Faculty and teams from the Duke Clinical Research Institute (DCRI) contributed to a broad range of scientific and educational sessions at the 2026 European Society of Cardiology (ESC) Congress, held Aug. 28-31 in Munich. Their work was featured across presentations, guideline discussions, chair and discussant roles, and several of the congress's highly anticipated Hot Line studies.
Key Scientific Themes
Contributions from the DCRI reflected several of the most important themes shaping contemporary cardiovascular medicine, including heart failure, atrial fibrillation, cardiovascular prevention, hypertension, and implementation of evidence-based care. Faculty presentations explored topics ranging from novel gene and RNA-based therapies to strategies for reducing treatment delays in myocardial infarction, optimizing heart failure management, and improving outcomes for patients living with complex arrhythmias.
Heart failure and rhythm disorders emerged as particularly prominent areas of focus. Marat Fudim, MD, MHS, presented findings from the MUSIC-HFpEF study, which reported sustained improvements in invasive exercise hemodynamics after a single intracoronary dose of SRD-002 gene therapy in patients with heart failure with preserved ejection fraction. At 12 months, 80% of treated patients met the threshold for normalized cardiac filling pressures, mean peak exercise pulmonary capillary wedge pressure was reduced by approximately 30%, and no serious adverse events were reported.
Other sessions emphasized how cardiovascular care is being shaped not only by new therapies, but also by clearer definitions and implementation strategies. Stephen Greene, MD, contributed to engaging discussions on heart failure treatment implementation and guideline-directed therapy, while Jonathan Piccini, MD, MHS, and Sana Al-Khatib, MD, MHS, contributed to sessions on atrial fibrillation, catheter ablation, pacing, stroke prevention, and broader rhythm management.
Kristin Newby, MD, MHS, led discussions on the Fifth Universal Definition of Myocardial Infarction (MI). Newby also served as the ACC/AHA co-chairperson for the definition taskforce. The new definition replaces the prior numerical MI classification with three clinical categories to better align diagnosis with underlying pathophysiology, objective criteria, and real-world clinical evaluation.
Prevention, diagnosis, and cardiovascular risk reduction were also recurring themes throughout the congress. Christopher Granger, MD, presented on emerging RNA-based therapies for hypertension and stroke prevention strategies in atrial fibrillation, while Neha Pagidipati, MD, MPH, shared research examining angiotensinogen-targeting therapies and hypertension management.
Manesh Patel, MD, presented on artificial intelligence and health equity, Nishant Shah, MD, shared research on lipoprotein(a) testing and lipid management, and Jennifer Rymer, MD, MBA, MHS, highlighted opportunities to reduce total ischemic time in acute myocardial infarction care.
DCRI Contributions to Hot Line Science
The DCRI also played important roles in several studies featured in the congress’s Hot Line sessions, which highlight major late-breaking clinical trials expected to influence practice and future research. Among those studies, ACACIA-HCM reported that aficamten significantly improved symptom burden and exercise capacity in patients with symptomatic nonobstructive hypertrophic cardiomyopathy, a population with no currently approved treatment options. The trial is the first to document clinically meaningful improvements for this form of inherited heart disease.
LIBREXIA ACS tested whether adding the factor XIa inhibitor milvexian to standard antiplatelet therapy after acute coronary syndrome could reduce recurrent cardiovascular events without increasing serious bleeding. The trial found the therapy did not reduce major adverse cardiovascular events compared with placebo and was discontinued for futility, though it also did not increase intracranial or fatal bleeding.
CARDIO-TTRansform evaluated eplontersen, a once-monthly RNA-targeted silencer, in patients with transthyretin amyloid cardiomyopathy. Although eplontersen suppressed transthyretin as expected, the study did not meet its primary endpoint of reducing cardiovascular deaths and recurring cardiovascular events overall, with findings suggesting that background stabilizer therapy may have influenced the results.
Renato Lopes, MD, PhD, MHS, served in leadership roles across several of these efforts, including as chair of the clinical events committee for ACACIA-HCM and as a member of the steering committee for LIBREXIA ACS. DCRI teams contributed clinical events classification leadership and adjudication support across multiple Hot Line studies, highlighting the DCRI’s vital role in producing and interpreting evidence that advances understanding of treatment benefit, safety, and remaining unmet needs in cardiovascular care.
Patient Experience and Quality Improvement Research
DCRI investigators also presented research focused on patient experience and quality improvement. Sean Pokorney, MD, MBA, shared findings examining the impact of paroxysmal supraventricular tachycardia (PSVT) on patients' daily lives between symptomatic episodes. The longitudinal study found that PSVT effects extend beyond acute episodes, with many patients changing their daily activities in attempts to avoid stress, and reduce activity or exercise. Patients also reported disruptions to driving, travel, sleep, work, and overall quality of life.
The findings add nuance to how PSVT burden is understood by showing that episode frequency and duration do not fully capture the condition's impact on patients. Anxiety and activity avoidance between episodes point to the importance of incorporating patient-reported outcomes and day-to-day lived experience into research, clinical conversations, and treatment evaluation.
Pokorney also presented primary results from the RECTIFY study, a quality-improvement initiative focused on improving management of cardiac implantable electronic device infections. The multicenter initiative increased guideline-recommended device removal for cardiac implant device infections by nearly 50%. The improvement was driven by a scalable intervention that combined multidisciplinary care teams, electronic health record alerts, and health system workflow changes to support earlier diagnosis and treatment.