Cardio Trial Files: Liberal Fluid vs. Fluid Restriction in HF, Tirzepatide in HF & Obesity, and TAVR for HFrEF on GDMT with Moderate AS
Liberal fluid intake versus fluid restriction in chronic heart failure
Herrmann JJ et al. Nature (March 2025)
Bottom Line: This multicenter open-label trial evaluated the effects of fluid restriction in outpatients with chronic heart failure. A total of 504 patients were randomized to receive advice for liberal fluid intake or fluid restriction (up to 1,500 ml per day). The primary outcome was health status after 3 months, measured by the Kansas City Cardiomyopathy Questionnaire Overall Summary Score, showing scores of 74.0 and 72.2 for the liberal intake and restriction groups, respectively (mean difference 2.17, 95% CI -0.06 to 4.39; P = 0.06). No differences in safety events were observed, leading to the conclusion that fluid restriction may not be beneficial in this population.
Effects of Tirzepatide on the Clinical Trajectory of Patients With Heart Failure, Preserved Ejection Fraction, and Obesity
Zile MR et al. Circulation (November 2024)
Bottom Line: This double-blind randomized clinical trial evaluated the efficacy of tirzepatide (titrated up to 15 mg SC weekly) versus placebo in 731 patients with class II to IV heart failure and obesity over a median duration of 104 weeks. The primary outcomes included the reduction in cardiovascular death or worsening heart failure and improvement in Kansas City Cardiomyopathy Questionnaire Clinical Summary Score. Results showed a significant increase in Kansas City Cardiomyopathy Questionnaire score by 6.9 points (95% CI, 3.3-10.6) and 6-minute walk distance by 18.3 meters (95% CI, 9.9-26.7) for the tirzepatide group. The study concluded that tirzepatide led to meaningful improvements in heart failure management.
Transcatheter Aortic Valve Replacement in Patients With Systolic Heart Failure and Moderate Aortic Stenosis (TAVR UNLOAD)
Van Mieghem NM et al. JACC (March 2025)
Bottom Line: This international, randomized controlled trial investigated the clinical benefits of transcatheter aortic valve replacement (TAVR) in patients with heart failure with reduced ejection fraction (HFrEF) and moderate aortic stenosis (AS) on guideline-directed medical therapy (GDMT). A total of 178 patients were randomized to TAVR or clinical aortic stenosis surveillance (CASS) over a median follow-up of 23 months. The primary outcome was a hierarchical composite of clinical events and quality of life, with TAVR showing a win ratio of 1.31 (95% CI: 0.91-1.88) and a significant improvement in Kansas City Cardiomyopathy Questionnaire score (12.8 ± 21.9 points vs 3.2 ± 22.8 points; P = 0.018). TAVR was found to be safe and may enhance quality of life.
Cardio Trial Files Issue #CRD-2025-10
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