Research Highlights in 2023

In a study published in Nature, Jia and colleagues use advanced optical electrophysiology tools coupled with 3D-printed moulds to capture the very first heartbeat of zebrafish.

The metabolic maturation of mammalian cardiomyocytes that occurs during the early postnatal period shapes the epigenetic landscape of cardiomyocytes and creates a barrier for cell division, but reversing this remodelling process can restore the reparative capacity of the heart in mice, according to a study published in Nature.

Two studies now report that TET2-driven clonal haematopoiesis of indeterminate potential (CHIP) is associated with poor prognosis in patients with heart failure (HF) and preserved ejection fraction and that DNMT3A CHIP driver mutations promote dysregulated gene expression profiles that are associated with inflammation in monocytes in the setting of HF.

In patients with heart failure (HF) with preserved ejection fraction and obesity, treatment with the glucagon-like peptide 1 receptor agonist semaglutide (2.4 mg) leads to large reductions in HF-related symptoms and physical limitations, improves exercise function and decreases body weight compared with placebo, according to the STEP-HFpEF trial.

An interaction between blood vessels and nerve fibres in the heart contributes to the decline in nerve density in the ageing left ventricle, potentially increasing susceptibility to arrhythmias.

The FIRE trial showed that complete revascularization improves outcomes in older patients with myocardial infarction (MI) and multivessel disease compared with culprit-lesion-only revascularization, whereas the MULTISTARS AMI trial reported that immediate multivessel revascularization is non-inferior to staged revascularization in patients with ST-segment elevation MI.

In the CASTLE HTx trial, patients with symptomatic atrial fibrillation and end-stage heart failure who underwent catheter ablation and received medical therapy had improved outcomes compared with patients who received medical therapy only.

New data from the ECLS-SHOCK trial and a meta-analysis indicate that the routine use of venoarterial extracorporeal membrane oxygenation does not increase survival in patients with myocardial infarction-related cardiogenic shock.

Two clinical trials presented at the ESC Congress 2023 provide conflicting evidence on the use of optical coherence tomography to guide percutaneous coronary intervention.

According to data from the COP-AF trial, anti-inflammatory therapy with colchicine does not reduce the risk of perioperative atrial fibrillation or myocardial injury in patients undergoing major non-cardiac thoracic surgery.

In the REPRIEVE trial, pitavastatin treatment in patients with human immunodeficiency virus (HIV) infection without pre-existing cardiovascular disease prevented cardiovascular events compared with placebo.

A new study reveals that the disrupted sleep patterns that are frequently observed in patients with cardiac disease are driven by immune-mediated sympathetic denervation and dysfunction of the pineal gland, which leads to a decrease in the circulating levels of melatonin and subsequent sleep disruption.

A study shows that macrophages undergo substantial expansion in the diseased atria of patients with atrial fibrillation (AF), and identifies two potential immunotherapy targets for the treatment of AF.

In failing cardiomyocytes, depletion of carnitine acetyltransferase promotes cholesterol catabolism via the bile acid synthesis pathway. The intracellular accumulation of bile acid intermediates induces the release of mitochondrial DNA into the cytosol, triggering type I interferon responses and AIM2 inflammasome activation, thereby contributing to chronic myocardial inflammation and heart failure progression.

Patients with hypertension who receive a single subcutaneous dose of zilebesiran, a novel small-interfering RNA that inhibits hepatic angiotensinogen synthesis, have reductions in serum angiotensinogen levels and 24-h ambulatory blood pressure that last for up to 24 weeks, according to a phase I study.

According to two papers from the OPTICO-ACS study, patients with acute coronary syndrome and an intact fibrous cap (plaque erosion), tend to have lower levels of inflammation and better prognosis than patients with rupture of the fibrous cap. In addition, Toll-like receptor 2-mediated neutrophil activation has a key role in plaque erosion.

The FDA-approved drug ruxolitinib has been identified as an inhibitor of Ca²⁺/calmodulin-dependent protein kinase II (CaMKII) that has the potential to be repurposed to treat arrhythmias induced by CaMKII hyperactivity.

In the multicentre, randomized, placebo-controlled RAPID trial, use of symptom-prompted, self-administered, intranasally delivered etripamil was safe and superior to placebo for the conversion of paroxysmal superventricular tachycardia to sinus rhythm.

Testosterone-replacement therapy in men with hypogonadism and a high risk of cardiovascular disease does not increase the risk of adverse cardiac events, according to data from the TRAVERSE trial.

New research shows that the reduced risk of major adverse cardiovascular events associated with light or moderate alcohol consumption is partly mediated by attenuation of the activity of a stress-related neural network.