Clinical Cardiology最新文献

{"title":"Impact of Adherence to Guideline-Directed Prevention Strategies on Clinical Outcomes in Patients With Coronary Artery Disease and Diabetes Mellitus Following Acute Coronary Syndrome: A 3-Year Cohort Study","authors":"Nur Kamer Kaya İnalkaç,&nbsp;Fuat Polat,&nbsp;İbrahim Keleş","doi":"10.1002/clc.70164","DOIUrl":"https://doi.org/10.1002/clc.70164","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Coronary artery disease (CAD) and diabetes mellitus (DM) significantly increase the risk after acute coronary syndrome. This study evaluated adherence to guideline-directed secondary prevention strategies and demonstrated their substantial impact on reducing rehospitalization and mortality in this population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study was conducted on 987 CAD and DM patients admitted for ACS between 2015 and 2018. Adherence to seven evidence-based secondary prevention strategies was assessed: smoking cessation, physical activity, antiplatelet therapy, statins, blood pressure control, ACEi/ARB therapy, and SGLT-2i therapy. Patients were categorized into groups based on the number of recommendations followed (0–2, 3–4, and 5+). Primary outcomes included rehospitalization and all-cause mortality over a 3-year follow-up period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At baseline, only 12.4% of patients adhered to five or more recommendations, which dramatically increased to 71.9% by the 3-year follow-up. Individual adherence to each of blood pressure control (HR = 0.81, 95% CI: 0.70–0.94), ACEi/ARB therapy (HR = 0.77, 95% CI: 0.67–0.89), and SGLT-2i therapy (HR = 0.79, 95% CI: 0.68–0.92) significantly reduced rehospitalization risk. Similarly, adherence to these therapies individually reduced mortality risk (HR = 0.78, 95% CI: 0.67–0.91; HR = 0.74, 95% CI: 0.63–0.87; and HR = 0.72, 95% CI: 0.61–0.85, respectively). Importantly, a stepwise increase in adherence was associated with a dose-dependent reduction in mortality (HR = 0.65, 95% CI: 0.52–0.81, <i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study highlights the critical role of comprehensive, multifactorial secondary prevention in its association with improved long-term outcomes in patients with CAD and DM following ACS.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 6","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70164","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144197190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Determinants of Coronary Artery Calcification in Adults With Metabolic Syndrome: A Systematic Review and Meta-Analysis","authors":"Aftab Ullah,&nbsp;Asif Jan,&nbsp;Hasan Naeem Kareem,&nbsp;Wahby Mohammed Ahmed Babaresh,&nbsp;Abdur Rahim,&nbsp;Syed Shaukat Ali,&nbsp;Waheed Ali Shah,&nbsp;Salim K. Hajwal,&nbsp;Alaa Hamza Hermis,&nbsp;Mustafa Kareem Jawad,&nbsp;Sajjad Sadeq Salman,&nbsp;Murtadha Abdulridha Ajel,&nbsp;Fatimah Saleh Alsuwayidi,&nbsp;Fadhilah N. Alobaidan,&nbsp;Ameer Hasan Kadhem","doi":"10.1002/clc.70156","DOIUrl":"https://doi.org/10.1002/clc.70156","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Metabolic syndrome (MetS) is a recognized risk factor for coronary artery calcification (CAC), a subclinical marker of atherosclerosis associated with elevated cardiovascular risk. However, the prevalence and determinants of CAC in individuals with MetS have not been comprehensively synthesized. This systematic review and meta-analysis aimed to estimate the pooled prevalence of CAC and identify associated factors among adults with MetS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive search was conducted in PubMed, LILACS, Web of Science, Embase, Scopus, AJOL, and gray literature through December 2024, following PRISMA 2020 guidelines. Eligible studies included adults (≥ 18 years) with MetS, defined by established criteria, and reported CAC scores via validated CT imaging techniques. Observational studies and RCTs were included. Study quality was assessed using the Joanna Briggs Institute checklist. Pooled estimates were derived using a random-effects model, and heterogeneity was assessed with the <i>I</i>² statistic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 17 studies comprising 20 745 individuals were included. The pooled prevalence of CAC in adults with MetS was 39.8% (95% CI: 28.4%–52.5%), with wide variation across study design, geography, and imaging modality. Males had a higher CAC prevalence (RR: 2.00), and MetS was linked to increased CAC scores (SMD: 0.10) and odds of calcification (OR: 1.34–1.50). Subgroup analyses showed variability by region and CT modality. High CAC scores were associated with elevated cardiovascular event rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CAC affects ~40% of adults with MetS and is associated with higher cardiovascular risk. These findings support the integration of CAC screening in MetS management strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 6","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70156","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190780","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":"Effectiveness of Cardiac Rehabilitation in Enhancing Adherence and Improving Clinical Outcomes Post-Acute Coronary Syndrome: A Randomized Controlled Trial","authors":"Haşim Tüner,&nbsp;Fuat Polat,&nbsp;Enes Alıç,&nbsp;Ali Nail Kaya,&nbsp;Çiğdem Bahar Çakmak,&nbsp;Ferhat Coşkun,&nbsp;Emrah Özbek","doi":"10.1002/clc.70160","DOIUrl":"https://doi.org/10.1002/clc.70160","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Acute coronary syndrome (ACS) remains a major contributor to cardiovascular morbidity and mortality. Cardiac rehabilitation programs have shown promise in improving adherence to lifestyle and medical recommendations, yet their impact on clinical outcomes and complications requires further investigation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective, randomized, single-center study evaluated the effects of cardiac rehabilitation on adherence and clinical outcomes in ACS patients. A total of 340 patients were randomized into a Cardiac Rehabilitation Group or Control Group. The Cardiac Rehabilitation Group underwent supervised exercise, dietary counseling, and education, while the Control Group received standard recommendations. Outcomes, including adherence rates and complications, were assessed over 1 year, with additional interim analyses to evaluate early sustainability of behavioral changes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients in the Cardiac Rehabilitation Group demonstrated significant improvements in adherence to dietary recommendations (73.5% vs. 52.4%, <i>p</i> &lt; 0.01) and physical activity (85.3% vs. 68.2%, <i>p</i> &lt; 0.01). Cardiac Rehabilitation Group patients also experienced fewer instances of weight gain (22.9% vs. 34.7%, <i>p</i> = 0.017) and access site complications (21.2% vs. 40%, <i>p</i> &lt; 0.01). Hospital readmissions were reduced in the Cardiac Rehabilitation Group compared to the Control Group (18.8% vs. 31.2%, <i>p</i> = 0.015). Non-adherence to dietary recommendations (HR: 2.42, 95% CI: 1.08–5.41, <i>p</i> = 0.032) and medical treatments (HR: 2.84, 95% CI: 1.32–6.11, <i>p</i> = 0.007) were significantly associated with increased risk of revascularization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Cardiac rehabilitation significantly enhances adherence to medical and lifestyle recommendations, reduces complications, and improves outcomes in ACS patients. These findings emphasize the critical role of structured rehabilitation in post-ACS management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 6","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70160","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190661","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":"Authors' Reply to “Questioning the Rhythm: A Closer Look at Heart Rate Trends”","authors":"Eitaro Kodani,&nbsp;Takeshi Yamashita,&nbsp;Hiroshi Inoue,&nbsp;Hirotsugu Atarashi,&nbsp;Ken Okumura,&nbsp;Hideki Origasa,&nbsp;J-RHYTHM Registry Investigators","doi":"10.1002/clc.70158","DOIUrl":"https://doi.org/10.1002/clc.70158","url":null,"abstract":"&lt;p&gt;We would like to thank Dr. Hassan for your interest in our recently published study “Association between changes in heart rate and adverse events in patients with non-valvular atrial fibrillation: A post hoc analysis of the J-RHYTHM Registry.” [&lt;span&gt;1&lt;/span&gt;] There were several limitations in our study as already mentioned in the article [&lt;span&gt;1&lt;/span&gt;]. Our replies to the comments are as follows.&lt;/p&gt;&lt;p&gt;First, we agree that heart rate (HR) fluctuation may have influenced the incidence of adverse events. However, the present study was based on the results of our previous analysis that HR at the time closest to an event or at the last visit during the follow-up period (HR-end) was more strongly associated with the incidence of adverse events than the baseline HR in patients with nonvalvular atrial fibrillation (AF) [&lt;span&gt;2&lt;/span&gt;]. Specifically, the highest quartile of HR-end (≥ 80 bpm) was independently associated with the incidence of major hemorrhage, all-cause death, and cardiovascular death compared with the second quartile (64–71 bpm), even after adjusting for known confounding factors and HR-controlling drug use [&lt;span&gt;2&lt;/span&gt;]. Therefore, we adopted the changes in HR from the baseline to the end instead of HR fluctuation during the whole follow-up period in the present analysis [&lt;span&gt;1&lt;/span&gt;]. We had HR data at each time when patients visited their outpatient clinic. We could have analyzed visit-to-visit changes in HR for each patient; however, for simplicity, we analyzed changes in HR from the baseline to the end of follow-up [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In addition, when patients were divided into four baseline HR groups (&lt; 60, 60–79, 80–109, and ≥ 110 bpm) using clinically relevant cutoff HR values based on the Rate Control Efficacy in Permanent Atrial Fibrillation II (RACE II) trial [&lt;span&gt;3&lt;/span&gt;], no significant trend in the rate of any adverse event was observed across these baseline HR groups in our cohort [&lt;span&gt;2&lt;/span&gt;]. Therefore, we decided to use the HR quartiles in the present study [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Second, as you pointed out, changes in drugs including oral anticoagulants and HR-controlling drugs, their dosages, and adherence were not considered during the follow-up period in this study. We recognize this is a limitation of this study. However, hazard ratios were adjusted for the use of HR-controlling drugs including β-blocker, K channel blocker, Ca channel blocker, and digitalis in a multivariable Cox regression model in this study [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Third, since the J-RHYTHM Registry was an observational study, the causal relationship between changes in HR and adverse events, as well as the underlying mechanisms, could not be determined from this study. That is known as a general limitation of the observational study. Indeed, we indicated only the association between changes in HR and adverse events and did not mention causality throughout the article. Of course, there is a possibility that the changes ","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 6","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70158","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190781","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":"Right Heart Contrast Echocardiography Microbubble Count and Migraine Severity: A Dose–Effect Relationship Study","authors":"Haijuan Gu,&nbsp;Wenjun Fan,&nbsp;Jiesheng Xia,&nbsp;Jianwei Shi","doi":"10.1002/clc.70155","DOIUrl":"https://doi.org/10.1002/clc.70155","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to investigate whether a dose–effect relationship exists between the number of microbubbles detected on right heart contrast echocardiography (RHCE) and the clinical severity of migraine.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a cross-sectional study of 190 adult patients diagnosed with migraine who underwent RHCE. Microbubble counts were categorized into four grades per frame (Grades 0–III) based on their appearance in the left atrium within three to six cardiac cycles after right atrial opacification. Migraine severity was assessed using the Migraine Disability Assessment (MIDAS) score and the Headache Impact Test (HIT-6). Multivariate linear regression was used to evaluate the association between microbubble grades and migraine severity. The predictive ability of the model was assessed using the residual plots and variance inflation factors. Sensitivity analyses were performed to test the robustness of the findings by adjusting for potential confounders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A clear dose–response relationship was identified, with patients in higher microbubble-grade groups demonstrating significantly elevated MIDAS and HIT-6 scores (<i>p</i> &lt; 0.001). Patients with Grade III microbubbles reported the highest mean MIDAS (18.2 ± 6.1) and HIT-6 (64.8 ± 4.9) scores, compared to those in lower grades (<i>p</i> &lt; 0.001). Regression analyses confirmed that the higher microbubble burden independently predicted migraine severity (<i>β</i> = 0.46, <i>p</i> &lt; 0.001). Sensitivity analyses yielded consistent findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our results suggest a notable dose–effect relationship between RHCE microbubble count and migraine severity. These findings highlight the potential role of right-to-left shunting as a physiological contributor to migraine.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 6","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70155","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190782","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":"How to Integrate Echocardiographic Risk Factors for Atrial Fibrillation Following Acute Myocardial Infarction","authors":"Naoya Kataoka,&nbsp;Teruhiko Imamura","doi":"10.1002/clc.70163","DOIUrl":"https://doi.org/10.1002/clc.70163","url":null,"abstract":"<p>De novo atrial fibrillation (AF) following cardiac interventions frequently recurs, and early detection is particularly crucial in patients with acute myocardial infarction (AMI). The authors of the present study demonstrated that several echocardiographic parameters reflecting left atrial function were associated with the subsequent development of AF following AMI [<span>1</span>]. However, several concerns merit discussion.</p><p>Defining true de novo AF can be inherently challenging, as asymptomatic or subclinical AF may go undetected. How did the authors exclude the possibility of pre-existing silent AF before the onset of AMI? Such undiagnosed episodes may have contributed to the observed left atrial remodeling.</p><p>The study population was limited to patients with AMI [<span>1</span>], in whom AF development is often precipitated by systemic inflammation or left atrial ischemia [<span>2, 3</span>]. Did the authors identify any supportive evidence for these mechanisms? For example, occlusion of the right coronary artery or left circumflex artery—both of which may involve atrial branches—could plausibly be linked to AF onset.</p><p>From a practical standpoint, how might these findings be applied in real-world clinical settings? Even if we succeed in identifying patients at high risk, continuous rhythm monitoring using standard modalities would still be required for AF detection. Alternatively, could prophylactic catheter ablation be considered in select high-risk individuals? Additionally, given that patients routinely receive antiplatelet therapy after AMI, the timing and feasibility of left atrial appendage closure following AF detection warrant further clarification [<span>4</span>].</p><p>The authors have nothing to report.</p><p>The authors have nothing to report.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 6","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70163","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190783","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":"C-Reactive Protein–Albumin–Lymphocyte (CALLY) Index as an Independent Risk Factor for Postoperative Atrial Fibrillation Recurrence","authors":"Ye Deng,&nbsp;Jianya Huang,&nbsp;Li Deng,&nbsp;Yuxuan Zhou,&nbsp;Lu Pan,&nbsp;Jingyi Wang,&nbsp;Qianwen Chen,&nbsp;Qingqing Gu,&nbsp;Yang Zhang,&nbsp;Jun Wei,&nbsp;Ruxing Wang,&nbsp;Ling Sun,&nbsp;Yuan Ji,&nbsp;Qingjie Wang","doi":"10.1002/clc.70157","DOIUrl":"https://doi.org/10.1002/clc.70157","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Atrial fibrillation (AF) recurrence after catheter ablation remains a clinical challenge despite guideline-recommended efficacy. Emerging evidence implicates inflammatory biomarkers in predicting arrhythmia recurrence. This study investigated the novel CALLY index, a composite inflammatory marker, as a prognostic indicator for postablation AF recurrence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospective cohort study, 556 consecutive AF patients undergoing catheter ablation (June 2018–June 2023) were stratified into recurrence and sinus rhythm (SR) maintenance groups. Cox regression and Kaplan–Meier analyses evaluated associations between the CALLY index and recurrence risk. Predictive accuracy was assessed via receiver operating characteristic (ROC) curves and area under the curve (AUC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Over a median 12-month follow-up, 102 patients (18.3%) experienced recurrence. The SR group exhibited significantly higher CALLY indices than the recurrence group (3.24 ± 1.68 vs. 1.89 ± 0.57; <i>p</i> &lt; 0.001). Univariate Cox regression identified the CALLY index as inversely associated with recurrence (HR: 0.439, 95% CI: 0.292–0.659; <i>p</i> &lt; 0.001), with persistence after multivariable adjustment (HR: 0.887, 95% CI: 0.789–0.956; <i>p</i> = 0.031). Tertile-based stratification revealed a 29% lower recurrence risk in the high-CALLY group versus the low-CALLY group (HR: 0.71, 95% CI: 0.68–0.76; <i>p</i> = 0.017). ROC analysis demonstrated optimal discrimination at a CALLY threshold ≥ 1.433 (AUC: 0.7899; sensitivity: 76.4%; specificity: 74.8%; <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The CALLY index independently predicts AF recurrence postablation, offering potential utility in risk stratification. These findings support its integration into clinical decision-making to optimize post-procedural management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 6","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70157","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190784","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":"Real-World Health Care Resource Utilization and Costs Associated With First-Line Dronedarone Versus First-Line Ablation in Adults With Atrial Fibrillation","authors":"Stephen J. Greene,&nbsp;Samantha Schilsky,&nbsp;Andrew W. Roberts,&nbsp;Shaum M. Kabadi,&nbsp;David S. McKindley,&nbsp;Ron Preblick,&nbsp;Jason Rashkin,&nbsp;Reno C. Leeming,&nbsp;Renee M. Sajedian,&nbsp;Andrea M. Russo","doi":"10.1002/clc.70145","DOIUrl":"https://doi.org/10.1002/clc.70145","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Rhythm control therapy with antiarrhythmic drugs (AADs) or catheter ablation is recommended for treatment of atrial fibrillation (AF). The impact of first-line AAD therapy (including dronedarone) or ablation on health care resource utilization (HCRU) is unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Optum's de-identified Clinformatics Data Mart Database (January 1, 2012 to January 31, 2022) was used to assess US adults with AF (within 1 year) and no prior AADs who received first-line dronedarone or first-line ablation (including non-dronedarone AADs then ablation within 90 days) using a comparative cohort design. Dronedarone and ablation cohorts were propensity score matched. HCRU and per-patient per-month (PPPM) payer costs were compared over 24-months' follow-up. Sensitivity analyses assessing first-line ablation with no prior AADs were conducted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Post-matching, dronedarone and ablation cohorts (<i>n</i> = 1440) were similar. Event rate ratios (ERR; [95% CI]) for inpatient (0.85 [0.77–0.93]), any outpatient (0.95 [0.94–0.96]), or emergency room (0.91 [0.85–0.97]) visits, or atrial tachyarrhythmia (ATA)/AF–related procedures (0.72 [0.71–0.74]) were significantly lower with first-line dronedarone versus ablation (all <i>p</i> &lt; 0.01). Dronedarone was associated with reduced mean PPPM costs for total HCRU (−$2603), any outpatient visits (−$2401), and ATA/AF–related procedures (−$1880) versus ablation (all <i>p</i> &lt; 0.01). In contrast to the primary analysis, sensitivity analyses showed no significant difference in ERR for all-cause inpatient or any outpatient visits, but dronedarone remained associated with significantly lower mean PPPM total costs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Over 24-months' follow-up in patients with AF, first-line dronedarone was associated with comparable rates of inpatient/outpatient visits, and lower total payer costs compared with an ablation-based approach.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 6","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70145","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144171619","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":"Meta-Analysis of Thermal Versus Pulse Field Ablation for Pulmonary Vein Isolation Durability in Atrial Fibrillation: Insights From Repeat Ablation","authors":"Jin-Cheng Chen,&nbsp;Yin-Jun Mao,&nbsp;Qun-Ying Huang,&nbsp;Zhen-Dong Cheng,&nbsp;Shao-Bin He,&nbsp;Qiu-Xia Xu,&nbsp;Yin Zhang","doi":"10.1002/clc.70151","DOIUrl":"https://doi.org/10.1002/clc.70151","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Pulsed field ablation (PFA) represents an innovative technique for pulmonary vein isolation (PVI), exhibiting promising efficacy and safety in initial clinical studies. However, the long-term durability of PVI and reconnection patterns following PFA are not as well-characterized compared to those associated with thermal energy sources such as cryoballoon ablation (CBA) or radiofrequency ablation (RFA). The objective of this study is to compare the durability of lesions resulting from repeat ablation after index PVI using PFA versus thermal ablation (TA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a comprehensive search of multiple databases to identify relevant studies published before January 2025. PVI durability was assessed on a per patient and per vein level.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This study included 14 trials involving a total of 7,367 patients. PFA demonstrated a trend toward reduced rates of repeat ablation in comparison to TA (OR 0.77; 95% CI, 0.59–1.00). Durability of PVI per patient (OR 1.42; 95% CI, 0.92–2.19) or per vein (OR 1.42; 95% CI, 0.92–2.19) were similar after PFA and TA. The most common site of reconnection was the right inferior PV for both PFA and TA (39.7% and 38.1%, respectively). Subgroup analyses demonstrated that PVI durability per vein was significantly higher with PFA compared to RFA (OR 1.32; 95% CI, 1.03–1.70).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>At the time of repeat ablation, PFA exhibited a trend toward a reduced incidence of repeat procedures compared to CBA or RFA. PFA is comparable to CBA in achieving durable isolation of all veins but demonstrates superiority over RFA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 6","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70151","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144171694","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":"Immune Checkpoint Inhibitor-Related Myocarditis: A Single Center Observational Registry","authors":"Grace Alexander,&nbsp;Ibrahim Mortada,&nbsp;Mohammed Mhanna,&nbsp;Stefano Byer,&nbsp;Udhayvir Singh Grewal,&nbsp;Shareef Mansour","doi":"10.1002/clc.70154","DOIUrl":"https://doi.org/10.1002/clc.70154","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Immune checkpoint inhibitors (ICIs) are associated with myocarditis, which is rare but has a high mortality. This study aimed to describe cases of ICI-related myocarditis at the University of Iowa Hospitals &amp; Clinics and, in doing so, provide valuable insights into patient characteristics, treatment, and outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center observational registry included cases of ICI-related myocarditis identified from 2009 to 2024. Data were collected retrospectively from electronic medical records and included demographics, cardiovascular risk factors, medications, and cancer characteristics. Between-group comparisons for continuous data were conducted using unpaired Student's <i>t</i>-tests or the Wilcoxon rank-sum test. Categorical data were analyzed with Fisher's exact test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighteen patients were included. The mean age was 74 ± 9.4 years with 61% being male. Compared to controls, patients with ICI-related myocarditis had a significantly higher prevalence of coronary artery disease (36.8% vs. 7.5%, <i>p</i> = 0.01) and obstructive sleep apnea (33% vs. 10%, <i>p</i> = 0.03). They were less likely to have a normal sinus rhythm on baseline electrocardiogram (50% vs. 70%, <i>p</i> &lt; 0.01) and more likely to suffer from a major adverse cardiac event (MACE) (38.9% vs. 2.5%, <i>p</i> &lt; 0.01). Twelve (66.7%) of patients with ICI-related myocarditis also had myasthenia gravis-like overlap syndrome and 9 (50%) had myositis/rhabdomyolysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>ICI-related myocarditis at a tertiary care center is rare with a calculated incidence of 0.48%. Despite this, the disease has a high incidence of MACE. Patients with pre-existing cardiovascular disease are at higher risk of developing ICI-related myocarditis. Careful cardiovascular monitoring in patients undergoing ICI therapy is warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 5","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70154","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144108892","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}