centered on Avidity’s neuromuscular disease programs and muscle-targeted RNA technology.

• Rethinking Transplant Referral: New data suggests that the classic threshold of peak VO2 < 12 mL/kg/min for heart transplant referral is outdated. Researchers examined 8k patients and found that measuring ventilatory efficiency (VE/VCO2 slope) and exercise oscillatory ventilation offered superior risk stratification over peak VO2. Many patients previously deemed transplant-eligible now show survival rates comparable to transplant recipients, so clinical guidelines might need to be updated to reflect modern heart failure management.

• New VTE Biomarkers: Curious about catching venous thromboembolism earlier? A recent Circulation study suggests that there could be 23 different VTE plasma protein biomarkers. Among the study’s 59.8k participants, researchers found 15 new biomarkers including TAGLN, SVEP1, and TIMP4 among the eight that were already known. According to the study’s methods, these proteins may be involved in biological pathways beyond traditional clotting, such as extracellular matrix regulation, immunity, and vascular senescence, providing new potential targets for VTE risk stratification and prevention.

• AFib Post-Transplant: While many worry about graft rejection or hemodynamics after a heart transplant, new research suggests developing AFib could be a risk as well. In a study of 1,072 patients, 11% developed AFib after heart transplantation, correlated with lower 5-year survival (72% vs. 86%). The study’s authors think early AFib is linked to donor age and procedural factors, while later AFib is driven by rejection and vasculopathy.

• Radiotracers and Structural Heart: Cardiac radiotracers could be even better for diagnosing structural heart issues than previously thought. A cohort study of 76 patients revealed that [18F]-sodium fluoride PET can identify distinct thoracic aortopathy phenotypes. Unexpectedly, low uptake was associated with faster aortic growth and poorer structural integrity, while high uptake reflected a stiffer, slower-growing wall. This noninvasive imaging could significantly improve risk stratification for bicuspid aortic valve patients, helping clinicians determine the best timing for prophylactic aortic surgery.

• Traditional Medicine in Cardiology: Traditional Chinese medicine might be onto something after researchers found that adding Tongxinluo capsules to statins significantly stabilizes coronary plaques in ACS patients. Over 12 months, the Tongxinluo group showed increased minimum fibrous cap thickness (115.0 μm vs 80.0 μm) and a greater reduction in lipid arc compared to placebo. Additionally, patients experienced improved angina symptoms, though MACE risk was the same. Tongxinluo consists of Panax ginseng, Borneolum syntheticum, scorpion, cockroach, and centipede among other things and could help with STEMI.

• AFib on the Rise in Denmark: A recent Danish nationwide study suggests that atrial fibrillation incidence in the country will increase while heart failure, myocardial infarction, and stroke incidences decrease, though prevalence will still rise for all four conditions. Projections to 2040 estimate AFib incidence will rise 28% to 26k new cases annually and prevalence will increase 56% to 274k cases. Among adults aged 65-94, new AFib cases are projected to surpass combined new cases of HF, MI, and stroke by 2040.

A Solution for Your Entire Cardiology Service Line

The pace of change in healthcare can be dizzying, creating new and more complex challenges for cardiology departments to overcome. See how Merge Cardio and Merge Hemo can turn those challenges into opportunities for greater workflow efficiency and improved care.

Fujifilm’s Ultrasound for every Cardiovascular Ultrasound Environment

From academia to clinical diagnostics, versatility in cardiac ultrasound is essential. Discover why clinicians are choosing Fujifilm’s LISENDO 880 for exceptional image quality, comprehensive strain analysis, stress imaging, and innovative Virtual Contrast technology — all while delivering outstanding value.

Discover The Monebo Advantage

Need complex ECG monitoring algorithms for use in a variety of applications? Here are just a few reasons why companies across the healthcare spectrum rely on Monebo to power their ECG monitoring and analysis.

The Resource Wire

• Diagnosing Cardiac Amyloidosis Using Echo AI: Catching cardiac amyloidosis early is critical to giving patients the best possible outcome. Read Us2.ai’s latest paper in Circulation to learn how their echocardiography AI solution and new Us2.ca model helped clinicians diagnose cardiac amyloidosis with higher sensitivity and specificity.

• How Vista AI Helps Solve the Technologist Shortage: Fewer than 2% of MRI scanners are routinely used for cardiac imaging—mainly due to a shortage of trained technologists amid rising demand. Vista AI addresses this challenge by automating CMR scanning, empowering technologists of all experience levels to deliver high-quality cardiac exams consistently and efficiently.

• Assessing CAD with Circle CVI: Did you know that Circle CVI offers a suite of cardiac CT tools for the assessment of coronary artery disease? See how Circle combines heart function segmentation, automated plaque analysis, CAC scoring, reporting, and viewing in a single dedicated Cardiac CT package.

• The Largest Registry on Plaque Analysis in CAD: What if 50% of your CCTA patients could benefit from an adjustment to their treatment plan? Read more about Heartflow’s DECIDE registry that demonstrates how Heartflow Plaque Analysis using its Plaque Staging software empowers physicians with clinical insights that lead to real-world impact.

• The Power of AI in Cardiovascular Imaging: Cardiac labs are under more pressure than ever to deliver more with greater speed and precision. Hear from ACUSON Origin customer, Tony Gallagher about how Siemens Healthineers’ cardiovascular ultrasound system is improving exam efficiency and showing positive impact on ROI.

The Industry Wire

1. Measles outbreaks are costing the U.S. millions of dollars.
2. Independent physicians are fighting back against rising costs.
3. Medicare Advantage enrollment declines for the first time in 7 states.
4. Trump admin halts $259M in Medicaid funds to Minnesota.
5. Cigna’s Evernorth acquires hospital pharmacy CarepathRx.
6. Carelon president exits Elevance Health.
7. Centene urges CMS to cut red tape for fraud crackdowns.
8. Walgreens launches virtual GLP-1 clinic.
9. Teladoc projects lower membership amid ACA subsidy lapse.
10. Eli Lilly launches a new form of Zepbound.