Clinical Cardiology最新文献

{"title":"Evaluation of the Presence of Native Valvular Disease in Patients With Atrial Fibrillation Using the EHRA (Evaluated Heartvalves, Rheumatic, or Artificial) Classification","authors":"Antonio Escolar Conesa,&nbsp;María Asunción Esteve-Pastor,&nbsp;Vanessa Roldán,&nbsp;Eva Soler Espejo,&nbsp;José Miguel Rivera-Caravaca,&nbsp;Pablo Gil Pérez,&nbsp;Eduardo González Lozano,&nbsp;José María Arribas Leal,&nbsp;Sergio Cánovas López,&nbsp;Daniel Saura Espín,&nbsp;María José Oliva Sandoval,&nbsp;Eduardo Pinar Bermúdez,&nbsp;Juan García De Lara,&nbsp;Gregory Y. H. Lip,&nbsp;Francisco Marín","doi":"10.1002/clc.70172","DOIUrl":"https://doi.org/10.1002/clc.70172","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Atrial fibrillation (AF) in association with native valvular heart disease (VHD) is very common and both entities perpetuate each other due to volume and pressure overload. In 2017, the new EHRA classification (Evaluated Heartvalves, Rheumatic or Artificial) was proposed: EHRA 1 (mechanical prostheses or moderate/severe mitral stenosis), EHRA 2 (native valvular involvement or biological prosthesis) and EHRA 3 (without valve disease). The objective was to analyze the clinical characteristics as well as adverse events in the follow-up of AF patients under oral anticoagulation classified according EHRA classification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A multicenter retrospective observational descriptive study was designed and collected clinical, analytical, echocardiographic characteristics as well as adverse events in the follow-up of patients with AF who start oral anticoagulation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>1.399 patients were included (mean age 75.3 ± 9.9 years; 659 (47.1%) male), of whom, 63% were classified as EHRA 2. After a median follow-up of 910 (IQR 730−1018) days, native EHRA 2 patients had higher event rates/patient-year as well as a higher total rate of adverse events such as cardiovascular mortality (5.5% vs. 1.1% event/patient-year; 8.7% vs. 1.1% <i>p</i> &lt; 0.001) and major adverse cardiovascular events (MACE) (8.9% vs. 3.4% event/patient-year; 14.2% vs. 3.1% <i>p</i> &lt; 0.001), compared with EHRA 3 patients. Multivariate logistic regression analysis showed that native EHRA 2 group was independently associated with all major adverse events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In anticoagulated AF patients, those with native valve involvement (EHRA 2) have a worse prognosis than patients without valve involvement (EHRA 3). The presence of native valvular disease is shown as an independent risk factor for all-cause mortality, major bleeding, cardiovascular mortality, ACS, heart failure, and MACE.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 8","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70172","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144740514","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":"Trends in Cardiovascular Mortality in Patients With Chronic Kidney Disease From 1999 to 2020: A Retrospective Study in the United States","authors":"Eeman Ahmad,&nbsp;Shoaib Ahmad,&nbsp;Azka Naeem,&nbsp;Shahzaib Ahmed,&nbsp;Maryam Shehzad,&nbsp;Umar Akram,&nbsp;Hamza Ashraf,&nbsp;Obaid Ur Rehman,&nbsp;Irfan Ullah,&nbsp;Raheel Ahmed,&nbsp;Chadi Alraies,&nbsp;Gregg C. Fonarow","doi":"10.1002/clc.70174","DOIUrl":"https://doi.org/10.1002/clc.70174","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Chronic kidney disease (CKD) may be associated with fatal cardiovascular diseases (CVDs). We aim to identify CVD-related mortality trends in patients with CKD in the US, examining the variation by sex, race, and region, and compare them to CVD-related mortality trends in general.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The CDC-WONDER database was used to obtain age-adjusted mortality rates (AAMRs) per 100,000 population. Annual percent change (APC) and average APC (AAPC) in these rates were calculated using Joinpoint regression and comparisons were done using pairwise comparison.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 1999 to 2020, a total of 605,384 CVD-related deaths were observed in patients with CKD. The AAMR was almost double in males (11.0) than females (6.3). NH (Non-Hispanic) Blacks or African Americans displayed the highest overall AAMR while NH Asians or Pacific Islanders displayed the lowest. AAMRs also varied substantially by region (Midwest: 8.8; West: 8.6; South: 8.0; Northeast: 7.3). States with the highest AAMR was the District of Columbia. Nonmetropolitan regions exhibited a slightly higher AAMR (8.6) than metropolitan regions (8.1). The AAPC for CVD-related deaths in patients with CKD differed significantly from that of the general population for the entire cohort, across both sexes, as well as among NH Whites, NH Black or African Americans, and Hispanics or Latinos. Regional differences were also observed in the Midwest, Northeast, and West.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Significant differences in CVD-related deaths in patients with CKD were observed. These high-risk groups should be the point of focus for targeted interventions to reduce CVD-related mortality in CKD patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 8","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70174","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144740512","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":"The Effect of Age on 1-Year Readmissions in Atrial Fibrillation Patients: Trends and Insights From a Conflict-Stricken Country","authors":"Ibrahim Antoun,&nbsp;Alkassem Alkhayer,&nbsp;Aref Jalal Eldin,&nbsp;Alamer Alkhayer,&nbsp;Riyaz Somani,&nbsp;G. André Ng,&nbsp;Mustafa Zakkar","doi":"10.1002/clc.70186","DOIUrl":"https://doi.org/10.1002/clc.70186","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Atrial fibrillation (AF) is a leading cause of cardiovascular morbidity and hospitalization worldwide. However, limited data exist on AF readmissions in low-resource and conflict-affected settings. This study investigates the impact of age on 1-year readmission rates among AF patients in a Syrian tertiary hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective observational cohort study was conducted at a tertiary Syrian center between June/2021–November/2023. Patients admitted with primary AF were included, while those with secondary AF or missing demographic data were excluded. Patients were stratified into three age groups: 18–50 years (Group 1), 51–70 years (Group 2), and &gt; 70 years (Group 3). The primary outcome was all-cause and cardiovascular-related 1-year readmissions, with secondary outcomes including readmission frequencies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 657 AF patients were included, with a median age of 60 320 (52%) were males. One-year readmission occurred in 64% of patients, with AF being the most common cause (75%). Group 1 had the highest smoking rates (70%). Group 3 had the highest rates of ischemic heart disease (47%), congestive cardiac failure (CCF) (35%), chronic kidney disease (15%, <i>p</i> &lt; 0.001) and chronic liver disease (20). Older age was significantly associated with increased readmissions (87% in Group 3 vs. 62% in Group 2 and 49% in Group 1, <i>p</i> &lt; 0.001). Frequent readmissions were more prevalent in Group 3 (≥ 3 admissions: 46%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Older AF patients in a conflict-affected setting experience significantly higher readmission rates. Addressing healthcare resource limitations and optimizing AF management strategies are crucial to improving outcomes in resource-limited settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 7","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70186","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144705692","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":"Revisiting the Boundaries of GDMT Optimization: Beyond Adverse Effects and Into the Future of Personalized Heart Failure Care","authors":"Ateeq Ur Rehman,&nbsp;Syed Muhammad Rayyan,&nbsp;Areeba Khan","doi":"10.1002/clc.70187","DOIUrl":"https://doi.org/10.1002/clc.70187","url":null,"abstract":"&lt;p&gt;We read with interest the study by Velasco et al. on tolerability and adverse effects (AEs) encountered during heart failure (HF) guideline-directed medical therapy (GDMT) optimization [&lt;span&gt;1&lt;/span&gt;]. The authors highlight an increasingly relevant challenge in HF management: real-world implementation of GDMT often falls short of guideline recommendations. While the study sheds light on important aspects of AEs and patient characteristics influencing dose titration, several key limitations and oversights merit critical discussion.&lt;/p&gt;&lt;p&gt;First, the inclusion of only those patients who completed the optimization program introduces selection bias, possibly underestimating the true burden of titration-limiting AEs. Patients unable to complete the program potentially due to more severe AEs or clinical decompensation were excluded from analysis. This risks portraying a more favorable safety and tolerability profile than might exist in broader clinical practice [&lt;span&gt;1&lt;/span&gt;]. Additionally, the lack of a comparator group limits the ability to assess whether the program truly improved outcomes beyond natural progression or standard care.&lt;/p&gt;&lt;p&gt;Second, while older age and atrial fibrillation were identified as predictors of suboptimal beta-blocker and RAAS inhibitor dosing, the effect sizes were modest (OR 1.04 for age) and potentially confounded by unmeasured variables such as frailty or social support [&lt;span&gt;1&lt;/span&gt;]. Surprisingly, hypertension appeared protective, contradicting conventional expectations. This counterintuitive finding may reflect physiological buffering in hypertensive patients or clustering of other unmeasured favorable traits. We believe it suggests a need to explore vascular-autonomic phenotyping in HF patients, an underexplored frontier.&lt;/p&gt;&lt;p&gt;Moreover, the focus on four common AEs, bradycardia, hypotension, hyperkalemia, and renal dysfunction while pragmatic, overlooks other frequent clinical barriers such as fatigue, dizziness, ACEi-induced cough, polypharmacy, and most crucially, therapeutic inertia [&lt;span&gt;2, 3&lt;/span&gt;]. Clinical inertia, the reluctance to intensify treatment despite suboptimal control, has been shown to significantly impede GDMT application, with over 50% of physicians reducing therapy based on anticipated rather than actual AEs [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The study's population was relatively young, with fewer comorbidities, and a notable “obesity paradox”: obese patients were more likely to reach target doses [&lt;span&gt;1&lt;/span&gt;]. This reflects findings from the Swedish HF Registry, where obese patients had greater GDMT adherence, possibly due to physiological reserve or clinician bias [&lt;span&gt;5&lt;/span&gt;]. This observation raises the question: should GDMT targets be individualized rather than uniform?&lt;/p&gt;&lt;p&gt;Importantly, the authors report no titration-limiting AEs in patients on SGLT2 inhibitors, aligning with emerging evidence of their favorable safety profile and supporting their expanded use as foundational ther","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 7","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70187","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144705693","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":"Exploring the Interaction Between Sleep Patterns, Cardiac Autonomic Function, and Traditional Cardiovascular Risk Factors Following Acute Myocardial Infarction","authors":"Mohamed Ali Hbaieb,&nbsp;Laurent Bosquet,&nbsp;Omar Hammouda,&nbsp;Raghda Hbaieb,&nbsp;Ines Mezghani,&nbsp;Salma Charfeddine,&nbsp;Leila Abid,&nbsp;Mouna Turki,&nbsp;Tarak Driss,&nbsp;Benoit Dugué","doi":"10.1002/clc.70183","DOIUrl":"https://doi.org/10.1002/clc.70183","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Monitoring lifestyle habits and physiological metrics are essential for improving cardiovascular outcomes and supporting recovery after acute cardiac events. Sleep is acknowledged as a core component of cardiovascular health and a predictive tool of adverse outcomes following acute myocardial infarction (AMI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The present study aimed to assess sleep metrics and explore the links between sleep patterns, heart rate variability (HRV) parameters, and traditional cardiovascular risk factors in patients with AMI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Sixty male patients with AMI (56.77 ± 8.24 years) participated in this study. Cardiac autonomic function was assessed with short-term HRV analysis during the second week post-AMI. Physical activity level was assessed using accelerometers. Sleep quality and quantity were evaluated objectively using a wrist-worn accelerometer and subjectively by the Pittsburgh Sleep Quality Index. Chronotype was evaluated with the Horne and Otsberg questionnaire.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty post-AMI patients (33.3%) tended to experience poor sleep quality, with a sleep efficiency inferior to 85%. Thirty patients (50%) experienced short sleep duration, 16 (26.7%) had a healthy sleep duration (7−8 h), and 14 (23.3%) slept more than 8 h. Multiple regression analysis revealed that patients with healthy sleep quality and quantity exhibited higher HRV parameters, both in time and frequency domain values (<i>p</i> &lt; 0.05). Low physical activity level was observed in patients with long sleep duration (<i>p</i> = 0.005) and evening chronotype (<i>p</i> = 0.022).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients who spent more time performing moderate to vigorous physical activity tended to exhibit good sleep health and increased parasympathetic activity which are considered cardioprotective after AMI.</p>\u0000 \u0000 <p><b>Trial Registration:</b> PACTR202208834230748.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 7","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70183","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688222","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 the Gap Between Artificial Intelligence Understanding and Clinical Implementation in Cardiovascular Medicine: A Commentary on Heinrich and Voigt's Review","authors":"Shaher Yar,&nbsp;Keshav R. Baskaran,&nbsp;Aarushi Mishra,&nbsp;Pratiksha Paudel","doi":"10.1002/clc.70185","DOIUrl":"https://doi.org/10.1002/clc.70185","url":null,"abstract":"&lt;p&gt;The comprehensive analysis by Heinrich and Voigt on artificial intelligence (AI) concepts in cardiovascular medicine has piqued our interest [&lt;span&gt;1&lt;/span&gt;]. Their methodical approach to clarifying AI principles provides an essential foundation for physicians' knowledge and understanding of AI in clinical practice. However, we believe that the discussion would benefit from addressing significant implementation gaps beyond theoretical understanding. It is essential to consider the practical challenges that hinder the adoption of AI in routine cardiovascular practice.&lt;/p&gt;&lt;p&gt;While inadequate understanding and mistrust among physicians certainly pose barriers to the acceptance of AI, institutional infrastructure constraints represent equally significant challenges. Many healthcare systems still lack the robust technical infrastructure, effective data standardization procedures, and cohesive regulatory frameworks necessary for the seamless integration of AI [&lt;span&gt;2&lt;/span&gt;]. This is particularly concerning in resource-limited environments, where the potential benefits of AI could be most transformative. For healthcare managers and physicians contemplating AI integration into their clinical practice, the fragmented regulatory landscape, exacerbated by rapidly changing FDA approval procedures for AI-enabled medical devices, adds another layer of uncertainty.&lt;/p&gt;&lt;p&gt;Validation problems in cardiovascular AI models require special attention. While many of these models demonstrate impressive performance in retrospective studies, they often struggle to produce generalizability in prospective studies in clinical settings. Although controlled studies indicate that 68.75% of AI interventions lead to clinical improvements compared to human experts, only 17.2% of these interventions have been subjected to randomized controlled trials [&lt;span&gt;3&lt;/span&gt;]. This highlights a significant gap in evidence. The discrepancy between theoretical potential and actual performance underscores the need for robust external validation systems that take into account institutional variations, demographic diversity, and differences in equipment.&lt;/p&gt;&lt;p&gt;The authors rightly emphasize the importance of physician education and understanding of AI integration. However, successful implementation requires coordinated and multidisciplinary strategies. Currently, AI development is often driven by industry silos that prioritize commercial viability over clinical effectiveness. The lack of physician involvement in AI training and validation has resulted in models that, despite theoretical promise, lack significant clinical benefits [&lt;span&gt;4&lt;/span&gt;]. Additionally, the complexity of these models, often described as “black boxes,” undermines physician confidence and complicates medical decision-making, particularly in terms of accountability [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In addition to technical issues, it's important to consider the financial implications of integrating AI. Smaller institutions and un","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 7","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70185","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144681256","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":"A Valuable Contribution to Atrial Fibrillation Ablation in Young Adults: The Role of Long-Term Follow-Up and Silent Atrial Fibrillation Monitoring","authors":"Elif Y. Arı,&nbsp;Özden Seçkin,&nbsp;Serkan Ünlü","doi":"10.1002/clc.70182","DOIUrl":"https://doi.org/10.1002/clc.70182","url":null,"abstract":"&lt;p&gt;We read with great interest the article titled “Clinical Characteristics and Outcomes of Catheter Ablation in Young Patients With Atrial Fibrillation” by Wang et al. [&lt;span&gt;1&lt;/span&gt;]. We commend the authors for addressing an important and underexplored area in the management of atrial fibrillation (AF) among young patients.&lt;/p&gt;&lt;p&gt;AF is the most common sustained arrhythmia in adults, and its prevalence has been increasing among younger individuals in recent years. While catheter ablation (CA) has emerged as an effective treatment modality—especially in patients who are symptomatic or refractory to antiarrhythmic drugs—data specific to young populations remain limited. In this context, the study by Wang et al. [&lt;span&gt;1&lt;/span&gt;] offers valuable insights into procedural outcomes and recurrence predictors following CA in young adults. Notably, the large sample size and comprehensive reporting of procedural characteristics strengthen the reliability and generalizability of the findings.&lt;/p&gt;&lt;p&gt;However, we would like to highlight some important limitations that deserve consideration. First, the average follow-up duration reported in the study was only 249 days [&lt;span&gt;1&lt;/span&gt;]. While this duration may capture early procedural success, it falls short of assessing long-term rhythm outcomes, which are particularly relevant in a young population expected to live for decades after the intervention. Late AF recurrences represent a significant clinical issue, especially when sustained sinus rhythm is a primary therapeutic goal in younger patients.&lt;/p&gt;&lt;p&gt;Several studies have demonstrated that AF may recur even many years after apparently successful ablation. For example, Winkle et al. [&lt;span&gt;2&lt;/span&gt;] reported a decline in freedom from AF from 68% at 5 years to 48% at 15 years postablation. Similarly, Steinberg et al. [&lt;span&gt;3&lt;/span&gt;] and Erhard et al. [&lt;span&gt;4&lt;/span&gt;] emphasized that late recurrences are common, and long-term follow-up is essential for understanding the true durability of CA. In particular, Erhard et al. showed that arrhythmia recurrence can occur even beyond the first 12 months [&lt;span&gt;4&lt;/span&gt;], potentially due to progressive electrical remodeling or emerging triggers. Such late events may necessitate additional interventions or repeat procedures. In light of these findings, Calkins and others have underscored the importance of long-term surveillance and careful patient selection [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Furthermore, as young individuals often experience asymptomatic (silent) AF episodes, relying solely on symptom-driven follow-up may lead to underestimation of true recurrence rates. Incorporating prolonged rhythm monitoring techniques—such as extended Holter monitoring or implantable loop recorders—beyond the standard 3-month blanking period would likely yield a more accurate assessment of long-term procedural efficacy.&lt;/p&gt;&lt;p&gt;In addition, several reports have highlighted the importance of AF duration before ablation as a strong predictor of ","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 7","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70182","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672009","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":"Comments on “Association Between F-SIRI and Adverse Prognosis in Patients With Chronic Heart Failure”","authors":"Çağrı Zorlu","doi":"10.1002/clc.70181","DOIUrl":"https://doi.org/10.1002/clc.70181","url":null,"abstract":"&lt;p&gt;We read with interest the article by Liu et al. published in Clinical Cardiology (2025; DOI: 10.1002/clc.70166), which explores the prognostic value of the fibrinogen and systemic inflammation response index (F-SIRI) in patients with chronic heart failure (CHF) [&lt;span&gt;1&lt;/span&gt;] The study provides valuable insights into the role of inflammation and coagulation in CHF risk stratification. However, we would like to raise several points for clarification and discussion to enhance the interpretation of the findings.&lt;/p&gt;&lt;p&gt;The authors determined F-SIRI cut-off values (SIRI ≥ 1.22, fibrinogen ≥ 2.55 g/L) using a Receiver Operating Characteristic (ROC) curve with 100 random splits and threefold cross-validation. While this approach is robust, the rationale for selecting these specific cut-offs and their generalizability across diverse CHF populations is unclear. Could the authors provide further details on how these thresholds were validated externally or compared to existing literature? For instance, studies like Xia et al. used different SIRI cut-offs for cardiovascular outcomes, which may affect the reproducibility of F-SIRI [&lt;span&gt;2&lt;/span&gt;]. Additionally, the single measurement of F-SIRI at admission may not capture dynamic inflammatory changes, as acknowledged in the limitations. Have the authors considered serial measurements to assess the stability of F-SIRI's prognostic value?&lt;/p&gt;&lt;p&gt;The study reports a significant association between higher F-SIRI levels and all-cause mortality (adjusted HR 2.37, 95% CI 1.46–3.83, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) but no significant association with major adverse cardiac and cerebral events (MACCEs) or cardiovascular death after multivariate adjustments. This discrepancy is puzzling, as inflammation and coagulation are established contributors to cardiovascular events in CHF [&lt;span&gt;3, 4&lt;/span&gt;]. For example, the CANTOS trial demonstrated that targeting inflammation reduces cardiovascular events in patients with elevated inflammatory markers [&lt;span&gt;5&lt;/span&gt;]. Could the authors elaborate on potential reasons why F-SIRI predicts all-cause mortality but not cardiovascular-specific outcomes? Specifically, were non-cardiovascular causes of death (e.g., infections and malignancies) analyzed separately to explain this finding?&lt;/p&gt;&lt;p&gt;The multivariate Cox models adjusted for numerous confounders, including demographics, comorbidities, and medications. However, the study does not account for the severity of heart failure, such as New York Heart Association (NYHA) functional class or specific etiologies (e.g., ischemic vs. non-ischemic CHF). These factors significantly influence prognosis and inflammatory markers [&lt;span&gt;6&lt;/span&gt;]. Could the authors clarify whether NYHA class or heart failure etiology was considered in the analysis? Additionally, the lack of significant differences in left ventricular ejection fraction (LVEF) across F-SIRI groups (&lt;i&gt;p&lt;/i&gt; = 0.3596) is surprising, given the known association between inflammation and re","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 7","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70181","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144666554","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 by Deng et al. Regarding Article, “C-Reactive Protein–Albumin–Lymphocyte (CALLY) Index as an Independent Risk Factor for Postoperative Atrial Fibrillation Recurrence”","authors":"Ye Deng,&nbsp;Yuan Ji,&nbsp;Ling Sun","doi":"10.1002/clc.70184","DOIUrl":"https://doi.org/10.1002/clc.70184","url":null,"abstract":"<p>We thank the authors for their thoughtful comments on our article “C-Reactive Protein–Albumin–Lymphocyte (CALLY) Index as an Independent Risk Factor for Postoperative Atrial Fibrillation Recurrence” [<span>1</span>] and appreciate the opportunity to address their considerations.</p><p>First, Repeat ablations were performed in a subset of patients with recurrent AF, during which the status of pulmonary vein isolation was assessed. Regrettably, the sample size of these cases was insufficient to warrant a formal subgroup analysis. However, we hypothesize that a higher CALLY index may indicate inherently poorer atrial substrate properties—specifically, that an activated inflammatory state could facilitate myocardial fibrosis and the formation of reentrant circuits, thereby predisposing to AF recurrence. This hypothesis, of course, necessitates validation through further clinical and preclinical investigations.</p><p>Second, we concur that the CALLY index, which incorporates albumin levels, may reflect an activated inflammatory state that encompasses hepatic processes. Accumulating evidence suggests potential crosstalk between the liver and heart in the context of cardiovascular disease: for instance, cardiovascular conditions have been shown to exacerbate liver fibrosis in patients with fatty liver disease, with Ly6Chi monocytes playing a pivotal role [<span>2</span>]. It is reasonable to hypothesize that such liver-heart interactions may contribute to AF recurrence, potentially mediated by the inflammatory pathways captured by the CALLY index. As you suggested, advanced imaging modalities (e.g., cardiac magnetic resonance imaging) would undoubtedly help elucidate the intricate relationships between the CALLY index, myocardial inflammation, and AF recurrence. This constitutes a pivotal direction for our subsequent research endeavors.</p><p>Third, our baseline data revealed no significant association between alcohol consumption and AF recurrence. This is also consistent with previous study [<span>3</span>]. We acknowledge that larger-scale and multicenter studies are warranted to more thoroughly explore the potential role of alcohol and other lifestyle factors in AF recurrence.</p><p>Finally, we thank the authors for their insightful comments, which have improved our work's clarity and interpretative depth, thereby enhancing its clinical value in guiding AF treatment.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 7","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70184","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144666470","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":"Tolerability and Adverse Effects in a Specialized Heart Failure Guideline-Directed Medical Therapy Optimization Program","authors":"Claudia Mae Velasco,&nbsp;Gladys Baksh,&nbsp;Michele Haydo,&nbsp;Heather Reesor,&nbsp;John Boehmer,&nbsp;Omaima Ali","doi":"10.1002/clc.70179","DOIUrl":"https://doi.org/10.1002/clc.70179","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Utilization of heart failure (HF) guideline-directed medical therapy (GDMT) to target doses is suboptimal, with studies citing adverse effects (AEs), physiological factors, and therapeutic inertia as potential contributing factors. The objective of our study was to explore tolerability and GDMT titration-limiting AEs in a specialized heart failure optimization program implemented at our institution.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We studied the baseline characteristics of 254 patients who successfully completed our program and analyzed the frequency and severity of the four most common GDMT-related AEs: hypotension, bradycardia, hyperkalemia, and renal dysfunction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients who achieved target doses were younger, more likely to have nonischemic HF, less likely to have a recent HF-related hospitalization, had less coronary artery disease, and were more likely to be obese. Multivariate analyses revealed significant associations between beta blocker suboptimal dosing (&lt; 50% of target dose) and older age (odds ratio [OR]: 1.04; 95% confidence interval [CI]: 1.0–1.07; <i>p</i> = 0.031), presence of atrial fibrillation (OR: 2.57; 95% CI: 1.18–5.58; <i>p</i> = 0.017), and absence of hypertension (OR: 0.39; 95% CI: 0.17–0.89; <i>p</i> = 0.025). For angiotensin converting enzyme inhibitors/angiotensin II receptor blockers/angiotensin receptor neprilysin inhibitors, suboptimal dosing was associated with the presence of atrial fibrillation (OR: 2.08; 95% CI: 1.04–4.17; <i>p</i> = 0.039). Of the patients who completed the program, 59.1% encountered at least one AE that hindered the titration to target GDMT doses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our findings highlight the complexities of GDMT optimization within a specialized program and the need for standardized definitions of GDMT-related AEs and management strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 7","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70179","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144624745","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}