Clinical Cardiology最新文献

{"title":"Outcomes of an Interventional Approach in STEMI and NSTEMI All-Comer Octo and Nonagenarians","authors":"Charlotte E. P. Siegers,&nbsp;Quinten P. Hoogervorst,&nbsp;Jan van Ramshorst,&nbsp;Sanneke P.M. de Boer,&nbsp;Maurits Dirksen,&nbsp;Victor A. W. M. Umans","doi":"10.1002/clc.70463","DOIUrl":"10.1002/clc.70463","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The number of octogenarians and nonagenarians presenting with (NSTEMI) is rising. However, they are underrepresented in studies. Therefore, we aim to clarify patient characteristics and compare all-cause mortality of an initial invasive strategy versus optimal medical treatment in (N)STEMI octo and nonagenarians.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All consecutive patients with (N)STEMI admitted from 2020 until 2023 were included. Patients were divided into invasive and OMT groups. Multi-variation corrected analyses were performed in two age groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>775 consecutive patients &gt; 80 years old were analyzed (81 &gt; 90 years). A predominance of women, lower hemoglobin levels, eGFR, and lower rates of coronary angiography and PCI were observed in the nonagenarians. Six patients underwent CABG; all were in the 80–90-year age group. No differences existed in clinical complication rates between the groups. Invasive treatment demonstrated lower 1 year mortality, predominantly seen in NSTEMI elderly patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In octo and nonagenarian (N)STEMI patients, stratifying to an invasive strategy with PCI/CABG appears to be feasible and is associated with improved mortality outcomes. This benefit is predominantly observed in patients with NSTEMI. Stratification can be done immediately on common clinical variables and appropriate shared decision-making.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70463","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910906","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":"Closed-Loop AI Systems for Arrhythmia Management: Toward Predictive, Personalized, and Safe Cardiac Care","authors":"Mohammed AbuBaha,&nbsp;Yousef I. Barqawi,&nbsp;Bara AbuBaha,&nbsp;Salsabeel Bishawi,&nbsp;Duma Hamada,&nbsp;Mohammed Saleh,&nbsp;Sarah Saife,&nbsp;Yahia AlJallad,&nbsp;Elias Salah,&nbsp;Anas Salah,&nbsp;Hossam Salameh","doi":"10.1002/clc.70468","DOIUrl":"10.1002/clc.70468","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cardiac arrhythmias impose a substantial global health and economic burden. Despite advances in electrophysiology and device-based therapy, management still depends on episodic monitoring and delayed decision-making, leaving a persistent gap between detection and intervention that is widest for intermittent and asymptomatic rhythm disturbances.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This narrative review traces the shift from open-loop arrhythmia care to closed-loop, AI-assisted systems that couple continuous sensing, automated decision-making, and therapeutic actuation within a feedback-controlled architecture. Its contribution is to reframe arrhythmia AI around the control loop and its safety constraints rather than around detection accuracy alone, addressing a gap left by reviews that focus on classification algorithms or digital-twin modeling.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We synthesized evidence from landmark device-programming trials, foundational work in control theory and machine learning, and current regulatory guidance to define the principles, technological basis, and system-level requirements of closed-loop arrhythmia care. As a narrative review, it emphasizes control logic, safety constraints, feedback, and clinical integration rather than algorithmic performance in isolation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Device-programming trials show that conservative timing, hierarchical escalation, and defined safety boundaries reduce inappropriate therapy and can improve survival, establishing the control principles on which AI systems must build. Machine learning extends these principles to scalable monitoring and adaptive decision-making but introduces concerns of stability, transparency, bias, and performance drift. Safe implementation therefore requires dependable sensing, bounded adaptation, supervisory control, and lifecycle evaluation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Closed-loop AI extends established electrophysiologic control principles rather than replacing clinical judgment. Embedded within transparent, governed architectures with bounded adaptation and human oversight, such systems may improve the personalization, safety, and outcomes of arrhythmia care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70468","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910976","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":"Targeted Superior Vena Cava Isolation Combined With Pulmonary Vein Isolation Versus Pulmonary Vein Isolation Alone Using Cryoballoon Ablation for Atrial Fibrillation","authors":"Yanxin Han,&nbsp;Yangyang Bao,&nbsp;Yun Xie,&nbsp;Yue Wei,&nbsp;Qingzhi Luo,&nbsp;Tianyou Ling,&nbsp;Wenqi Pan,&nbsp;Ning Zhang,&nbsp;Qi Jin,&nbsp;Changjian Lin,&nbsp;Liqun Wu","doi":"10.1002/clc.70469","DOIUrl":"10.1002/clc.70469","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The superior vena cava (SVC) is a common non-pulmonary vein (non-PV) trigger site in atrial fibrillation (AF), but its triggers are frequently underdetected without systematic mapping and provocation maneuvers. This study aimed to assess the temporal trend in SVC trigger detection rates and compare the efficacy and safety of cryoballoon-based targeted SVC isolation combined with pulmonary vein isolation (PVI) versus PVI alone.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis was conducted on 990 consecutive patients who underwent cryoballoon ablation for AF between January 2020 and December 2024. Annual SVC trigger detection rates were assessed using the Cochran-Armitage trend test. After excluding redo cases and performing 1:1 propensity score matching, 55 matched pairs were compared in terms of procedural outcomes, complications, and 12-month freedom from atrial tachyarrhythmias.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>SVC trigger detection rates increased significantly over the study period, from 6.8% in 2020 to 21.3% in 2024 (P for trend = 0.023). After matching, the PVI + SVCI group showed significantly higher 12-month freedom from atrial tachyarrhythmias compared to the PVI-only group (90.9% vs. 76.4%, <i>p</i> = 0.037). Procedural time was modestly longer in the PVI + SVCI group (93 ± 26 min vs. 80 ± 20 min, <i>p</i> = 0.003), but fluoroscopy time (12 ± 5 min vs. 10 ± 4 min, <i>p</i> = 0.276) and complication rates (5.5% vs. 3.6%, <i>p</i> = 0.500) were comparable between groups, both with low overall complication rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Cryoballoon-based targeted SVC isolation guided by systematic mapping and provocation maneuvers significantly enhances freedom from atrial tachyarrhythmias without compromising safety.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70469","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910914","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":"Prospective Evaluation of Quality-of-Life Improvement After Dapagliflozin Initiation in a Greek Population With HFrEF: The EVOLUTION-HF 12-Month Results","authors":"Victoria Potoupni,&nbsp;Aristi Boulmpou,&nbsp;Spyridon Maragkoudakis,&nbsp;Alexandros Briasoulis,&nbsp;Emmanouil Foukarakis,&nbsp;Alexia Stavrati,&nbsp;Konstantinos Papadopoulos,&nbsp;Katerina K. Naka,&nbsp;Anna Kotsia,&nbsp;Ioannis Parissis,&nbsp;Antonios Ziakas,&nbsp;Stamatis Adamopoulos,&nbsp;Dimitrios Tziakas,&nbsp;Sotirios Patsilinakos,&nbsp;Melanie Konstantinidou,&nbsp;Periklis Davlouros,&nbsp;Zacharias Christogiannis,&nbsp;Konstantinos Tsitlakidis,&nbsp;Ioannis Pantelakis,&nbsp;Georgios Stefanakis,&nbsp;Marios Kolios,&nbsp;Ioannis Baltogiannis,&nbsp;Evangelos Voltyrakis,&nbsp;Christos Varounis,&nbsp;Andreas Samothrakitis,&nbsp;Dimitrios Krikidis,&nbsp;Panagiotis Tsialoukis,&nbsp;Zoe Paparepa,&nbsp;Dimitrios Gourlis,&nbsp;Nikolaos Papoutsidakis,&nbsp;Apostolos Karavidas,&nbsp;Christodoulos Papadopoulos","doi":"10.1002/clc.70466","DOIUrl":"10.1002/clc.70466","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Heart failure with reduced ejection fraction (HFrEF), defined by a left ventricular ejection fraction ≤ 40%, remains a major global health challenge, associated with substantial morbidity, mortality, and impaired quality of life (QoL), particularly in patients with higher NYHA class. Sodium–glucose cotransporter-2 (SGLT2) inhibitors have emerged as a cornerstone therapy for HFrEF, significantly reducing hospitalizations and mortality regardless of glycemic status, sex, race, or comorbidities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>EVOLUTION-HF was an observational, multi-center, longitudinal cohort study involving 257 consecutive patients diagnosed with HFrEF who initiated dapagliflozin in a routine clinical setting in Greece. The primary objectives were to characterize baseline demographic and clinical features of patients newly initiated on dapagliflozin for HFrEF and to evaluate dapagliflozin treatment patterns, including discontinuation timing, reasons for discontinuation, and concomitant heart failure and glucose-lowering therapies over time. The secondary objectives are to describe patient-reported outcomes using the KCCQ-23 and to assess adherence to dapagliflozin among patients with HFrEF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 257 patients were enrolled and the follow-up period lasted for 12 months. Significant improvements among all KCCQ-23 scores were observed from baseline to 12-months post dapagliflozin initiation, revealing that the initiation and optimization of guideline-directed medical therapy in routine clinical practice provides improvement to quality of life over time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Dapagliflozin was safe and well-tolerated throughout the observation period. Although benefits are observed in most patients, individuals aged &gt; 65 years, with prior myocardial infarction, or recent hospitalizations show a diminished response, underscoring the need for tailored management and closer follow-up in these higher-risk groups.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13546617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896557","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":"Temporal Trends and Demographic Disparities in Mortality Due to Coronary Artery Disease and Hypertension in Adults Aged 25 and Above in the United States (2000 to 2024)","authors":"Muhammad Shayan Tariq,&nbsp;Rai Muhammad Umar Khan,&nbsp;Asad Ullah Farooq,&nbsp;Kinza Raza,&nbsp;Maryam Athar,&nbsp;Shumail Tariq,&nbsp;Muhammad Raza Asif,&nbsp;Noor Ul Huda Ramzan,&nbsp;Ameer Haider Cheema","doi":"10.1002/clc.70465","DOIUrl":"10.1002/clc.70465","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Coronary artery disease (CAD) remains a leading cause of mortality, and hypertension serves as a primary, modifiable risk factor. While cardiovascular mortality historically declined, recent data indicate this trajectory has plateaued and begun to reverse. This study analyzes the temporal trends and demographic disparities in mortality due to CAD and hypertension among adults in the United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study utilized the CDC WONDER database to extract mortality data from 2000 to 2024. Deaths among adults aged 25 years and older with CAD and hypertension were identified. Age-adjusted mortality rates (AAMRs) per 100 000 population were calculated. Temporal patterns and annual percent change (APC) were evaluated using Joinpoint regression analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between 2000 and 2024, 3 776 396 deaths occurred due to CAD and hypertension among US adults. Overall AAMR rose from 57.22 to 76.95, driven by a steep 2018–2021 increase (APC: 10.13%) before a recent decline (2021–2024, APC: −3.50%). By 2024, male AAMR (106.43) doubled female AAMR (52.68). Non-Hispanic African American adults experienced the highest AAMR (96.90). Non-metropolitan areas saw greater sustained increases (AAPC: 2.79%) than metropolitan areas (AAPC: 1.23%), with the South recording the highest regional AAMR (70.25; AAPC: 1.53%). While essential hypertension mortality stabilized, hypertensive heart disease (AAPC: 4.35%) and renal disease (AAPC: 8.83%) surged. Chronic ischemic heart disease remained the leading CAD subtype (AAPC: 1.37%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CAD and hypertension-related mortality among adults has increased significantly over the past 25 years, exposing significant demographic disparities. Targeted public health strategies prioritizing optimal blood pressure management and equitable healthcare access are essential to mitigate this escalating burden.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891102","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":"Patient Self-Reported Global Satisfaction With Rivaroxaban in Patients With Atrial Fibrillation: A Comparison Between Oral Anticoagulation-Naïve Versus Oral Anticoagulation-Experienced Patients","authors":"Bogdan G. Markovic,&nbsp;Miroslav Mihajlovic,&nbsp;Aleksandar Kocijancic,&nbsp;Jelena Simic,&nbsp;Milan Marinkovic,&nbsp;Vladan Kovacevic,&nbsp;Milica Ivanisevic,&nbsp;Nikola Isailovic,&nbsp;Nebojsa Mujovic,&nbsp;Belma Pojskic,&nbsp;Tatjana Potpara,&nbsp;the GUARDIAN Investigators","doi":"10.1002/clc.70461","DOIUrl":"10.1002/clc.70461","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Long-term oral anticoagulant therapy (OAC) is essential to effective stroke prevention in patients with atrial fibrillation (AF), but adherence to OAC is a concern. Patient self-reported satisfaction with OAC is a major contributor to OAC adherence. We compared the levels of and time trends in patient global satisfaction with rivaroxaban in OAC-naïve and OAC-experienced AF patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An international, prospective, observational study of treatment with generic rivaroxaban included direct oral anticoagulant (DOAC)-eligible AF patients, whether OAC-naïve or previously taking any OAC except rivaroxaban. At enrollment, all participants were prescribed rivaroxaban. Patient self-reported global satisfaction with rivaroxaban was assessed at 3, 6, and 12 months using a modified Treatment Satisfaction Questionnaire for Medication Version 2 (TSQM-II). The lower the TSQM-II value, the higher patient satisfaction level.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 1020 participants (mean age 68.02 ± 9.65 y, 43.6% female), 630 (61.8%) were OAC-naïve. The mean patient satisfaction level was consistently higher in OAC-experienced versus OAC-naïve patients across all follow-up visits (1.41 ± 0.518 vs. 1.49 ± 0.604, <i>p</i> = 0.034, 1.45 ± 0.552 vs. 1.56 ± 0.585, <i>p</i> = 0.004 and 1.40 ± 0.511 vs. 1.52 ± 0.540, <i>p</i> &lt; 0.001 at 3, 6, and 12 months, respectively). OAC-naïve status was consistently significantly associated with the level of patient satisfaction during follow-up, and significant fluctuations in patient satisfaction levels were observed at 6 months among OAC-naïve but not OAC-experienced patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our results suggest that OAC-naïve patients need additional support, reassurance and more intense regular clinical follow-up, particularly in the first 6 months after initiation of DOAC therapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872869","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":"Longitudinal Serum Uric Acid Variation and Risk of Major Adverse Cardiovascular Events and Mortality: A Systematic Review and Meta-Analysis","authors":"Saima Nisar,&nbsp;Asif Shah,&nbsp;Abida Perveen","doi":"10.1002/clc.70453","DOIUrl":"10.1002/clc.70453","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Longitudinal variability in serum uric acid (SUA) has emerged as a potential predictor of adverse cardiovascular outcomes beyond a single baseline measurement. However, the relationship between temporal changes in SUA and major adverse cardiovascular events (MACE) and mortality remains unclear. This systematic review and meta-analysis evaluated the association between longitudinal variation in SUA and cardiovascular events and mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search of PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library was conducted from database inception to June 2026 following PRISMA 2020 guidelines. Prospective and retrospective cohort studies involving repeated SUA measurements in adults and reporting adjusted hazard ratios (HRs) for cardiovascular outcomes or mortality were included. Study quality was assessed using the Newcastle–Ottawa Scale, and pooled HRs with 95% confidence intervals (CIs) were calculated using a random-effects model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Six cohort studies involving 160 640 participants were included. Greater longitudinal SUA variation was associated with an increased risk of all-cause mortality (pooled HR 1.18, 95% CI 1.10–1.27; <i>I</i>² = 62%), incident cardiovascular disease/MACE (pooled HR 1.21, 95% CI 1.11–1.32; <i>I</i>² = 55%), and cardiovascular mortality (pooled HR 1.25, 95% CI 1.10–1.42; <i>I</i>² = 48%). One study also reported an increased risk of heart failure-related outcomes (HR 1.31, 95% CI 1.12–1.54). Sensitivity analyses demonstrated robust findings across all pooled outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Greater longitudinal SUA variability is independently associated with increased risks of mortality and adverse cardiovascular outcomes. Serial SUA assessment may improve cardiovascular risk stratification beyond baseline SUA measurement.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13535827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872847","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":"Angiography-Based Index of Microcirculatory Resistance in Assessing the MVO and Infarct Size in STEMI Patients","authors":"Tian Wu,&nbsp;Xiaojiao Zhang,&nbsp;Chen Li,&nbsp;Yumeng Hu,&nbsp;Mengying Dong,&nbsp;Jiaqi Chai,&nbsp;Inam Ullah,&nbsp;Han Xu,&nbsp;Pengsheng Chen,&nbsp;Huiping Xu,&nbsp;Xiaoru Cheng,&nbsp;Xiaoxuan Gong,&nbsp;Wei Li,&nbsp;Jianping Xiang,&nbsp;Ruina Hao,&nbsp;Chunjian Li","doi":"10.1002/clc.70464","DOIUrl":"10.1002/clc.70464","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate angiography-based index of microcirculatory resistance (angio-IMR) in assessing microvascular obstruction (MVO) and infarct size (IS) in ST-segment elevation myocardial infarction (STEMI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The effect of thrombolysis on post-percutaneous coronary intervention (PCI) angio-IMR, and its associations with MVO and IS remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>One hundred twenty-three STEMI patients randomized to receive 5 mg intravenous bolus of recombinant staphylokinase (r-SAK) or normal saline (NS) before PCI were recruited. Angio-IMR was computed in infarct-related arteries. MVO and IS were detected by cardiac magnetic resonance imaging.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared with NS group, r-SAK group exhibited numerically lower post-PCI angio-IMR (39.12 U vs. 42.57 U; <i>p</i> = 0.567), MVO (54.0% vs. 70.9%; <i>p</i> = 0.059), MVO extent (0.70% vs. 1.90%; <i>p</i> = 0.101) and IS (21.30% vs. 24.50%; <i>p</i> = 0.079). Post-PCI angio-IMR was positively correlated with MVO extent (<i>ρ</i> = 0.347; <i>p</i> &lt; 0.001) and IS (<i>ρ</i> = 0.324; <i>p</i> &lt; 0.001). Receiver operating characteristic analyses showed moderate diagnostic performance of angio-IMR for MVO (area under the curve [AUC] = 0.750; <i>p</i> &lt; 0.001), MVO &gt; 2.6% (AUC = 0.735; <i>p</i> &lt; 0.001) and IS &gt; 25% (AUC = 0.712; <i>p</i> &lt; 0.001). The exploratory optimal cut-off values for these endpoints were approximately 40 U.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In STEMI patients, a single bolus of r-SAK before PCI was associated with numeric reductions in post-PCI angio-IMR, MVO, MVO extent and IS. Additionally, angio-IMR exhibited a significantly positive correlation with both MVO extent and IS, demonstrating the diagnostic value of this wire-free method for assessing microvascular injury.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13535982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872895","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":"Left Atrium and Left Atrial Appendage Remodeling Assessed by Echocardiography Predict Atrial Fibrillation Recurrence After Radiofrequency Catheter Ablation","authors":"Binyang Zhu,&nbsp;Shaohui Qu,&nbsp;Hairu Li,&nbsp;Dandan Yu,&nbsp;Yingying Liu,&nbsp;Xin Ai,&nbsp;Guangyin Li,&nbsp;Shuangquan Jiang","doi":"10.1002/clc.70457","DOIUrl":"10.1002/clc.70457","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The aim of this study is to evaluate left atrium (LA) and left atrial appendage (LAA) remodeling using two-dimensional speckle tracking echocardiography (2D-STE) and investigate its predictive value for atrial fibrillation (AF) recurrence after radiofrequency catheter ablation (RFCA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>One hundred patients with AF underwent TTE and TEE before undergoing RFCA. LA and LAA strain and strain rate values obtained by 2D-STE. Logistic regression analysis was used to analyze independent contributors for AF recurrence after RFCA. The prediction efficiency of clinical ultrasound parameter models associated with the presence of AF recurrence was evaluated by the receiver operating characteristic (ROC) curve with area under curve (AUC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>①During the 1-year follow-up, 33% of patients experienced AF recurrence. ②The recurrent group had significantly higher NLR, NT-proBNP, and LAVImin values compared to the non-recurrent group (<i>p</i> &lt; 0.05). ③The recurrence group had significantly lower LAEF, LAEI, LAA-EV, LAS, LASR, LAAS, LAASR values than the non-recurrent group (<i>p</i> &lt; 0.05). ④LAAS and LAASR were potential factors contributing to AF recurrence (<i>p</i> &lt; 0.05). In addition, incorporating LAAS and LAASR into predictive models can provide extra valuable information to identify patients at a higher risk of AF recurrence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>LAAS and LAASR, as obtained by 2D-STE, are potential predictors of AF recurrence after RFCA. By incorporating these 2D-STE parameters into preoperative clinical data along with TTE and TEE, it may be possible to identify impaired LA/LAA function in AF patients early. This could aid in choosing suitable patients and improving the benefit ratio of RFCA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13535973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872905","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":"Racial and Ethnic Disparities in Acute Myocarditis Outcomes in the United States","authors":"Maria F. Osorio,&nbsp;Paola Lecompte-Osorio,&nbsp;Sebastian Vasquez-Ariza,&nbsp;Michael Dangl,&nbsp;Louis Vincent,&nbsp;Johanna Contreras,&nbsp;Rosario Colombo","doi":"10.1002/clc.70460","DOIUrl":"10.1002/clc.70460","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Racial and ethnic disparities in cardiovascular outcomes are well established, but whether these inequities extend to acute myocarditis remains insufficiently characterized.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>Racial and ethnic minority groups hospitalized with acute myocarditis would have higher odds of in-hospital mortality than White patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using the National Inpatient Sample from 2012 to 2021, we identified adult hospitalizations with a primary diagnosis of acute myocarditis. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included cardiogenic shock, mechanical circulatory support (MCS), cardiac arrest, ventricular tachycardia/fibrillation (VT/VF), acute kidney injury, renal replacement therapy, and stroke. Multivariable logistic regression estimated adjusted odds ratios (aORs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 105 235 weighted hospitalizations were identified. After adjustment, all minority groups had higher odds of in-hospital mortality than White patients: Black (aOR 1.30, 95% CI 1.10–1.55), Hispanic (aOR 1.37, 95% CI 1.14–1.66), Asian/Pacific Islander (aOR 2.07, 95% CI 1.58–2.72), and Other (aOR 1.40, 95% CI 1.07–1.83). Asian/Pacific Islander patients had the highest odds of cardiogenic shock and MCS use. Black patients had higher odds of cardiac arrest and VT/VF. Hispanic patients had higher in-hospital mortality despite lower odds of VT/VF and MCS use. Race and ethnicity by pandemic era interaction for mortality was not significant (<i>p</i> = 0.072).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among adults hospitalized with acute myocarditis, racial and ethnic minority groups had higher adjusted odds of in-hospital mortality than White patients. Distinct patterns of complications further underscore the need for equitable, attentive, and risk-informed clinical care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863737","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}