Clinical Cardiology最新文献

{"title":"Sex-Specific Differences in Cardiovascular Adaptations and Risks in Elite Athletes: Bridging the Gap in Sports Cardiology","authors":"Siamak Afaghi,&nbsp;Fatemeh Sadat Rahimi,&nbsp;Pegah Soltani,&nbsp;Arda Kiani,&nbsp;Atefeh Abedini","doi":"10.1002/clc.70006","DOIUrl":"10.1002/clc.70006","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The growing participation of women in competitive sports necessitates a comprehensive understanding of sex-specific cardiovascular adaptations and risks. Historically, research has predominantly focused on male athletes, leaving a gap in knowledge about the unique cardiovascular dynamics of female peers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>we hypothesized that female athletes exhibit distinct cardiovascular adaptations and face different risks, influenced by physiological, hormonal, and structural differences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review of the literature was conducted, analyzing studies on cardiovascular responses and adaptations in athletes. Data were extracted on hemodynamic changes, autonomic and neural reflex regulation, cardiac remodeling, and arrhythmias. Comparative analyses were performed to identify sex-specific patterns and discrepancies in cardiovascular health outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We revealed considerable sex differences in cardiovascular adaptations to athletic training. Female athletes generally have longer QT intervals, greater sinoatrial node automaticity, and enhanced atrioventricular node function compared to males. They also exhibit lower sympathetic activity, lower maximal stroke volumes, and a tendency toward eccentric cardiac remodeling. Conversely, male athletes are more prone to concentric hypertrophy and higher incidences of bradyarrhythmia and accessory pathway arrhythmias. Female athletes are more likely to experience symptomatic atrial fibrillation and face higher procedural complications during catheter ablation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings underscore the necessity for sex-specific approaches in sports cardiology. Recognizing and addressing these differences could enhance performance and reduce adverse cardiac events in athletes. Future research should focus on developing tailored screening, prevention, and treatment strategies to bridge the knowledge gap and promote cardiovascular health in both male and female athletes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Donor−Recipient BMI Ratio on Survival Outcomes of Heart Transplant Recipients: A Retrospective Analysis Study","authors":"Yucheng Zhong,&nbsp;Changdong Zhang,&nbsp;Yixuan Wang,&nbsp;Mei Liu,&nbsp;Xiaoke Shang,&nbsp;Nianguo Dong","doi":"10.1002/clc.70010","DOIUrl":"10.1002/clc.70010","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to investigate the impact of the donor−recipient BMI ratio on the survival outcomes of heart transplant recipients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis was conducted on 641 heart transplant patients who underwent surgery between September 2008 and June 2021. The BMI ratio (donor BMI divided by recipient BMI) was calculated for each patient. Kaplan−Meier survival analysis and Cox proportional hazards regression were performed to evaluate survival rates and determine the hazard ratio (HR) for mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Significant differences were found in donor age and donor−recipient height ratio between the BMI ratio groups. The BMI ratio ≥ 1 group had a higher mean donor age (37.27 ± 10.54 years) compared to the BMI ratio &lt; 1 group (34.72 ± 11.82 years, <i>p</i> = 0.008), and a slightly higher mean donor−recipient height ratio (1.02 ± 0.06 vs. 1.00 ± 0.05, <i>p</i> = 0.002). The Kaplan−Meier survival analysis indicated that the survival rate in the BMI ratio ≥ 1 group was significantly lower than in the BMI ratio &lt; 1 group. Cox multivariate analysis, adjusted for confounding factors, revealed a HR of 1.50 (95% CI: 1.08−2.09) for mortality in patients with a BMI ratio ≥ 1. No significant differences were observed in ICU stay, postoperative hospitalization days, or total mechanical ventilation time between the groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A higher donor−recipient BMI ratio was associated with an increased risk of mortality in heart transplant recipients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11375284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132011","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":"Characteristics of Patients With Atherosclerotic Cardiovascular Disease in Belgium and Current Treatment Patterns for the Management of Elevated LDL-C Levels","authors":"Eléonore Maury,&nbsp;Samuel Brouyère,&nbsp;Mieke Jansen","doi":"10.1002/clc.24330","DOIUrl":"https://doi.org/10.1002/clc.24330","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Dyslipidemia remains the major cause of atherosclerotic cardiovascular disease (ASCVD). Lipid management in patients with increased cardiovascular (CV) risk needs improvement across Europe, and data gaps are noticeable at the country level.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>We described the current treatment landscape in Belgium, hypothesizing that lipid management in patients with ASCVD remains inadequate and aiming to understand the reasons.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using data from an anonymized primary care database in Belgium derived from 494 750 individuals, we identified those with any CV risk factor between November 2019 and October 2022 and described the clinical features of patients with ASCVD. The main outcomes were the proportion of patients (i) receiving lipid-lowering therapies (LLTs), (ii) per low-density lipoprotein cholesterol (LDL-C) threshold, stratified per LLT, (iii) reaching the 2021 ESC recommended LDL-C goals, and (iv) LDL-C reduction per type of LLT was also determined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 40 888 patients with very high CV risk, 24 859 had established ASCVD. Most patients with ASCVD were either receiving monotherapy (59.6%) or had no documented LLT (25.1%). Further, 64.2% of those with no documented LLT exhibited LDL-C levels ≥ 100 mg/dL. Among common treatment options, one of the greatest improvements in LDL-C levels was achieved with combination therapy of statin and ezetimibe, reducing LDL-C levels by 41.5% (<i>p</i> &lt; 0.0001). Yet, in this group, 24.8% of patients had still LDL-C levels ≥ 100 mg/dL and only 20.7% were at goal.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study emphasizes the importance of developing strategies to help patients achieve their LDL-C goals, with a focus on supporting the implementation of combination LLT in routine clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24330","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100024","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":"Clopidogrel Versus Aspirin as Monotherapy Following Dual Antiplatelet Therapy in Patients With Acute Coronary Syndrome Receiving a Drug-Eluting Stent: A Systematic Literature Review and Meta-Analysis","authors":"Dirk Sibbing,&nbsp;Johny Nicolas,&nbsp;Alessandro Spirito,&nbsp;Birgit Vogel,&nbsp;Davide Cao,&nbsp;Wanda Stipek,&nbsp;Ellen Kasireddy,&nbsp;Andi Qian,&nbsp;Irfan Khan,&nbsp;Roxana Mehran","doi":"10.1002/clc.24326","DOIUrl":"https://doi.org/10.1002/clc.24326","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to evaluate the comparative effectiveness and safety of clopidogrel versus aspirin as monotherapy following adequate dual antiplatelet therapy (DAPT) in patients with acute coronary syndrome (ACS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>MEDLINE, Embase, and CENTRAL were searched from database inception to September 1, 2023. Randomized controlled trials (RCTs) and observational studies evaluating the effectiveness or safety of clopidogrel versus aspirin as monotherapy following DAPT in patients with ACS who received a drug-eluting stent were included. Random-effects meta-analyses were conducted to compare risks of major adverse cardiovascular events (MACE) and clinically relevant bleeding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 6242 abstracts identified, three unique studies were included: one RCT and two retrospective cohort studies. Studies included a total of 7081 post-percutaneous coronary intervention ACS patients, 4260 of whom received aspirin monotherapy and 2821 received clopidogrel monotherapy. Studies included variable proportions of patients with ST-elevation myocardial infarction (STEMI), non-STEMI, and unstable angina. From the meta-analysis, clopidogrel was associated with a 28% reduction in the risk of MACE compared with aspirin (hazard ratio [HR]: 0.72; 95% confidence interval [CI]: 0.54, 0.98), with no significant difference in clinically relevant bleeding (HR: 0.92; 95% CI: 0.68, 1.24).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Despite the paucity of published evidence on the effectiveness and safety of clopidogrel versus aspirin in patients with ACS post-drug-eluting stent implantation, this meta-analysis suggests that clopidogrel versus aspirin may result in a lower risk of MACE, with a similar risk of major bleeding. The present results are hypothesis-generating and further large RCTs comparing antiplatelet monotherapy options in ACS patients are warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24326","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100025","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":"Lack of Class I Vasoreactivity Testing for Diagnosing Patients With Coronary Artery Spasm","authors":"Shozo Sueda,&nbsp;Yutaka Hayashi,&nbsp;Hiroki Ono,&nbsp;Hikaru Okabe,&nbsp;Tomoki Sakaue,&nbsp;Shuntaro Ikeda","doi":"10.1002/clc.70004","DOIUrl":"10.1002/clc.70004","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Vasoreactivity testing, such as intracoronary acetylcholine (ACh) or ergometrine (EM), is defined as Class I for the diagnosis of patients with vasospastic angina (VSA) according to recommendations from the Coronary Vasomotion Disorders International Study (COVADIS) group and guidelines from the Japanese Circulation Society (JCS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>Although vasoreactivity testing is a clinically useful tool, it carries some risks and limitations in diagnosing coronary artery spasm.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Previous reports on vasoreactivity testing for diagnosing the presence of coronary spasm are summarized from the perspective of Class I.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There are several problems such as reproducibility, underestimation, overestimation, and inconclusive/nonspecific results associated with daily spasm. Because provoked spasm caused by intracoronary ACh is not always similar to that caused by intracoronary EM, possibly due to different mediators, supplementary use of these vasoreactivity tests is necessary for cardiologists to diagnose VSA when a provoked spasm is not revealed by each vasoactive agent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Cardiologists should understand the imperfection of these vasoreactivity tests when diagnosing patients with VSA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11350217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142079351","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":"Revisiting Echocardiographic Ranges of Left Ventricular End-Diastolic Volume Index: An Analysis of the Discrepancies Between the 2006 and the 2015 Recommendation for Chamber Quantification Guidelines","authors":"Parisa Fallahtafti,&nbsp;Reza Bahramrafiee,&nbsp;Roya Sattarzadeh Badkoubeh,&nbsp;Akram Sardari,&nbsp;Mohammad Reza Eftekhari,&nbsp;Babak Geraiely,&nbsp;Farnoosh Larti","doi":"10.1002/clc.70003","DOIUrl":"10.1002/clc.70003","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Indexed left ventricular end-diastolic volume (LVEDVi) is a left ventricle (LV) size marker. The “Recommendations for Chamber Quantification” guideline was published in 2006 and updated in 2015. Although the previous guideline maintained uniform cutoff points for both men and women, the latest revision introduced new thresholds that vary between genders. We evaluated the extent of change in labeled indexed LV diastolic volumes in men and women following the adoption of the 2015 guideline.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were extracted from a web-based registry from March 2020 to October 2022. LV indexed volume variables were categorized on the basis of the 2006 and 2015 guidelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 7598 individuals, the classification of LVEDVi differed in 910 (12.0%) individuals. In 213 (5.5%) female subjects, substantial reclassification (i.e., transitioning from normal to moderate LV enlargement to mild to severe LV enlargement) occurred on the basis of the 2015 guideline. All females classified as having moderately abnormal LVEDVi according to the 2006 guideline were reclassified as having severely abnormal LVEDVi according to the 2015 guideline. Age, LV ejection fraction (LVEF), and significant aortic regurgitation (AR) were common factors contributing to the observed discrepancy in both men and women. Significant mitral regurgitation (MR) and regional or global motion abnormality were correlated with the reclassification of LVEDVi to higher abnormal partitions only in women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The observed disparities underscore the importance of ongoing dedicated research to reassess the range of indexed echocardiographic parameters, considering various outcomes and differences in countries.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11350272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142079352","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 Relationship Between Ambulatory Arterial Stiffness Index and Incident Atrial Fibrillation","authors":"Christopher Boos","doi":"10.1002/clc.70007","DOIUrl":"10.1002/clc.70007","url":null,"abstract":"<p>We would like to thank Dr Candemir and Kızıltunç for their follow-up letter in response to our manuscript. They have raised several very important questions. Regarding their first question as to whether there was a statistically significant difference in the diagnosis duration between patients who did and did not develop AF? Unfortunately, we did not collect data on the duration of diagnoses for the cardiovascular risk factors studied and hence will not be able to address this question. We agree this would be an interesting area for future research. It is worth noting that, in addition to duration (which can often be difficult to confirm), the severity of an associated AF risk factor, such as left ventricular ejection fraction (LVEF) in patients with heart failure (HF), is also important. In our manuscript, we observed that the patients who went on to develop AF had a significantly lower LVEF, eGFR, and blood pressure dipping than the non-AF group, suggesting relatively more severe cardiac and renal dysfunction and poorer hypertension control.</p><p>In response to their second point, we have repeated our Cox regression analyses with the additional inclusion of background diagnoses of HF and stroke, both of which were noted to be of greater prevalence in patients who developed AF compared to those who did not. In the full multivariable model, a 1-SD increase in AASI (HR 1.34; 95% CI 1.04–1.72; <i>p</i> = 0.21) and HF (HR 3.47; 95% CI 1.80–6.68; <i>p</i> &lt; 0.001) was significantly associated with newly diagnosed AF, along with a history of previous AF, diastolic blood pressure (DBP), but not stroke and hypertension. Repeating the analysis using categorical AASI (above vs. ≤ median), the result was very similar; however, AASI was just above the significance cut-off (HR 1.65; 95% CI 0.99–2.74; <i>p</i> = 0.053).</p><p>On their final point regarding additional adjustment for beta-blocker (BB) use and other medications, repeating the full multivariable analysis with the additional adjustment for background BB use, as well as a 1-SD increase in AASI, HF, stroke, DBP, sex, previous AF, and hypertension, showed that the independent predictors of new AF were again male, sex, previous AF, lower DBP, HF, AASI (HR 1.36; 95% CI 1.06–1.75; <i>p</i> = 0.017), but not previous stroke, hypertension, and BB use. Repeating this analysis using categorical AASI (above vs. ≤ median) rather than continuous AASI revealed comparable results (AASI HR 1.69; 95% CI 1.02–2.81; <i>p</i> = 0.043).</p><p>Even further analyses with adjustment for the use of calcium channel blockers, ACE inhibitors/angiotensin II receptor blockers, statin use, and mineral corticoid antagonists, in addition to the factors above, revealed equivalent results for both continuous and categorical AASI.</p><p>In summary, the results of this manuscript have shown that AASI is a robust and independent predictor of new-onset AF in a cohort of adults investigated or managed for hypertension.</p><p>The ","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055109","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":"Cephalic Vein Puncture in CIED Implantation: The Emerging Standard and Its Clinical Implications","authors":"Mustafa Mansoor,&nbsp;Ibrahim Manzoor,&nbsp;Muhammad Ahmed","doi":"10.1002/clc.70005","DOIUrl":"10.1002/clc.70005","url":null,"abstract":"<p>The use of cardiac implantable electronic devices (CIRDs) has seen a significant rise in recent years. The European Heart Rhythm Association (EHRA) reported a 20% increase in pacemaker (PM) implantations and a 44% increase in implantable cardioverter-defibrillator (ICD) over a 10-year period in its member countries, prompting the need for safe, efficient, and simple-to-master techniques for establishing venous access [<span>1</span>]. The latest guidelines from the EHRA recommend cephalic vein access, commonly done via cephalic vein cut-down (CVC), for CIRD implantation. However, the greater skill and training required for CVC, coupled with anatomical challenges, often lead to the usage of alternative subclavian venous access (SVC) in patients initially approached via CVC, increasing adverse events [<span>2</span>]. To address this, a modified Seldinger technique has been described recently, offering the potential for an easier-to-learn method with decreased complexity, promising higher success rates and fewer adverse events.</p><p>To assess the efficacy and safety of cephalic venous puncture (CVP) compared to SVP for CIED implantation, Weidauer et al. conducted a study [<span>3</span>]. In a setting where most surgeons lacked prior training in cephalic vein access, CVP was mandated for all procedures. The researchers employed the modified Seldinger technique for CVP, involving initial cephalic vein puncture followed by guidewire-facilitated catheter or sheath insertion. This less invasive approach avoided the need for direct subclavian vein puncture using a large-bore needle. The study involved 229 consecutive patients receiving a CIED. Among these patients, 61 were implanted using primary or bail-out SVP, while 168 patients underwent primary cephalic vein preparation with CVP when feasible. Results showed successful implantation of at least one lead in 90% of CVP patients, with complete lead implantation in 72.6%. There were no significant differences in procedure time, fluoroscopy use, or radiation dose between the two groups. Importantly, none of the 122 patients with solely CVP lead implantation developed pneumothorax, compared to 7.5% in the SVP group with at least one lead through SVP. Hence, showing that changing the mandatory primary venous access for CIED from a subclavian puncture to the cephalic vein can be achieved without compromising procedure times or success rates.</p><p>The study's robust design and consistent findings significantly contribute to establishing CVP as a potential standard procedure for CIED implantation. In this context, the axillary vein puncture (AVP) approach has emerged as a viable alternative, demonstrating high success rates, low complication rates, reduced procedural times, and lower radiation exposure [<span>4</span>]. Direct visualization of the vessel during puncture is facilitated by the axillary approach. Furthermore, ultrasound-guided axillary access (USAA) proves advantageous for patients with cha","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035426","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":"Effect of Obesity on the Use of Antiarrhythmics in Adults With Atrial Fibrillation: A Narrative Review","authors":"Fahad Shaikh,&nbsp;Rochelle Wynne,&nbsp;Ronald L. Castelino,&nbsp;Patricia M. Davidson,&nbsp;Sally C. Inglis,&nbsp;Caleb Ferguson","doi":"10.1002/clc.24336","DOIUrl":"10.1002/clc.24336","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Atrial fibrillation (AF) and obesity coexist in approximately 37.6 million and 650 million people globally, respectively. The anatomical and physiological changes in individuals with obesity may influence the pharmacokinetic properties of drugs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This review aimed to describe the evidence of the effect of obesity on the pharmacokinetics of antiarrhythmics in people with AF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Three databases were searched from inception to June 2023. Original studies that addressed the use of antiarrhythmics in adults with AF and concomitant obesity were included.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 4549 de-duplicated articles were screened, and 114 articles underwent full-text review. Ten studies were included in this narrative synthesis: seven cohort studies, two pharmacokinetic studies, and a single case report. Samples ranged from 1 to 371 participants, predominately males (41%–85%), aged 59–75 years, with a body mass index (BMI) of 23–66 kg/m². The two most frequently investigated antiarrhythmics were amiodarone and dofetilide. Other drugs investigated included diltiazem, flecainide, disopyramide, propafenone, dronedarone, sotalol, vernakalant, and ibutilide. Findings indicate that obesity may affect the pharmacokinetics of amiodarone and sodium channel blockers (e.g., flecainide, disopyramide, and propafenone). Factors such as drug lipophilicity may also influence the pharmacokinetics of the drug and the need for dose modification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Antiarrhythmics are not uniformly affected by obesity. This observation is based on heterogeneous studies of participants with an average BMI and poorly controlled confounding factors such as multimorbidity, concomitant medications, varying routes of administration, and assessment of obesity. Controlled trials with stratification at the time of recruitment for obesity are necessary to determine the significance of these findings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24336","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142016529","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":"Optimal Revascularization Timing of Coronary Artery Bypass Grafting in Acute Myocardial Infarction","authors":"Hyo-Hyun Kim,&nbsp;Myeongjee Lee,&nbsp;Kyung-Jong Yoo","doi":"10.1002/clc.24325","DOIUrl":"10.1002/clc.24325","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Acute myocardial infarction (AMI) is a major global health concern. However, the optimum timing of coronary artery bypass grafting (CABG) in AMI patients remains controversial. This study investigated the optimal timing of CABG and its impact on postoperative outcomes. We hypothesized that determining the optimal timing of CABG could positively impact postoperative outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a nationwide retrospective analysis of the National Health Insurance Service of Korea database, focusing on 1 705 843 adult AMI patients diagnosed between 2007 and 2018 who underwent CABG within 1 year of diagnosis. Patients were categorized based on CABG timing. Primary endpoints included cohort identification and the time interval from AMI diagnosis to CABG. Secondary endpoints encompassed major adverse cardiac and cerebrovascular events (MACCEs) and the impact of postoperative medications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the patients, 20 172 underwent CABG. Surgery within 24 h of AMI diagnosis demonstrated the most favorable outcomes, reducing cardiac death, myocardial infarction recurrence, and target vessel revascularization. Delayed CABG within 3 days also outperformed surgery within 1–2 days post-AMI. Additionally, postoperative aspirin use was associated with improved MACCE outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CABG within 24 h of AMI diagnosis was associated with significantly minimized myocardial injury, emphasizing the critical role of rapid revascularization. Delayed CABG within 3 days related to better outcomes compared with that of surgery within 1–2 days. These findings provide evidence-based recommendations for optimizing CABG timing in AMI patients, consequentially reducing morbidity and mortality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24325","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975231","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}