Clinical Cardiology最新文献

{"title":"Association of Transition Zone Burden With Recurrence in Elderly Patients With Paroxysmal Atrial Fibrillation Without Low-Voltage Areas","authors":"Yuxuan Wang,&nbsp;Yue Qiu,&nbsp;Haojun Wang,&nbsp;Chang Cui,&nbsp;Zidun Wang,&nbsp;Xiaohong Jiang,&nbsp;Mingfang Li,&nbsp;Juejin Wang,&nbsp;Hongwu Chen,&nbsp;Minglong Chen","doi":"10.1002/clc.70435","DOIUrl":"10.1002/clc.70435","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Transition zone (TZ) may serve as a potential substrate for atrial fibrillation (AF). This study aims to investigate the relationship of TZ burden with left atrial conduction velocity (LACV) and recurrence after circumferential pulmonary vein isolation (CPVI) in elderly patients with paroxysmal AF without low-voltage areas (LVA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with paroxysmal AF without LVA were categorized into three groups based on the TZ burden (&lt; 5%, 5%–15% and &gt; 15%). TZs were defined as regions with bipolar voltage between 0.5 and 1 mV in more than 3 adjacent points. TZ burden was calculated as the proportion of TZ on the entire left atrium surface. LACV were calculated as conduction distance divided by conduction time. Recurrence was defined as any episode of atrial tachyarrhythmia (ATA) lasting ≥ 30 s after a 3-month blanking period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 158 enrolled patients (mean age 69.7 ± 3.8 years), 48 (30.4%) had a TZ &lt; 5%, 66 (41.8%) had a TZ of 5%–15%, and 44 (27.8%) had a TZ &gt; 15%. Patients with higher TZ burden exhibited significantly decreased anterior LACV (1.52 ± 0.36 vs. 1.21 ± 0.27 vs. 1.02 ± 0.25 m/s, <i>p</i> &lt; 0.0001). After a mean follow-up of 24.9 months, 40 (25.3%) patients experienced recurrence. Patients with recurrence had higher TZ burden (15.4 [7.2–22.4] vs. 8.2 [3.5–14.3], <i>p</i> &lt; 0.0001). TZ burden remained significantly associated with recurrence in a multivariable Cox regression model (adjusted HR 1.065 [95% CI 1.034–1.098], <i>p</i> &lt; 0.0001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>TZ burden is correlated with slow LACV and independently predicts ATA recurrence following CPVI.</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/PMC13530383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863762","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":"Safety and Efficacy of Pulsed-Field Ablation With a Pentaspline Ablation Catheter Versus Cryoablation for Atrial Fibrillation: A Systematic Review and Meta-Analysis","authors":"Yi Cai,&nbsp;Hao Chen,&nbsp;Miao-Fu Li,&nbsp;Yi-Zhou Xu","doi":"10.1002/clc.70459","DOIUrl":"10.1002/clc.70459","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pulsed-field ablation (PFA) is an emerging technology for atrial fibrillation (AF) ablation. However, there is few studies comparing the clinical advantages and disadvantages of PFA and cryoballoon ablation (CBA). This study aimed to perform a comprehensive meta-analysis to evaluate the efficacy and safety of PFA using a pentaspline ablation catheter compared with CBA for treating AF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study was registered in the International Prospective Register of Systematic Reviews (ID: CRD420251061599). Studies comparing PFA using a pentaspline ablation catheter with CBA for pulmonary vein isolation (PVI) were systematically searched from database inception to March 2025.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Six trials involving 2024 patients were included. No significant difference was observed in atrial tachyarrhythmia recurrence between PFA and CBA (OR) = 0.71; 95% confidence interval (CI): 0.48 to 1.06). However, in patients with paroxysmal AF, the PFA group exhibited a lower incidence of AT recurrence (OR = 0.62; 95% CI: 0.46 to 0.85). PFA was superior to CBA in terms of ablation time (MD) = −14.12; 95% CI: −16.31 to −11.93) and left atrial dwell time (MD = −9.44; 95% CI: −15.69 to −3.19). Hypersensitive troponin release was higher in the PFA group (MD = 547.29; 95% CI: 53.55 to 1041.03), while CBA was associated with a higher incidence of phrenic nerve palsy (OR = 0.06; 95% CI: 0.01 to 0.30).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>PFA demonstrates superior safety and efficacy compared with CBA for PVI in patients with AF. These findings provide additional procedural options for patients and electrophysiologists in clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863684","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 Guideline-Directed Medical Therapy in Black versus White Patients With Heart Failure With Reduced Ejection Fraction in a Large, Integrated Health Care System","authors":"Natalia C. Berry,&nbsp;Yi-Shin Sheu,&nbsp;Karen Chesbrough,&nbsp;R. Clayton Bishop,&nbsp;Suma Vupputuri","doi":"10.1002/clc.70452","DOIUrl":"10.1002/clc.70452","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Guideline-directed medical therapy (GDMT) improves clinical outcomes for patients with heart failure with reduced ejection fraction (HFrEF). While GDMT treatment differences have been described for Black patients, data are limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>We sought to evaluate, among Black and White HFrEF patients, differences in GDMT use and target dosing by race.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials &amp; Methods</h3>\u0000 \u0000 <p>We examined health records of Black and White patients with HFrEF between 2015 and 2022. GDMT was defined by four medication classes—ACEi/ARB/ARNi, beta blocker (BB), mineralocorticoid receptor antagonist (MRA), and SGLT2i. Proportions of patients on GDMT and achieving target dose were examined for each class. Logistic regression was used to assess variables associated with differential GDMT use and dosing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our cohort totaled 2825 HFrEF patients (61.2% Black; 38.8% White). Compared to White patients, Black patients had higher treatment with ACEi/ARB/ARNi (84.1% vs. 80.0%), BB (85.3% vs. 74.9%), and MRA (27.9% vs.18.4%), but similar SGLT2i treatment. Among treated, Black patients were more likely to be treated to target with ACEi/ARB/ARNi (45.2% vs. 34.2%), BB (25.0% vs. 17.8%), and MRA (80.3% vs. 72.1%). After multivariate adjustment, MRA treatment was associated with race (OR = 1.39; 95% CI: 1.10–1.75). Among treated, Black patients had higher odds of treatment to target with ACEi/ARB/ARNi (OR = 2.0; 95% CI: 1.61–2.53) and MRA (OR = 1.6; 95% CI: 1.01–2.57).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Using real-world data from a diverse health system, we demonstrated that Black patients had 2.0 times and 1.6 times greater odds of being treated to target with ACEi/ARB/ARNi and MRAs, respectively, compared to White patients. Future research should explore whether these differences translate to improved health outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863729","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":"Mechanistic Insights Into the Association Between Gut Microbiota Diversity and Atherosclerosis, Acute Coronary Syndrome, and Peripheral Arterial Disease Progression","authors":"Amr Ali Mohamed Abdelgawwad El-Sehrawy,&nbsp;Usamah Sayed,&nbsp;Zarina Nasirova,&nbsp;Quvonch Tursunov,&nbsp;Omer Qutaiba B. Allela,&nbsp;Lara Asim Kzar,&nbsp;Rajashree Panigrahi,&nbsp;Neeraj Bainsal","doi":"10.1002/clc.70455","DOIUrl":"https://doi.org/10.1002/clc.70455","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The gut microbiome has emerged as a potential contributor to cardiovascular diseases (CVDs), including atherosclerosis, acute coronary syndrome (ACS), and peripheral arterial disease (PAD). While observational studies link dysbiosis to CVD, causal relationships remain uncertain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This narrative review synthesizes evidence from human observational studies, clinical interventions, and experimental models to distinguish association from mechanistic plausibility and clinical causality. Literature was searched through July 2026 in PubMed/MEDLINE, Web of Science, and Scopus.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Microbial metabolites—including trimethylamine N-oxide (TMAO), short-chain fatty acids (SCFAs), bile acids, and lipopolysaccharide (LPS)—modulate endothelial function, immune cell programming, platelet activity, and plaque stability through receptor-mediated signaling and epigenetic regulation. SCFAs demonstrate potentially protective effects via GPCR and HDAC pathways, while TMAO is associated with atherothrombotic risk. However, much mechanistic evidence derives from preclinical studies. Heterogeneity from diet, geography, host characteristics, renal function, and medications substantially influences microbiota-CVD associations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The gut-vascular connection is biologically plausible, but definitive clinical causality remains unproven. Microbiome-directed therapies (dietary modulation, pre/pro/synbiotics, targeted metabolite inhibition) are investigational. Prospective, standardized, adequately powered human studies with clinically meaningful outcomes are essential before routine cardiovascular application.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70455","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148816660","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":"Hypertrophic Cardiomyopathy and the Risk of Bradyarrhythmia and Permanent Pacemaker Implantation: A Nationwide Cohort Study","authors":"Tsu-An Yang,&nbsp;Yu-Yu Hsiao,&nbsp;Shang-Ju Wu,&nbsp;Yu-Shan Chien,&nbsp;Ming-Jen Kuo,&nbsp;Yu-Shan Huang,&nbsp;Guan-Yi Li,&nbsp;Ching-Heng Lin,&nbsp;Cheng-Hung Li,&nbsp;Jiunn-Cherng Lin,&nbsp;Jin-Long Huang,&nbsp;Yun-Yu Chen,&nbsp;Li-Wei Lo,&nbsp;Yenn-Jiang Lin,&nbsp;Yu-Cheng Hsieh,&nbsp;Shih-Ann Chen","doi":"10.1002/clc.70454","DOIUrl":"10.1002/clc.70454","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hypertrophic cardiomyopathy (HCM) is associated with various arrhythmias, including bradyarrhythmia. The relationship between HCM and bradyarrhythmia, and subsequent need for permanent pacemaker (PPM) implantation, remains unclear. This study aimed to evaluate the risk of bradyarrhythmia and PPM implantation in HCM patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective, population-based cohort study identified patients with newly diagnosed HCM from 2012 to 2017 in Taiwan's National Health Insurance Research Database. Patients with prior bradyarrhythmia or PPM implantation were excluded. A control cohort was selected by matching patients without HCM to the study cohort by age and gender in a 1:1 ratio. The primary and secondary outcomes were the occurrence of bradyarrhythmia and PPM implantation, respectively. A multivariate Cox proportional hazards regression model was used to evaluate the hazard ratios (HR) for the outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 15 266 patients with a mean age of 63.8 ± 14.5 years constituted the HCM (<i>n</i> = 7633) and control (<i>n</i> = 7633) cohorts. During a follow-up period of 4.05 ± 2.03 years, HCM was associated with higher risks of bradyarrhythmia (adjusted HR: 2.15, <i>p</i> &lt; 0.001) and PPM implantation (adjusted HR: 6.58, <i>p</i> &lt; 0.001). In patients with HCM, the presence of AF increased the risks of both bradyarrhythmia (adjusted HR: 1.61, <i>p</i> &lt; 0.001) and PPM implantation (adjusted HR: 2.12, <i>p</i> &lt; 0.001), while HF increased the risks of PPM implantation (adjusted HR: 1.61, <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients with HCM had higher risks of bradyarrhythmia and PPM implantation. Patients with HCM should be carefully monitored for AF and HF, which might increase the risks of future PPM implantation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13507695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817271","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":"Artificial Intelligence in Coronary Computed Tomography Angiography: A Bibliometric Analysis of Trends and Themes","authors":"Shanshan Jiang,&nbsp;Yucong Zheng,&nbsp;Keqin Pan,&nbsp;Lu Ma","doi":"10.1002/clc.70447","DOIUrl":"10.1002/clc.70447","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Artificial intelligence (AI) in coronary computed tomography angiography (CCTA) is increasingly recognized, but comprehensive bibliometric analyses on its integration are scarce.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>This study aims to bridge this gap by delineating research trajectories, influential entities, and evolving themes within this field.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A bibliometric analysis was conducted on literature from the Web of Science Core Collection, spanning publications from January 2007 to October 2024. Analysis tools included VOSviewer, CiteSpace, and R-bibliometrix, which were used to map and visualize the publication trends, collaborative networks, and thematic evolution. A manual relevance audit and a sensitivity analysis using a narrower query were performed to validate the search strategy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 499 articles were analyzed. The number of publications increased annually in the past decade, with a peak of 113 in 2022. China led with 193 articles, and the USA served as a central node in the cooperation network. The Medical University of South Carolina and Yonsei University tied for first with 54 articles each. Schoepf U. Joseph was the most influential author. <i>European Radiology</i> led in h-index and total publications. The keyword analysis revealed “coronary artery disease” as the most frequent, followed by “deep learning” and“machine learning.” Notable burst keywords included “fractional flow reserve,” “diagnostic accuracy,” and “SCCT guidelines.”</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The field of AI in CCTA is rapidly evolving, with increasing international collaboration and a focus on technological advancements. Machine learning prediction has emerged as a bibliometrically prominent theme with intense citation activity, warranting further validation and standardized integration into clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148808308","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":"Enhanced Pain Management With Combined EMLA Patch and Local Anesthetic Infiltration in Transradial Angiography","authors":"Mohamad Amer Nashtar,&nbsp;Obayda Azizy,&nbsp;Jörn Trippe,&nbsp;Ali Canbay,&nbsp;Polykarpos Christos Patsalis,&nbsp;Martin Steinmetz","doi":"10.1002/clc.70444","DOIUrl":"10.1002/clc.70444","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background/Objectives</h3>\u0000 \u0000 <p>Pain at the radial access site remains common during coronary angiography. Evidence on topical anesthesia with EMLA patches is inconsistent, and the added value of combining EMLA with local lidocaine infiltration has not been fully clarified. This study compared the analgesic effectiveness of three strategies: EMLA patch, local lidocaine infiltration, and their combination.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this retrospective study, 275 patients undergoing elective transradial coronary angiography received either EMLA patch (<i>n</i> = 88), local infiltration (<i>n</i> = 96), or combined EMLA + infiltration (<i>n</i> = 91). Inclusion required the availability of complete data on pain assessments and access-site complications. Pain intensity during the procedure and over 24 h was assessed using the Numeric Pain Rating Scale at five time points. Group comparisons used the Mann–Whitney <i>U</i>, Kruskal–Wallis, one-way ANOVA, or chi-square test. Linear regression was applied to identify predictors of pain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Pain during angiography was lowest with combined anesthesia (median 0 [0–1]), compared with EMLA (1 [0–2]) or infiltration (3 [1–5]) (<i>p</i> &lt; 0.001). Similar findings were observed for the 24 h cumulative pain score. An EMLA application time of 100–300 min was associated with substantially lower pain than shorter or longer durations (both <i>p</i> &lt; 0.001). Obesity (BMI ≥ 30 kg/m²) independently predicted higher procedural pain (B = 0.96; <i>p</i> = 0.020) and higher 24 h cumulative pain (B = 2.70; <i>p</i> = 0.002).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Combined EMLA patch plus local lidocaine infiltration was associated with superior analgesia during and after transradial coronary angiography compared with either method alone. An EMLA application time of 100–300 min may optimize analgesic effectiveness, while patients with obesity may benefit from tailored pain-management strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148808251","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":"Correlation Between the High-Sensitivity C-Reactive Protein-to-Albumin Ratio and All-Cause Mortality in Patients With Acute Exacerbation of Chronic Heart Failure","authors":"Xi Gu,&nbsp;Jinli Feng,&nbsp;Pinye Chen,&nbsp;Hao Wang,&nbsp;Tao Rui,&nbsp;Junfang Guo","doi":"10.1002/clc.70456","DOIUrl":"10.1002/clc.70456","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the correlation between the high-sensitivity C-reactive protein-to-albumin ratio (CAR) and all-cause mortality in patients with acute exacerbation of chronic heart failure (AECHF).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this retrospective cohort study, 342 patients were enrolled from the First People's Hospital of Zhenjiang City between January 1, 2020, and December 31, 2025. Cox regression analyses, subgroup analyses, Kaplan−Meier survival curves, and receiver operating characteristic (ROC) analyses were employed to assess the association between CAR and all-cause mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During a median follow-up period of 16.35 months, 95 patients (27.8%) died. Multivariate Cox regression analysis revealed that each unit increase and each standard deviation increase in CAR were associated with a 41.2% and 40.7% increased risk of all-cause mortality, respectively (HR: 1.412, 95% CI: 1.221−1.633; HR: 1.407, 95% CI: 1.219−1.625). The risk of all-cause mortality in the high CAR group was 1.778 times that of the low CAR group (HR: 1.778; 95% CI: 1.092−2.894). The robustness of the association between CAR and all-cause mortality was further corroborated by subgroup and sensitivity analyses (<i>p</i> &lt; 0.05). Kaplan–Meier survival curves revealed significant survival differences across CAR subgroups, with markedly lower cumulative survival observed in the high-CAR group (<i>p</i> &lt; 0.05). ROC curve indicated a weak but statistically significant predictive value for all-cause mortality risk (<i>p</i> = 0.025).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Higher levels of CAR are associated with a higher risk of all-cause mortality in AECHF patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148808313","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":"Tobacco-Attributable Burden of Early-Onset Ischemic Heart Disease From 1990 to 2023: A Global Analysis Using GBD 2023 and Age-Period-Cohort Modeling","authors":"Xin Ouyang,&nbsp;Xiangting Chen,&nbsp;Fei He,&nbsp;Qingbin Li,&nbsp;Xuhui Lin,&nbsp;Kailun Qiu,&nbsp;Ruowen Zhao,&nbsp;Bowen Liu,&nbsp;Yibin Liu,&nbsp;Pengcheng He","doi":"10.1002/clc.70451","DOIUrl":"10.1002/clc.70451","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Early-onset ischemic heart disease (IHD) is a growing global threat, with tobacco exposure as a key modifiable risk factor. A global assessment of its tobacco-attributable burden is needed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using Global Burden of Disease Study 2023 data, we assessed tobacco-attributable deaths and disability-adjusted life years (DALYs) from early-onset IHD in 204 countries and territories during 1990–2023. Trends were evaluated using estimated and average annual percentage changes (EAPCs and AAPCs). Age-period-cohort (APC) models characterized age, period, and cohort patterns, and Bayesian APC models projected age-standardized rates to 2050. A sensitivity analysis compared the sexes aged 40–54 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 1990 to 2023, tobacco-attributable DALYs increased from 15.21 to 17.12 million and deaths from 342 900 to 386 300. Conversely, ASDR declined from 381.54 to 221.82 per 100 000 (EAPC −1.84%, 95% CI −1.94 to −1.73) and ASMR from 8.69 to 4.96 per 100 000 (EAPC −1.88%, 95% CI −1.98 to −1.77). Male rates remained higher, including when both sexes were restricted to ages 40–54 years. APC analyses showed significant favorable net drifts and lower period and cohort rate ratios in recent periods and birth cohorts. Bayesian projections suggested declining ASDRs through 2050, whereas ASMR estimates were stable or slightly increased with widening uncertainty.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The age-standardized burden of tobacco-attributable early-onset IHD declined substantially between 1990 and 2023, but absolute DALYs and deaths increased and disparities by development level and sex persisted. Stronger tobacco control and integrated cardiovascular prevention are needed, particularly for high-risk males and in low- and middle-SDI settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148808299","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 Prehospital Ticagrelor Loading Dose Combined With Aspirin Dual Antiplatelet Therapy on Post-PCI TIMI Flow Grade in Patients With ST-Elevation Myocardial Infarction","authors":"Pingwei Liu,&nbsp;Guangsheng Cai,&nbsp;Yanmei Wang,&nbsp;Qirong He","doi":"10.1002/clc.70448","DOIUrl":"https://doi.org/10.1002/clc.70448","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Early dual antiplatelet therapy (DAPT) improves outcomes in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). Although guidelines recommend prompt P2Y12 inhibitor use, the optimal timing of administration, particularly prehospital versus in-hospital delivery, remains uncertain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study evaluated whether prehospital ticagrelor loading plus aspirin improves coronary reperfusion and outcomes compared with in-hospital administration in STEMI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed 428 consecutive STEMI patients treated with primary PCI between January 2023 and December 2025. Patients received ticagrelor 180 mg and aspirin 300 mg either prehospital via emergency medical services (<i>n</i> = 186) or after emergency department arrival (<i>n</i> = 242). The primary endpoint was post-PCI Thrombolysis in Myocardial Infarction (TIMI) flow grade 3. Secondary endpoints included myocardial blush grade (MBG), ST-segment resolution, 30-day major adverse cardiovascular events (MACE), and bleeding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>TIMI 3 flow occurred more frequently with prehospital DAPT than with in-hospital administration (91.4% vs. 82.2%, <i>p</i> = 0.007). Complete ST-segment resolution (≥ 70%) was higher in the prehospital group (76.3% vs. 64.5%, <i>p</i> = 0.008), as was MBG 2–3 (84.9% vs. 74.4%, <i>p</i> = 0.009). Time from first medical contact to DAPT was shorter prehospital (8 vs. 42 min, <i>p</i> &lt; 0.001). Prehospital DAPT independently predicted TIMI 3 flow (OR 2.18, 95% CI 1.24–3.84). Thirty-day MACE was reduced (5.4% vs. 11.2%, <i>p</i> = 0.038), without increased major bleeding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Prehospital ticagrelor plus aspirin is associated with superior reperfusion and improved short-term outcomes without excess bleeding, supporting routine implementation within emergency medical services. These findings may inform systems of care and optimize early pharmacologic strategies worldwide in practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70448","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148783791","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}