ESC Congress 2025 Highlights | Live From Madrid

Here’s a breakdown of the key takeaways from the provided text, organized for clarity:

1. Beta-Blocker Use After Heart Attack (MI) – LVEF Considerations

* LVEF 41-49%: Patients with a Left Ventricular Ejection Fraction (LVEF) in this range appeared to benefit more from beta-blockers.
* LVEF ≥50%: The data suggests that withdrawing beta-blockers might be appropriate for patients with an LVEF of 50% or higher, especially older patients and women.
* Caution & Re-evaluation: Experts (like Cleland) advise caution. Because immediate post-MI LVEF assessments can be unreliable, and the risk of events is high instantly after an MI, a strategy of routine initiation of beta-blockers followed by re-evaluation 6-12 weeks later is recommended. Unneeded treatments (including beta-blockers, RAS inhibitors, and antiplatelet agents) could then be withdrawn.
* Context: The trials had lower mortality rates (around 3%) than typical post-MI mortality (around 10%).

2. Hypertrophic Cardiomyopathy (HCM) Trials

* MAPLE-HCM: Aficamten (a new drug) was superior to metoprolol (a standard beta-blocker) in improving oxygen uptake, hemodynamics, and reducing symptoms in patients with obstructive HCM.
* ODYSSEY-HCM: Mavacamten did not show notable betterment in exercise capacity or health status compared to placebo in patients with non-obstructive HCM. This is significant as ther are currently no approved therapies for this condition.

3. Global Heart Health Initiatives

* MHYH Trial: Reconditioned pacemakers are a viable and safe option in low- and middle-income countries, with infection rates comparable to new pacemakers. This could significantly increase access to life-saving devices.
* Home-Based Hypertension Care (South Africa): New research suggests promising advancements in managing hypertension in resource-limited settings.

In essence, the article highlights:

* A nuanced approach to beta-blocker use post-MI, based on LVEF.
* Potential new treatment options for obstructive HCM (Aficamten).
* The lack of effective medical therapies for nonobstructive HCM.
* Innovative solutions for improving heart health access globally.