Clinical Cardiology最新文献

{"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}

{"title":"Methodological Issues Related to the Reported Association of A Body Shape Index With Abdominal Aortic Calcification in Patients With Hypertension","authors":"Laiba Shahab,&nbsp;Syed Huzaifa Khan,&nbsp;Javeria Kashaf Zain","doi":"10.1002/clc.70390","DOIUrl":"10.1002/clc.70390","url":null,"abstract":"&lt;p&gt;We have read with much interest the paper by Qiu and Wang, which appeared in Clinical Cardiology [&lt;span&gt;1&lt;/span&gt;]. The researchers suggested that ABSI could predict the risk of AAC development and serve for cardiovascular risk stratification in hypertensive patients. We concur with both the novelty of the studied population as well as the significance of identifying AAC biomarkers. Nevertheless, we feel compelled to bring to your attention some issues regarding multicollinearity during the computation of ABSI, misinterpretation of the results of dose-response modeling, and excessive importance attributed to ABSI as a predictor. Addressing these issues will help to better understand the significance of the obtained results.&lt;/p&gt;&lt;p&gt;First of all, it seems that there is some inconsistency related to the application of a specific regression model. Indeed, ABSI depends on BMI, waist circumference, and height of participants. Therefore, taking all of them as covariates when performing multiple regression analysis implies control for BMI and waist circumference. ABSI was designed to be mathematically independent of BMI and waist circumference and hence substitutable for them in regression analysis models, as shown by Krakauer and Krakauer [&lt;span&gt;2&lt;/span&gt;]. In addition, Christakoudi et al. demonstrated that adjustment for BMI and waist circumference renders ABSI mathematically meaningless [&lt;span&gt;3&lt;/span&gt;]. Furthermore, Midi et al. stated that the simultaneous inclusion of mathematically correlated covariates in regression models may bias and render unstable the estimates of their coefficients [&lt;span&gt;4&lt;/span&gt;]. Consequently, conclusions about the independent predictive ability of ABSI cannot be drawn on the basis of such models, and the results should be reproduced using a properly constructed model.&lt;/p&gt;&lt;p&gt;Aside from the problem highlighted above, three further concerns render the results less reliable. To start with, the authors conclude that &lt;i&gt;p&lt;/i&gt; &gt; 0.05 in their restricted cubic spline analysis confirms a linear relationship between ABSI and AAC. However, a non-significant result for nonlinearity simply indicates insufficient statistical power to detect a curved relationship, not confirmation of true linearity [&lt;span&gt;5&lt;/span&gt;]. This is further contradicted by Yin et al. who, using the exact same NHANES 2013–2014 data set, reported a &lt;i&gt;U&lt;/i&gt;-shaped relationship between ABSI and AAC [&lt;span&gt;6&lt;/span&gt;], directly challenging the linear claim of the target article. Second, the authors describe an AUC of 0.625 as having moderate discriminatory ability; however, by established standards in clinical prediction research, this value falls within the poor discrimination range [&lt;span&gt;7&lt;/span&gt;]. Furthermore, no formal statistical comparison of AUC values was conducted using the DeLong test, the recommended method for comparing correlated AUC values [&lt;span&gt;8&lt;/span&gt;]. Third, the TRIPOD guidelines, the international standard for prediction model reporting, requi","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 6","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70390","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148293577","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":"Survival Improvement With Steroid Use for Pulmonary Veno-Occlusive Disease With the Aid of Pulmonary Vasodilators and Tyrosine-Kinase Inhibitor, a Retrospective Study","authors":"Mayumi Finger,&nbsp;Kaori Takeuchi,&nbsp;Hanako Kikuchi,&nbsp;Ayumi Goda,&nbsp;Takumi Inami,&nbsp;Yuichi Tamura,&nbsp;Masaharu Kataoka,&nbsp;Toru Satoh","doi":"10.1002/clc.70379","DOIUrl":"10.1002/clc.70379","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Steroids are effective in patients with heart failure, connective tissue disease, and interstitial lung disease, which are conditions often associated with Pulmonary veno-occlusive disease (PVOD). This study assessed the efficacy of steroid treatment combined with pulmonary vasodilators and tyrosine kinase inhibitors in patients with PVOD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>This retrospective study aims to explore the effect of steroids on patient condition and survival, and the hypothesis that steroids may improve the survival of patients with PVOD was verified.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study involved two facilities in Tokyo with the same supervisors. Ten patients were diagnosed with PVOD from April 2006 to May 2018, divided into two categories: the patients not receiving (PNS, <i>n</i> = 5) and those receiving steroids (PRS, <i>n</i> = 5). The difference in survival between the two groups was evaluated with log-rank test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Based on the Kaplan-Meier curve, median survival length after symptom onset in pulmonary hypertension was 3.3 [1.3–4.3] years (outcome: all died) for PNS (<i>n</i> = 5) and 7.1 [5.2–11.0] years (outcome: three were alive, one had lung transplant, and one died) for PRS (<i>n</i> = 5). Although steroids did not necessarily improve patients' conditions, PRS had relatively stable conditions for a remarkably extended time compared to PNS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>While the sample set is relatively small and this is a non-controlled retrospective study, the results indicate that a combination of steroids with pulmonary vasodilators and tyrosine-kinase inhibitors appears to be a promising treatment, especially for the purpose of extending patient survival until lung transplantation; however, this warrants further large-scale investigation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 6","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70379","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148293657","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":"Diuretic Intensity Score and Mortality in Hospitalized Heart Failure Patients: A Multicenter Propensity-Matched Analysis","authors":"Jianwei Zhou","doi":"10.1002/clc.70386","DOIUrl":"10.1002/clc.70386","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To develop and evaluate a novel Diuretic Intensity Score (DIS) and investigate its relationship with mortality in hospitalized heart failure patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed propensity-matched data from two independent cohorts: MIMIC-IV (<i>n</i> = 15 942) and the China Regional Heart Failure Database (<i>n</i> = 1884). DIS was calculated based on diuretic types, routes, and combinations. Primary and secondary outcomes were 28- and 90-day all-cause mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Higher DIS was significantly associated with reduced 28-day mortality (Severe vs. Mild: HR 0.27, <i>p</i> &lt; 0.001 in MIMIC-IV; HR 0.10, <i>p</i> &lt; 0.001 in Chinese cohort) and 90-day mortality. Restricted cubic spline analysis revealed an inverse, non-linear relationship, with mortality risk decreasing as intensity increased and then plateauing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this propensity-matched analysis of two independent cohorts, a higher DIS was associated with lower 28- and 90-day all-cause mortality in hospitalized heart failure patients. Given the observational design, these findings should be regarded as hypothesis-generating associations rather than evidence of a causal benefit and require confirmation in prospective randomized trials before any change in clinical practice can be recommended.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 6","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70386","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148276395","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":"Impact of Chronic Kidney Disease Severity on Clinical Outcomes After Drug-Eluting Stent Implantation: A Propensity Score–Matched Analysis","authors":"Hongxu Zhu,&nbsp;Qi Jin","doi":"10.1002/clc.70387","DOIUrl":"10.1002/clc.70387","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Chronic kidney disease (CKD) is prevalent among patients undergoing percutaneous coronary intervention (PCI) and associated with adverse cardiovascular outcomes. This study evaluated the association between moderate-to-severe CKD and major adverse cardiovascular events (MACE) after drug-eluting stent (DES) implantation using propensity score matching.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study included 200 patients undergoing PCI with DES implantation (January 2020 to January 2025). Patients were stratified by baseline eGFR: non-CKD/mild CKD (≥ 60 mL/min/1.73 m²); and moderate-to-severe CKD (&lt; 60 mL/min/1.73 m²). After 1:1 propensity score matching, 55 pairs were analyzed. The primary endpoint was MACE, defined as all-cause death, myocardial infarction, stroke, or ischemia-driven repeat revascularization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After matching, patients with moderate-to-severe CKD had lower MACE-free survival (log-rank <i>p</i> = 0.003). Cox regression with robust sandwich standard errors clustered by matched pair showed that moderate-to-severe CKD was independently associated with higher MACE risk (HR 3.20, 95% CI 1.36–7.53; <i>p</i> = 0.008). Renal function deterioration (eGFR decline ≥ 30%) occurred more frequently in the CKD group (20.0% vs. 3.6%; <i>p</i> = 0.028). Higher rates of BARC type 2–5 bleeding and contrast-associated AKI were observed in the CKD group; contrast-associated AKI reached statistical significance in the matched analysis (<i>p</i> = 0.030). Sensitivity analysis using inverse probability of treatment weighting supported the robustness of these findings (MACE: <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Moderate-to-severe CKD was independently associated with a higher risk of MACE and renal deterioration after DES implantation. These findings support incorporating CKD severity into post-PCI risk stratification and highlight the potential value of integrated cardiorenal monitoring and individualized management in this high-risk population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 6","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70387","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148276423","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}