Clinical Cardiology最新文献

{"title":"The Prognostic Value of Platelet-Albumin-Bilirubin Score in Patients Undergoing Transcatheter Aortic Valve Replacement","authors":"Farman Ullah Khan,&nbsp;Muhammad Ammar ul hassan khan,&nbsp;Muhammad Aamir khan,&nbsp;Shad Khan,&nbsp;Muhammad Ismail","doi":"10.1002/clc.70119","DOIUrl":"https://doi.org/10.1002/clc.70119","url":null,"abstract":"<p>We read with great interest the article “The Prognostic Value of Platelet-Albumin-Bilirubin Score in Patients Undergoing Transcatheter Aortic Valve Replacement.” by Duan et al. [<span>1</span>]. Reading such a well-written and complete piece is satisfying and the author's efforts on this important subject must be acknowledged. This study comprehensively evaluates the predictive efficacy of the platelet-albumin-bilirubin (PALBI) score for mortality in patients having transcatheter aortic valve replacement (TAVR), as well as its significance for enhancing risk classification alongside the Society of Thoracic Surgeons (STS) score. Although the research provides significant insights, some aspects demand further consideration and discussion.</p><p>First of all, this study only used the PALBI score, which includes platelet count, albumin, and bilirubin, in assessing liver function in TAVR patients. However, it did not consider other liver prognostic models, such as the Child-Pugh (CP) and Model for End-Stage Liver Disease (MELD) scores, which involve biomarkers such as creatinine and INR. A multicenter study found that using various hepatic prognostic models can improve outcome prediction in TAVR patients [<span>2</span>].</p><p>Additionally, this investigation excluded significant comorbidities that have reduced the PALBI score's predictive validity, including frailty, systemic inflammation, malnutrition, and anticoagulant treatment. These factors significantly affect albumin and platelet counts, which could reduce PALBI's precision as a predictor. By incorporating these variables into multivariate models, PALBI's feasibility as an independent predictor of TAVR-related mortality would be strengthened. The 2018 study found that comorbid conditions like malnutrition significantly affect TAVR outcomes. In TAVR patients, low serum albumin, a gauge of both malnutrition and frailty, has been associated with a higher 30-day mortality rate and more postoperative complications [<span>3</span>].</p><p>Furthermore, the PALBI score may not provide a complete risk assessment for patients undergoing TAVR because it does not account for key cardiac-specific factors such as left ventricular ejection fraction (LVEF), aortic valve gradient (AVG), or the presence of coronary artery disease. Relying only on the PALBI score ignoring these key cardiac characteristics may result in an inadequate assessment of patient risk, thus limiting its predictive accuracy in TAVR populations. Reduced LVEF and low AVG are substantially related with poor post-TAVR outcomes, with low AVG providing as a significant predictor of mortality [<span>4</span>].</p><p>This study does not include people with chronic liver illness, end-stage renal disease (ESRD), and dialysis, limiting its credibility. These high-risk patients typically have poor post-TAVR outcomes, their exclusion may underestimate PALBI's true prognostic value in real-world circumstances. Chronic kidney disease (CKD) and ESRD ","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70119","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143638797","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 Trends in Mortality Due to Ischemic Stroke Among Older Adults With Atrial Fibrillation in the USA, 1999–2020","authors":"Saeed Aftab Khan,&nbsp;Arfa Ahmed Assad,&nbsp;Hamza Ashraf,&nbsp;Hanzala Ahmed Farooqi,&nbsp;Sabahat Ul Ain Munir Abbasi,&nbsp;Hira Saleem,&nbsp;Reyan Khalid,&nbsp;Aala Saleh,&nbsp;Muhammad Hashim Akram","doi":"10.1002/clc.70115","DOIUrl":"https://doi.org/10.1002/clc.70115","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Atrial fibrillation (AF) is a significant contributor to ischemic stroke risk and mortality, particularly in aging populations. This study examines mortality trends from ischemic stroke secondary to AF in the U.S. from 1999 to 2020, focusing on demographic and regional disparities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using data from the CDC WONDER database, this cross-sectional analysis included individuals aged ≥ 65 years with death certificates indicating ischemic stroke (ICD I63) and AF (ICD I48) as contributing causes. Age-adjusted mortality rates (AAMR) were calculated, and temporal trends were analyzed using join-point regression to estimate annual percentage changes (APC). Data were stratified by age, sex, race/ethnicity, urbanization, and geographic regions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 1999 to 2020, ischemic stroke with AF caused 62,443 deaths (AAMR: 6.75/100,000; 95% CI: 6.70–6.80). Mortality rates increased significantly after 2010, peaking between 2014 and 2017 (APC: 31.3 for females, 28.1 for males). Older adults (≥ 85 years) exhibited the highest AAMR (43.2/100,000; 95% CI: 41.6–44.8). Nonmetropolitan areas consistently showed higher mortality compared to metropolitan regions. Demographic disparities were evident, with higher AAMRs in females, Whites, and the Western U.S., though Hispanics had the sharpest APC increase during 2014–2017.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Mortality rates from ischemic stroke with AF are rising in older adults, with significant demographic and regional disparities. The findings underscore the need for targeted public health strategies to mitigate AF-related stroke risks and improve healthcare equity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70115","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143622663","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":"Clinical Outcomes of Immediate Versus Staged Revascularization of Nonculprit Arteries in Patients With Acute Coronary Syndrome: A Systematic Review and Meta-Analysis","authors":"Farah Yasmin,&nbsp;Syeda Farwa Zaidi,&nbsp;Abdul Moeed,&nbsp;Maryam Shahzad,&nbsp;Muhammad Sohaib Asghar,&nbsp;Mahnoor Sadiq,&nbsp;Javed Iqbal,&nbsp;Salim Surani,&nbsp;M. Chadi Alraies","doi":"10.1002/clc.70105","DOIUrl":"https://doi.org/10.1002/clc.70105","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Recent guidelines for acute coronary syndrome (ACS) with multivessel coronary artery disease (MVD) recommend revascularization of non-culprit lesions following primary percutaneous coronary intervention (PCI). However, the optimal timing for this procedure—whether immediate or staged—remains uncertain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive search using PubMed (MEDLINE), Cochrane Central, and Google Scholar was conducted to identify studies comparing clinical outcomes between immediate and staged revascularization approaches in patients with MVD undergoing PCI. A random effects model was used to calculate risk ratios (RRs) for dichotomous outcomes with 95% confidence intervals (CIs). The primary outcome was 1-year all-cause mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 10 randomized controlled trials (RCTs), comprising 3886 patients (1964 in the immediate revascularization group and 1940 in the staged revascularization group), with a median follow-up of 12 months, were included in the analysis. No significant difference in the risk of 1-year mortality was noted between the two approaches. The risk of target vessel revascularization (TVR) at 1-year follow-up was significantly lower in the immediate revascularization group compared to the staged revascularization group (RR: 0.64; 95% CI: 0.47–0.86; I²: 0%; <i>p</i> = 0.03). Additionally, the immediate revascularization group had a significantly lower risk of myocardial infarction (MI) at 1-year follow-up than the staged approach (RR: 0.57; 95% CI: 0.37–0.88; I²: 10%; <i>p</i> = 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This meta-analysis suggests that immediate revascularization is associated with a significantly lower risk of TVR and MI at 1-year compared to staged revascularization.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70105","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143595331","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":"Urgent Transcatheter Mitral Edge-to-Edge Repair Is Associated With Worse in-Hospital Outcomes: A Nationwide Analysis","authors":"Carlos Diaz-Arocutipa,&nbsp;Cesar Joel Benites-Moya,&nbsp;Javier Torres-Valencia,&nbsp;Adhya Mehta,&nbsp;Lourdes Vicent","doi":"10.1002/clc.70067","DOIUrl":"https://doi.org/10.1002/clc.70067","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>To assess in-hospital outcomes in patients undergoing urgent versus non-urgent transcatheter mitral edge-to-edge repair (TEER).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used the NIS database 2016−2019 to include admissions who underwent TEER. Inverse probability of treatment weighting (IPTW) was used to compare urgent versus non-urgent groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 29 730 weighted admissions were included, of whom 21.6% were urgent admissions. Urgent admissions had a higher risk of in-hospital mortality (risk ratio [RR] 3.67, 95% confidence interval [CI] 2.39−5.62), cardiogenic shock (RR 4.95, 95% CI 3.73−6.57), intra-aortic balloon pump (RR 3.97, 95% CI 2.53−6.23), percutaneous ventricular assist device (RR 17.24, 95% CI 6.37−46.66), mechanical ventilation (RR 3.79, 95% CI 2.80−5.11), acute stroke (RR 2.56, 95% CI 1.32−4.97), in-hospital cardiac arrest (RR 2.25, 95% CI 1.08−4.69), major bleeding (RR 5.18, 95% CI 2.97−9.06), increased length of stay (6 vs. 2 days, <i>p</i> &lt; 0.001), and higher total costs ($229 160 vs. $164 653, <i>p</i> &lt; 0.01) compared to non-urgent admissions. There was no difference between both groups for renal replacement therapy and pericardial complication.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our results suggest that urgent TEER implantation was associated with an increased risk of in-hospital death and other short-term complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70067","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143594917","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":"Blood Metabolome Mediates the Effect of the Plasma Lipidome on the Risk of Atrial Fibrillation: A Mendelian Randomization Study","authors":"Yanglulu Su,&nbsp;Yi Ning,&nbsp;Zhiyuan Jiang,&nbsp;Guoqiang Zhong","doi":"10.1002/clc.70112","DOIUrl":"https://doi.org/10.1002/clc.70112","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objective</h3>\u0000 \u0000 <p>Atrial fibrillation (AF), a common arrhythmic disorder, is increasing in prevalence annually and has become an important public health problem that jeopardizes human health. Metabolites are small molecules produced in the process of metabolic reactions, and they can affect the risk of disease and possibly become targets for disease management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used two-sample and bidirectional MR to explore potential causal associations between lipid groups and AF. Two-step MR analysis was used to explore whether plasma metabolites mediated a causal effect from lipidomes to AF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Result</h3>\u0000 \u0000 <p>We assessed the effect of 179 lipids on AF using IVW models and observed that 8 lipids were associated significantly with AF (<i>p</i> &lt; 0.05). Likewise, we assessed the effect of 1091 metabolites and 309 metabolite ratios on AF and observed that 22 metabolites were significantly associated with AF (<i>p</i> &lt; 0.05). We analyzed the blood metabolites above as mediators in the pathway from the lipidomes above to AF. We found that levels. Of lipid sterol ester (27:1/18:3) were associated with lower homoarginine levels, and lower metabolite homoarginine levels were associated with an increased risk of AF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study identified a causal relationship between plasma liposomes and AF, and additionally found that the plasma metabolite homoarginine levels can act as a mediator of the lipid sterol ester in its effect on AF.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70112","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143564728","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":"Investigating Left Atrial Diameter and Heart Failure Onset in Middle-Aged and Elderly: A Retrospective-Prospective Study","authors":"Ai Wang,&nbsp;Huilin Hu,&nbsp;Dai Zhang,&nbsp;Gang Qian,&nbsp;Haihua Pan,&nbsp;Changlin Zhai,&nbsp;Yan Yan","doi":"10.1002/clc.70085","DOIUrl":"https://doi.org/10.1002/clc.70085","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Left atrium (LA) is an integral component of left heart remodeling, reflecting hemodynamics and ventricular status. It remains uncertain whether left atrial diameter (LAD) can be utilized for predicting and evaluating the occurrence of heart failure (HF) in middle-aged and elderly individuals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study aimed to explore the correlation between LAD and HF in middle-aged and elderly individuals, elucidating the timing of occurrence HF in relation to LAD. The retrospective-prospective study investigated 4025 patients who underwent echocardiography at Zhongshan Hospital's Cardiovascular Department from January 2015 to December 2017. Patients were continuously monitored for HF until January 31, 2024. Cox regression analyses related baseline LAD to HF incidence, adjusted for known risk factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 4025 individuals (mean age: 55 years, 45.29% male) were studied, spanning ages 45–91. Fifty-one developed HF during a median follow-up of 4.36 years. Cox regression model demonstrated the association between HF and LAD (HR = 5.721, 95% CI 3.768–8.687, <i>p</i> &lt; 0.001) even after adjusting for covariates (age, weight, eGFR, HDL-C, lymphocyte count, systolic blood pressure, FPG, HbA1C, waist circumference, hip circumference, valvular disease history, atrial fibrillation history).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The link between LAD and future HF occurrence risk among middle-aged and older adults shows a dose–response pattern. This relationship persists post-adjustment for HF-related factors, highlighting the predictive value of LAD in forecasting HF incidence.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70085","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143564727","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":"Elucidating the Linkage Between Obesity-Related Body Fat Indicators and Atrial Fibrillation: Supported by Evidence From Mendelian Randomization and Mediation Analyses","authors":"Junxian Wang,&nbsp;Shengzhi Zhou,&nbsp;Xiaoming Xie,&nbsp;Wenlin Liu","doi":"10.1002/clc.70103","DOIUrl":"https://doi.org/10.1002/clc.70103","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To elucidating the linkage between obesity-associated body fat indicators and atrial fibrillation (AF) using Mendelian Randomization (MR) and mediation analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study utilized three independent genome-wide association study (GWAS) datasets, with containing over 450 000 individuals each, to represent body fat indicators as the exposure variable. Additionally, two summary genetic datasets of AF were utilized as the clinical outcome. Single nucleotide polymorphisms (SNPs) with <i>p</i>-values less than 5 × 10⁻¹⁰ were identified as instrumental variables (IVs) for MR analysis. The primary analysis method employed was the inverse-variance weighting (IVW) model, supplemented by three additional models: MR-Egger regression, weighted median, and maximum likelihood. Sensitivity analysis was conducted, encompassing tests for heterogeneity and horizontal pleiotropy, utilizing Cochran's Q, MR-Egger intercept, and MR-PRESSO tests to validate the reliability of the findings. Furthermore, a mediation analysis was conducted to explore potential mediators involved in the pathogenesis of AF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The IVW model demonstrated that per 1-SD increase in body fat indicators (body fat percentage, whole body fat mass, and trunk fat mass) is associated with an elevated risk of AF, with values of 63.1%, 55.0%, and 55.8% respectively. All three supplementary models arrived comparable conclusions with IVW model. The sensitivity analysis confirmed the absence of horizontal pleiotropy, thereby validating the reliability of the findings. Additionally, the mediation study indicates that hypertension and sleep apnea syndrome are identified as significant mediators during the pathogenesis of AF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The study reveals that individuals with a higher body fat percentage tend to exhibit a heightened genetic predisposition for susceptibility to AF. Meanwhile, hypertension and sleep apnea syndrome have been identified as key mediators contributing to the pathogenesis of AF.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70103","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143554534","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":"Unmasking Arrhythmia Mortality: A 25-Year Analysis of Trends and Disparities in the United States (1999–2023)","authors":"Bazil Azeem,&nbsp;Laiba Khurram,&nbsp;Bakhtawar Sharaf,&nbsp;Arwa Khan,&nbsp;Ayesha Habiba,&nbsp;Rabia Asim,&nbsp;Muskan Khelani,&nbsp;Hamza Ali,&nbsp;Abdul Hadi Ansari,&nbsp;Tazheen Saleh Muhammad,&nbsp;Muhammad Abdullah Naveed,&nbsp;Mata-e-Alla Dogar,&nbsp;Aalaa Saleh,&nbsp;Hamza Ashraf","doi":"10.1002/clc.70109","DOIUrl":"https://doi.org/10.1002/clc.70109","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Arrhythmias are a significant cause of cardiovascular mortality in the U.S. This study examines trends in arrhythmia-related mortality from 1999 to 2023, focusing on gender, racial, regional disparities, and specific arrhythmic conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To analyze trends and disparities in arrhythmia-related mortality among U.S. adults aged ≥ 35 years from 1999 to 2023, with a focus on the impact of sex, race, geographic location, and urbanization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed mortality data from the CDC WONDER database, focusing on deaths where arrhythmias were a contributing cause. Age-adjusted mortality rates (AAMRs) were calculated and stratified by sex, race/ethnicity, state, and region. The annual percentage change (APC) and average annual percentage change (AAPC) were estimated using Joinpoint regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 5,050,271 arrhythmia-related deaths were recorded, with the overall AAMR increasing from 111.4 in 1999 to 137.3 in 2023. Mortality rates declined significantly from 1999 to 2009 (APC: −1.04%; <i>p</i> = 0.003) but rose sharply from 2009 to 2018 (APC: 1.69%; <i>p</i> = 0.003), peaking in 2021 during the COVID-19 pandemic (APC: 8.63%; <i>p</i> &lt; 0.001). A subsequent decline was observed from 2021 to 2023 (APC: −3.91%; <i>p</i> = 0.044). Males consistently exhibited higher AAMRs than females (137.2 vs. 95.3), as did non-Hispanic White individuals compared to other racial groups. Geographic disparities revealed higher mortality rates in Nonmetropolitan areas and the Midwest, with the highest AAMR observed in Oregon and the lowest in Hawaii.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Despite an overall decline in arrhythmia-related mortality, recent increases, especially in West Virginia and among certain racial groups, highlight the need for targeted public health interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70109","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143535840","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":"Predictive Value of Lung Ultrasound Combined With ACEF Score for the Prognosis of Acute Myocardial Infarction","authors":"Okasha Tahir,&nbsp;Ali Bin Nasir,&nbsp;Sonam Lohana,&nbsp;Taha Naveed,&nbsp;Muhammad Abdullah","doi":"10.1002/clc.70111","DOIUrl":"https://doi.org/10.1002/clc.70111","url":null,"abstract":"<p>We read the recent study by Lun et al. [<span>1</span>] on the “Predictive value of lung ultrasound (LUS) combined with the ACEF score for the prognosis of acute myocardial infarction (AMI)” with great interest. The authors provide a novel approach to risk stratification, yet several methodological and clinical concerns warrant discussion.</p><p>The study's exclusion of patients older than 80, those with significant pulmonary disease, and those without LUS within 48 h of admission substantially limits its external validity. Elder patients and those with chronic lung conditions constitute a substantial proportion of AMI cases, and their exclusion raises concerns about the findings' real-world applicability [<span>2, 3</span>]. The single-center design with a relatively small sample size (<i>n</i> = 204) further restricts generalizability. By addressing this limitation, future research could improve the external validity of LUS as a prognostic tool for a broader patient population.</p><p>While the study suggests that combining LUS with the ACEF score improves predictive performance, it does not adequately account for key confounders. For instance, diuretic use was significantly associated with adverse outcomes (OR 4.79, <i>p</i> &lt; 0.01), yet its impact on B-line counts and overall prognostication was not thoroughly explored. Without rigorous adjustment, the study may overestimate the independent predictive value of LUS [<span>3</span>]. A more rigorous multivariate analysis or propensity score matching would strengthen the study's conclusions and ensure that LUS retains its predictive value independent of other clinical interventions.</p><p>The median follow-up period of 12 months is insufficient to capture long-term cardiovascular outcomes, particularly for AMI patients at risk of late heart failure events. Additionally, the reliance on telephone follow-ups introduces potential reporting bias, as clinical outcomes were not objectively verified through imaging or biomarker assessments [<span>4</span>]. Extending the follow-up period and incorporating objective clinical data would enhance the reliability of LUS and ACEF score-based prognostication.</p><p>Despite these limitations, the study introduces an important concept by integrating LUS into AMI risk stratification. Future studies with more extensive, multicenter cohorts, improved statistical adjustments, and extended follow-up are necessary to confirm the robustness of this approach. We commend the authors for their valuable contribution to the evolving landscape.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70111","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530318","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":"Melatonin as a Novel Drug to Improve Cardiac Function and Quality of Life in Heart Failure Patients: A Systematic Review and Meta-Analysis","authors":"Abolfazl Sam Daliri,&nbsp;Nima Goudarzi,&nbsp;Arshia Harati,&nbsp;Kourosh Kabir","doi":"10.1002/clc.70107","DOIUrl":"https://doi.org/10.1002/clc.70107","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Heart failure as an advanced cardiac disease has a high incidence and prevalence in all societies nowadays. Many drugs and treatment methods have been discovered for improving heart failure patients' conditions till now in this way melatonin therapy is one of the less-known methods rarely used by clinicians.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>To investigate the positive effect of melatonin on heart failure development, we conducted a systematic review and meta-analysis by searching valid databases with keywords based on the protocol. Based on the eligible criteria, four articles were selected for data synthesis and analysis after scanning the title and/or abstract and reading full-text.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>As a result of analysis, increasing ejection fraction (Mean difference: 2.39 [−1.82, 6.59] <i>p</i> = 0.27), <i>NYHA</i> (New York Heart Association Functional Class) (Odds ratio: 4.84 [1.00, 23.44] <i>p</i> = 0.05), and significant elevation of quality of life (Mean difference: −5.95 [−9.54, −2.35] <i>p</i> = 0.001) were observed. As the effect of melatonin, fatigue, and <i>NT-Pro BNP</i> were reduced but on the contrary sleep quality, appetite, and <i>FMD</i> (Flow-Mediated Dilation) significantly increased.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Thus, melatonin, by increasing psychologic parameters and cardiac potency, could be advised as a novel drug for treatment and palliating heart failure patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70107","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530317","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}