Monthly cardiology bulletin — September 18, 2026

CARDIOLOGY BULLETIN — September 18, 2026
Period covered: August 19 – September 18, 2026.

The month was dominated by the ESC Congress 2026 (Munich, August 28–31): new heart failure guidelines, several high-profile neutral trials (milvexian, eplontersen), and positive results for statins in patients over 70, tricuspid repair, and intensive blood pressure control. Sources reviewed included English, Spanish, Portuguese, Chinese, Japanese, Korean, Russian, Arabic, Turkish, and German; items from outside North America and Western Europe come from China, Korea, India, and the Dominican Republic. In Japan, Russia, and the Middle East, nothing verifiable from the past month was found.

Clinical Cardiology and Prevention

1. New ESC 2026 heart failure guidelines: mildly reduced EF disappears

[Guideline] [Europe]
Published August 28 in the European Heart Journal (doi 10.1093/eurheartj/ehag100). Only two phenotypes remain: reduced EF (<50%) and preserved EF (≥50%); "acute" becomes "decompensated"; GDMT is replaced by guideline-directed foundational, additional, and interventional medical therapy. MRAs class I regardless of EF; semaglutide or tirzepatide class IIa in preserved EF with obesity; digoxin/digitoxin, durable mechanical circulatory support, and edge-to-edge mitral repair move up.
Why it matters: it simplifies things, but requires a cautious re-reading of the HFmrEF evidence, and GLP-1 agents run into availability and cost issues in the Dominican Republic.
Source: https://www.escardio.org/news/press/press-releases/major-changes-made-to-the-esc-guidelines-on-heart-failure/

2. STAREE: atorvastatin in primary prevention in adults over 70

[Clinical trial] [Australia]
9,971 adults ≥70 years without CVD, diabetes, or dementia; atorvastatin 40 mg vs placebo, 5.9 years. Major CV events 6.0% vs 8.3% (HR 0.70; 95% CI 0.61–0.82; p<0.001). Disability-free survival unchanged (HR 0.94).
Why it matters: the first trial dedicated to this age group; benefit in events, not in disability or mortality; supports not withholding statins on the basis of age alone.
Source: https://www.escardio.org/news/press/press-releases/cholesterol-lowering-medication-reduces-major-cardiovascular-events-by-30-per-cent-in-older-people-without-known-cardiovascular-disease/

3. CRHCP at 7 years: intensive BP control in rural China reduces dementia

[Clinical trial] [China]
Cluster-randomized trial, 326 villages, nearly 34,000 hypertensive patients, non-physician community health workers, target <130/80. SBP −17.6 vs −2.4 mmHg; dementia 8.85% vs 10.55% (RR 0.85; 95% CI 0.78–0.91; p<0.001); cognitive impairment −13%.
Why it matters: a scalable model that is transferable to the Caribbean; dementia diagnosis in rural settings has limitations. (Source in English and Chinese.)
Source: https://www.escardio.org/news/press/press-releases/long-term-intensive-blood-pressure-control-reduces-dementia-risk/

4. ACACIA-HCM: aficamten in non-obstructive hypertrophic cardiomyopathy

[Clinical trial] [United States / international]
Phase 3, 517 patients, aficamten vs placebo: +3.0 points on KCCQ-CSS and +0.67 mL/kg/min peak VO2; LVEF <50% in 10.5% vs 0.8%. NEJM, August 28.
Why it matters: the first positive myosin inhibitor in the non-obstructive form; a modest effect, Cytokinetics sponsorship, and a need for serial echocardiography.
Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2603021

5. CARDIO-TTRansform: eplontersen does not reduce events in transthyretin cardiac amyloidosis

[Clinical trial] [international, 20 countries]
1,432 patients with ATTR-CM on standard treatment; eplontersen 45 mg every 4 weeks vs placebo. Rate ratio for CV death and recurrent events 0.89 (95% CI 0.73–1.09; p=0.277). A nominal signal only in patients without a background stabilizer.
Why it matters: neutral compared with vutrisiran (HELIOS-B); the widespread use of tafamidis/acoramidis likely diluted the effect.
Source: https://www.radcliffecardiology.com/news/esc-congress-2026-day-1-hot-line-trials-what-data-show-and-what-cardiologists-think

6. TIME-HF (India): nurse-coordinated care improves survival in heart failure

[Clinical trial] [India]
22 centers, 1,507 patients with LVEF ≤40% (57% rural). Alive and free of hospitalization at 2 years 84% vs 79.4%; mortality 21.6% vs 26.7% (HR 0.78; 95% CI 0.63–0.95; p=0.028); quadruple therapy 37.3% vs 22.1%. Circulation, August 30.
Why it matters: a cheap, replicable intervention in our setting; open-label and single-country.
Source: https://cardiovascularbusiness.com/topics/clinical/heart-failure/nurse-coordinated-care-improves-heart-failure-survival

Interventional Cardiology and Structural Heart Disease

7. LIBREXIA ACS: milvexian does not reduce events after ACS

[Clinical trial] [international]
14,194 patients, milvexian vs placebo on top of standard antiplatelet therapy. CV death, myocardial infarction, or stroke 5.4% vs 5.1% (HR 1.05; 95% CI 0.91–1.21; p=0.50); intracranial or fatal hemorrhage 0.3% in both groups. NEJM, August 29.
Why it matters: the second major factor XI failure after asundexian; safe but without efficacy in ACS.
Source: https://www.escardio.org/news/press/press-releases/milvexian-did-not-reduce-cardiovascular-events-in-the-librexia-acs-trial/

8. TAVI PCI: TAVI-first is non-inferior to PCI-first

[Clinical trial] [Switzerland / Europe]
986 patients (mean age 82, SYNTAX 10), 48 centers. 1-year composite 22.2% vs 24.2% (difference −2.0; 95% CI −7.4 to 3.4; non-inferiority p<0.001); major bleeding 6.6% vs 9.7%; only 89% of the TAVI-first group went on to PCI. NEJM.
Why it matters: freedom of sequencing in simple anatomies; choose valves with good coronary access.
Source: https://www.news-medical.net/news/20260830/TAVI-first-strategy-proves-noninferior-to-PCI-first-approach-in-new-trial.aspx

9. TRIC-I-HF: transcatheter tricuspid repair vs medical therapy

[Clinical trial] [Germany]
Open-label, investigator-initiated, 360 patients with at least severe tricuspid regurgitation and a recent hospitalization, 29 centers. Win ratio 2.42 (95% CI 1.76–3.33); survival free of death or heart failure hospitalization 73.9% vs 48.4% at 1 year (HR 0.40); NNT 4.
Why it matters: a much larger effect than TRILUMINATE; open-label and single-country; the therapy is inaccessible on grounds of cost in the country.
Source: https://www.radcliffecardiology.com/news/esc-congress-2026-day-3-hot-line-trials-what-data-show-and-what-cardiologists-think

Arrhythmias and Electrophysiology

10. SINGLE-AF (Korea): anticoagulation with a single risk factor

[Clinical trial] [South Korea]
1,803 patients with CHA2DS2-VASc 1 (men) or 2 (women), apixaban/rivaroxaban vs nothing. 24-month composite 0.5% vs 1.5% (HR 0.31; 95% CI 0.10–0.94; p=0.028); ischemic stroke 0.1% vs 1.1%; major bleeding 0.3% vs 0.5%.
Why it matters: the first randomized data in the gray zone; few events, open-label, an Asian population; replication should be awaited. (Source in English and Korean.)
Source: https://www.radcliffecardiology.com/news/esc-congress-2026-day-1-hot-line-trials-what-data-show-and-what-cardiologists-think

11. PVI-SHAM-AF: ablation does not outperform a sham procedure on quality of life

[Clinical trial] [Germany / Poland]
262 patients, double-blind, 2:1 ablation vs sham. AFEQT at 6 months: difference 2.6 points (95% CI −2.7 to 8.0; p=0.36); rhythm outcomes favored ablation.
Why it matters: part of the symptomatic improvement is a placebo effect; a small, short trial.
Source: https://www.escardio.org/news/press/press-releases/catheter-ablation-does-not-improve-quality-of-life-related-to-atrial-fibrillation/

12. ENRICH-AF: edoxaban after intracranial hemorrhage does not reduce stroke and doubles major bleeding

[Clinical trial] [Canada / international]
948 patients, 28 months. Stroke or embolism 11.8% vs 12.8% (HR 0.88; p=0.48); major bleeding 11.6% vs 5.2% (HR 2.23; p<0.001).
Why it matters: the DOAC does not pay off in this group; left atrial appendage closure remains an alternative to study.
Source: https://www.hcplive.com/view/esc-congress-2026-day-2-recap-6-headlines-to-know

13. FDA approves Abbott's TactiFlex Duo catheter (pulsed field + radiofrequency)

[FDA regulatory] [Industry] [United States]
Approved September 8 for atrial fibrillation; based on the FlexPulse IDE study (ESC 2026, EP Europace), with no figures in the press release.
Why it matters: the first dual-energy catheter in the US; industry news until the trial itself is read.
Source: https://abbott.mediaroom.com/2026-09-08-Abbott-receives-FDA-approval-for-its-TactiFlex-TM-Duo-Ablation-Catheter-to-treat-people-with-abnormal-heart-rhythms

Cardiac Surgery and Cardiovascular Imaging

14. POET-II: shortening antibiotics in left-sided endocarditis is non-inferior, with more relapses

[Clinical trial] [Denmark / Sweden / United States]
508 stable patients, 13 centers. Antibiotics for 26 vs 41 days; composite of mortality, unplanned surgery, or embolism 8.2% vs 10.7% (non-inferior); relapses 5.1% vs 1.6%.
Why it matters: it saves two weeks but triples relapses; it calls for close follow-up.
Source: https://www.hcplive.com/view/esc-congress-2026-day-2-recap-6-headlines-to-know

15. Fifth Universal Definition of Myocardial Infarction

[Guideline] [ESC / ACC / AHA / WHF, endorsed by EACTS and STS]
European Heart Journal (doi 10.1093/eurheartj/ehag101). Three profiles: primary, secondary, and procedure-related (30 days after PCI or surgery, identical criteria, with a coronary complication plus a contractility abnormality or loss of viability). Sex-specific troponin, silent infarction, alignment with ICD-11.
Why it matters: it changes the count of periprocedural infarction in CABG vs PCI; the imaging requirement may underdiagnose (Kirtane); the chairs' industry ties.
Source: https://www.tctmd.com/news/fifth-universal-definition-mi-unveiled-esc-2026

Cross-cutting: Latin America and the Caribbean

16. SCORE2-LAC: 10-year cardiovascular risk calibrated for Latin America and the Caribbean

[Publication] [ESC – SIAC]
A recalibration of SCORE2 using data from 32 countries and 2.6 million people, with external validation; a preliminary model in April and a paper in the European Heart Journal (doi 10.1093/eurheartj/ehag698) coinciding with ESC 2026, according to Sodocardio, whose delegation met with the ESC and ACC in Munich.
Why it matters: the first table calibrated for the region; based on national mortality, not on Dominican cohorts. (Sources in English and Spanish.)
Source: https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehag698/8772342

Upcoming meetings and dates

• Oct 1–4: 9th Inter-American Congress of Heart Failure and Pulmonary Hypertension (SIAC – Sodocardio North Chapter), Punta Cana
• Oct 8–10: World Congress of Cardiology + 81st Brazilian Congress of Cardiology, Rio de Janeiro
• Oct 9–12: HFSA, Phoenix
• Oct 14–16: SAC.26, Buenos Aires
• Oct 29 – Nov 1: CVEN Summit 2026 (SODOCICAR), Punta Cana
• Oct 31 – Nov 3: TCT 2026, San Diego
• Nov 6–9: AHA Scientific Sessions 2026, Chicago
• Feb 18–20, 2027: First SODOCI International Congress, venue TBA

Monthly cardiology bulletin — September 18, 2026

A month dominated by ESC Congress 2026 in Munich: new heart failure guidelines, several high-profile neutral trials, and positive results in statins for older adults, tricuspid repair, and intensive blood pressure control.

Three worth your time:
• New ESC 2026 heart failure guidelines collapse ejection fraction into just two phenotypes (<50% vs ≥50%), with MRAs class I across the board and GLP-1 agents class IIa in preserved EF with obesity.
• STAREE: atorvastatin 40 mg cut major cardiovascular events from 8.3% to 6.0% in 9,971 adults over 70 without known cardiovascular disease (HR 0.70), with no change in disability-free survival.
• TRIC-I-HF: transcatheter tricuspid repair nearly doubled survival free of death or heart failure hospitalization versus medical therapy (73.9% vs 48.4% at 1 year, NNT 4).

Full bulletin: https://boletinesmedicos.com/en/cardiologia/2026-09-18.html

ESC 2026 recap: new HF guidelines cut EF to 2 phenotypes; STAREE shows statins cut CV events 30% in adults 70+; TRIC-I-HF nearly doubles event-free survival vs medical therapy. Full bulletin: https://boletinesmedicos.com/en/cardiologia/2026-09-18.html