Late-breaking science presented at ESC Congress 2026 and simultaneously published in JACC Journals explore the performance of 124I-evuzamitide PET/MRI in patients with established or suspected cardiac amyloidosis (CA), treatment effect of vutrisiran by baseline tafamidis use, and impact of dapagliflozin on congestion in patients hospitalized for heart failure (HF).

The first study, published in JACC: Cardiovascular Imaging, found that 124I-evuzamitide PET performed well in patients with suspected or known CA, demonstrating excellent diagnostic accuracy.

Ahmad Masri, MD, MS, FACC, et al., included 126 patients (mean age 71.6 ± 10.6 years, 76% male) who underwent imaging with 124I-evuzamitide. PET/MRI was the preferred imaging modality (n=123), while PET/CT was used as an alternative (n=3). Visually positive scans were defined as tracer uptake in the left ventricular (LV) myocardium greater than blood pool activity, identified by three expert readers.

Overall, 69% of patients were diagnosed with CA using the 124I-evuzamitide PET imaging. All patients with established CA had positive scans and all patients without CA had negative scans, confirmed by all three readers. In five patients, readers had disagreement on whether scans should be graded as equivocal or negative, but none received a CA diagnosis. The study’s quantitative analysis mirrored the visual scan findings, with the mean LV/blood pool standardized uptake value ratio being 1.89 ± 0.29 in patients with CA and 0.91 ± 0.15 in patients without CA (p<0.001).

In evaluating the procedure’s safety, the authors report no significant tracer-related adverse events. “124I-evuzamitide was well-tolerated without infusion-related reactions or related adverse events up to [seven] days post-infusion (no loss to follow-up),” note the authors. “One patient had skin irritation from an adhesive used as part of the study procedures.”

A HELIOS-B analysis, published in JACC, found no significant interaction between vutrisiran treatment effect and baseline tafamidis use.

Including 654 patients with transthyretin amyloidosis with cardiomyopathy (ATTR-CM), Yasuhiro Hamatani, MD, PhD, et al., assessed treatment effects of vutrisiran 25 mg or placebo every three months according to baseline tafamidis use. The primary outcome was all-cause mortality and recurrent cardiovascular events. At baseline, 40% of patients were receiving tafamidis. These patients tended to be younger and have higher baseline six-minute walk distance and KCCQ-OSS.

Baseline tafamidis therapy did not influence treatment effect, with no statistically significant interaction identified (p for interaction = 0.55). “The absence of significant interaction does not rule out the possibility that there may be effect modification,” state the authors. In both baseline tafamidis strata, vutrisiran preserved six-minute walk distance (p for interaction = 0.24). Meanwhile, smaller improvements in KCCQ-OSS were observed in patients receiving tafamidis at baseline.

In an accompanying editorial comment, Kevin Michael Alexander, MD, FACC, and Marcus Anthony Urey, MD, add that “the current study provides hypothesis-generating evidence for the consistent treatment effect of vutrisiran with or without background TTR stabilizer. Further studies are needed before considering broad use of combination therapy among ATTR-CM patients.”

An analysis of the DAPA ACT HF-TIMI 68 trial, published in JACC: Heart Failure, determined that patients hospitalized for HF receiving in-hospital initiation of dapagliflozin saw modest yet significant improvements in congestion within one week.

Andre M. Small, MD, et al., included 2,401 patients hospitalized for HF (12% with no congestion, 63% with mild-to-moderate congestion, 24% with severe congestion), investigating the impact of dapagliflozin initiation on changes in Efficacy of Vasopressin Antagonism in Heart Failure (EVEREST) Composite Congestion Score (CCS) along with other factors including body weight, mean daily loop diuretic dose and body weight adjusted for mean daily loop diuretic dose (diuretic efficiency). These measures were assessed at one week, one month and two months.

Dapagliflozin improved all decongestion-related endpoints within one week when compared to placebo. Of note, the least squares mean difference was –0.18 for CCS (95% CI, –0.33 to –0.04; p=0.011) and –0.93 kg/furosemide 40 mg IV equivalents for diuretic efficiency (95% CI, –1.61 to –0.25; p=0.008).

At two-month follow up, the authors noted that improvements in congestion measures were sustained, and diuretic efficiency progressively increased. “Collectively, these findings demonstrate that in-hospital initiation of dapagliflozin during HF hospital promotes a trajectory of early and sustained decongestion in the postdischarge period,” state the authors. “Whereas the very early improvement in decongestion parameters support a direct diuretic effect of SGLT2 inhibitors, the progressive improvement in diuretic efficiency over time may reflect effects beyond direct diuretic augmentation.”

Visit the JACC Journals at ESC Congress 2026 page to see the full list of simultaneous publications.


Clinical Topics:
Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Acute Heart Failure, Interventions and Imaging, Computed Tomography, Magnetic Resonance Imaging, Nuclear Imaging


Keywords:
ESC Congress, ESC26, Positron Emission Tomography Computed Tomography, Sodium Potassium Chloride Symporter Inhibitors, Sodium-Glucose Transporter 2 Inhibitors, Cardiomyopathies, Heart Failure, Amyloidosis, Magnetic Resonance Imaging