New science presented at HFSA 2026 and simultaneously published in JACC: Heart Failure spans several evolving areas in heart failure (HF), from ATTR-CM biomarkers and measures of physical function to predictors of adverse outcomes in transplant recipients to artificial intelligence (AI) wearables enhancing discharge care following HF hospitalization.

ATTRibute-CM Analysis: sTTR/NT-proBNP Ratio as Prognostic Marker of Clinical Outcomes

A post-hoc analysis of ATTRibute-CM biomarker data from 587 participants (mean age, 77 years; 9% women) found that an integrated biomarker ratio of log₂-transformed serum transthyretin (sTTR) at day 28 to log₂-transformed NT-proBNP at month 12 was associated with subsequent risk of all-cause mortality or first cardiovascular-related hospitalization in transthyretin amyloid cardiomyopathy (ATTR-CM). Each 0.1-unit increase in the ratio (reflecting higher sTTR relative to NT-proBNP) was associated with a 63% lower adjusted risk of the composite outcome (hazard ratio [HR], 0.37; p<0.001). However, investigators Peder L. Myhre, MD, PhD, and colleagues report that the ratio did not improve discrimination over models incorporating the two biomarkers separately and that "its potential value lies in expressing early target engagement and later myocardial effect as a single treatment-responsive measure. If validated, this could simplify endpoint reporting in TTR stabilizer trials."

SPPB vs. 6MWT For ATTR-CM

A single-center study found that the Short Physical Performance Battery (SPPB) tool and the 6-minute walk test (6MWT) were concordant measures of physical function and were moderately correlated (r=0.68; p<0.001) among 316 patients with ATTR-CM (mean age, 76 years; 12% women; 77.2% wild-type), most of whom had early-stage disease (National Amyloidosis Center stage I, 64%). Investigators Bilal Ansari, MD; Matthew S. Maurer, MD, et al., found that a one-point increase in SPPB was associated with a 33.6-meter greater 6MWT distance after adjustment for age, sex, weight, disease severity and lumbar spinal stenosis (LSS). LSS was additionally associated with approximately 2.7-fold greater odds of having preserved SPPB despite impaired 6MWT performance.

Furthermore, over a median follow-up of 20.1 months, both SPPB and 6MWT demonstrated comparable prognostic performance for a composite of death or HF hospitalization after adjustment for disease severity, with declines in either measure also predicting recurrent HF hospitalization. "Although 6MWT remains the standard functional measure in ATTR-CM trials, SPPB is established in the HF population and offers practical advantages: no special space, less time, ease of administration, and multidomain assessment (gait speed, balance, and chair stands) that identifies specific functional limitations," Ansari and colleagues conclude.

PVR, TPG and Adverse Outcomes in Transplant Recipients

A retrospective analysis of 42,845 adult primary heart transplant recipients in the Organ Procurement and Transplantation Network database found that elevated pulmonary vascular resistance (PVR) without elevated transpulmonary gradient (TPG) was not associated with excess one-year post-transplant mortality, whereas elevated TPG was associated with higher mortality regardless of PVR. Study authors Ahmed A. Zayed, MB, BCh, et al., categorized recipients into four cohorts based on guideline thresholds of 3 Wood Units for PVR and 12 mm Hg for TPG. Compared to the reference, after adjustment the high PVR/low TPG group showed no excess one-year mortality (adjusted HR [aHR], 1.06) while both the low PVR/high TPG and high PVR/high TPG groups did (aHR, 1.15 and 1.18, respectively). Among all patients with elevated PVR, concomitant high TPG identified excess risk (high vs. low: aHR, 1.24); in continuous analyses mutually adjusted for PVR and TPG, TPG remained associated with mortality while PVR did not. While concluding that TPG "merits integration into candidate evaluation," the authors caution that "clinically, candidates with elevated PVR but low TPG should not be disqualified on PVR alone; TPG should be interpreted alongside PVR, and an elevated TPG warrants attention to reversibility and perioperative right ventricular protection."

LINK-HF2: AI Monitoring Feasible Post Acute HF Hospitalization Discharge

The multicenter, randomized LINK-HF2 trial found that AI-enabled continuous physiological monitoring for up to 90 days was feasible and associated with less AI-detected physiological instability in 171 patients (mean age, 73 years; 7% women) following hospitalization for acute HF, although it did not affect HF rehospitalization or a composite outcome of all-cause unplanned rehospitalization, emergency department visits and mortality. All patients wore a continuous multisensor patch and had physiological data processed by the AI algorithm, but notifications were communicated to clinicians only in the intervention group (n=80). Median monitoring adherence for the entire cohort was 72.4%, and at least one notification was generated for 52.6% of patients, most commonly for elevated heart rate. In the intervention group, clinicians responded to communicated notifications within a median of one day, with reassessment of symptoms after three days being the most common response pathway (65.7%).

HF rehospitalization did not differ significantly between the intervention and control groups (16.3% vs. 18.7%; HR, 0.90; p=0.76), nor did the composite of all-cause unplanned rehospitalization, emergency department visits and mortality (HR, 1.03; p=0.89). However, the rate of AI-detected physiological instability was lower in the intervention group (HR, 0.76; p=0.025).

"The reduction in AI-detected physiological deviations observed in the intervention group raises the possibility that clinician engagement with alerts may influence patient behavior or physiological stability even in the absence of measurable reductions in clinical events during short-term follow-up," study investigators Konstantinos Sideris, MD, et al., write. They conclude that AI-enabled monitoring can be integrated into HF care, but detecting physiological instability alone may not improve clinical outcomes without clearly actionable signals and corresponding therapeutic responses.

HF Clinical Case and More

A simultaneously published clinical case in JACC: Case Reports describes the successful co-administration of mavacamten and tacrolimus in a 62-year-old renal transplant recipient with symptomatic obstructive hypertrophic cardiomyopathy.

Explore the full case report, as well as all the HFSA simultaneous publications and author interviews on the JACC Journals HFSA event page.

Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Aortic Surgery, Cardiac Surgery and Heart Failure, Acute Heart Failure, Heart Transplant, Interventions and Structural Heart Disease

Keywords: Wearable Electronic Devices, Artificial Intelligence, Transplant Recipients, Cardiomyopathy, Hypertrophic, Monitoring, Physiologic, Heart Transplantation, Heart Failure, Amyloidosis, Biomarkers