30-Second Takeaway
- Mavacamten in oHCM linked to higher-than-predicted new AF risk.
- CVOTs (2016–2026) reframed care toward cardiorenal-metabolic protection.
- Metabolomic indices improve HFpEF/HFrEF risk stratification differentially.
- SMART-REACH stratifies post-stroke MACE and higher-risk patients gain larger ARR with colchicine.
Week ending May 2, 2026
MedBrevia Grand Rounds: Selected cardiology studies (Apr 2026)
Mavacamten associated with increased new and recurrent AF in obstructive HCM
In 160 oHCM patients treated with mavacamten, new AF occurred at 6.4%/year among those without prior AF. Observed 2-year symptomatic AF risk modestly exceeded HCM-AF score predictions (8.2% vs 6.9%). On multivariable analysis, mavacamten treatment was associated with higher new AF risk (HR 3.0, p=0.01). Among patients with prior AF, recurrence rate during treatment was 19.3%/year.
A decade of CVOTs shifted practice to a cardiorenal-metabolic framework
CVOTs from 2016–2026 transformed safety trials into evidence of cardiorenal protection beyond glycaemic control. Landmark trials across GLP-1 and SGLT2 inhibitor classes reoriented therapeutic priorities toward CRM care. The review synthesises trajectories, key trial findings, and emerging therapies shaping precision cardiometabolic medicine.
Metabolomic indices differentially predict outcomes in HFpEF versus HFrEF
In 1,520 international HF patients, netNO-pEF and netPurine-pEF predicted outcomes in HFpEF, while netACa-rEF and netAA-rEF did so in HFrEF. Every 20% higher netNO-pEF associated with lower mortality in HFpEF (PEOPLE HR 0.64; SHOP HR 0.40). Higher netPurine-pEF and netACa-rEF linked to worse outcomes (e.g., netPurine-pEF PEOPLE HR 1.71). Adding orotic acid to a clinical model modestly improved 2-year mortality prediction (AUROC 0.82→0.83).
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.