Clinical Cardiology最新文献

{"title":"The Multidimensional Lens: Rethinking HRQoL Assessment in Older Adults After PCI","authors":"Xiaoxia Xiao","doi":"10.1002/clc.70484","DOIUrl":"https://doi.org/10.1002/clc.70484","url":null,"abstract":"<p>We read with great interest the study by Lappalainen, et al. about the relationship between age and health-related quality of life (HRQoL) in patients with percutaneous coronary intervention (PCI) [<span>1</span>]. This work provides crucial and encouraging evidence that older patients derive comparable, clinically meaningful benefits from PCI in terms of disease-specific HRQoL as their younger counterparts. This finding is paramount for clinical decision-making in our aging population, affirming that PCI can successfully achieve its primary goal of symptom relief across all ages.</p><p>The study's true novelty and depth, however, lie in its sophisticated use of dual HRQoL instruments, which unveils a critical, often overlooked distinction in post-procedural evaluation. The parallel trajectories of the Seattle Angina Questionnaire (SAQ-7) and the generic 15D instrument tell two different stories. While the SAQ-7 scores robustly reflect sustained, CAD-specific improvement, the 15D scores reveal a subsequent decline, particularly in the oldest group, driven by age-related rather than CAD-related dimensions. This divergence is not merely a methodological footnote; it is the study's most significant contribution, prompting three essential considerations for both research and practice:</p><p><b>Firstly, clarifying the Therapeutic “Target” of PCI.</b> PCI is a targeted mechanical solution for coronary stenosis [<span>2, 3</span>]. The sustained improvement in SAQ-7 confirms it hits this target brilliantly, regardless of age. The decline in generic HRQoL underscores that PCI is not a panacea for the broader, multisystem functional decline associated with aging. This elegantly disentangles the procedure's direct benefit from the backdrop of geriatric frailty, helping to set realistic expectations.</p><p><b>Secondly, the Imperative of Instrument Selection in Geriatric Cardiology.</b> Your findings forcefully argue that a disease-specific instrument like the SAQ is non-negotiable for accurately capturing the success of CAD interventions in older adults. Relying solely on generic tools may underestimate the procedure's value by “diluting” its benefit with unrelated age-related morbidity. Future trials and quality assessments must incorporate such targeted tools to avoid erroneously concluding that older patients benefit less.</p><p><b>Thirdly, a Call for Integrated Post-PCI Care.</b> The declining 15D score, especially in the ≥ 75-year group, should be seen not as a failure of PCI, but as a powerful signal. It highlights a cohort of patients who, having successfully had their cardiac constraint alleviated, may now have their functional status limited by other geriatric syndromes (e.g., musculoskeletal issues, sensory impairment). This identifies a pivotal window for proactive, multidisciplinary geriatric assessment and intervention after successful revascularization to help patients translate their angina-free state into broader functional gains.</p><p>I","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70484","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206029","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":"H2FPEF Score and Charlson Comorbidity Index as Independent Predictors of Cardiovascular Outcomes in Elderly Patients Undergoing Geriatric Rehabilitation","authors":"Nicolas Dayer,&nbsp;Denise Auberson,&nbsp;Henri Lu,&nbsp;Elsa Costa,&nbsp;Hélène Krief,&nbsp;Sylvain Nguyen,&nbsp;Kristof Major,&nbsp;Wanda Bosshard,&nbsp;Roger Hullin,&nbsp;Pierre Monney","doi":"10.1002/clc.70496","DOIUrl":"10.1002/clc.70496","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Heart failure with preserved ejection fraction (HFpEF) is difficult to diagnose in older adults. The H₂FPEF score estimates the likelihood of HFpEF and has been associated with adverse prognosis, but its performance has not been evaluated in geriatric inpatients with a high comorbidity burden.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>We hypothesized that the H₂FPEF score predicts adverse outcomes in geriatric inpatients independently of comorbidity burden.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective cohort included consecutive patients admitted to a geriatric rehabilitation unit. All patients underwent functional and echocardiographic assessment at admission. The ability of the H₂FPEF score, the Charlson comorbidity index (CCI), and their combination to predict 1-year all-cause mortality (ACM) or cardiovascular rehospitalization (CR) was evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 302 patients (median age 83 years, 40% men), 24% had a H₂FPEF score ≥ 6 indicating high HFpEF probability and 42% had a CCI &gt; 3 indicating high comorbidity burden. The H₂FPEF score correlated with CCI (<i>β</i> = 0.27, <i>p</i> &lt; 0.01) and functional disability (lower Instrumental Activities of Daily Living score; <i>β</i> = −0.17, <i>p</i> = 0.003), but not with cognitive impairment. Both a high H₂FPEF score and high CCI were associated with a higher risk of the combined outcome of 1-year ACM or CR (adjusted HR 2.89 [95% CI 1.63–5.10], <i>p</i> &lt; 0.001 and adjusted HR 2.66 [95% CI 1.67–4.21], <i>p</i> &lt; 0.001, respectively), with no interaction between them (<i>p</i> = 0.63). Patients with both high-risk scores had the highest risk (adjusted HR 4.66 [95% CI 2.54–8.57], <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In geriatric inpatients, a high H₂FPEF score is common and independently identifies patients at increased risk of adverse cardiovascular outcomes at 1 year.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70496","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191777","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 Clinical Outcomes Across Ambulatory Cardiac Monitoring Modalities","authors":"Suneet Mittal,&nbsp;Matthew R. Reynolds,&nbsp;Alejandro Hughes,&nbsp;Erin K. Buysman,&nbsp;Erik M. Hendrickson,&nbsp;Ken Boyle,&nbsp;Brent Wright,&nbsp;Jeffrey M. Ashburner,&nbsp;Mintu P. Turakhia,&nbsp;Rod S. Passman","doi":"10.1002/clc.70500","DOIUrl":"10.1002/clc.70500","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Comparative effectiveness data across ambulatory cardiac monitoring (ACM) modalities are limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To confirm and extend comparative findings across ACM modalities and vendors in commercially insured and Medicare Advantage beneficiaries without prior arrhythmia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective study using Optum Research Database. Adults ≥ 18 years with first ACM use between January 1, 2017 and June 30, 2022 were categorized as long-term continuous monitors (LTCM), Holter, external ambulatory event monitors (AEM), or mobile cardiac telemetry (MCT). Outcomes were arrhythmia diagnosis (90 days), repeat monitoring (180 days), cardiovascular events, hospitalization, emergency department [ED] visits, and costs (365 days). Inverse probability of treatment weighting used a specific LTCM (iRhythm Technologies, San Francisco, CA) as reference.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 352,782 patients (mean age 62.0 ± 17.1 years; 61% female), 25% received LTCM, 37% Holter, 20% AEM, and 18% MCT. Among LTCM users, 58% received iRhythm LTCM. Compared with this LTCM, Holter, MCT, and other LTCM had lower odds of arrhythmia diagnosis (IPTW-weighted ORs 0.50−0.95; <i>p</i> &lt; 0.01); AEM did not differ. Repeat monitoring was higher for other LTCM, AEM, and Holter (IPTW-weighted ORs 1.99−2.77; <i>p</i> &lt; 0.001); MCT did not differ. All other modalities had higher IPTW-weighted odds of cardiovascular events (ORs 1.10−1.66; <i>p</i> &lt; 0.001), hospitalization (ORs 1.12−2.04; <i>p</i> &lt; 0.001), ED visits (ORs 1.09−2.08; <i>p</i> &lt; 0.001), and costs (IPTW-weighted cost ratios 1.03−1.28; <i>p</i> &lt; 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Outcomes differed across ACM modalities and vendors, confirming observations in other payer populations. A specific LTCM was associated with higher claims-based arrhythmia yield and lower repeat monitoring than most alternatives, and with lower hospitalization, health care utilization, and costs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70500","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191667","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":"Diagnostic Performance of a Deep Learning Model Using Phonocardiogram and Single-Lead ECG Signals for Detecting Moderate-or-Greater Aortic Stenosis: Multicenter External Validation","authors":"Shumpei Saito,&nbsp;Masanobu Ishii,&nbsp;Shimpei Ogawa,&nbsp;Hiroshi Seki,&nbsp;Koshiro Ikeda,&nbsp;Youhei Kayano,&nbsp;Yuhei Yasui,&nbsp;Ginga Sato,&nbsp;Mitsuru Ohishi,&nbsp;Takuro Kubozono,&nbsp;Naritatsu Saito,&nbsp;Eri Toda Kato,&nbsp;Masahiro Yamada,&nbsp;Shunsuke Natori,&nbsp;Yuki Kunikane,&nbsp;Takafumi Yokomatsu,&nbsp;Masashi Kato,&nbsp;Yasuaki Sagara,&nbsp;Nami Uchiyama,&nbsp;Nobuhiko Atsuchi,&nbsp;Shota Kawahara,&nbsp;Shoji Natsugoe,&nbsp;Noriaki Tabata,&nbsp;Kenichi Tsujita","doi":"10.1002/clc.70498","DOIUrl":"10.1002/clc.70498","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Valvular heart disease, particularly aortic stenosis (AS), often remains asymptomatic until advanced stages, making early detection challenging. Although cardiac auscultation is a traditional screening tool, its diagnostic accuracy is limited. We aimed to externally validate a deep learning–based model (eAS model) using phonocardiogram (PCG) and single-lead electrocardiogram (ECG) signals to detect moderate-or-greater AS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>PCG and ECG recordings were acquired using a PCG device (Cardio-EGG). Transthoracic echocardiography served as the reference standard. The external validation cohort consisted of 951 patients from 3 medical institutions, including 70 with moderate-or-greater AS. The primary outcome was sensitivity for detecting moderate-or-greater AS; secondary outcomes included the area under the receiver operating characteristic curve (AUROC), specificity, predictive values, and likelihood ratios (LR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The external validation cohort (<i>n</i> = 951, median age 73 years, male 65%) exhibited more advanced valvular disease than the training/development cohort. The eAS model achieved an AUROC of 0.9632 (95% CI: 0.9471–0.9774). Using the pre-determined threshold, sensitivity was 92.9% and specificity 87.9%, yielding a positive LR of 7.65 and negative LR of 0.08. Model-derived probabilities showed strong associations with echocardiographic measures of AS severity (adjusted <i>R</i>² = 0.5051 for peak transvalvular velocity). Exploratory subgroup analyses showed generally consistent performance, although estimates were imprecise in small subgroups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The eAS model demonstrated high diagnostic performance for detecting moderate-or-greater AS in a multicenter external validation cohort. AI-based PCG/ECG analysis may support the decision to refer patients from auscultation to echocardiography for AS evaluation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70498","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191721","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":"Association of Iron Homeostasis With One-Year All-Cause Mortality Among Intensive Care Unit Patients with Atrial Fibrillation: A Retrospective Study","authors":"Mingze Wu,&nbsp;Juan Hua,&nbsp;Yao Zhou,&nbsp;Yu Zhang,&nbsp;Lin Zhang,&nbsp;Yu Wang,&nbsp;Qinmei Xiong","doi":"10.1002/clc.70494","DOIUrl":"10.1002/clc.70494","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Perturbations in iron homeostasis can substantially affect cardiovascular outcomes. This study aims to evaluate the prognostic value of various iron homeostasis indicators for all-cause mortality in critically ill AF patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Data for this retrospective study were obtained from the Medical Information Mart for Intensive Care IV database. Based on the iron homeostasis-related indicators (ferritin, serum iron, transferrin, and total iron-binding capacity [TIBC]), the risks of 1-year mortality among critically ill patients with atrial fibrillation were calculated using Cox proportional-hazards regression. Associations of iron homeostasis indicators with all-cause mortality in critically ill AF patients were assessed via Kaplan–Meier curves, restricted cubic splines, and subgroup analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After multivariable adjustment, patients in the highest ferritin quartile had a greater risk of 1-year mortality than those in the lowest quartile (Q4 HR 1.277, 95% CI 1.083−1.506, <i>p</i> &lt; 0.01). In contrast, the highest quartiles of transferrin (Q4 HR 0.732, 95% CI 0.622−0.861, <i>p</i> &lt; 0.01) and TIBC (Q4 HR 0.732, 95% CI 0.622−0.861, <i>p</i> &lt; 0.01) were associated with lower mortality. No significant association was observed between serum iron quartiles and 1-year mortality (Q4 HR 1.067, 95% CI 0.914−1.245, <i>p</i> = 0.41). Restricted cubic spline analyses further characterized the exposure and outcome patterns for these iron-related parameters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Among critically ill patients with AF, ferritin, transferrin and TIBC levels were independently associated with 1-year all-cause mortality. No significant association was observed for serum iron.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179541","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":"Response to Commentary on the Prognostic Value of the Naples Prognostic Score After PCI in Acute Coronary Syndrome","authors":"Mustafa Bilal Ozbay,&nbsp;Yasin Özen,&nbsp;Bülent Özbay","doi":"10.1002/clc.70485","DOIUrl":"10.1002/clc.70485","url":null,"abstract":"&lt;p&gt;We sincerely thank Dr. Cao and Dr. Xiang for their thoughtful and constructive comments regarding our recently published meta-analysis evaluating the prognostic value of the Naples Prognostic Score (NPS) in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) [&lt;span&gt;1, 2&lt;/span&gt;]. We appreciate the opportunity to clarify several methodological considerations and to further contextualize our findings.&lt;/p&gt;&lt;p&gt;We fully acknowledge the well-recognized statistical limitation associated with dichotomizing continuous variables. Indeed, serum albumin, total cholesterol, neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR) are inherently continuous parameters and may exhibit non-linear associations with clinical outcomes [&lt;span&gt;3, 4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;However, our meta-analysis synthesized data from previously published observational studies, all of which applied the validated, predefined categorical NPS framework (0–2 vs. 3–4) [&lt;span&gt;5-11&lt;/span&gt;]. As a result, our analysis was constrained by the reporting structure of the original studies. Individual patient data were not available to permit modeling of continuous relationships, spline-based analyses, or interaction testing between score components.&lt;/p&gt;&lt;p&gt;Importantly, our goal was not to modify the NPS but to assess how well it predicts outcomes in its current form as used in clinical research. While modeling biomarkers continuously may enhance risk discrimination at an individual level, categorical risk scores remain highly pragmatic tools in routine clinical workflows, particularly in time-sensitive settings such as ACS [&lt;span&gt;12&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;We agree that future prospective investigations using continuous modeling, penalized regression, or machine learning approaches may refine prognostic calibration. Nevertheless, such efforts represent methodological extensions beyond the scope of a study-level meta-analysis.&lt;/p&gt;&lt;p&gt;The authors appropriately highlight that the NPS combines markers of nutritional status and systemic inflammation, potentially encompassing heterogeneous biological phenotypes. We agree that distinct mechanistic pathways, such as malnutrition-driven vulnerability versus hyperinflammatory states, may coexist under the same total score. However, composite risk indices are intentionally designed to integrate multidimensional biological signals to enhance global risk stratification rather than to function as mechanistic classifiers.&lt;/p&gt;&lt;p&gt;Our study did not aim to delineate inflammatory phenotypes but to determine whether the total NPS is associated with adverse outcomes. In this regard, the pooled data demonstrated consistent associations with all-cause mortality and no-reflow despite inter-study variability. Thus, while phenotypic refinement is an important future direction, it does not invalidate the prognostic signal observed with the current validated NPS construct.&lt;/p&gt;&lt;p&gt;We agree that observational data do not establish causali","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70485","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135229","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 Significance and Factors Associated With Worsening LV Dilatation in Heart Failure","authors":"Tauben Averbuch,&nbsp;Robert J. H. Miller,&nbsp;Justin Ezekowitz,&nbsp;Jonathan G. Howlett,&nbsp;Finlay A. McAlister,&nbsp;Erik Youngson,&nbsp;Nowell M. Fine","doi":"10.1002/clc.70490","DOIUrl":"10.1002/clc.70490","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Left-ventricular end-systolic dimension (LVESD) and end-diastolic dimension (LVEDD) are associated with adverse outcomes in heart failure (HF). The prognostic significance of a change in LVESD or LVEDD is uncertain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study included patients experiencing ≥ 1 HF hospitalization or emergency department (ED) visit between April 2008 and March 2016 and underwent ≥ 2 echocardiograms, separated by ≥ 6 months. The primary outcome was the composite all-cause mortality, HF hospitalization, and ED visits for HF. We performed cut-point analysis to determine the threshold increase in LVESD or LVEDD associated with all-cause mortality. We evaluated characteristics associated with an increase in LVESD and LVEDD above threshold using multivariable logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 8790 patients, 56.1% were male, with a mean (SD) age of 70.9 (14.5). The thresholds for change in LVESD and LVEDD associated with all-cause mortality were −3.13% and 1.33%, respectively. Patients with ischemic cardiomyopathy and lower LVEF were at increased risk of a change in LV size above the threshold. There was a significant association between an increase in LVESD or LVEDD above threshold and the composite outcome (HR 1.13; 95% CI 1.06, 1.20; HR 1.07; 95% CI 1.01, 1.13, respectively). An increase in LVESD or LVEDD above threshold was associated with increased risk of HF hospitalization (HR 1.27; 95% CI 1.15, 1.39; HR 1.24; 95% CI 1.12, 1.36) and an increased risk of ED visits for HF (HR 1.25; 95% CI 1.15, 1.37; HR 1.16; 95% CI 1.06, 1.26).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Small adverse changes in linear dimensions of LVESD and LVEDD are clinically significant in patients with HF.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644549/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126813","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":"Association Between Hemoglobin Glycation Index and Prevalence of Cardiovascular Disease in Middle-Aged and Older Adults With Hip Fracture: Findings From CHARLS and NHANES","authors":"Xinyu Ma,&nbsp;Bo Yuan","doi":"10.1002/clc.70481","DOIUrl":"10.1002/clc.70481","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cardiovascular disease (CVD) is a major cause of morbidity in middle-aged and older adults with hip fracture. This study examined the association between the hemoglobin glycation index (HGI) and CVD prevalence in this population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS) and the National Health and Nutrition Examination Survey (NHANES). Multivariable logistic regression models were used to examine the association between HGI and prevalent CVD among participants with a history of hip fracture. Sensitivity analyzes and subgroup analyzes were performed to evaluate result robustness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The final analysis included 264 participants from CHARLS and 194 from NHANES. In CHARLS, the highest HGI tertile was significantly associated with higher CVD prevalence after full multivariable adjustment; a positive association was also observed when HGI was modeled continuously. In NHANES, after accounting for the complex survey design, the associations for HGI tertiles were no longer statistically significant, although a significant positive association persisted for continuous HGI. Sensitivity analyzes yielded broadly consistent patterns within each cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Elevated HGI was significantly associated with higher CVD prevalence among middle-aged and older adults with hip fracture in the CHARLS cohort, independent of diabetes status. In the NHANES cohort, the association was attenuated and largely non-significant after full adjustment. These heterogeneous findings suggested that HGI may serve as a complementary marker of inter-individual glycation variation in selected populations. Given the cross-sectional design, the results should be regarded as hypothesis-generating; prospective studies are needed to evaluate any potential clinical utility.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Clinical Trial Number</h3>\u0000 \u0000 <p>Not applicable.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126816","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":"National and Subnational Trends in Ischemic Heart Disease Burden in Iran, 1990–2023: A Systematic Review","authors":"Mehrdad Rabiee Rad,&nbsp;Bahar Darouei,&nbsp;Ghazal Ghasempour Dabaghi,&nbsp;Reza Amani-Beni,&nbsp;Fahimeh Bagheri,&nbsp;Shahla Shahidi,&nbsp;Noushin Mohammadifard,&nbsp;Fatemeh Sabeti,&nbsp;Sana Azizian,&nbsp;Ali Pourmoghaddas,&nbsp;Shahin Shirani,&nbsp;Mohammadreza Sabri,&nbsp;Nizal Sarrafzadegan","doi":"10.1002/clc.70487","DOIUrl":"10.1002/clc.70487","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Ischemic heart disease (IHD) remains a major cause of morbidity and mortality in Iran, but evidence is dispersed across model-based estimates, population studies, registries, hospital surveillance, and death-registration data. We synthesized national and subnational evidence on IHD burden in Iran from 1990 to 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>PubMed/MEDLINE and Scopus were searched through August 15, 2026, supplemented by Google Scholar and citation searching. Eligible studies reported incidence, prevalence, mortality, hospitalization, case fatality, post-myocardial infarction survival, or burden-of-disease measures. Model-based and empirical evidence were synthesized separately, overlapping data sources were mapped, and findings were narratively synthesized because of heterogeneity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-two reports representing 35 evidence-source families were included. Within GBD 2019, age-standardized IHD mortality declined from 285.7 to 163.6 per 100 000 between 1990 and 2019, incidence from 898.3 to 829.1, and prevalence from 6250.6 to 6198.5 per 100 000, while incident cases increased from 218 181 to 593 001. Successive GBD vintages also showed declining age-standardized mortality but were not directly comparable because of modeling differences. Empirical studies generally showed higher coronary event rates in men, while Isfahan surveillance and the Iranian MI Registry indicated higher short-term post-MI case fatality among women. Burden increased with age, provincial variation was substantial, and urban-rural patterns were inconsistent. Hospital surveillance suggested improving short-term outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Successive GBD analyses estimated substantial declines in age-standardized IHD mortality, while absolute burden remained large and differences persisted by age, sex, geography, and data source. Stronger prevention and geographically representative surveillance are needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126791","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":"Association of RSV Vaccination With Clinical Outcomes in Older Adults With Heart Failure: A Propensity-Matched Analysis","authors":"Allahdad Khan,&nbsp;Muhammad Raffey Shabbir,&nbsp;Jamil Nasrallah,&nbsp;Mahrukh Imtiaz,&nbsp;Harshith Thyagaturu,&nbsp;Marat Fudim,&nbsp;Robert J. Mentz,&nbsp;Gregg C. Fonarow","doi":"10.1002/clc.70488","DOIUrl":"10.1002/clc.70488","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Respiratory syncytial virus (RSV) is increasingly recognized as a trigger for adverse outcomes in older adults with heart failure (HF). Following FDA approval of RSV vaccines for adults ≥ 60 years in 2023, real-world evidence in HF populations remains limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a multicenter retrospective cohort study using the TriNetX US Collaborative Network. Adults ≥ 60 years with HF were identified and stratified by RSV vaccination status from May 1, 2023, to January 01, 2026. Propensity score matching (1:1) was performed. The primary outcome was all-cause mortality. Secondary outcomes included respiratory failure, healthcare utilization, and cardiovascular events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After PSM, 777 vaccinated and 777 unvaccinated HF patients were analyzed. All-cause mortality (HR 0.51, 95% CI, 0.33−0.79) and ICU admissions were significantly lower in vaccinated patients (2.7% vs. 5.8%, HR 0.46, 95% CI 0.25–0.86), while healthcare utilization was significantly higher in the vaccinated cohort (HR 1.85, 95% CI 1.65–2.08). No significant differences were observed in respiratory failure (7.3% vs. 9.4%, HR 0.87, 95% CI 0.61–1.23), inpatient or emergency visits (29.9% vs. 35.1%, HR 0.97, 95% CI 0.81–1.16), HF exacerbations, myocardial infarction, or stroke. Age-stratified subgroup analyses (60–75 and 75–90 years) showed consistent findings, with no significant cardiovascular differences and significantly higher healthcare utilization in vaccinated patients across both age groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In older adults with HF, RSV vaccination was associated with lower mortality and fewer ICU admissions, without a corresponding reduction in overall inpatient/emergency use or acute-care utilization. These findings are hypothesis-generating and may reflect prevention of severe respiratory illness.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13640967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104840","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}