Clinical Cardiology最新文献

{"title":"Trend Analyses on Interventional Treatment of Atrial Fibrillation From 2016 to 2022: Insights From a Multicenter Hospital Database of Left Atrial Catheter Ablation Cases.","authors":"Sebastian König, Sven Hohenstein, Johannes Leiner, Anne Nitsche, Henning T Baberg, Michael Wiedemann, Melchior Seyfarth, Armin Sause, Alexander Staudt, Christopher Reithmann, Carsten Wunderlich, Jürgen Tebbenjohanns, Dong-In Shin, Frank Steinborn, Michael Niehaus, Kerstin Bode, Andreas Bollmann","doi":"10.1002/clc.70280","DOIUrl":"https://doi.org/10.1002/clc.70280","url":null,"abstract":"<p><strong>Background: </strong>Current real-world data on the utilization of atrial fibrillation (AF) catheter ablation (CA) are scarce, as is information on the impact of the COVID-19 pandemic on trends in interventional AF treatment. Aims of this study were to describe case characteristics and trends of CA management using a contemporary multicenter database.</p><p><strong>Methods: </strong>In this retrospective, cross-sectional analysis, we investigated administrative data provided by 87 German hospitals from 01/01/2016 to 12/15/2022. Based on ICD-10 and OPS codes, inpatient cases with a main or secondary discharge diagnosis of AF who underwent CA were extracted. Incidence-rate ratios (IRR) for case numbers with 95% confidence intervals (CI) were calculated using negative binomial models. Trends based on regression analysis were adjusted for baseline variables.</p><p><strong>Results: </strong>Analyzing 29 144 CA cases (89.4% from high-volume centers), a significant increase in case numbers was observed throughout the study period (IRR 1.05, 95% CI 1.03-1.07, p < 0.001). There was no sustained impact on the overall trend from the COVID-19 pandemic, but a temporary drop in case numbers in 2020. Utilization of transesophageal echocardiography (OR 0.82, 95% CI 0.81-0.83, p < 0.001) and intensive care treatment declined (OR 0.92, 95% CI 0.89-0.94, p < 0.001) and there was a trend toward a reduced incidence of pericardial tamponade. The ratio of cryoablations to radiofrequency CA case numbers increased from 0.29 ± 0.06 in 2016 to 0.50 ± 0.07 in 2022.</p><p><strong>Conclusion: </strong>We observed an increase in AF CA case numbers over the study period without a sustained influence of the COVID-19 pandemic on this long-term trend. Reported adaptations in CA management deserve further attention.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 5","pages":"e70280"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13112413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147763983","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":"Admission Shock Index Is an Independent Predictor of In-Hospital All-Cause Mortality in Patients With Acute Aortic Dissection and Intramural Hematoma.","authors":"Lingbin He, Yequn Chen, Cuihong Tian, Junshuang Tang, Shiwan Wu, Qiongxia Xu, Jiaxuan She, Xuerui Tan, Xin Zhang","doi":"10.1002/clc.70333","DOIUrl":"10.1002/clc.70333","url":null,"abstract":"<p><strong>Background: </strong>Acute aortic dissection (AD) and intramural hematoma (IMH) are associated with high mortality, necessitating reliable early risk prediction. The shock index (SI) is a potential prognostic marker in critical care, but its value in AD/IMH remains unclear. This study evaluated the association between admission SI and in-hospital all-cause mortality.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included 1250 patients with acute AD/IMH, stratified by an optimal SI cut-off of 0.6 determined by ROC analysis. Kaplan-Meier curves and Cox proportional hazards models were used to assess the relationship. Subgroup analyses were also conducted to confirm the consistency of the main findings.</p><p><strong>Results: </strong>The 30-day cumulative in-hospital all-cause mortality was significantly higher in the SI ≥ 0.6 group than in the SI < 0.6 group (Total: 25.7% vs. 14.4%, p < 0.001; Stanford A: 35.5% vs. 25.2%, p < 0.001; Stanford B: 13.4% vs. 4.8%, p < 0.001). An SI ≥ 0.6 was independently associated with increased in-hospital mortality (adjusted hazard ratio (aHR) 1.67, p = 0.004), consistent across Stanford A (aHR 1.52, p = 0.038) and Stanford B (aHR 2.57, p = 0.014) subgroups. Furthermore, the association was stronger among patients managed without surgery or thoracic endovascular aortic repair (TEVAR) (Total: aHR 2.02, p < 0.001; Stanford A: aHR 1.77, p = 0.009; Stanford B: aHR 3.30, p = 0.004).</p><p><strong>Conclusion: </strong>An admission SI ≥ 0.6 is independently associated with increased in-hospital all-cause mortality in acute AD/IMH, particularly among those managed without surgery/TEVAR. Admission SI may serve as a simple, rapid, and valuable tool for early clinical risk stratification.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 5","pages":"e70333"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13112594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147763878","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":"Point-of-Care Lung Ultrasound in Ambulatory Heart Failure-Moving From Feasibility to Outcomes.","authors":"Shaher Yar, Khadija Sana, Aiman Aijaz, Parvat Kuwar Chhetri","doi":"10.1002/clc.70342","DOIUrl":"10.1002/clc.70342","url":null,"abstract":"","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 5","pages":"e70342"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834401","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":"Quantitative Assessment of Myocardial Perfusion in Physiological and Pathological Hypertrophy Using Myocardial Contrast Echocardiography.","authors":"Liu Chunyao, Jiang Ruihan, Li Kai, Lin Mingming, Wang Xiaofan, Lv Qifeng, Song Xiaoxia, Tian Yu, Sun Juanjuan, Sun Pin","doi":"10.1002/clc.70285","DOIUrl":"https://doi.org/10.1002/clc.70285","url":null,"abstract":"<p><strong>Objective: </strong>To quantitatively evaluate myocardial perfusion levels in patients with physiological and pathological myocardial hypertrophy using myocardial contrast echocardiography (MCE), and to investigate the diagnostic value of MCE parameters for differentiating between these conditions.</p><p><strong>Methods: </strong>From June 2023 to December 2024, 25 hypertensive patients with myocardial hypertrophy (pathological hypertrophy group), 25 healthy athletes (physiological hypertrophy group), and 25 healthy controls were enrolled. All participants underwent two-dimensional echocardiography and MCE. Myocardial perfusion parameters-peak intensity (A-value), wash-in slope (β-value), and myocardial blood flow (MBF)-were quantified using a 17-segment model. Differences in perfusion parameters were compared, and receiver operating characteristic (ROC) curve analysis was performed to evaluate diagnostic efficacy.</p><p><strong>Results: </strong>Compared with controls, the physiological hypertrophy group showed significantly increased peak intensity (A-value) and MBF (p < 0.05), whereas the pathological hypertrophy group exhibited decreased A-value, slope rate (β-value), and MBF (p < 0.05). Intragroup segmental analysis revealed that in pathological hypertrophy, the basal segments had significantly lower A-value and MBF compared to mid and apical segments (p < 0.05). Intermural comparison demonstrated that in both control and physiological hypertrophy groups, the free wall had lower A-value and MBF than the septum (p < 0.05). In contrast, pathological hypertrophy showed reduced A-value but increased β-value in the free wall (p < 0.05). ROC curve analysis identified an optimal cutoff value of A > 8.13 dB (AUC = 0.904) for discriminating exercise-induced physiological hypertrophy from hypertension-induced pathological hypertrophy.</p><p><strong>Conclusion: </strong>MCE enables quantitative assessment of myocardial perfusion in hypertrophic patients. The A value, reflecting microvascular density, serves as a reliable discriminator between physiological and pathological hypertrophy.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 5","pages":"e70285"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13132156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811786","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":"Apolipoprotein A-I (CSL112) and Cardiovascular Outcomes in Atherosclerotic Cardiovascular Disease: A Scoping Review.","authors":"Awais Habib, Muhammad Saood Moazzam Khan, Ahmad Aneeq, Hafiz Muhammad Talha Tahir, Amin Mehmoodi, Jahanzeb Malik, Abida Perveen","doi":"10.1002/clc.70305","DOIUrl":"https://doi.org/10.1002/clc.70305","url":null,"abstract":"<p><strong>Background: </strong>Apolipoprotein A-I (ApoA-I), the principal protein component of high-density lipoproteins (HDL), plays a pivotal role in cardiovascular physiology and has gained increasing attention in atherosclerotic cardiovascular disease (ASCVD). Its involvement extends beyond lipid transport to include anti-inflammatory and antioxidant mechanisms.</p><p><strong>Objective: </strong>To comprehensively evaluate the role of ApoA-I in ASCVD, including its biological functions, clinical relevance as a biomarker, and potential as a therapeutic target.</p><p><strong>Methods: </strong>A scoping review of the literature was conducted to examine current evidence on ApoA-I in cardiovascular health and disease. Studies assessing its role in reverse cholesterol transport (RCT), association with cardiovascular outcomes, and emerging therapeutic strategies were included.</p><p><strong>Results: </strong>ApoA-I contributes significantly to reverse cholesterol transport and exhibits antioxidant and anti-inflammatory properties that protect against atherosclerosis. Elevated ApoA-I levels are consistently associated with reduced risk of major adverse cardiovascular events, supporting its utility as a biomarker for cardiovascular risk assessment. However, variability in HDL particle composition and the influence of confounding factors such as comorbidities and lifestyle limit its interpretability. Therapeutic approaches targeting ApoA-I, including infusion therapies and mimetic peptides, have shown mixed results in clinical trials, highlighting ongoing challenges.</p><p><strong>Conclusion: </strong>ApoA-I remains a promising biomarker and therapeutic target in ASCVD, though its clinical application is complicated by biological and methodological variability. Future research focusing on gene therapies, small molecule modulators, and ApoA-I mimetics may enhance its functional properties and clinical utility. Integrating ApoA-I into personalized treatment strategies could improve cardiovascular outcomes and reduce disease burden.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 5","pages":"e70305"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13122269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147763982","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":"DOAC Score Versus HAS-BLED and ORBIT for Predicting Bleeding Events in Atrial Fibrillation on Direct Oral Anticoagulants.","authors":"Yanfei Guo, Wengen Zhu, Qunfeng Ren","doi":"10.1002/clc.70315","DOIUrl":"https://doi.org/10.1002/clc.70315","url":null,"abstract":"<p><strong>Background: </strong>The comparative performance of the DOAC score versus established bleeding risk scores in patients with atrial fibrillation (AF) receiving direct oral anticoagulants (DOACs) remains uncertain. This meta-analysis evaluated the predictive ability of the DOAC score compared with HAS-BLED and ORBIT.</p><p><strong>Methods: </strong>PubMed and Embase were systematically searched to identify studies assessing the predictive performance of the DOAC score in AF patients treated with DOACs. Pooled C-indices were calculated to compare discrimination. Reclassification metrics (net reclassification improvement [NRI], integrated discrimination improvement [IDI]), calibration analyses, and decision curve analyses (DCA) were synthesized qualitatively.</p><p><strong>Results: </strong>Nine studies comprising 12 cohorts were included (n = 89 688). The DOAC score demonstrated significantly superior discrimination for major bleeding compared with HAS-BLED (C-index 0.68 vs. 0.63). No significant differences were observed for intracranial hemorrhage, gastrointestinal bleeding, or clinically relevant non-major bleeding, nor in comparisons with ORBIT. Reclassification analyses showed heterogeneous findings, with several studies reporting no incremental benefit of the DOAC score, although one large cohort demonstrated improved NRI and IDI over HAS-BLED. Calibration analyses revealed good performance across scores, though both HAS-BLED and DOAC tended to overestimate bleeding risk in high-risk groups. DCA suggested variable but occasionally greater net benefit of the DOAC score at clinically relevant risk thresholds.</p><p><strong>Conclusions: </strong>The DOAC score provides modest but statistically significant improvement in predicting major bleeding compared with HAS-BLED, with comparable performance to ORBIT. However, reclassification, calibration, and clinical utility vary across settings, underscoring the need for further prospective validation.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 5","pages":"e70315"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13112412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764006","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":"Circulating Level of Growth-Differentiation Factor 15 and Mortality of Patients With Acute Heart Failure: A Meta-Analysis.","authors":"Pingkui Jin, Yanjie Geng, Erwei Huo, Yanhong Xue, Daofeng You, Qinghou Zheng","doi":"10.1002/clc.70338","DOIUrl":"10.1002/clc.70338","url":null,"abstract":"<p><strong>Background: </strong>Growth differentiation factor-15 (GDF-15) is a stress-responsive biomarker implicated in inflammation and myocardial injury. Its prognostic value for mortality risk in acute heart failure (AHF) remains uncertain. This meta-analysis evaluated the association between elevated admission circulating GDF-15 levels and subsequent mortality in patients hospitalized with AHF.</p><p><strong>Methods: </strong>PubMed, Embase, and Web of Science were systematically searched for prospective or retrospective cohort studies and post-hoc trial analyses enrolling adult AHF patients with blood GDF-15 measured on admission. Risk ratios (RRs) for all-cause mortality comparing high versus low GDF-15 categories were pooled using random-effects models incorporating the influence of potential heterogeneity.</p><p><strong>Results: </strong>Ten studies with 3724 patients with AHF were included. Overall, high admission GDF-15 levels were significantly associated with increased mortality risk during follow-up (RR = 2.82, 95% CI: 2.39-3.32; p < 0.001), with no evidence of between-study inconsistency (I² = 0%). Sensitivity analyses confirmed robustness (leave-one-out RR range: 2.73-3.00), and results remained consistent in high-quality studies (NOS ≥ 8; RR = 2.72, 95% CI: 2.26-3.27). Subgroup analyses demonstrated similar associations across Asian and Western cohorts, prospective and retrospective designs, different sampling times (at admission to within 48 h), assay methods (ELISA vs. ECLIA), cutoff definitions, follow-up duration, and adjustment for BNP/NT-proBNP (all p for subgroup differences >0.05). No significant publication bias was detected (Egger's p = 0.59).</p><p><strong>Conclusions: </strong>Elevated circulating GDF-15 levels at admission are strongly associated with increased mortality risk in patients with AHF, supporting its potential role in early risk stratification.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 5","pages":"e70338"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834261","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":"Association Between Lactate/Albumin Ratio and Delirium Risk in Critically Ill Patients With Acute Heart Failure: A Retrospective Cohort Study","authors":"Wenjuan Yan,&nbsp;Yajuan Wang,&nbsp;Qiulan Wen,&nbsp;Pengwei Shi","doi":"10.1002/clc.70307","DOIUrl":"10.1002/clc.70307","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Delirium is a common and serious complication in critically ill patients, particularly those with acute heart failure (HF). The lactate/albumin ratio (LAR) has emerged as a potential biomarker reflecting metabolic and nutritional status, serving as an indicator for delirium risk. This study aims to investigate the association between LAR and delirium incidence in acute heart failure patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective observational cohort analysis using the Medical Information Mart for Intensive Care IV (MIMIC-IV-3.1) database, which includes ICU admissions from 2008 to 2022. A total of 1,695 patients diagnosed with acute heart failure were enrolled. LAR was calculated by dividing serum lactate levels by serum albumin levels. Bivariate analyses assessed the relationship between LAR and delirium, while mediation analysis and propensity score matching controlled for confounding variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We found a significant association between elevated LAR values and increased delirium risk. Patients with higher LAR exhibited a markedly higher delirium incidence compared to those with lower levels. Age, body mass index (BMI), and specific comorbidities significantly mediated the relationship between LAR and delirium risk, underscoring the multifactorial nature of delirium development in this population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings suggest that LAR is a valuable biomarker for predicting delirium risk in critically ill acute heart failure patients. Recognizing at-risk patients may enable timely interventions to mitigate delirium and improve ICU outcomes. Further research is warranted to validate these findings and explore targeted management strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70307","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697275","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":"“Reassessing CT-Verified Micra Pacing Locations: Methodological Limitations and Future Clinical Directions”","authors":"Ibadullah Tahir,&nbsp;Hunain Shahbaz","doi":"10.1002/clc.70303","DOIUrl":"10.1002/clc.70303","url":null,"abstract":"&lt;p&gt;The article published recently by Zhang et al. describing a CT-verifying Micra pacemaker placement has generated interest; its strongest component is the extensive application of a post-implant 3D cardiac CT scan to locate and verify leadless RV pacing placement locations compared with standard fluoroscopy alone. Prior research has demonstrated that both fluoroscopic images and ECG criteria frequently incorrectly categorize septal and free wall implant positioning [&lt;span&gt;1, 2&lt;/span&gt;]. In confirming the Micra tip position with CT, Zhang et al. confirmed that most Micra implants were located mainly within an anterior septal/free wall “hinge” region and related these specific regions to ECG pacing patterns for leadless RV pacing. These CT imaging data support prior studies and demonstrate that the placement of the lead tip (when confirmed with CT) is useful for prognostic determination [&lt;span&gt;3&lt;/span&gt;]. The authors deserve recognition for their use of advanced imaging techniques to better understand the anatomy of leadless RV pacing.&lt;/p&gt;&lt;p&gt;There are some factors to consider. First, the study focused on a small sample (&lt;i&gt;n&lt;/i&gt; = 20) of bradycardic patients in one centre only, so the potential for selection bias is high and the results will be limited in their generalizability. All participants had a normal baseline LVEF, and so the findings may not apply to those with LV dysfunction or structural heart disease. Second, although the participants were identified prospectively for inclusion in this study, a separate analysis was then performed to compare “septal” versus “free wall” sites of implantation. This later analysis was not prespecified and therefore is based on retrospective evidence. Furthermore, the classification of pacing locations into “septal” or “free wall” is itself somewhat subjective; as previously reported by Tsukahara et al., the septum/free wall boundary (the ‘hinge’) represents a transition zone that makes it difficult to determine the pacing location accurately using only electrocardiographic data [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Attributing outcome variations to these zones is problematic due to the absence of an independent gold standard or randomized assignment. The follow up period (3 months) was very short, and clinical endpoints were not reported. Since pacing induced desynchrony may have an effect on LV over several months, clinicians should be careful when interpreting the minor LVEF differences and event free status that were reported in this study. The QRS patterns of paced patients that have the same morphology as left bundle branch block have been documented to cause pacing induced cardiomyopathy later [&lt;span&gt;4&lt;/span&gt;]. In addition, complications related to the Micra device have been documented by the EPLS in post market research [&lt;span&gt;6&lt;/span&gt;]. Thus, there is uncertainty regarding the clinical significance of the differences between the ECGs and LVEF until longer term follow up is.&lt;/p&gt;&lt;p&gt;All authors have read and approv","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70303","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697267","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":"Is MELD-Na Truly Predictive of Diuretic Response in Heart Failure? Methodological and Physiological Considerations","authors":"Karan Chaman Lal,&nbsp;Minal Fatima,&nbsp;Sana Soomro,&nbsp;Aiza Siddiqui","doi":"10.1002/clc.70300","DOIUrl":"10.1002/clc.70300","url":null,"abstract":"&lt;p&gt;We read with keen interest the retrospective observational study by Kozluca et al., which evaluated the role of MELD score in predicting the diuretic response in patients with heart failure [&lt;span&gt;1&lt;/span&gt;]. The study provides valuable insights into the cardiorenal interaction by measuring the urinary sodium to assess the link between MELD score and early diuretic response in this population. However, there are a few methodological limitations that need to be addressed to improve the reliability and generalizability of the results.&lt;/p&gt;&lt;p&gt;A key limitation in this study is that urine sodium is the primary factor affecting the diuretic response, whereas MELD-Na includes serum sodium and INR, which reflect sodium handling and neurohormonal activation. Because both the predictor (MELD-Na) and the outcome (diuretic response) are influenced by sodium-related factors, the apparent correlation is circular reasoning rather than an independent predictive relationship. Testani et al. defined the diuretic response as measured solely by the total sodium excretion in urine. Salt retention is the primary mechanism that drives extracellular volume expansion [&lt;span&gt;2&lt;/span&gt;]. They present a physiology-based strategy for assessing natriuretic response to loop diuretics and emphasize urine salt as a clinical sign of diuretic efficacy.&lt;/p&gt;&lt;p&gt;Furthermore, this study does not fully adjust for well-known factors that influence diuretic response in patients with acute decompensated heart failure. Although the authors describe an independent link between the MELD-Na score and poor diuretic response, several key confounders were not adequately considered. These include the starting dose of loop diuretics, underlying kidney function, the intensity of neurohormonal therapy, and the timing of intravenous diuretic administration. All of these factors are known to directly affect natriuresis and urine sodium-based measures of diuretic response [&lt;span&gt;3-5&lt;/span&gt;]. Diuretic response in heart failure is inherently multifactorial, reflecting the combined effects of renal function, neurohormonal activation, haemodynamics, and pharmacologic exposure. Failure to adjust for these variables limits causal interpretation and introduces significant residual confounding. This concern is particularly relevant given that patients with poorer diuretic response received higher doses of loop diuretics, which themselves are associated with impaired natriuresis and worse outcomes, independent of congestion severity. Prior studies have shown that dose-adjusted or dose-normalized natriuresis is essential to distinguish true diuretic resistance from treatment intensity [&lt;span&gt;3, 4&lt;/span&gt;]. The absence of such modeling substantially undermines the internal validity of the reported findings [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Another critical limitation in this study is that the MELD-Na score was measured solely at the time of admission. However, diuretic response in heart failure is an evolving process that ch","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70300","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697394","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}