Clinical Cardiology最新文献

{"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}

{"title":"SGLT2 Inhibitors and Sleep Quality in Heart Failure: Implications for Patient-Centered Outcomes","authors":"Surender Himral,&nbsp;Jaibharat Sharma,&nbsp;Shivali Sandal,&nbsp;Kunal Mahajan","doi":"10.1002/clc.70208","DOIUrl":"https://doi.org/10.1002/clc.70208","url":null,"abstract":"<p>We read with great interest the article by Erbay et al. [<span>1</span>] evaluating the impact of sodium-glucose co-transporter-2 (SGLT2) inhibitors on sleep quality, anxiety, and quality of life in patients with heart failure (HF). The study contributes meaningfully to the dialog surrounding patient-centered outcomes in HF management. However, several important methodological limitations essential for interpretation were not sufficiently discussed in the manuscript. First, the nonrandomized, physician-directed allocation of SGLT2 inhibitor therapy in this study introduces a substantial potential for selection bias and confounding by indication. Physicians may preferentially prescribe SGLT2 inhibitors to patients who are perceived to be more likely to benefit, be clinically stable, or demonstrate better adherence [<span>2</span>]. Such confounding can extend beyond the measured baseline parameters and affect both clinical and subjective outcomes, including sleep and anxiety. Second, the study groups were imbalanced with respect to key baseline characteristics: the SGLT2 cohort was notably younger and had a significantly higher prevalence of diabetes mellitus (DM). Both age and DM status independently alter sleep architecture, anxiety, and overall quality of life, increasing the risk that these factors, rather than the intervention itself, underpin the observed improvements [<span>3</span>]. In small sample sizes, the capacity to statistically adjust for these complex interrelations is inherently limited. Third, sleep quality assessment in the study relied solely on the Pittsburgh Sleep Quality Index (PSQI), a validated but subjective questionnaire, without incorporating objective sleep measures such as actigraphy or polysomnography. Given the high prevalence of undiagnosed sleep-disordered breathing in HF and the recognized limitations of self-reported measures in this population, the absence of objective evaluation may introduce measurement bias and limit causal inference [<span>4</span>]. Fourth, the study is limited by its short follow-up duration (6 months) and the absence of granular data on changes in concurrent HF and psychotropic medications during follow-up. Short-term improvements may not be sustained over time, and undocumented modifications in concomitant therapy can confound the attribution of the observed benefits exclusively to SGLT2 inhibitors. Furthermore, differential attrition, particularly resulting from hospitalization or mortality, exacerbates the potential for survivor bias [<span>5</span>], a critical consideration in the HF population. Taken together, these limitations underscore the need for cautious interpretation of the reported benefits and reinforce the imperative for future randomized, controlled, and objectively assessed studies with longer follow-ups to establish the patient-centered efficacy of SGLT2 inhibitors in HF.</p><p>All authors contributed to the writing of the correspondence and have approved the fina","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.70208","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012645","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":"Methodological and Statistical Concerns Regarding “Can Sodium-Glucose Co-Transporter-2 Inhibitors Improve Sleep Quality, Anxiety, and Quality of Life in Patients With Heart Failure?”","authors":"Rajeev Gupta,&nbsp;Shekhar Vohra,&nbsp;Anshul Yadav,&nbsp;Neelesh Gupta,&nbsp;Rohit Mody","doi":"10.1002/clc.70203","DOIUrl":"https://doi.org/10.1002/clc.70203","url":null,"abstract":"<p>The recent article by Erbay et al. reporting improved sleep quality, anxiety, and quality of life in heart failure patients receiving SGLT2 inhibitors [<span>1</span>] addresses a clinically important but underexplored area. However, several methodological limitations merit attention before these findings are generalized.</p><p>First, there was a significant baseline imbalance in Pittsburgh Sleep Quality Index (PSQI) scores between groups (5.0 vs. 6.0, <i>p</i> = 0.036). This difference, favoring the SGLT2 inhibitor group at baseline, may partially explain the magnitude of improvement observed. While within-group analyses were performed, regression models should have included baseline PSQI as a covariate to mitigate this confounding [<span>2</span>].</p><p>Second, the multivariate logistic regression did not adjust for several potential confounders that could influence patient-reported outcomes, including changes in diuretic dosing, concurrent initiation of other guideline-directed medical therapies, and intercurrent hospitalizations. These variables are known to impact congestion, sleep, and mood in heart failure [<span>3, 4</span>].</p><p>Third, the subgroup analyses by ejection fraction status are based on small sample sizes, limiting statistical power and precision. Without reporting interaction <i>p</i>-values, the assertion of consistent benefit across EF strata is premature [<span>5</span>].</p><p>Fourth, multiple SF-36 domains and other secondary outcomes were tested without correction for multiplicity. In this setting, the risk of false-positive findings is high, particularly in small observational cohorts [<span>6</span>].</p><p>Lastly, the study's observational, single-center design precludes definitive causal inference, yet several statements in the discussion imply a treatment effect. This language should be tempered to reflect association rather than causation [<span>7</span>].</p><p>Given the increasing integration of SGLT2 inhibitors into heart failure care, it is critical that conclusions about novel patient-reported benefits be supported by rigorous methodology. Randomized controlled trials incorporating objective sleep measures (e.g., polysomnography) and adequate adjustment for confounding are needed to validate these intriguing findings.</p><p>Use of AI for paraphrasing and in analyzing the statistical model used in the study.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 9","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70203","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144927315","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":"Case Ascertainment and Exposure Classification in Acute Myocardial Infarction Mortality Studies Involving Psychoactive Substance Use","authors":"Noor-ul-Eman Haider,&nbsp;Syed Muhammed Rayyan,&nbsp;Muhammad Abbas","doi":"10.1002/clc.70202","DOIUrl":"https://doi.org/10.1002/clc.70202","url":null,"abstract":"<p>We welcome the recent analysis of acute myocardial infarction (AMI) death in US adults aged ≥ 65 with documented psychoactive substance abuse disorders [<span>1</span>]. Attention by the authors to an elderly population is well-timed, in light of increased co-occurrence of cardiovascular disease and substance abuse in the elderly. Two important limitations—one clinical, the other methodological—are acknowledged, however, because they affect substantially both validity and interpretability of the results.</p><p>Epidemiological studies that use death certificate data for employment are fraught with a very high potential for case ascertainment bias in this particular situation. In elderly populations, AMI is frequently listed on death certificates by clinical history or circumstantial information in place of verifying electrocardiography or cardiac biomarker tests [<span>2</span>]. Challenging presentations, cross-competing comorbidities, and silent myocardial infarction are not uncommon in this group and make both under- and overattribution of AMI as a cause of death more likely [<span>3</span>].</p><p>Equally problematic is the determination of psychoactive substance use. Toxicology is not the norm for older deaths unless there is obvious suspicion, and when it is done, it can be a restricted panel only [<span>4</span>]. This results in severe underreporting of drug use. Social stigma, clinician refusal to report, and ignorance regarding how to distinguish from prescribed versus nonprescribed use contribute to the risk of misclassification. When both outcome and exposure are tainted by classification error, cause-specific mortality rate estimates can distort changes in reporting patterns rather than capturing epidemiologic trends. Follow-up analyses using mortality registry data here need to be controlled for this dual-source bias to maintain interpretive validity.</p><p>Second, operationalization of exposure—reducing all ICD-10 F10–F19 categories into a single combined “psychoactive substance use disorder” category—is clinically restrictive. All of those codes cannot be collapsed into one usefully homogeneous category from the viewpoint of cardiovascular pathophysiology. Risk of AMI due to alcohol is secondary to chronic remodeling and arrhythmogenesis of the myocardium; cocaine and amphetamines via acute coronary vasospasm and proarrhythmic effects; opioids via hypoxia and bradyarrhythmia; sedatives via induction of hypotension and delay in conduction [<span>5</span>].</p><p>By combining these mechanistically different exposures, the study conceals substance-specific patterns of mortality and prevents investigators from being able to determine whether trends are a result of stimulant-induced acute events, alcohol-induced chronic damage, or polypharmacy effects. This limitation reduces the value of the study for cardiologists, addiction specialists, and policymakers who need substance-specific data to implement effective interventions. Further","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 9","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70202","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144918635","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":"Prevalence of Pulmonary Hypertension in Individuals With Heart Failure: A Systematic Review and Meta-Analysis","authors":"Maaedah Khan,&nbsp;Rhea Suribhatla,&nbsp;Jak Spencer,&nbsp;Nadia Daniel,&nbsp;Alex Pitcher,&nbsp;Christiana Kartsonaki","doi":"10.1002/clc.70197","DOIUrl":"https://doi.org/10.1002/clc.70197","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Heart failure (HF) is a leading cause of hospitalizations worldwide. HF can lead to pulmonary hypertension (PH) and co-occurrence of HF and PH is associated with a poor prognosis. This systematic review and meta-analysis aim to estimate the prevalence of PH in patients with HF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched MEDLINE and EMBASE for studies reporting the prevalence of PH amongst HF patients. A meta-analysis of PH prevalence, including subgroup analyses, was conducted using a random-effects model. Subgroup analyses and meta-regressions by comorbidities and patient characteristics were done. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Tool.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-four papers with 259 665 HF patients were included, of which 46 004 also had PH. The overall PH prevalence estimate in individuals with HF is 46.6% (95% CI: 39.6%–53.7%). Prevalence varied by diagnostic method, with studies using right heart catheterization reporting the highest estimates (62.5%; 52.0%–72.0%), hospital recorded data the lowest (18.4%; 14.4%–23.3%), and echocardiography 45.7% (37.1%–54.6%). Prevalence was higher in HF with preserved (47.2%; 34.8%–60.0%) than reduced ejection fraction (35.7%; 22.6%–51.3%). Prospective studies show higher estimates (60.1%; 50.7%–68.8%) than retrospective studies (37.3%; 29.5%–45.9%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This is the first systematic review and meta-analysis investigating the prevalence of PH in HF patients and shows that the prevalence of PH in this patient population is strikingly high. There is notable variability in estimates reported by different studies, largely attributed to differences in the diagnostic method of PH. Future studies with robust, standardized methodologies are needed to estimate prevalence more accurately.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 9","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70197","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144915034","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}