Clinical Cardiology最新文献

{"title":"Heart Failure With Preserved Ejection Fraction-Like Phenotype in Coronary Artery Disease and Obstructive Sleep Apnea: Insights From the RICCADSA Cohort","authors":"Erik Thunström,&nbsp;Helena Glantz,&nbsp;Aylin Pihtili,&nbsp;Yüksel Peker","doi":"10.1002/clc.70402","DOIUrl":"10.1002/clc.70402","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Heart failure with preserved ejection fraction (HFpEF) is closely linked to aging and cardiometabolic risk factors and frequently coexists with obstructive sleep apnea (OSA). We aimed to investigate the prevalence and clinical correlates of an HFpEF-like phenotype in a revascularized coronary artery disease (CAD cohort), focusing on OSA and its severity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 435 patients with preserved left ventricular ejection fraction from the RICCADSA cohort were included. OSA was defined as apnea–hypopnea index (AHI) ≥ 15 events/h. HFpEF-like phenotype was defined by ≥ 2 of the following: elevated filling pressures (E/e′ ≥ 15), left atrial enlargement, increased left ventricular mass index, elevated pulmonary artery systolic pressure (≥ 35 mmHg), and elevated NT-proBNP (≥ 125 pg/mL). Multivariable logistic regression analyses included age, sex, obesity, hypertension, diabetes, and OSA status. Additional models evaluated AHI and oxygen desaturation index (ODI) as continuous variables and assessed the impact of excluding body mass index (BMI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Mean age was 63.6 ± 8.6 years and BMI 28.1 ± 4.1 kg/m²; 69.9% met HFpEF-like criteria. Age and obesity were independently associated with HFpEF-like phenotype, whereas categorical OSA was not. AHI and ODI were not independently associated after adjustment; however, in models excluding BMI, both AHI (OR 1.019, 95% CI 1.005–1.033) and ODI (OR 1.030, 95% CI 1.010–1.050) were significant predictors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>HFpEF-like phenotype is highly prevalent in CAD and primarily associated with aging and adiposity. The relationship between OSA severity and cardiac remodeling appears dependent on obesity, underscoring the interplay between cardiometabolic and sleep-related factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Pre-registered Clinical Trial Number</h3>\u0000 \u0000 <p>The RICCADSA trial is registered at ClinicalTrials.gov (NCT00519597) and in the Swedish national research registry (FoU i Sverige—Research and Development in Sweden; registration no. VGSKAS-4731; April 29, 2005).</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70402","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148344047","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 Considerations Regarding Diuretic Intensity Score and Mortality in Hospitalized Heart Failure Patients","authors":"Noor-ul-Eman Haider,&nbsp;Uzair Ali Khan,&nbsp;Laraib Saleem,&nbsp;Masood Khan,&nbsp;Muhammad Hassan Fayaz","doi":"10.1002/clc.70403","DOIUrl":"10.1002/clc.70403","url":null,"abstract":"&lt;p&gt;Dear Esteemed Editor,&lt;/p&gt;&lt;p&gt;The investigation by Zhou et al., focused on exploring the relationship between Diuretic Intensity Score (DIS) and the probability of short-term survival increase among heart failure patients, is particularly interesting for us due to the new approach introduced by the scientists regarding the assessment of the treatment intensity [&lt;span&gt;1&lt;/span&gt;]. Despite the fact that the development of the standardized measures of the exposure level to the drug under analysis can be regarded as an innovation in the field, there are two possible methodological problems that might have an adverse impact on the accuracy of the results provided by the scientists.&lt;/p&gt;&lt;p&gt;The first problem concerns the possibility of the existence of exposure definition bias that can be compared to immortal time bias [&lt;span&gt;2&lt;/span&gt;]. The distinction between the traditional exposure definition and the DIS score estimation is the fact that the latter depends on the amount of exposure to the medicine during the patient's stay at the hospital. It means that only those patients who were placed into the moderate and severe categories were alive long enough to escalate their therapy and use more diuretics or intravenous therapy [&lt;span&gt;3&lt;/span&gt;]. It is especially critical taking into account the large scale of estimated hazard ratios. Thus, the hazard ratio for the most severe DIS group turned out to be exceptionally large, which would result in a more pronounced decrease in mortality compared with other modern approaches to treating heart failure. The reason why it can be explained by the so-called “survival paradox in an exposure-defined setting” since the real impact is due to various probabilities of treatment but not to its effectiveness [&lt;span&gt;4, 5&lt;/span&gt;]. Despite the possible survivorship bias mentioned by the authors themselves, the inability to perform a time-varying exposure analysis makes its detection difficult [&lt;span&gt;6&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The second point to consider in the context of the current research is the issue of DIS construct validity. Prognostic markers should provide maximum predictive accuracy in the clinical environment, and the capability of such markers to identify biological differences among patients in terms of their response to the treatment and additional prediction value as compared to other markers should be evaluated [&lt;span&gt;7&lt;/span&gt;]. When it comes to DIS, one has to mention various dimensions associated with the therapy including the mode of drug delivery, drugs employed, intensity of the treatment, and combination of treatment. All those dimensions are empirically weighted, but there is no explanation as for why those weights were selected in the framework of pharmacological approach. The main thing is that the predictive power in the current study does not indicate superiority of empirically weighted DIS to simply the number of prescribed diuretics. Thus, the question arises whether this weighting involves some knowledge abou","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70403","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148344021","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":"Ethanol Infusion Into the Vein of Marshall for Atrial Fibrillation: Clinical Efficacy and Technical Limitations","authors":"Xuepeng Zheng,&nbsp;Hongliang Yang,&nbsp;Huan Sun,&nbsp;Ming Yu,&nbsp;Lujia Ni,&nbsp;Daoyuan Si,&nbsp;Yuquan He","doi":"10.1002/clc.70398","DOIUrl":"10.1002/clc.70398","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Despite advancements in radiofrequency ablation (RFCA) technology and strategy, the long-term rhythm outcomes of persistent atrial fibrillation (PeAF) remain suboptimal. Since the vein of Marshall (VOM) is situated within the mitral isthmus (MI) area and covers local neural innervation and fiber networks, its pathophysiological role in mediating and maintaining atrial fibrillation (AF) and causing arrhythmia recurrence has garnered increasing attention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>Ethanol infusion into the vein of Marshall (EIVOM) may complement RFCA by delivering anatomically targeted chemical injury along the VOM course, thereby facilitating contiguous MI lesion formation and durable MI block.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a narrative review of mechanistic, procedural, and clinical evidence regarding EIVOM in AF ablation, with emphasis on MI block, rhythm outcomes, technical limitations, complications, and its potential role in pulsed field ablation (PFA)-based workflows.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Available evidence indicates that EIVOM facilitates durable MI block by targeting VOM-related epicardial connections and may improve rhythm outcomes when combined with RFCA in selected PeAF ablation strategies. Its clinical application is influenced by procedural and anatomical factors, while safety considerations and its potential complementary role in PFA-based workflows remain important areas for further evaluation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>EIVOM is a promising adjunct to RFCA, particularly for facilitating durable MI block and reducing residual epicardial conduction. Further standardized multicenter studies are needed to refine patient selection, procedural integration, safety optimization, and its role in contemporary AF ablation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70398","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148344023","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":"Inpatient Outcomes and Complications After Left Atrial Appendage Occlusion in Rural Versus Urban Hospitals in the United States","authors":"Amanda Nguyen,&nbsp;Muhammad Zia Khan,&nbsp;Joseph Neely,&nbsp;Waleed Alruwaili,&nbsp;Muhammad Abdullah Naveed,&nbsp;Justin Lim Devera,&nbsp;William E. Leon,&nbsp;Siddharth Agarwal,&nbsp;Zain Ul Abideen Asad,&nbsp;Samrina Khan,&nbsp;Karthik Gonuguntla,&nbsp;Daniel Ice,&nbsp;Muhammad Bilal Munir","doi":"10.1002/clc.70397","DOIUrl":"https://doi.org/10.1002/clc.70397","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Disparities in management of atrial fibrillation in rural and urban hospitals across the U.S. have been reported. However, studies investigating disparities regarding outcomes and complications after left atrial appendage occlusion (LAAO) based on hospital location are lacking.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate differences in outcomes and complications related to LAAO among rural and urban hospitals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The National Inpatient Sample was used to identify patients who underwent LAAO implantations in the U.S. from 2016−2020. Study endpoints assessed included inpatient complications, outcomes, and resource utilization after LAAO procedures among rural and urban hospitals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 2016−2020, there were a total of 87 315 and 1985 LAAO device placements in urban and rural hospitals, respectively. Baseline characteristics were similar among both groups, with a few exceptions. After multivariable adjustment for confounders, odds of inpatient complications and mortality were similar among both groups. However, rural LAAO recipients experienced greater rates of discharge to an acute care facility (3.3% vs 2.4%, <i>p</i> = 0.01), as well as lower costs (aOR: 0.58, 95% CI: 0.49–0.69) and length of stay (aOR: 0.89, 95% CI: 0.81–0.98).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A majority of LAAO implantations occurred in urban hospitals in the U.S. Baseline characteristics and adjusted odds of inpatient complications and mortality were similar in rural and urban recipients. However, important differences were described regarding resource utilization and disposition. Further investigation into the specific factors driving these inequities is encouraged to promote improved access to and outcomes of cardiovascular care for rural residents.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70397","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148324784","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":"Evaluate the Prognostic Value of serumγKlotho on Long-Term Prognosis of Patients With Multivessel Coronary Artery Disease and Establish a Prognostic Model","authors":"Tuersunjiang Naman,&nbsp;Yu-ting Zhang,&nbsp;Ayinuer Maihemuti,&nbsp;Hui Cheng,&nbsp;Wen-bo Fu,&nbsp;Xiao-lin Yu,&nbsp;Zhao Wang,&nbsp;Yi-ning Yang,&nbsp;Zi-tong Guo","doi":"10.1002/clc.70393","DOIUrl":"10.1002/clc.70393","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study was aimed at analyzing the correlation of serum γKlotho with the long-term prognosis of multivessel coronary artery disease (MVD) and develop a predictive model to predict an accurate long-term prognosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We enrolled 969 MVD patients and classified them into three groups: training (<i>n</i> = 552), internal validation (<i>n</i> = 224), and external validation (<i>n</i> = 193) groups, respectively. The training group data helped in establishing a prognostic model. Univariable Cox regression analyses were conducted using serum and clinical γKlotho levels. Thereafter, the least absolute shrinkage and selection operator (LASSO) regression model was utilized for optimizing feature selection. Additionally, we constructed a prognosis prediction nomogram with multivariate Cox regression results by incorporating features screened with the LASSO model. Moreover, the as-constructed prognosis model's discriminability, consistency, and clinical usefulness were assessed by receiver operating characteristic (ROC) curve, C-index, decision curve analysis (DCA), and calibration plot analysis, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Result</h3>\u0000 \u0000 <p>Included in our prognosis prediction nomogram, the predictors of the long-term prognosis of MVD patients were age, BMI, diabetes mellitus (DM), antiplatelets, LDL-C, LVDD, and serum γKlotho level. Consequently, this nomogram displayed high discriminability, according to ROC and C-index analyses. Moreover, according to the calibration plot, the nomogram's probabilities exhibited high consistency with the actual levels. Based on DCA, this nomogram displayed good clinical usefulness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Higher serum γKlotho levels correlated with the poor prognosis of MVD patients, our predictive model exhibited better predictive ability and clinical usefulness.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 6","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70393","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148307324","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":"CDK7 as a Potential Exploratory Biomarker for Distinguishing Acute Myocardial","authors":"Awais Mehmood,&nbsp;Romesa Tahir","doi":"10.1002/clc.70396","DOIUrl":"10.1002/clc.70396","url":null,"abstract":"&lt;p&gt;We read with interest the article by Ripon et al. regarding the differential expression of DNA damage response (DDR) genes across STEMI and NSTEMI subtypes in a Bangladeshi cohort [&lt;span&gt;1&lt;/span&gt;]. This study provides valuable data on South Asian populations, an underrepresented group in cardiovascular genomics. The authors' identification of CDK7 as a subtype-specific gene elevated in NSTEMI and significantly after clinical adjustment is a notable finding.&lt;/p&gt;&lt;p&gt;However, we must raise a significant methodological concern regarding the exclusive use of GAPDH as the reference gene for qRT-PCR normalization. This choice has substantial implications for the interpretation of the findings. GAPDH encodes a central glycolytic enzyme, and its expression is well-documented to fluctuate under the hypoxic and oxidative stress conditions intrinsic to acute myocardial ischemia. As demonstrated by Zhong and Simons [&lt;span&gt;2&lt;/span&gt;], GAPDH mRNA levels are significantly upregulated during hypoxia, whereas many other housekeeping genes remain stable.&lt;/p&gt;&lt;p&gt;In the context of this study, this issue is critical because STEMI and NSTEMI differ fundamentally in ischemic severity. STEMI involves complete coronary occlusion and more profound hypoxia, while NSTEMI typically involves partial occlusion with relatively preserved perfusion. If GAPDH expression varies in proportion to the ischemic burden, a biologically plausible scenario, its use as a normalization control introduces a systematic bias. It is possible that the observed upregulation of CDK7 in NSTEMI relative to STEMI reflects altered GAPDH expression in the more severely ischemic STEMI group rather than a true difference in CDK7 transcriptional activity.&lt;/p&gt;&lt;p&gt;The Minimum Information for Publication of Quantitative Real-Time PCR Experiments (MIQE) [&lt;span&gt;3&lt;/span&gt;] guidelines strongly recommend the use of at least two validated reference genes to ensure normalization reliability. Relying on a single, unvalidated reference gene, especially one prone to context-dependent variability, fails to meet these rigorous standards. Established tools, such as the geNorm algorithm introduced by Vandesompele et al., [&lt;span&gt;4&lt;/span&gt;] provide a framework for identifying the most stable reference genes across specific experimental conditions and represent the standard practice for gene expression studies in pathological states.&lt;/p&gt;&lt;p&gt;We recommend that follow-up studies validate at least two or three reference genes before normalization. Genes such as HPRT1, B2M, and RPL13A have shown more stable expression under ischemic stress. Tools such as geNorm, NormFinder, or BestKeeper make this achievable and are now widely used in published qRT-PCR work. On a practical note, if raw GAPDH &lt;i&gt;C&lt;/i&gt;&lt;sub&gt;t&lt;/sub&gt; values are still accessible, a direct comparison between the STEMI and NSTEMI groups would quickly clarify whether GAPDH fluctuation contributed to the CDK7 differences observed.&lt;/p&gt;&lt;p&gt;Without confirming GAPDH stability across ","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 6","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70396","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148307245","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":"Beyond Integration: Unresolved Causal and Temporal Challenges in Multi-Domain QT Risk Modeling","authors":"Muhammad Mudasir,&nbsp;Shafaq Rafiq","doi":"10.1002/clc.70394","DOIUrl":"10.1002/clc.70394","url":null,"abstract":"&lt;p&gt;We read with interest the framework recently proposed by Farjam et al. [&lt;span&gt;1&lt;/span&gt;], which brings together molecular mechanisms, multi-factorial risk factors, and AI-based tools for predicting QT prolongation and sudden cardiac death. The authors are to be commended for integrating genetic, metabolic, pharmacological, and computational domains within a single conceptual model. We would, however, like to draw attention to two methodological issues that, in our view, merit further consideration before this framework can be translated into clinical practice: its reliance on associative rather than causal relationships, and its lack of explicit temporal modeling across data streams operating on very different timescales.&lt;/p&gt;&lt;p&gt;First, the framework primarily reflects associative relationships rather than causal ones. In a condition such as QT prolongation, where multiple interacting pathways converge on a single phenotype, correlation alone can obscure the true drivers of risk. An observed association between metabolic dysfunction and QT prolongation, for instance, does not establish that one causes the other, and without an explicit causal framework, this distinction remains unresolved. This matters most at the point of clinical translation: a clinician acting on a risk model needs to know not only what is associated with risk, but what can actually be modified to reduce it. Embedding causal structure into predictive models—an approach increasingly emphasized in the causal-inference and explainable-AI literature—would substantially improve both the interpretability and the clinical actionability of the proposed framework [&lt;span&gt;2, 3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;A second, related limitation is the framework's implicit treatment of heterogeneous data streams as though they were temporally commensurate. In practice, the variables it integrates operate on markedly different timescales: genetic predisposition is fixed over a lifetime, metabolic derangements evolve over months to years, pharmacological effects fluctuate over hours to days, and electrophysiological parameters such as the QT interval can change from 1 min to the next. Combining these inputs without an explicit temporal architecture risks producing unstable or misleading risk estimates, since the clinical relevance of any given variable depends heavily on its timing. A transient, drug-induced QT prolongation, for example, could be weighted equivalently to a chronic metabolic abnormality if temporal context is not built into the model. Incorporating time-aware and longitudinal modeling approaches—an active area of development in healthcare machine learning—would help the framework capture dynamic risk trajectories more reliably and reduce bias arising from misaligned data sources [&lt;span&gt;4, 5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In conclusion, Farjam et al. [&lt;span&gt;1&lt;/span&gt;] have offered a valuable conceptual synthesis for multi-domain QT risk modeling, but its translation into clinical practice remains premature without ad","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 6","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70394","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148301076","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 and Disparities in Acute Myocardial Infarction-Related Mortality With Co-Listed Nicotine Dependence in the United States, 1999–2020","authors":"Asad Ali Ahmed Cheema,&nbsp;Abu Huraira Bin Gulzar,&nbsp;Mishal Zehra,&nbsp;Ayesha Ahmed Cheema,&nbsp;Ayesha Saleem,&nbsp;Sayed Mohammad Saud Jalal,&nbsp;Nimra Shafi,&nbsp;Mirza Ammar Arshad,&nbsp;Kinza Raza,&nbsp;Iffat Ambreen Magsi","doi":"10.1002/clc.70392","DOIUrl":"10.1002/clc.70392","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Nicotine use is a major modifiable risk factor for acute myocardial infarction (AMI), yet national mortality patterns involving co-listed nicotine dependence remain under-characterized.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using CDC WONDER Multiple Cause of Death data from 1999 to 2020, we evaluated AMI-related mortality among US adults aged ≥ 25 years with co-listed death-certificate-coded nicotine dependence, operationally defined using ICD-10 F17.0–F17.9. AMI was identified using ICD-10 I21.0–I22.9. Age-adjusted mortality rates (AAMRs) per 100 000 population were calculated using the 2000 US standard population. Temporal trends were assessed using Joinpoint regression and stratified by sex, age, race/ethnicity, region, urbanization, state, and place of death.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 1999 to 2020, 357 167 AMI-related deaths with co-listed nicotine dependence occurred among adults aged ≥ 25 years. The AAMR increased from 1.64 to 9.46 per 100 000 population (average annual percent change, 10.27%; <i>p</i> &lt; 0.001). Men had higher AAMRs than women (11.30 vs. 4.27), with significant increases in both groups. Mortality increased with age, highest among adults aged ≥ 85 years (33.55) and lowest among those aged 35–44 years (0.83). Non-Hispanic American Indian/Alaska Native adults had the highest AAMR (10.30). Rates were higher in the Midwest and South, nonmetropolitan areas exceeded metropolitan areas, and the highest state-level AAMRs occurred in North Dakota and Wyoming. Most deaths occurred in inpatient facilities or at home.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>AMI-related mortality with co-listed nicotine dependence increased substantially from 1999 to 2020, with persistent demographic and geographic disparities. These findings may inform targeted tobacco-control, nicotine-cessation, and cardiovascular prevention strategies for high-risk populations over time.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 6","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70392","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148301024","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":"Efficacy and Safety of Baxdrostat for Hypertension: A Systematic Review and Meta-Analysis of Three Phase 2/3 Randomized Controlled Trials","authors":"Rahul Falodia,&nbsp;Ehsanullah Alokozay,&nbsp;Mohammad Idrees,&nbsp;Darsh Paghdar,&nbsp;Ali Msheik,&nbsp;Taha Alam,&nbsp;Saeedullah Zadran","doi":"10.1002/clc.70391","DOIUrl":"10.1002/clc.70391","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Baxdrostat is a selective aldosterone synthase (CYP11B2) inhibitor for treatment-resistant and uncontrolled hypertension, evaluated in phase 2/3 RCTs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To estimate pooled placebo-corrected reductions in seated office and ambulatory SBP, characterize the dose–response relationship, assess cortisol selectivity, and quantify hyperkalemia risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a systematic review and meta-analysis of phase 2/3 randomized, double-blind, placebo-controlled trials of baxdrostat in hypertension, searching MEDLINE/PubMed, EMBASE, ClinicalTrials.gov, and NEJM.org to March 2026. The primary outcome was placebo-corrected change in seated office SBP, analyzed using random-effects meta-analysis (REML) with metafor in R. Risk of bias and certainty were evaluated using Cochrane RoB 2.0 and GRADE, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three RCTs (BrigHTN, BaxHTN, Bax24; <i>N</i> = 1285) were included. The pooled seated SBP reduction was −9.44 mmHg (95% CI: −11.09 to −7.79; <i>I</i>² = 0.0%), with dose subgroup estimates of −8.57 mmHg (1 mg) and −10.11 mmHg (2 mg) and a clear dose–response in BrigHTN (slope −4.2 mmHg/mg; <i>R</i>² = 0.96). Bax24 demonstrated a 24 h ambulatory SBP reduction of −14.0 mmHg (95% CI: −17.2 to −10.8). Serum cortisol was unsuppressed at all doses, while the pooled OR for potassium ≥ 6.0 mmol/L was 5.14 (95% CI: 1.76 to 14.97). GRADE certainty was moderate for seated SBP, low to moderate for ambulatory outcomes, and low for hyperkalemia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Baxdrostat produces meaningful, selective BP reductions across hypertensive populations. Hyperkalemia is manageable with structured monitoring. Certainty is limited by a few trials, a short follow-up, and safety imprecision. Long-term cardiovascular outcome data are needed before guideline incorporation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 6","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70391","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148301109","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 Comparative Analysis of the Effects of Cardioversion and Ablation on Anxiety, Sleep, and Quality of Life in Patients Diagnosed With Atrial Fibrillation","authors":"Besey Oren,&nbsp;Busra Zehra Buyukkilic,&nbsp;Kubra Soydas,&nbsp;Ekin Oren","doi":"10.1002/clc.70388","DOIUrl":"10.1002/clc.70388","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>This study aims to evaluate changes in quality of life, anxiety levels, and sleep quality before and after elective electrical cardioversion or ablation in patients diagnosed with chronic atrial fibrillation (AF).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a single-center, quasi-experimental study with a two-group, pretest−posttest design conducted between January and December 2024 in a training and research hospital in Istanbul. A total of 57 patients who underwent either cardioversion (<i>n</i> = 30) or ablation (<i>n</i> = 27) were included. Data were collected using the AFEQT Quality of Life Questionnaire, Beck Anxiety Inventory, and Pittsburgh Sleep Quality Index, and analyzed with R software. Statistical analyses included Student's <i>t</i>-test, Pearson's Chi-square, Fisher's exact test, paired two-sample <i>t</i>-test, and Welch's unequal variance <i>t</i>-test. A <i>p</i> value of &lt; 0.05 was considered significant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Post-treatment quality of life significantly improved in both groups (AFEQT: ablation +21, cardioversion +11 points). Anxiety levels decreased in the ablation group (–4.7 points), while sleep quality showed no significant change (<i>p</i> = 0.092). In the cardioversion group, significant improvements were observed in both anxiety and sleep quality (BAI –8.63; PSQI –1.10; <i>p</i> &lt; 0.001). Regression analyses showed significant correlations between quality of life, anxiety, and sleep both before and after treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Improvements in quality of life were observed following both ablation and cardioversion procedures in patients with AF. Greater reductions in anxiety and sleep disturbance scores were observed in the cardioversion group compared with the ablation group.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 6","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70388","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148301294","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}