Clinical Cardiology最新文献

{"title":"Trends in Hyperkalemia-Related Sudden Cardiac Death Among Older Adults in the United States, 1999–2020","authors":"Ibrahim Nagmeldin Hassan,&nbsp;Mohamed Ibrahim,&nbsp;Siddig Yaqub,&nbsp;Muhsin Ibrahim,&nbsp;Nagmeldin Abuassa","doi":"10.1002/clc.70483","DOIUrl":"10.1002/clc.70483","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hyperkalemia is a potentially life-threatening electrolyte disturbance, particularly in older adults with comorbidities. Hyperkalemia can trigger fatal arrhythmias and contribute to sudden cardiac death (SCD). However, national trends in hyperkalemia-related SCD remain poorly defined, especially in the aging US population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a cross-sectional analysis using CDC WONDER mortality data from 1999 to 2020. Deaths were identified using ICD-10 codes for SCD (I46.1, I46.9) as the underlying cause and hyperkalemia (E87.5) as a contributing cause. Age-adjusted mortality rates (AAMRs) were calculated using the 2000 US standard population. Joinpoint regression was used to assess temporal trends and estimate annual percentage changes (APCs). Analyses were stratified by sex, age, race/ethnicity, region, urbanization, and state.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between 1999 and 2020, 36 607 hyperkalemia-related SCD deaths were recorded. The national AAMR more than doubled, from 0.65 to 1.32 per 100 000. Mortality was stable from 1999 to 2009 (APC –1.09%, <i>p</i> = 0.0566) but rose significantly from 2010 to 2020 (APC +5.02%, <i>p</i> &lt; 0.0001). Males, Black individuals, and residents of the South and Midwest had the highest AAMRs and steepest increases. Rural areas consistently showed higher mortality than urban ones. Though most deaths occurred in older adults, significant increases were observed in younger adults (25–44 years) in the last decade. Nevada, Rhode Island, and California had the highest state-level rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Hyperkalemia-related SCD mortality has risen substantially, with marked disparities by sex, race, geography, and age. These trends underscore the need for improved potassium monitoring, risk stratification, and equitable healthcare access to reduce preventable deaths.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13640976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104892","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":"Screening Strategies for Silent Myocardial Ischemia in Individuals With Diabetes Without Known Coronary Artery Disease: Systematic Review and Meta-Analysis","authors":"Vanessa del Carmen Romero Martínez,&nbsp;Juan Pablo Tobón Cuenca,&nbsp;Paula Alejandra Longas García,&nbsp;Luis Eduardo Salazar Moreno,&nbsp;Gloria Ibis Tirado Romero","doi":"10.1002/clc.70470","DOIUrl":"10.1002/clc.70470","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Diabetes mellitus markedly increases atherosclerotic cardiovascular risk, and coronary artery disease remains a leading cause of morbidity and mortality. Silent myocardial ischemia (SMI) is clinically relevant in diabetes because autonomic dysfunction and altered pain perception may attenuate typical ischemic symptoms; however, the clinical benefit of routine screening in asymptomatic individuals without known coronary artery disease (CAD) remains uncertain.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To evaluate whether systematic screening for silent myocardial ischemia or occult CAD in asymptomatic adults with diabetes and no known CAD improves major cardiovascular outcomes.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We performed a systematic review of studies published from January 1, 2000 through March 31, 2025. The primary effectiveness synthesis included randomized trials comparing systematic screening with no systematic screening or usual care. Primary outcomes were major adverse cardiovascular events (MACE), cardiovascular mortality, and all-cause mortality; secondary outcomes included detection yield, downstream testing or revascularization, and reported screening-related harms. Compatible study-level hazard ratios (HRs) and risk ratios (RRs) were synthesized on the log scale using random-effects inverse-variance meta-analysis, with heterogeneity and sensitivity analyses prespecified. The review was not prospectively registered.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Five RCTs (&lt;i&gt;n&lt;/i&gt; = 3315; DIAD, DYNAMIT, FACTOR-64, DADDY-D, and the pilot trial by Faglia et al.) met the eligibility criteria. Screening did not significantly reduce major cardiovascular outcomes in the four trials included in the quantitative synthesis (pooled HR/RR 0.76; 95% CI 0.48–1.19). DYNAMIT was synthesized narratively because its published primary composite was not directly harmonizable with the pooled endpoint. Reporting of false-positive results and procedure-related harms was incomplete and heterogeneous.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;In asymptomatic adults with diabetes and no known CAD, routine screening detects occult ischemia or atherosclerosis but has not demonstrated a reduction in MACE or mortality compared with the trial-era usual-care or protocol-defined medical-management strategies studied. These findings do not support routine population-wide screening; selective testing is","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13635979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104860","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":"Clarification of Reported Statistical Inconsistencies in a CHA2DS2-VA Analysis of No-Reflow After Primary Percutaneous Coronary Intervention","authors":"Fatih Akkaya,&nbsp;Nihan Bahadır","doi":"10.1002/clc.70478","DOIUrl":"10.1002/clc.70478","url":null,"abstract":"&lt;p&gt;Sun et al. report that the CHA2DS2-VA score predicts angiographic no-reflow after primary percutaneous coronary intervention in women but not in men [&lt;span&gt;1&lt;/span&gt;]. The hypothesis is clinically relevant, and the reported sex interaction is noteworthy. Three issues affecting interpretation, together with several reporting errors, require clarification.&lt;/p&gt;&lt;p&gt;First, Table 6 reports the number of stents implanted in men as an adjusted odds ratio of 1.844 (95% confidence interval [CI], 1.055–3.223) with &lt;i&gt;p&lt;/i&gt; = 0.320. Because the CI excludes unity, the reported odds ratio and CI are consistent with &lt;i&gt;p&lt;/i&gt; approximately 0.032, not 0.320; the univariable estimate is also significant (odds ratio, 1.899; 95% CI, 1.114–3.238; &lt;i&gt;p&lt;/i&gt; = 0.018). Yet the Results state that only platelet count was an independent predictor in men, consistent with a nonsignificant stent effect. Thus, the adjusted &lt;i&gt;p&lt;/i&gt; value, CI, and textual model interpretation are mutually inconsistent; the authors should clarify which is correct.&lt;/p&gt;&lt;p&gt;Second, Tables 5 and 6 report identical odds ratios, CIs, and &lt;i&gt;p&lt;/i&gt; values for total stent length and number of lesion vessels within each sex-stratified univariable analysis: 1.013 (95% CI, 0.986–1.041; &lt;i&gt;p&lt;/i&gt; = 0.343) in women and 1.015 (95% CI, 0.996–1.034; &lt;i&gt;p&lt;/i&gt; = 0.117) in men. In the overall cohort, these predictors differ (Table 4: odds ratios, 1.014 and 0.929, respectively). Repetition across two differently scaled predictors in both sex strata suggests a possible transcription or output-transfer error. Verification against the original model output and correction of the affected rows are needed.&lt;/p&gt;&lt;p&gt;Third, the receiver operating characteristic analyses report sensitivity and specificity without the selected cutoffs, preventing reproduction or clinical application of the operating points. At the observed prevalence of 18.3% in women, the reported rounded sensitivity of 78.1% and specificity of 47.6% imply a positive predictive value of approximately 25%. Because the authors conclude that the score alone provides adequate risk stratification in women, the selected cutoff and corresponding positive and negative predictive values, with CIs, should be reported.&lt;/p&gt;&lt;p&gt;Several additional reporting errors warrant correction. In Table 3, CAD in the normal-flow group is reported as 7 (11.1%), although the percentage, cohort totals, and reported &lt;i&gt;p&lt;/i&gt; = 0.613 indicate that the intended count is 71; &lt;i&gt;p&lt;/i&gt; values shown as “0.000” and the neutrophil-to-lymphocyte ratio entry “6.42 (583)” also require correction or confirmation.&lt;/p&gt;&lt;p&gt;We raise these points because the reported sex interaction merits further study, not to dismiss the hypothesis. Several table entries remain internally inconsistent, and the absent receiver operating characteristic thresholds limit clinical interpretation. Corrected tables and clarification of the original model output would allow readers to assess the robustness and applicability of the f","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104881","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":"From Genomics to Precision Cardiology: A Comprehensive Review of Clinical Applications and Challenges in Cardiovascular Diseases","authors":"Neda Mohsen-Pour,&nbsp;Shiva Esmaeili,&nbsp;Aydin Feyzi,&nbsp;Ali Sharafi,&nbsp;Majid Maleki,&nbsp;Samira Kalayinia","doi":"10.1002/clc.70482","DOIUrl":"10.1002/clc.70482","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Genomic cardiology is an emerging field integrating genetic, molecular, imaging, and digital health data to improve cardiovascular disease (CVD) prevention, diagnosis, and treatment. The genetic architecture of CVD encompasses rare, high-impact variants as well as polygenic susceptibility, both of which influence disease risk, severity, and clinical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>Integration of genomic information, including rare variants and polygenic risk scores (PRS), with clinical, imaging, biomarker, and artificial intelligence (AI)-based approaches may enhance personalized cardiovascular risk stratification and therapeutic decision-making.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This review summarizes current applications and emerging developments in genomic cardiology, including whole-genome and whole-exome sequencing, multigene panels, structural variant detection, PRS, multi-omics integration, and AI-assisted risk prediction. Current challenges and emerging therapeutic approaches, including RNA-based therapies and gene editing, are also discussed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Clinical genomic tools are increasingly being incorporated into the evaluation of inherited cardiac conditions. PRS can identify individuals with elevated lifelong CVD risk, although their current clinical utility is primarily as risk-enhancing markers rather than standalone diagnostic tests. Integration of genomic, clinical, imaging, and biomarker data using AI may further improve risk prediction and personalized treatment selection. However, ancestry bias, uncertainty in variant interpretation, limited accessibility, workflow integration barriers, and ethical and privacy concerns remain important challenges.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Genomic cardiology has substantial potential to advance precision cardiovascular medicine. Continued development of diverse genomic databases, standardized clinical implementation frameworks, and emerging genomic therapies will be important for translating genomic advances into equitable and clinically meaningful cardiovascular care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Regionalization of High-Volume Cardiac Pacing: A Prospective Cohort Study on Safety, Feasibility, and the Learning Curve in a Geriatric Population","authors":"Sergejs Pikta,&nbsp;Deniss Vasiļjevs,&nbsp;Kaspars Kupics,&nbsp;Oskars Kalejs,&nbsp;Nikolajs Nesterovics","doi":"10.1002/clc.70479","DOIUrl":"https://doi.org/10.1002/clc.70479","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Centralizing pacemaker implantations delays care for geriatric populations in remote regions, particularly in post-Soviet healthcare systems like Latvia. We hypothesized that a regional hospital could safely establish a high-volume pacing program to overcome geographical barriers, utilizing structured mentorship from a national tertiary center.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This 2-year prospective observational study evaluated 173 consecutive patients (mean age 78.1 years) undergoing permanent pacemaker implantation at Daugavpils Regional Hospital. Procedures were performed by two regional interventional cardiologists transitioning to independent practice, supported by Latvian Cardiology Centre mentors. Endpoints included 30-day major complications, procedural efficiency, surgical learning curve evaluation using Cumulative Sum (CUSUM) analysis, and patient-reported quality of life (AQUAREL, SF-36).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Across 173 procedures (66.5% dual-chamber, 33.5% single-chamber), the overall complication rate was 5.7%. CUSUM analysis demonstrated a complication rate reduction from 8.7% during the initial acquisition phase to a 3.4% expertise plateau. Procedural efficiency stabilized with a mean fluoroscopy time of 3.9 min. Specific complications included lead dislodgement (2.3%), pocket hematoma (1.7%), pneumothorax (1.1%), and wound infection (0.6%), managed successfully without mortality or device abandonment. At 6-month follow-up, patients reported significant quality of life improvements and high trust in the regional team.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Regional high-volume cardiac pacing programs are safe and vital for equitable geriatric care. With structured mentorship, regional hospitals can overcome historical centralization, safely transitioning to independent high-volume centers and achieving an expert-level safety profile non-inferior to tertiary standards.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70479","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149072657","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":"Antithrombotic Therapy in Coronary Artery Aneurysm, Ectasia, and Slow Flow: A Systematic Review","authors":"Nasim Kheirandish,&nbsp;Maliheh Kamali,&nbsp;Alireza Khodadadiyan,&nbsp;Helia Bazroodi,&nbsp;Mohammadhossein Imani,&nbsp;Sahar Ghahramani,&nbsp;Amirhossein Saem,&nbsp;Amirhossein Imani,&nbsp;Haniyeh Alaei,&nbsp;Alireza Abdi-Ardekani,&nbsp;Saideh Jamshidi,&nbsp;Mehdi Bazrafshan,&nbsp;Alireza Arzhangzade,&nbsp;Zahra Hooshanginezhad,&nbsp;Hamed Bazrafshan Drissi","doi":"10.1002/clc.70471","DOIUrl":"10.1002/clc.70471","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Coronary artery aneurysm (CAA), coronary artery ectasia (CAE), and coronary slow flow phenomenon (CSFP) are coronary pathologies associated with altered hemodynamics and increased thrombotic risk. However, optimal antithrombotic management remains uncertain because of limited and heterogeneous evidence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This systematic review aimed to synthesize data on the efficacy and safety of antiplatelet and anticoagulant therapies in patients with CAA, CAE, and CSFP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Following PRISMA 2020 guidelines, PubMed, Scopus, Web of Science, and ProQuest were searched through September 2025 for randomized and observational studies evaluating antithrombotic therapy in adults with these conditions. Outcomes included major adverse cardiovascular events and major bleeding. Narrative synthesis was conducted using the SWiM framework. Risk of bias was assessed using ROBINS-I and RoB 2.0, and certainty of evidence using GRADE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eleven studies comprising 3271 participants were included: six on CAE (<i>n</i> = 895), four on CAA (<i>n</i> = 2356), and one on CSFP (<i>n</i> = 20). In CAE, dual antiplatelet therapy (DAPT) and oral anticoagulation (OAC) were associated with fewer ischemic events than no therapy, although direct comparisons were inconsistent. The only randomized trial in CAE showed numerically lower recurrent myocardial infarction and cardiovascular death with single antiplatelet therapy (SAPT) plus direct oral anticoagulant (DOAC) versus DAPT, but findings were nonsignificant and based on few events. Evidence for CAA and CSFP remains limited and inconclusive.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Intensified antithrombotic therapy may benefit patients with CAE, but evidence remains inconclusive for CAA and CSFP. Large, multicenter randomized trials are warranted to establish condition-specific treatment recommendations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70471","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036722","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 the Comparison of Clevidipine and Nicardipine in Hypertensive Emergencies","authors":"Shuai Zhang,&nbsp;Yishuo Zhang","doi":"10.1002/clc.70476","DOIUrl":"10.1002/clc.70476","url":null,"abstract":"&lt;p&gt;We read with great interest the systematic review and meta-analysis by Ullah et al. comparing clevidipine and nicardipine in hypertensive emergencies [&lt;span&gt;1&lt;/span&gt;]. The authors have assembled the available comparative data on a question that clinicians face almost daily in emergency and critical care settings, and their conclusion that the two agents perform comparably on most efficacy and safety endpoints is broadly consistent with an earlier meta-analysis restricted to cerebrovascular populations [&lt;span&gt;2&lt;/span&gt;]. Several methodological aspects, however, deserve closer attention before these findings inform treatment choices.&lt;/p&gt;&lt;p&gt;First, eight of the nine included studies were retrospective, and pooling them with the single randomized trial in one random-effects model may overstate the certainty of the pooled estimates. In observational cohorts, the choice between clevidipine and nicardipine is seldom arbitrary; it reflects illness severity, clinical context, institutional protocols, and formulary constraints, precisely the conditions under which confounding by indication can distort both efficacy and safety comparisons [&lt;span&gt;3&lt;/span&gt;]. Newcastle–Ottawa scores were not uniformly high, and adjusted estimates from the cohorts were not synthesized separately. A design-stratified analysis, or at minimum a sensitivity analysis restricted to the randomized data, would help readers judge how much of the comparable result reflects true equivalence rather than residual confounding.&lt;/p&gt;&lt;p&gt;Second, one of the primary outcomes, time to target systolic blood pressure, is not a standardized construct. The included studies used different target thresholds, titration intervals, and measurement frequencies, and the pooled estimate carried substantial heterogeneity (&lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 82%). The subgroup findings are also difficult to reconcile: clevidipine appeared faster in both clinical settings, yet the overall estimate did not reach statistical significance, and the difference in the general hypertensive crisis subgroup (−2.79 min) is unlikely to matter clinically. Subgroup-specific estimates, without a formal test of interaction between subgroups, provide limited support for a genuine speed advantage. By contrast, the percentage of time within the target range, a measure of sustained control that has been linked to cardiovascular outcomes [&lt;span&gt;4&lt;/span&gt;], did not differ between groups, which tempers enthusiasm for any meaningful pharmacologic superiority.&lt;/p&gt;&lt;p&gt;Third, the lower infusion volume associated with clevidipine should be interpreted cautiously. This difference largely reflects formulation: clevidipine is delivered as a concentrated lipid emulsion, whereas nicardipine is typically diluted in larger volumes. It is a pharmacokinetic and practical property rather than a demonstrated clinical benefit, and the high heterogeneity (&lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 88%) further limits interpretability. The authors' suggestion that lower infusion volume m","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70476","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036646","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":"Long-Term Renal Function and Clinical Outcomes of Sacubitril/Valsartan in HFrEF and Stage 3–4 Chronic Kidney Disease: A 24-Month Single-Centre Cohort","authors":"Fatih Akkaya,&nbsp;Onur Osman Şeker,&nbsp;Ercan Türkmen,&nbsp;Seçkin Dereli","doi":"10.1002/clc.70473","DOIUrl":"10.1002/clc.70473","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Stage 3–4 chronic kidney disease (CKD) is common in heart failure with reduced ejection fraction (HFrEF) but remains underrepresented in angiotensin receptor–neprilysin inhibitor (ARNI) trials, fostering reluctance to initiate sacubitril/valsartan (S/V).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>We hypothesized that, over 24 months, S/V would be associated with stable renal function and acceptable clinical outcomes; the study was designed to be descriptive rather than comparative.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed 360 adults with HFrEF (LVEF &lt; 40%) and predialysis stage 3–4 CKD who initiated S/V (2017–2023) and were followed for up to 24 months; decedents were analyzed as events, not excluded. The primary renal composite (sustained ≥ 30% eGFR decline, chronic dialysis, or end-stage kidney disease) was analyzed with competing-risk methods (Aalen–Johansen and Fine–Gray, with death competing); mortality with Cox regression; longitudinal eGFR with mixed-effects; and sparse-event models with Firth penalization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among survivors, mean eGFR was stable (mixed-model slope non-significant), with no creatinine rise; NT-proBNP and CRP fell (both <i>p</i> &lt; 0.001) and NYHA class improved. The renal composite occurred in 12/360 (3.3%); all-cause and cardiovascular mortality were 6.1% and 3.9%. Lower baseline eGFR was associated with the renal composite. Analyzes of maintenance dose and concomitant SGLT2-inhibitor use were confounded by treatment tolerance and calendar era and were hypothesis-generating only.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this single-arm cohort of HFrEF with stage 3–4 CKD, S/V was generally well tolerated, with stable renal function and low event rates over 24 months. These descriptive, hypothesis-generating findings cannot establish comparative benefit and require confirmation in controlled studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comments on the “Spontaneous Coronary Reperfusion in STEMI After Pre-Hospital Loading Dose of Triple Antithrombotic Therapy”","authors":"Muhammad Atif,&nbsp;Hamed Khan,&nbsp;Iqra Alam,&nbsp;Hamad Ullah","doi":"10.1002/clc.70472","DOIUrl":"10.1002/clc.70472","url":null,"abstract":"&lt;p&gt;Having read the recently published article by Meunier et al. paper [&lt;span&gt;1&lt;/span&gt;]. This study evaluates spontaneous coronary reperfusion (SCR) in patients with ST-segment elevation myocardial infarction (STEMI) treated with pre-hospital triple antithrombotic therapy before primary percutaneous intervention PCI, we can state that the authors deserve appreciation for performing an impactful prospective bicentric study on the topic that is of significant importance, but remains understudied. The discovery of spontaneous TIMI 3 flow in almost one-fifth of patients, along with the reduction in infarct-related biomarker levels, provides novel and highly relevant information to the existing literature. However, some aspects need to be highlighted since they might affect the interpretation of the main findings of the study.&lt;/p&gt;&lt;p&gt;To begin with, there was heterogeneity of the antithrombotic therapy applied to the study sample despite the fact that it was considered as a group receiving a certain treatment. All the patients were pre-treated with aspirin and anticoagulation before hospital admission, but different P2Y12 inhibitors were used; ticagrelor, clopidogrel, prasugrel, and cangrelor, while two types of anticoagulant therapy were utilized; enoxaparin and unfractionated heparin. The main thing is that the clopidogrel was preferred for patients with contraindications to stronger P2Y12 inhibitors. This pharmacological heterogeneity might have mitigated treatment-specific effects on spontaneous reperfusion, making it impossible to conclude that pre-hospital P2Y12 loading had no effect on the development of spontaneous TIMI 3 flow. In recent pharmacodynamics studies, differences in antiplatelet efficacy, mode of delivery, and timing had a significant impact on the degree of platelet inhibition prior to primary PCI [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Second, while the time from symptom onset to PCI was provided in the study, no information about the time interval between loading-dose administration and coronary angiography was included in the results. This time interval can be considered one of the key factors that determine the degree of pre-procedural platelet inhibition, especially for oral P2Y12 inhibitors in the setting of acute STEMI, due to gastrointestinal absorption delay, the administration of opioids, and hemodynamic instability [&lt;span&gt;3&lt;/span&gt;]. Hence, there could be insufficient pharmacodynamic effect rather than therapeutic equivalence in comparison of ticagrelor and clopidogrel, which would be more convincingly shown by reporting treatment-to-angiography time.&lt;/p&gt;&lt;p&gt;Lastly, the connection between spontaneous reperfusion and out-of-hospital cardiac arrest needs to be interpreted carefully. The study proposes that arrhythmias caused by spontaneous reperfusion may have contributed to the increased prevalence of cardiac arrest seen among patients with spontaneous TIMI 3 flow. However, as mentioned in the study, a coronary angiogram was performed only p","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13596006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015631","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":"Letter to the Editor: Beyond Rural Versus Urban: The Role of Referral Pathways in Interpreting Outcomes After Left Atrial Appendage Occlusion","authors":"Muhammad Umer Hameed,&nbsp;Abdullah Khan,&nbsp;Awais Mehmood","doi":"10.1002/clc.70426","DOIUrl":"10.1002/clc.70426","url":null,"abstract":"&lt;p&gt;I read with great interest the recent study evaluating inpatient outcomes after left atrial appendage occlusion (LAAO) in rural versus urban hospitals across the United States [&lt;span&gt;1&lt;/span&gt;]. The authors report comparable adjusted mortality and complication rates despite marked differences in procedural volume between settings, an important and reassuring finding. I would like to raise several considerations that may help contextualize this comparison.&lt;/p&gt;&lt;p&gt;First, referral pathways may substantially confound the rural–urban comparison. Patients undergoing LAAO at rural hospitals may represent a preselected, lower-risk population with relatively straightforward left atrial appendage anatomy, whereas patients with more complex morphology, greater comorbidity burden, or higher anticipated procedural risk are more likely to be referred to tertiary urban centers with established structural heart programs [&lt;span&gt;2&lt;/span&gt;]. If such informal triage occurred upstream of the procedure, hospital location in this analysis may partly reflect differences in patient selection rather than genuine differences in procedural quality. This mechanism could also explain a notable pattern in the original data: unadjusted complication rates were numerically higher at urban hospitals despite their considerably greater procedural volume. Rather than being paradoxical, this may simply reflect a higher-risk case mix being channeled toward urban centers, which would elevate raw complication rates independent of operator skill or institutional quality. Consistent with this volume-related concern, an analysis of the NCDR LAAO Registry found that lower hospital and physician procedural volumes were independently associated with a reduced likelihood of procedural success, underscoring that volume and outcome are not always straightforwardly related to setting alone [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Second, the higher frequency of discharge to acute care facilities among rural patients merits further discussion. Although inpatient mortality and procedural complications were comparable after adjustment [&lt;span&gt;1&lt;/span&gt;], the greater need for post-discharge transfer may reflect differences in regional care pathways rather than differences in procedural safety. Rural hospitals may appropriately perform LAAO while relying on affiliated facilities for downstream monitoring, rehabilitation, or management of complex comorbidities [&lt;span&gt;4&lt;/span&gt;]. Discharge disposition may therefore reflect regional organization of healthcare delivery and resource allocation rather than adverse procedural outcomes, and this distinction is relevant when evaluating equity in structural heart disease care.&lt;/p&gt;&lt;p&gt;Third, a binary rural-versus-urban framework may not fully capture institutional expertise in contemporary LAAO practice. LAAO is increasingly delivered within comprehensive structural heart disease programs alongside transcatheter aortic valve replacement, transcatheter mitral interventions, and other ","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13579787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976033","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}