Clinical Cardiology最新文献

{"title":"Management of Antithrombotic Therapy in Patients With Coexisting Atrial Fibrillation and Coronary Artery Disease Who Underwent Percutaneous Coronary Intervention Within the Last Year","authors":"Sebastian König,&nbsp;Sven Hohenstein,&nbsp;Johannes Leiner,&nbsp;Anne Nitsche,&nbsp;Alexander Staudt,&nbsp;Frank Steinborn,&nbsp;Christian Bietau,&nbsp;Henning T. Baberg,&nbsp;Michael Niehaus,&nbsp;Jürgen Tebbenjohanns,&nbsp;Melchior Seyfarth,&nbsp;Markus W. Ferrari,&nbsp;Marc M. Vorpahl,&nbsp;Ralf Kuhlen,&nbsp;Kerstin Bode,&nbsp;Andreas Bollmann","doi":"10.1002/clc.70196","DOIUrl":"10.1002/clc.70196","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Coronary artery disease (CAD) is a common comorbidity in patients with atrial fibrillation (AF), and optimal antithrombotic medication improves clinical outcomes in this high-risk population. The aim of our study was to describe antithrombotic drug regimens in different patient cohorts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We investigated data from the prospective Helios Heart registry (H2) and the Heart Center Leipzig routine clinical database (HZL). We included inpatient cases with AF and CAD (hospitalized from March 2021 to July 2024 [H2] or January 2017 to December 2021 [HZL]), who underwent percutaneous coronary intervention (PCI) within the last 12 months. Information on clinical characteristics, coronary interventions, and medication prescribed was obtained from electronic case report forms and/or administrative data based on ICD-10, OPS, and ATC codes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 3481 (HZL), and 205 (H2) index cases with comparable baseline characteristics. Overall, 92.5% (HZL) and 87.6% (H2) of patients were on any anticoagulation, and 93.0% (HZL) and 80.2% (H2) were prescribed ≥ 1 antiplatelet agent. There were relevant differences in antithrombotic therapy when stratifying for PCI timing. Factors associated with higher (older age) or lower (comorbidity burden, antiplatelet treatment, prior left atrial appendage occlusion) prescription rates of OAC were identified. OAC therapy without adjunctive antiplatelet therapy was associated with an increased rate of rehospitalization for major adverse cardiovascular events at 12 months (HZL).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We presented current data on antithrombotic drug utilization in patients with AF and CAD and found comorbidity burden, concomitant antiplatelet treatment and other factors to be associated with lower anticoagulant prescription rates.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 10","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12529229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145299042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Value of Platelet to Lymphocyte Ratio for Myocardial Infarction: A Systematic Review and Meta-Analysis","authors":"Hengxu Yu,&nbsp;Shitao Li,&nbsp;Yutong Wu,&nbsp;Xiangpeng Ren","doi":"10.1002/clc.70215","DOIUrl":"10.1002/clc.70215","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Correlations between platelet-to-lymphocyte ratio (PLR) and prognosis in patients with acute myocardial infarction (AMI) are reported in more studies, though there is no evidence-based data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Databases (PubMed, Embase, Web of Science, and Cochrane Library) were searched from their inception to April 19, 2024, to retrieve articles discussing associations between PLR and clinical outcomes in AMI patients. The primary outcomes, comprising mortality and major adverse cardiovascular events (MACE), were assessed with odds ratios (OR) and their 95% confidence intervals (CI). Sensitivity analyses and subgroup analyses were utilized to probe the results' robustness and potential heterogeneity sources. Analysis was carried out utilizing the software of Review Manager 5.4 &amp; STATA 15.0.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This article selected 18 cohort studies, covering 16,545 AMI patients. The meta-analysis found that elevated PLR was significantly linked with mortality in AMI patients (OR = 1.06; 95% CI: 1.04–1.08, <i>p</i> &lt; 0.00001). Additionally, PLR was highly linked with MACE risks in AMI patients (OR = 1.495; 95% CI: 1.24–1.80, <i>p</i> &lt; 0.0001). Further subgroup analyses discovered a significant correlation between PLR and mortality in prospective studies (OR = 1.07; 95% CI: 1.05–1.09), studies with a sample size ≥ 500 (OR = 1.06; 95% CI: 1.04–1.08), patients under 70 years of age (OR = 1.07; 95% CI: 1.05–1.09), studies from European regions (OR = 1.08; 95% CI: 1.06–1.10), patients with ST-elevation myocardial infarction (OR = 1.09; 95% CI: 1.07–1.11), and those with a PLR cutoff value &lt; 140 (OR = 1.07; 95% CI: 1.05–1.09) (<i>p</i> &lt; 0.05). For MACE, similar subgroup analyses also proved an obvious correlation between PLR and MACE in the aforementioned subgroups (<i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>PLR values are linked with mortality and MACE in AMI patients. PLR serves as an effective prognostic biomarker for AMI patients, providing precious opinions for sensible therapeutic decisions in AMI treatments.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 10","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12520137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145291384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Computed Tomography-Verified Pacing Location of Micra Leadless Pacemakers and Characteristics of Paced Electrocardiograms in Bradycardia Patients","authors":"Jianghua Zhang,&nbsp;Xianhui Zhou,&nbsp;Yanmei Lu,&nbsp;Yaodong Li,&nbsp;Qiang Xing,&nbsp;Zukela Tuerhong,&nbsp;Xu Yang,&nbsp;Jiasuoer Xiaokereti,&nbsp;Yankai Guo,&nbsp;Xiaohong Zhou,&nbsp;Samantha Kohnle,&nbsp;Siyuan Zou,&nbsp;Baopeng Tang","doi":"10.1002/clc.70209","DOIUrl":"https://doi.org/10.1002/clc.70209","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The leadless pacemakers are implanted routinely under fluoroscopic image, yet the pacing sites and corresponding paced electrocardiography (ECG) remain unclear. This study was to determine the computed tomography (CT)-verified location of the leadless Micra pacemakers (Micra) and ECG characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twenty consecutive patients who met the pacemaker indications for bradycardia and underwent fluoroscopy assisted Micra implantation were enrolled. All subjects underwent a postoperative CT scan to determine the precise location of the Micra pacing tip. Paced 12-lead ECG characteristics were analysed and correlated with the Micra tip location.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the nine partitions of fluoroscopic RAO images, 14 (70%) of 20 patients had the Micra tip in zone 5, 5 (25%) in zone 6 and 1 in zone 2. Reconstructed CT 3-D cardiac images found Micra tips mostly clustered near the anterior insertion between the RV septum and free wall with 12 cases at the insertion-septal side and 8 at the free-wall side. ECG morphological analysis found that the peak deflection index in ECG lead V1 was 0.409 ± 0.058 for Micra tips at the insertion-septal side and 0.527 ± 0.062 in the free-wall side (<i>p</i> &lt; 0.001 between two sides) and <i>R</i> wave amplitude in lead V6 appeared larger for Micra tips in the free-wall group compared to Micra tips in the insertion-septal group, while there was no difference in QRS duration between two sides.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In routine Micra implantation, the pacing sites were often located in the anterior insertion region.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 10","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70209","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145230521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping Gastroesophageal Reflux Disease and Coronary Artery Disease: A Comprehensive Analysis of Multivariable Mendelian Randomization and Shared Genetic Etiology.","authors":"Yiying Zhen, Xiang Yuan, Min Ruan, Huan Lu, Dakai Liang, Dehua Huang, Fengyang Deng, Haozhang Huang, Jiaman Ou","doi":"10.1002/clc.70213","DOIUrl":"10.1002/clc.70213","url":null,"abstract":"<p><strong>Aims: </strong>We employed a robust genetic approach to provide a better understanding of whether Gastroesophageal reflux disease (GERD) contributes to coronary artery disease (CAD) risk from a genetic perspective.</p><p><strong>Methods: </strong>Multivariable Mendelian Randomization (MVMR) was applied to explore causal links between GERD and CAD using genetic instruments derived from genome-wide association studies (GWAS). The MVMR models were adjusted for key metabolic confounders, including low-density lipoprotein cholesterol (LDL-C), body mass index (BMI), systolic blood pressure (SBP), and glycated hemoglobin (HbA1c). Genetic correlations were estimated using linkage disequilibrium score regression. Cross-trait meta-analyses, Heritability Estimation from Summary Statistics (ρ-HESS) and colocalization analyses were performed to identify pleiotropic genes and shared genetic loci, elucidating the genetic relationship between GERD and CAD.</p><p><strong>Results: </strong>Genetically predicted GERD was found to be causally linked with CAD (rg = 0.38, P = 2.37E-52), independent of metabolic risk factors, including LDL-C, BMI, SBP, and HbA1c (odds ratio: 1.24, 95% CI: 1.02-1.52, p < 0.05). Cross-trait meta-analyses identified eight novel pleiotropic single nucleotide polymorphisms, four of which were independent of metabolic confounders, including rs11764337 in MAD1L1, rs2240326 in RBM5, rs9615905 in FAM19A5, and rs9837341 in BSN. ρ-HESS and colocalization analysis further revealed shared genetic loci for GERD and CAD, specifically rs4643373 in IGF2BP1 (located in chr17: 45876022-47517400 and posterior probability for H4 > 0.75).</p><p><strong>Conclusions: </strong>GERD is identified as an independent risk factor for CAD. The discovery of shared genetic loci provides novel insights into the genetic mechanisms underlying GERD and CAD, with IGF2BP1 emerging as a potential therapeutic target for intervention.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 10","pages":"e70213"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12538509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145336468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Empagliflozin Versus Dapagliflozin on Left Ventricular Remodeling in Heart Failure Patients: A 1-Year Comparative Study","authors":"Mahmoud Balata,&nbsp;Marc Ulrich Becher,&nbsp;Marwa Hassan,&nbsp;Mohamed Rady,&nbsp;Shady Rashed,&nbsp;Usama Alkomi,&nbsp;Marian Christoph,&nbsp;Karim Ibrahim,&nbsp;Akram Youssef","doi":"10.1002/clc.70192","DOIUrl":"10.1002/clc.70192","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Sodium-glucose cotransporter-2 inhibitors (SGLT2is) reduce cardiovascular mortality and heart failure (HF)-related hospitalizations in HF patients. However, the mechanisms underlying these benefits remain unclear, and it is uncertain whether empagliflozin and dapagliflozin have differential effects on cardiac structure and function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study aims to compare the effects of these two SGLT2is on left ventricular echocardiographic parameters in HF patients over 1 year.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study included 558 consecutive HF patients newly prescribed either dapagliflozin or empagliflozin. Key echocardiographic parameters, such as peak E-wave velocity, E/e' ratio, left atrial volume index (LAVI), LV end-diastolic and end-systolic volumes (LV-EDVI, LV-ESVI), LV mass index (LV-MI), relative wall thickness (RWT), LV sphericity index (LV-SI), and ejection fraction (LVEF), were measured at baseline and after 1 year.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At 1-year, significant reductions were observed only in the empagliflozin group for peak E-wave velocity (mean difference = −12.76 cm/s, 95% CI: −16.26 to −9.27, <i>p</i> &lt; 0.001), E/e' ratio (mean difference = −3.04, 95% CI: −4.17 to −1.91, <i>p</i> &lt; 0.001), and LV sphericity index (LV-SI; mean difference = −0.01, 95% CI: −0.02 to −0.0005, <i>p</i> = 0.040). Both SGLT2is significantly improved E-wave deceleration time, LAVI, LV-EDVI, LV-ESVI, LV-MI, and LVEF. Neither medication produced significant changes in RWT, and no significant differences were noted between groups regarding HF hospitalizations or all-cause mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Empagliflozin demonstrated more pronounced effects on LV remodeling markers, including peak E-wave velocity, E/e' ratio, and LV-SI, compared to dapagliflozin. These findings suggest potential efficacy differences between SGLT2is, highlighting the need for future randomized comparative studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 9","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12445616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Sex-Based Differences in the Prescription of the Combination of Evidence-Based Medicine After the Occurrence of an Acute ST-Elevation Myocardial Infarction","authors":"A. Evelo,&nbsp;E. Leegwater,&nbsp;W. J. R. Rietdijk,&nbsp;T. D. Warning,&nbsp;C. E. Schotborgh,&nbsp;L. E. Visser","doi":"10.1002/clc.70195","DOIUrl":"https://doi.org/10.1002/clc.70195","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To evaluate sex-based differences in the prescription of the combination of evidence-based medicine (cEBM) at discharge after an acute ST-elevation myocardial infarction (STEMI). Secondly, we analysed risk factors for the absence of cEBM after discharge, and examined sex differences in adverse events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study compared women to men who were admitted with an acute STEMI at Haga Teaching Hospital between January 2017 and June 2023. The primary outcome was cEBM, defined as an active prescription of the combination of acetylsalicylic acid, P2Y₁₂-inhibitor, ACEi/ARB, beta-blocker, and statin/ezetimibe on the day after discharge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 1467 patients (27% women), women were older than men (74 years vs. 65 years, <i>p</i> &lt; 0.001). cEBM was less often prescribed to women than men (66.0% vs. 72.8%, <i>p</i> = 0.013), primarily due to ACEi/ARB (82.1% vs. 87.7%, <i>p</i> = 0.007) and statins (90.2% vs. 95.2%, <i>p</i> = 0.001). In a multivariable logistic regression analysis, female sex was not associated with the absence of cEBM (Odds Ratio (OR) = 1.01, 95% confidence interval [95% CI]: 0.73–1.39). Other confounders such as increasing age, decreasing haemoglobin, and oral anticoagulants were correlated with the absence of cEBM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A smaller proportion of women were prescribed cEBM post-STEMI compared to men. However, this difference disappeared when controlled for other confounders. Also, women remained to have a higher chance for a stroke or death at 6 months post-discharge. These findings highlight the need for further research into sex disparities and their underlying confounders in the field of evidence-based medicine after an acute STEMI.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 9","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70195","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145062555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acoustic Cardiography (ACG) for Left Ventricular Ejection Time (LVET) Monitoring in Preeclampsia Risk Prediction","authors":"Chunping Tang,&nbsp;Xinxin Zhang,&nbsp;Miao Wang,&nbsp;Yiyuan Xiong,&nbsp;Yingxia Zhu,&nbsp;Qiong Huang,&nbsp;Ningtian Zhou","doi":"10.1002/clc.70210","DOIUrl":"https://doi.org/10.1002/clc.70210","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Preeclampsia (PE), a leading cause of maternal morbidity, lacks reliable early biomarkers. This study evaluates acoustic cardiography (ACG) for noninvasive left ventricular ejection time (LVET) monitoring and its predictive value in PE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In an observational case-control study, 59 pregnant women (28 controls, 31 PE cases) underwent synchronized ECG-phonocardiogram (PCG) monitoring using AI-driven devices. LVET, Q2S2Max, and hemodynamic parameters were analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>ACG predict PE risk via LVET monitoring.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Significantly prolonged LVET in the PE group (320.28 ± 26.79 ms vs. 301.32 ± 35.42 ms, <i>p</i> = 0.026), correlating with increased cardiac afterload. ROC analysis revealed moderate diagnostic efficacy for LVET alone (AUC = 0.658, sensitivity 72.4%, specificity 57.1%). Combining LVET with hypertension history enhanced performance (AUC = 0.776, specificity 77.8%), reducing false positives. Elevated Q2S2Max in PE (426.10 ± 29.46 vs. 403.96 ± 33.28, <i>p</i> = 0.010) indicated vascular stiffness, suggesting early vascular-cardiac coupling dysfunction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>ACG-derived parameters, integrated with clinical risk factors, demonstrated cost-effective, dynamic monitoring potential for early PE detection, particularly in resource-limited settings. While limited by sample size and single-center design, this study highlights ACG as a promising tool for cardiovascular risk stratification in pregnancy, warranting further validation in larger cohorts.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 9","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70210","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145062606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Effectiveness of Cholesteryl Ester Transfer Protein (CETP) Inhibitors on Lipid Profiles in Adults With Hyperlipidemia: A Comprehensive Systematic Review and Frequentist Network Meta-Analysis of Randomized Controlled Trials","authors":"Ibrahim Khalil,&nbsp;M. Rafiqul Islam,&nbsp;Sunjida Amin Promi,&nbsp;Arindam Das Joy,&nbsp;Md Abu Sayed,&nbsp;Durjoy Acharjee,&nbsp;Ali Saad Al-shammari,&nbsp;Sakib Abrar,&nbsp;Ta-Seen Bin Jamil,&nbsp;Malaika Taseen,&nbsp;Suborna Biswas,&nbsp;Sumaya Khan Mifty,&nbsp;Sajjad Ghanim Al-Badri,&nbsp;Avijit Debnath,&nbsp;Md. Imran Hossain,&nbsp;Mahmuda Akter","doi":"10.1002/clc.70204","DOIUrl":"https://doi.org/10.1002/clc.70204","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hyperlipidemia, a key risk factor for cardiovascular disease, is characterized by elevated low-density lipoprotein cholesterol (LDL-C), triglycerides, and reduced high-density lipoprotein cholesterol (HDL-C). Cholesteryl ester transfer protein (CETP) inhibitors, such as anacetrapib, obicetrapib, evacetrapib, dalcetrapib, and torcetrapib, aim to improve lipid profiles by increasing HDL-C and reducing LDL-C, but their comparative efficacy remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This systematic review and frequentist network meta-analysis, conducted per PRISMA-NMA guidelines, included 33 randomized controlled trials (RCTs) involving 120,292 adults with hyperlipidemia. We compared CETP inhibitors, alone or with statins, against placebo or other lipid-lowering therapies. Primary outcome was LDL-C reduction; secondary outcomes included HDL-C, triglycerides, and total cholesterol changes. Random-effects models calculated mean differences (MD) with 95% confidence intervals (CI), and P-scores ranked interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Atorvastatin + obicetrapib showed the largest reduction in LDL-C levels (MD: −69.00, 95% CI: −95.96 to −42.04, <i>p</i> &lt; 0.0001), followed by rosuvastatin + obicetrapib (MD: −60.70, 95% CI: −99.28 to −22.12, <i>p</i> = 0.0020). Atorvastatin + obicetrapib yielded highly significant increase in HDL-C levels (MD: 149.90, 95% CI: 121.70 to 178.10, <i>p</i> &lt; 0.0001), but rosuvastatin + obicetrapib showed the greatest increase (MD: 158.90, 95% CI: 118.59 to 199.21, <i>p</i> &lt; 0.0001) and obicetrapib monotherapy (MD: 139.00, 95% CI: 129.05 to 148.96, <i>p</i> &lt; 0.0001), while rosuvastatin + evacetrapib led triglyceride reductions (MD: −31.70 mg/dL). Rosuvastatin was most effective for total cholesterol (MD: −31.60 mg/dL).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CETP inhibitors, particularly anacetrapib and obicetrapib combined with statins, significantly improve lipid profiles, offering potential therapeutic benefits for hyperlipidemia management and cardiovascular risk reduction.</p>\u0000 \u0000 <p><b>Trial Registration:</b> The study was registered with <b>PROSPERO</b> to ensure transparency and adherence to methodological rigor (Registration ID: CRD420250652666).</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 9","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70204","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145062607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“Bridging Guidelines and Real World Barriers: Reflections on GDMT Optimization in Heart Failure”","authors":"Ibadullah Tahir,&nbsp;Hunain Shahbaz,&nbsp;Aimal Khattak","doi":"10.1002/clc.70206","DOIUrl":"https://doi.org/10.1002/clc.70206","url":null,"abstract":"&lt;p&gt;Velasco et al. address a critical issue in contemporary HF care by examining titration limiting adverse effects (AEs) in a specialized guideline directed medical therapy (GDMT) optimization program [&lt;span&gt;1&lt;/span&gt;]. In their single center cohort (&lt;i&gt;n&lt;/i&gt; = 254 completers), 59% of patients encountered ≥ 1 AE (hypotension, bradycardia, hyperkalemia, renal dysfunction) hindering GDMT titration [&lt;span&gt;1&lt;/span&gt;]. Notably, younger, nonischemic patients more often reached target doses. These observations underscore the reality that, despite guidelines advocating quadruple therapy (ARNi/ACEi/ARB, beta-blockers, MRA, SGLT2i) for HFrEF [&lt;span&gt;2&lt;/span&gt;] real world implementation lags: fewer than one in five eligible patients currently receive all four classes [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Velasco et al. are to be commended for quantifying AE rates within an intensive titration program and for analyzing predictors of submaximal dosing (e.g., older age and atrial fibrillation predicted lower beta blocker titration) [&lt;span&gt;1&lt;/span&gt;]. This granular approach highlights important heterogeneity: for example, patients without hypertension or with atrial fibrillation had more difficulty up titrating renin angiotensin blockers [&lt;span&gt;1&lt;/span&gt;]. Such findings point to the need for personalized strategies. However, the study's retrospective, single center design and focus on program completers may limit generalizability. Patients who discontinued the program (perhaps due to severe intolerance) were excluded; thus the true burden of AEs may be underestimated. Only four AE domains were assessed, omitting others (e.g., volume depletion, gastrointestinal symptoms, or device-related issues) that can also limit GDMT. Finally, standardized definitions of “titration limiting” AEs were not detailed. As the authors note, establishing uniform AE criteria is essential for comparing programs and guiding practice [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Importantly, Velasco's results should be interpreted alongside broader barriers to GDMT uptake. Systematic reviews and registry data have documented multifactorial obstacles including clinician inertia, patient comorbidities, socioeconomic factors, and health system challenges that suppress GDMT use [&lt;span&gt;2, 5&lt;/span&gt;]. The 2022 AHA/ACC/HFSA guideline reiterates that quadruple GDMT markedly improves survival and symptoms, yet emphasizes tailoring therapy to individual patient risk/benefit profiles [&lt;span&gt;3&lt;/span&gt;]. Similarly, recent ACC consensus guidance highlights “special cohorts” (older adults, frailty, coexisting organ dysfunction, and socioeconomic barriers) that necessitate flexible GDMT strategies [&lt;span&gt;6&lt;/span&gt;]. In this light, Velasco's finding that obesity was associated with higher titration success may reflect survivor bias or phenotype differences, and warrants further study.&lt;/p&gt;&lt;p&gt;Where Velasco et al. add value is by quantifying how often AEs intrude on a dedicated titration effort. Their high AE rate parallels other quality improvement","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 9","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70206","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145021937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critique on “Evaluation of the Presence of Native Valvular Disease in Patients With Atrial Fibrillation Using the EHRA (Evaluated Heartvalves, Rheumatic, or Artificial) Classification”","authors":"Arooha Javed,&nbsp;Syed Muhammad Savez,&nbsp;Syed Muhammad Rayyan","doi":"10.1002/clc.70207","DOIUrl":"https://doi.org/10.1002/clc.70207","url":null,"abstract":"&lt;p&gt;We read with great interest the article “Evaluation of the Presence of Native Valvular Disease in Patients With Atrial Fibrillation Using the EHRA (Evaluated Heartvalves, Rheumatic, or Artificial) Classification” by Escolar Conesa et al [&lt;span&gt;1&lt;/span&gt;]. A critical clinical question is examined by Escolar Conesa et al that: Does a patient with native valvular disease (EHRA-2) have a different prognosis than a patient without valve involvement (EHRA-3) in anticoagulated patients with atrial fibrillation (AF)? The authors report significantly higher rates of major bleeding, cardiovascular mortality, heart failure, and MACE in EHRA-2 patients in a large multicenter cohort (&lt;i&gt;n&lt;/i&gt; = 1399) with a median follow-up of approximately 910 days. They also demonstrate that EHRA-2 status remained an independent predictor following multivariable adjustment [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The authors' use of a large, real-world data set and their publication of incident rates per 100 patient-years, a clinically valuable statistic, are commendable. Their straightforward explanation of baseline differences and Cox models makes the main point very evident: native valve involvement in AF is not harmless and should be taken into consideration when determining risk and selecting anticoagulation.&lt;/p&gt;&lt;p&gt;The immediate application of these discoveries to routine practice is limited by several challenges. Mild degenerative regurgitation, aortic stenosis, previous biological prosthesis, and other lesions are all grouped under the EHRA-2 category. These entities are pathophysiologically distinct and probably pose different risks; the observer cannot determine which valve lesions are the main drivers of the signal without lesion-specific subgroup studies [&lt;span&gt;2&lt;/span&gt;]. The study acknowledges the lack of standardized echocardiographic grading. Prognosis and treatment depend on severity (e.g., mild vs. moderate aortic stenosis or regurgitation); combining all native lesions into one category runs the danger of misclassifying clinical risk [&lt;span&gt;1&lt;/span&gt;]. EHRA-2 patients had higher HAS-BLED and CHA₂DS₂-VASc scores and were older. The connection may be partially explained by unmeasured confounders (frailty, frail-functional status, and hemodynamics related to the valves), even if adjusted models partially address this. After substantial correction, previous research indicated that the EHRA-2 signal attenuated [&lt;span&gt;3&lt;/span&gt;]. Sicker patients or those with less access to monitoring may prefer to stay on VKA, which could explain the apparent protective correlation of DOACs vs VKAs. Causal inference would be strengthened by using instrumental variable techniques, inverse probability weighting, or propensity matching [&lt;span&gt;4&lt;/span&gt;]. Only baseline measurements of CHA₂DS₂-VASc and HAS-BLED were made; events and comorbidity accrual over ~2.5 years may change treatment and risk choices. Updated analysis would more accurately represent clinical practice [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Futur","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 9","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70207","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}