The Rhythm | Issue 24
Issue 24 | Week of 14 September 2026
Cardiology Intelligence Briefing: diagnosis outpaces treatment
This was a week in which cardiology got sharper at telling patients apart, while two plausible treatments failed to deliver.34 A large European cohort showed that combining cardiac imaging with genetic testing separates high and low arrhythmic risk far more precisely than ejection fraction alone, exposing how many dangerous events occur in patients current guidelines would call low risk.1 A separate multicentre effort used invasive haemodynamic truth data to rebuild the noninvasive diagnostic pathway for heart failure with preserved ejection fraction (HFpEF), a condition current criteria misclassify more often than cardiologists would like to admit.2 A third analysis added artificial intelligence-derived imaging features to conventional risk factors and modestly improved prediction of future heart attacks, though as an exploratory single-cohort analysis it illustrates promise rather than proof.5
Against that progress in knowing who is sick, two therapeutic strategies came back empty-handed. Targeted vitamin D supplementation after myocardial infarction (MI) did not reduce major adverse cardiovascular events, and its lower secondary MI rate is worth watching rather than acting on.3 A novel anti-inflammatory strategy targeting myeloperoxidase in heart failure with preserved or mildly reduced ejection fraction failed on both co-primary endpoints.4
The field is getting better at finding the right patient and no better at treating them once found.1234 That gap is where cardiology's real work now sits: sharper phenotyping raises the stakes on treatments that keep falling short, and the next genuine advance will have to come from the treatment side, not the diagnostic one.
