Clinical Cardiology最新文献

{"title":"The Neutrophil-to-Lymphocyte Ratio Is an Independent Inflammatory Biomarker for Adverse Events in Patients With Atrial Fibrillation: Insights From the Murcia AF Project II (MAFP-II) Cohort Study","authors":"Eva Soler-Espejo,&nbsp;Francisco Marín,&nbsp;Raquel López-Gálvez,&nbsp;María Pilar Ramos-Bratos,&nbsp;María Sánchez-Villalobos,&nbsp;María Asunción Esteve-Pastor,&nbsp;Gregory Y. H. Lip,&nbsp;José Miguel Rivera-Caravaca,&nbsp;Vanessa Roldán","doi":"10.1002/clc.70102","DOIUrl":"https://doi.org/10.1002/clc.70102","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Systemic inflammation plays a central role in atrial fibrillation (AF). The neutrophil-to-lymphocyte ratio (NLR) is a simple hematological index that has been shown to be associated with prognosis in different pathologies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>The NLR is associated with an increased risk of adverse events in patients with AF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included a prospective cohort of AF patients who started vitamin K antagonists (VKAs) therapy between July 2016 and June 2018. NLR was assessed at baseline and classified into three categories: low (&lt; 3), moderate (3–5), and high (&gt; 5). During a 2-year follow-up period, all cardiovascular deaths, all-cause deaths, and net clinical outcomes (NCO; either ischemic stroke/transient ischemic attack, major bleeding or all-cause death), were recorded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1050 patients were included (51.4% women; median age 77 years). NLR was available in 936 patients: 507 (54.2%) had low NLR (&lt; 3), 239 (25.5%) had moderate NLR (3–5), and 190 (20.3%) had high NLR (&gt; 5). The primary endpoint was significantly increased in the high NLR category (<i>p</i> = 0.002 for cardiovascular death; <i>p</i> &lt; 0.001 for all-cause mortality, and <i>p</i> &lt; 0.001 for NCO), with higher IRRs (all <i>p</i> &lt; 0.001). Multivariate Cox regression analyses showed that high NLR was independently associated with an increased risk of cardiovascular death (aHR: 2.02; 95% CI: 1.04–3.92), all-cause mortality (aHR: 2.51; 95% CI: 1.58–3.97), and NCO (aHR: 1.99; 95% CI: 1.37–2.87), compared to low NLR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this prospective AF cohort receiving VKAs, elevated NLR was significantly associated with an increased risk of adverse clinical outcomes. NLR has independent prognostic value beyond other classical risk factors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70102","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466281","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 Scoring Model to Predict ICU Stay and Mortality After Emergency Admissions in Atrial Fibrillation: A Retrospective Study of 30 366 Patients","authors":"Tao Hong,&nbsp;Jian Huang,&nbsp;Jiewen Deng,&nbsp;Lirong Kuang,&nbsp;Mengyan Sun,&nbsp;Qianqian Wang,&nbsp;Chao Luo,&nbsp;Jikai Zhao,&nbsp;Xiaozhu Liu,&nbsp;Huishan Wang","doi":"10.1002/clc.70101","DOIUrl":"https://doi.org/10.1002/clc.70101","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The rapid assessment of the conditions is crucial for the prognosis of atrial fibrillation (AF) patients admitted to the emergency department (ED). We aim to derive and validate a more accurate and simplified scoring model to optimize the triage of AF patients in the ED.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We conducted a retrospective study using data from the Medical Information Mart for Intensive Care (MIMIC-IV) database and developed scoring models employing the Random Forest algorithm. The area under the receiver operating characteristic (ROC) curve (AUC) was used to measure the performance of the prediction for intensive care unit (ICU) stay, and the death likelihood within 3, 7, and 30 days following the ED admission.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 30 366 AF patients, randomly divided into training, validation, and testing cohorts at a 7:1:2 ratio. The training set consisted of 21 257 patients, the validation set included 3036 patients, and the remaining 6073 patients were classified as the validation set. Among the cohorts, 9594 patients (32%) required ICU transfers, with mortality rates of 1% at 3 days, 3% at 7 days, and 6% at 30 days. In the testing set, the scoring models demonstrated strong discriminative ability with AUCs of 0.724 for ICU stay, 0.782 for 3-day mortality, 0.755 for 7-day mortality, and 0.767 for 30-day mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We derived and validated novel simplified scoring models with good discriminative performance to predict the likelihood of ICU stay, 3-day, 7-day, and 30-day death in AF patients after ED admission.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70101","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143455753","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":"“A Biomarker-Based Scoring System to Assess the Presence of Obstructive Coronary Artery Disease in Patients With Myocardial Infarction”","authors":"María Jesús Espinosa Pascual,&nbsp;Jose Antonio Carnicero Carreño,&nbsp;Mariam El Assar,&nbsp;Renee Olsen Rodríguez,&nbsp;Alfonso Fraile Sanz,&nbsp;Paula Rodriguez Montes,&nbsp;Nuria Gil Mancebo,&nbsp;Alberto Sánchez Ferrer,&nbsp;Bárbara Izquierdo Coronel,&nbsp;María Álvarez Bello,&nbsp;María Martín Muñoz,&nbsp;Verónica Cámara Hernández,&nbsp;Miguel de La Serna Real de Asua,&nbsp;Silvia Humanes Ybañez,&nbsp;Patricia Sosa Callejas,&nbsp;Miguel Gutierrez Muñoz,&nbsp;Rebeca Mata Caballero,&nbsp;Paula Awamleh Garcia,&nbsp;Jesús Ángel Perea Egido,&nbsp;Javier López Pais,&nbsp;Leocadio Rodríguez Mañas,&nbsp;Joaquín Jesús Alonso Martín","doi":"10.1002/clc.70090","DOIUrl":"https://doi.org/10.1002/clc.70090","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Approximately 10% of patients with myocardial infarction present with non-obstructive coronary arteries (MINOCA), whose characteristics differ from those with obstructive coronary lesions (MICAD). Inflammation plays a key role in myocardial infarction. This study aims to develop a biomarker-based index for accurate differentiation between MINOCA and MICAD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A prospective, observational cohort study including 111 patients admitted for myocardial infarction: 46 with MINOCA and 65 with MICAD. Blood samples were collected within the first 24 h to measure high-sensitivity C-reactive protein, interleukin-6, asymmetric dimethylarginine, and peak high-sensitivity troponin T. The association of these biomarkers with MICAD risk was analyzed using logistic regression. Scoring systems were developed using optimization algorithms to predict the diagnosis before coronary angiography, applied to both individual biomarkers and a combined index.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients had a mean age of 67 years (SD 13.3), with a male predominance (68.5%). Higher levels of IL-6 and high-sensitivity troponin T were significantly associated with increased MICAD risk (OR: 1.58; 95% CI: 1.01–2.46, and OR: 2.27; 95% CI: 1.61–3.26, respectively). As score increases, interleukin-6 and high-sensitivity troponin T increase the likelihood of MICAD classification, while higher asymmetric dimethylarginine levels reduce it. Each one-point increase in the combined index multiplies MICAD risk by six (OR:6.16, 95%CI: 2.72–13.95; <i>p</i> &lt; 0.001). While individual indexes improved the diagnostic performance of biomarkers, the combined index demonstrated superior accuracy (AUC: 0.918).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A biomarker-based scoring system was developed, achieving superior discriminatory capacity for differentiating MINOCA from MICAD compared to the individual analysis of biomarkers in absolute values or independent indexes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70090","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439148","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":"Management of Echocardiography Requests for the Detection and Follow-Up of Heart Valve Disease: A Consensus Statement From the British Heart Valve Society","authors":"John Chambers,&nbsp;Benoy N. Shah,&nbsp;Madalina Garbi,&nbsp;Brian Campbell,&nbsp;Vassilios S. Vassiliou,&nbsp;Dominik Schlosshan","doi":"10.1002/clc.70099","DOIUrl":"https://doi.org/10.1002/clc.70099","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In the aftermath of the Covid19 pandemic and lockdowns, there has been a growing population awaiting transthoracic echocardiograms for potential valvular heart disease. Conducting comprehensive echocardiograms for all individuals may no longer be practical, leading to substantial delays in obtaining the necessary scans. This paper explores an alternative approach, suggesting the consideration of dedicated and shorter scans specifically for patients suspected of having valvular heart disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>To address the increasing waiting times and improve heart valve disease detection, the British Heart Valve Society recommends a tiered approach to echocardiograms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This approach includes basic/level 1, focused, minimum standard, and disease-specific scans. Urgency recommendations vary, with individuals experiencing exertional chest pain or pre-syncope requiring prompt scanning within 2 weeks, ideally at a valve clinic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients without known valve disease but with a murmur and stable breathlessness should be scanned as soon as possible, within a maximum of 6 weeks, balancing local demand and capacity. For those with an asymptomatic murmur and no prior scan, a basic/level 1 study is recommended to triage the necessity for a minimum standard study. Emphasizing appropriate triage for all requests, the statement guides decisions on the necessity for echocardiography, urgency level, and the required scan type.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This practical Consensus Statement from the British Heart Valve Society aims to support appropriate shorter transthoracic echocardiography for patients referred for suspected valvular heart disease. The goal is to enhance capacity in a secure manner, thereby minimizing the risks associated with delays in obtaining timely scans.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70099","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to Apply Predictive Model in Real-World Practice: The Standard of Model Validation","authors":"Rungroj Krittayaphong","doi":"10.1002/clc.70096","DOIUrl":"https://doi.org/10.1002/clc.70096","url":null,"abstract":"&lt;p&gt;We would like to thank Naoya Kataoka and Teruhiko Imamura for their comments regarding the issues that might be of concern. We would like to respond to clarify comments.&lt;/p&gt;&lt;p&gt;There might be a question about the justification for comparing the COOL-AF predictive model with the HAS-BLED model for intracranial hemorrhage (ICH), as the variables of the two models are different. HAS-BLED was designed to predict major bleeding [&lt;span&gt;1&lt;/span&gt;] whereas our predictive model is focused on ICH [&lt;span&gt;2&lt;/span&gt;]. We would like to explain the rationale for using ICH as the primary outcome of our study. ICH was chosen as the main outcome for several reasons. First, a previous study showed that Asian patients with atrial fibrillation (AF) who used warfarin had a fourfold increased risk of ICH compared to non-Asians [&lt;span&gt;3&lt;/span&gt;] and the results of the four DOAC trials demonstrated a much higher rate of ICH in Asians compared to non-Asians [&lt;span&gt;4&lt;/span&gt;]. Second, among the 3405 patients in our registry, 199 (5.5%) developed major bleeding during follow-up, with 70 cases of ICH (36% of all major bleeding). Moreover, the mortality rate from ICH was 39% compared to 14% of non-ICH major bleeding and 15% for ischemic stroke. Therefore, we chose ICH as the main outcome and the primary target for developing the prediction model.&lt;/p&gt;&lt;p&gt;We performed additional analysis to determine whether each component of the HAS-BLED score is a significant predictor for either ICH or major bleeding in the population of our study. The components of the HAS-BLED score are as follows: uncontrolled &lt;b&gt;H&lt;/b&gt;ypertension, &lt;b&gt;A&lt;/b&gt;bnormal renal, or liver function; history of &lt;b&gt;S&lt;/b&gt;troke; history of &lt;b&gt;B&lt;/b&gt;leeding; &lt;b&gt;L&lt;/b&gt;abile international normalized ratio (INR); &lt;b&gt;E&lt;/b&gt;lderly (age above 65 years); and, &lt;b&gt;D&lt;/b&gt;rugs or alcohol (1 point each). We identify that age &gt; 65 years, labile INR, and abnormal liver function are predictors of ICH, while only age &gt; 65 years is a predictor for major bleeding. Therefore, the score developed from one population may not be applicable or suitable for another population. It is important that we use our own data from our own population. When we want to apply the predictive model from another study to our population, we must carefully consider the basis of the predictive model and decide whether the nature of its development and validation is suitable for the population of interest.&lt;/p&gt;&lt;p&gt;The predictive model of our study was developed following the standard procedure outlines in the Prediction model Risk Of Bias ASsessment Tool (PROBAST) [&lt;span&gt;5&lt;/span&gt;]. We performed C- and &lt;span&gt;d&lt;/span&gt;-statistics using Bootstrap for internal validation. We used the Brier score to assess the predictive ability of the model. Additionally, the C-statistics, calibration slope and intercept were corrected for the optimism. We complied with the guidance of the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRI","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70096","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143404360","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":"Reply to “How to Prevent Arrhythmias Following Acute Coronary Syndrome”","authors":"Luca Cumitini,&nbsp;Ailia Giubertoni,&nbsp;Giuseppe Patti","doi":"10.1002/clc.70098","DOIUrl":"https://doi.org/10.1002/clc.70098","url":null,"abstract":"&lt;p&gt;We would like to thank Naoya Kataoka and Teruhiko Imamura for their thoughtful comments regarding our clinical research, and we would like to take the opportunity to point out some aspects.&lt;/p&gt;&lt;p&gt;We fully agree that including additional predictors, such as hyperuricemia, chronic obstructive pulmonary disease, and specific electrocardiographic/echocardiographic parameters may potentially improve the ability of detecting atrial fibrillation (AF) and ventricular arrhythmias (VA) [&lt;span&gt;1&lt;/span&gt;]. However, in our study we focused on the application of the PRAISE (PRedicting with Artificial Intelligence riSk aftEr acute coronary syndrome) score model [&lt;span&gt;2&lt;/span&gt;] to ensure consistency with the original validation and clinical interpretability of the results. This approach allowed us to evaluate the performance of the model in a real-world context without introducing additional variables that, if incorporated in the score, would have required its recalibration and revalidation. We recognize that the addition of these factors may be an interesting direction for future research.&lt;/p&gt;&lt;p&gt;Anemia increases the risk of arrhythmias [&lt;span&gt;3&lt;/span&gt;], alongside other variables, such as older age and reduced left ventricular ejection fraction (LVEF). In our clinical research, at univariate analysis LVEF was associated with the development of AF and VA, and age with the occurrence of VA. However, at multivariate analysis LVEF and age were not independent predictors of early arrhythmic complications [&lt;span&gt;4&lt;/span&gt;]. Moreover, we believe that the comprehensive use of the PRAISE score overcomes the inherent limitations of stratification based solely on traditional, individual parameters.&lt;/p&gt;&lt;p&gt;Finally, we found that the PRAISE score is a machine learning-based risk stratification tool with high specificity for predicting arrhythmic complications during hospitalization. By identifying patients at elevated risk for arrhythmias, the PRAISE score can allow for targeted interventions, such as enhanced rhythm monitoring or optimizing pharmacological treatments. These strategies are particularly relevant within the first 30 days postacute coronary syndrome (ACS), that is, during the critical phase of cardiac reverse remodeling. We demonstrated an early predictive value of the PRAISE score for arrhythmias, but its role in guiding long-term interventions remains under investigation [&lt;span&gt;4&lt;/span&gt;]. Incorporating the PRAISE score into post-ACS management could potentially improve outcomes even over the longer-term, by facilitating early detection of high-risk patients, promoting tailored use of secondary prevention measures (e.g., intensive lifestyle modifications, stricter rhythm monitoring, or extended pharmacological therapy), and optimizing resource allocation for arrhythmia prevention. However, this needs to be evaluated in future, prospective protocols. Further studies are also welcome to evaluate the utility of the PRAISE score in selecting patients candidates t","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70098","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143404451","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":"Author's Reply to “Digital Devices for Arrhythmia Detection: What Is Still Missing?”","authors":"Martin Manninger,&nbsp;David Zweiker,&nbsp;Tatevik Hovakimyan,&nbsp;Paweł T. Matusik,&nbsp;Sergio Conti,&nbsp;Pierre Ollitrault,&nbsp;Aapo Aro,&nbsp;Bart A. Mulder,&nbsp;Wolfgang Dichtl,&nbsp;Christian-Hendrik Heeger,&nbsp;Rachel M. A. ter Bekke,&nbsp;Enes Elvin Gul,&nbsp;Bob Weijs,&nbsp;Ann-Kathrin Rahm,&nbsp;Angeliki Darma,&nbsp;Banu Evranos,&nbsp;Avi Sabbag,&nbsp;Kgomotso Moroka,&nbsp;Vassil Traykov,&nbsp;Jacob Moesgaard Larsen,&nbsp;Gisella Rita Amoroso,&nbsp;Stijn Evens,&nbsp;William F. McIntyre,&nbsp;Dominik Linz","doi":"10.1002/clc.70092","DOIUrl":"https://doi.org/10.1002/clc.70092","url":null,"abstract":"<p>We thank Kataoka and Imamura for their interest in our recently published survey on physician's preferences in the use of novel digital devices in the management of patients with atrial fibrillation (AF) [<span>1, 2</span>].</p><p>Our survey shows, that digital devices are beginning to be implemented in clinical practice. We respectfully disagree with Kataoka and Imamura that the debate on the type of monitoring technology is not critical at the moment. Our international group of authors strongly believe that the switch to increased patient involvement, to patient-initiated rhythm monitoring and to telemedical care require physician (and not industry) driven education on the technologies used, recommendations for specific diagnostic pathways, cost-effectiveness analyses and outcome-centered research [<span>3-8</span>].</p><p>The clinical scenarios presented in this survey do not aim to give specific recommendations on diagnostic pathways but aim to reflect common clinical scenarios we experience as physicians in daily clinical practice. Diagnostic pathways for these scenarios are reflected in current clinical practice guidelines: There is a clear recommendation to confirm AF in symptomatic patients and to screen for AF in patients at risk [<span>5, 6</span>]. We agree with the Kataoka and Imamura that the duration of monitoring is crucial and still one of the unanswered questions, but first, there is evolving data in this field and second, screening duration using novel digital devices is often self-determined by patients [<span>9, 10</span>].</p><p>We agree with Kataoka and Imamura's opinion that AF screening in the general population shows questionable benefit. As the Apple Heart Study showed, even the number needed to screen to diagnose AF is exceptionally high [<span>11</span>]. Consequently, the number needed to screen to show clinical benefit in this population are expected to be even higher. However, the presented patient scenarios reflect opportunistic testing for AF in patients with risk factors for adverse outcomes as a result of under-detected AF, which represents a clinical challenge in several outpatient clinics [<span>6</span>].</p><p>We believe that novel digital devices for rhythm monitoring provide important diagnostic tools for screening, diagnosis and management of AF when used in the right populations at risk/patients. These devices may increase patient's adherence to treatment and even decrease anxiety related to known recurrences of benign arrhythmias. Referring to the author's question: “Digital Devices for Arrhythmia Detection: What is Still Missing?”: More physician and patient education on the potential of novel digital devices is required to achieve diagnostic pathways as suggested by the EHRA practical guide [<span>5</span>].</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70092","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143362661","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":"Cardiovascular Efficacy and Safety of Finerenone: A Meta-Analysis of Randomized Controlled Trials","authors":"Mushood Ahmed,&nbsp;Areeba Ahsan,&nbsp;Aimen Shafiq,&nbsp;Muhammad Talha Maniya,&nbsp;Hritvik Jain,&nbsp;Javed Iqbal,&nbsp;Muhammad Abdullah Naveed,&nbsp;Raheel Ahmed,&nbsp;Jamal S. Rana,&nbsp;Marat Fudim,&nbsp;Gregg C. Fonarow","doi":"10.1002/clc.70065","DOIUrl":"https://doi.org/10.1002/clc.70065","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Finerenone, a nonsteroidal mineralocorticoid receptor antagonist, has emerged as a novel therapeutic option for the management of patients with diabetes, chronic kidney disease, or heart failure. We seek to summarize the evidence on the drug's effectiveness regarding cardiovascular (CV) outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a literature search of Pubmed, Cochrane CENTRAL, Embase, and ClinicalTrials.gov from inception to September 2024. Trials exploring the effects of finerenone on CV outcomes were extracted and analyzed. The results of pooled analyses were presented as risk ratios (RRs) with 95% confidence intervals (CIs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of eight trials, incorporating 21 200 patients, were included. The pooled analysis demonstrated a significant reduction in all-cause death (RR 0.92, 95% CI: 0.85–0.99), major adverse CV events (RR 0.85, 95% CI: 0.81–0.90), heart failure-related hospitalizations or unplanned hospital visits (RR 0.82, 95% CI: 0.76–0.87) with finerenone administration compared to control. Finerenone use was associated with a trend of reduced risk of CV death without reaching statistical significance (RR 0.90, 95% CI: 0.81–1.00). The risk of myocardial infarction (RR 0.91, 95% CI: 0.74–1.12), adverse events (RR 0.96, 95% CI: 0.89–1.03), adverse events leading to discontinuation (RR 1.06, 95% CI: 0.96–1.17) remained comparable across both groups. However, an increased risk of hyperkalemia (RR 2.07, 95% CI: 1.88–2.27) was observed with finerenone therapy compared to the control group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Finerenone administration was associated with improved CV outcomes in the CV-renmetabolic conditions compared to the control group.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70065","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143248846","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":"Comparison of Single-Coil Versus Dual-Coil Implantable Cardioverter Defibrillator Devices: A Systematic Review and Meta-Analysis of Efficacy and Extraction-Related Outcomes","authors":"Muhammad Fawad Tahir,&nbsp;Adeena Maryyum,&nbsp;Zainab Mubbashir,&nbsp;Abdul Moiz Khan,&nbsp;Syed Irtiza Imam,&nbsp;Fatima Mustafa,&nbsp;Syeda Zahra Hasan,&nbsp;Umer Shoaib,&nbsp;Areej Iqbal,&nbsp;Osama Saeed,&nbsp;Manisha Purushotham,&nbsp;Maimoona Khan,&nbsp;Shahtaj Tariq,&nbsp;Muhammad Omar Larik,&nbsp;Muhammad Umair Anjum,&nbsp;Muhammad Hasanain,&nbsp;Tanesh Ayyalu,&nbsp;Mah I. Kan Changez,&nbsp;Javed Iqbal","doi":"10.1002/clc.70083","DOIUrl":"https://doi.org/10.1002/clc.70083","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Implantable cardioverter defibrillators (ICD) are battery-operated devices used to manage irregular heart rhythms and deliver therapeutic shocks to the heart. This updated systematic review and meta-analysis compares the efficacy and extraction-related outcomes of single-coil versus dual-coil ICDs in view of conflicting data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Several databases, including PubMed, Cochrane Library, and Google Scholar, were comprehensively explored dating from inception to April 1, 2024. Data were compared using odds ratio (OR), hazard ratio (HR), and mean differences (MD). A value of <i>p</i> &lt; 0.05 indicated statistical significance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ultimately, 28 studies were included in this quantitative synthesis. Defibrillation threshold (DFT) indicated statistical superiority in the dual-coil cohort (MD: 0.58; 95% confidence interval [CI]: 0.07–1.09; <i>p</i> = 0.03). In addition, all-cause mortality was significantly elevated in the dual-coil cohort (HR: 0.91; 95% CI: 0.87–0.97; <i>p</i> = 0.001). Furthermore, implant time was significantly lower in the single-coil group (MD: −7.44; 95% CI: −13.44 to −1.43; <i>p</i> = 0.02). Other outcomes, including first shock efficacy, cardiac mortality, post-extraction major complications, post-extraction procedural success, and post-extraction mortality, did not demonstrate any significant statistical differences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In conclusion, despite the desirable safety profile of single-coil ICDs, the use of dual-coil ICDs continues to hold merit due to their superior efficacy and advanced sensing capabilities, especially in complex cases. In addition, the perceived risk of a greater adverse profile in dual-coil lead extraction can be refuted by preliminary aggregate results generated within this meta-analysis. However, further robust studies are warranted before arriving at a valid conclusion.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70083","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143248771","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 Predictive Value of Circulating Gal-3 for New Stroke Events in Paroxysmal Atrial Fibrillation Patients Despite Oral Anticoagulation Medications","authors":"Yihan Wang,&nbsp;Qianran Luan,&nbsp;Ying Dong,&nbsp;Xiaoming Zhu","doi":"10.1002/clc.70084","DOIUrl":"https://doi.org/10.1002/clc.70084","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>CHA2DS2-VASc is used to assess the risk of stroke in patients with atrial fibrillation (AF) and guide anticoagulant treatment decisions, but it has limitations in accurately predicting stroke risk in individual patients. The objective of this study is to conduct a cohort study by assessing preoperative levels of Gal-3 in paroxysmal AF patients, aiming to observe its correlation with the subsequent incidence of stroke events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>This study enrolled 197 patients with nonvalvular paroxysmal AF. Blood samples were taken to test Gal-3 levels. All patients were followed up for 4 years after admission.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared to the nonstroke cases, serum levels of Gal-3 were markedly elevated in stroke cases (7.08 [IQR, 4.60–10.96] vs. 17.34 [IQR, 8.28–20.31], <i>p</i> &lt; 0.001). Gal-3 yields a superior AUC (0.748, with a 95%CI of 0.681–0.807) compared to other classical stroke indices, such as BNP, CHA2DS2-Vas score, and TNI. Remarkably, the Gal-3 index exhibited a superior predictive capacity, yielding a significant incremental predictive value that surpassed the conventional risk factors (CHA2DS2-VASc score) for stroke events, as evidenced by an IDI of 16.4% (<i>p</i> &lt; 0.001) and an NRI of 34.7% (<i>p</i> = 0.002).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The presence of Gal-3 is an independent risk factor for stroke in patients with AF. Elevated levels of Gal-3 have the potential to serve as a valuable biomarker for identifying incident strokes in AF patients. Furthermore, incorporating the assessment of Gal-3 levels into the conventional CHA2DS2-VASc score could significantly enhance its predictive accuracy for stroke in AF patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143111592","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}