Clinical Cardiology最新文献

{"title":"Initial Care Pathway in Acute Heart Failure From Home to Hospital","authors":"Pia Harjola,&nbsp;Veli-Pekka Harjola,&nbsp;Òscar Miró,&nbsp;Said Laribi,&nbsp;Tuukka Tarvasmäki","doi":"10.1002/clc.70161","DOIUrl":"https://doi.org/10.1002/clc.70161","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The prognosis of acute heart failure (AHF) remains poor. Studies focusing on the time-sensitivity of early AHF management have reported controversial results. Thus, our aim is to review current studies focusing on AHF patients using emergency medical services (EMS), their early management, and patient outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched the recent literature in PubMed and Scopus for studies comparing AHF patients arriving at the hospital by EMS to those self-presenting (non-EMS) at ED (emergency department) from database inception until November 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The literature search found five studies fulfilling our inclusion criteria. The percentage of AHF patients using EMS varied in these studies: 11.5% (100/873) in Finnish FINN-AKVA II, 22.1% (236/1068) in Canadian ASCEND-HF, 35.5% (5129/14454) in a Pakistan Heart Failure-registry study, 52.8% (3224/6106) in Spanish SEMICA, and 61.8% (309/500) in the European EURODEM study. The pre-hospital management differed across the reviewed studies. The use of NIV was rare, ranging from zero to four percent. Vasodilators and diuretics were more commonly used. Although, the differences in the use were obvious (range from 7.1% to 22.0%, and 0.0% to 29.0% accordingly). Three of the studies reported significantly higher 30-day mortality among EMS patients compared to non-EMS patients: ranging from 5.6% versus 3.5%, <i>p</i> &lt; 0.001% to 15.0% versus 6.9%, <i>p</i> &lt; 0.001.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The use of EMS, as well as pre-hospital management, varies between the international cohorts and registries. The pre-hospital AHF management is generally limited. Moreover, EMS patients tend to have worse outcomes compared to non-EMS patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 6","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70161","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144256092","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":"Diagnosis-to-Ablation Time to Predict the Recurrence of Atrial Fibrillation Following Catheter Ablation: A Systematic Review and Meta-Analysis","authors":"Hala Najeeb,&nbsp;Syeda Farwa Zaidi,&nbsp;Abdul Moeed,&nbsp;Farah Yasmin,&nbsp;Muhamamad Sohaib Asghar,&nbsp;Waqas Ullah,&nbsp;M. Chadi Alraies","doi":"10.1002/clc.70149","DOIUrl":"https://doi.org/10.1002/clc.70149","url":null,"abstract":"<p>A diagnosis-to-ablation time of &lt; 1 year and &lt; 3 years is associated with a significantly lower risk of atrial fibrillation reccurence compared to a time of &gt; 1 year and &gt; 3 years in atrial fibrillation patients awaiting ablation procedures.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 6","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144244399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Letter to the Editor “Atrial Fibrillation and Heart Failure: Synergistic Effect on Functional Class and Quality of Life”","authors":"James Samír Díaz,&nbsp;Johanna Marcela Vanegas","doi":"10.1002/clc.70159","DOIUrl":"https://doi.org/10.1002/clc.70159","url":null,"abstract":"&lt;p&gt;Response to Editor,&lt;/p&gt;&lt;p&gt;We welcome and appreciate the comments raised by Kataoka and colleagues related to our recent publication “Atrial fibrillation and heart failure: synergistic effect on functional class and quality of life” [&lt;span&gt;1&lt;/span&gt;]. In this study, we compared the evolution of functional class and quality of life in patients with heart failure (HF) according to the presence of atrial fibrillation (AF). The results highlighted the significant impact of AF on functional status in patients with HF. The coexistence of AF and reduced ejection fraction primarily impaired the physical dimension of quality of life (QoL) and limited improvement in NYHA functional class, underscoring the need for targeted management of these conditions in comprehensive HF care.&lt;/p&gt;&lt;p&gt;We appreciate the opportunity to clarify key aspects of our study and to address the important points raised regarding patient selection, AF subtypes, diagnostic definitions, and therapeutic strategies. These insights have allowed us to enhance the clarity and clinical relevance of our work. Below, we provide detailed, point-by-point responses to each of the comments.&lt;/p&gt;&lt;p&gt;In our study, we included patients across the full spectrum of LVEF, without applying exclusions based on LVEF range or age. This decision reflects the real-world population typically seen in HF clinics and was necessary given the relatively small sample size. To mitigate potential confounding, we performed stratified subgroup analyses according to LVEF (≤ 40% vs. &gt; 40%). We agree that a larger study, with more narrowly defined LVEF categories, could provide greater statistical power to better delineate the interaction between AF and systolic function in patient-reported outcomes [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Regarding the absence of distinction between paroxysmal and persistent AF, we acknowledge the importance of differentiating AF subtypes when evaluating its impact on QoL. Unfortunately, due to the retrospective nature of our study and limitations in the available clinical data, we were unable to consistently classify AF as paroxysmal or persistent/permanent across all patients. It is also important to note that our study focused on patients with coexisting AF and chronic HF, rather than AF in isolation, where the type of AF may have a more direct impact on patient QoL.&lt;/p&gt;&lt;p&gt;We agree that future prospective studies should include stratification by AF subtype and arrhythmia burden to more accurately assess their differential effects on clinical outcomes. Given the retrospective nature of our study, we defined arrhythmia-induced cardiomyopathy as cases of HF with coexisting AF in which LVEF improved following rhythm control or rate optimization. We agree that this entity may overlap with idiopathic cardiomyopathy in terms of clinical presentation. However, in our HF program, patients who do not show improvement in LVEF after achieving adequate ventricular rate control are routinely undergo further studies","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 6","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70159","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144206854","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":"Natriuretic Peptide-Guided Therapy in Acute Decompensated Heart Failure: An Updated Systematic Review and Meta-Analysis","authors":"Luciana Gioli-Pereira,&nbsp;Eric Shih Katsuyama,&nbsp;Christian Ken Fukunaga,&nbsp;Wilson Falco,&nbsp;Camila Campos Grisa Padovese,&nbsp;Rafael Hortencio Melo,&nbsp;Edielle de Sant'Anna Melo,&nbsp;Silvana E. Ribeiro Papp,&nbsp;Fernando Bacal","doi":"10.1002/clc.70165","DOIUrl":"https://doi.org/10.1002/clc.70165","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Natriuretic peptides (NP) are widely used to diagnose heart failure (HF), but their role in guiding treatment remains uncertain. We performed a randomized trial meta-analysis comparing NP-guided therapy to usual care in acute decompensated HF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched PubMed, Embase, and Cochrane for RCTs comparing NP-guided therapy to usual care in acute decompensated HF. Outcomes included all-cause mortality, cardiovascular death, and a composite of mortality and HF hospitalizations (reported as RR and 95% CI). Heterogeneity was assessed using <i>I</i>², and a random-effects model was applied when appropriate. Analyses were performed in R Studio 4.3.2.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 9 RCTs with 3992 patients, of whom 2007 (50.3%) underwent NP-guided treatment. The median follow-up was 12 months. All-cause mortality (RR: 0.84; 95% CI: 0.69–1.01; <i>p</i> = 0.069; <i>I</i>² = 41%), cardiovascular death (RR: 0.91; 95% CI: 0.78–1.08; <i>p</i> = 0.287; <i>I</i>² = 0%), and the composite outcome of HF hospitalization or cardiovascular death (RR: 0.91; 95% CI: 0.77–1.09; <i>p</i> = 0.308; <i>I</i>² = 56%) were not significantly different between groups. The time to event analysis of all-cause mortality had a slightly significant advantage in favor of NP-guided therapy (HR: 0.81; 95% CI: 0.69–0.95; <i>p</i> = 0.01; <i>I</i>² = 0%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Although NP-guided therapy showed a statistically significant benefit in time to all-cause mortality, this was not consistently reflected across other endpoints, and its overall clinical impact remains uncertain.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 6","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70165","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144206855","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 Adherence to Guideline-Directed Prevention Strategies on Clinical Outcomes in Patients With Coronary Artery Disease and Diabetes Mellitus Following Acute Coronary Syndrome: A 3-Year Cohort Study","authors":"Nur Kamer Kaya İnalkaç,&nbsp;Fuat Polat,&nbsp;İbrahim Keleş","doi":"10.1002/clc.70164","DOIUrl":"https://doi.org/10.1002/clc.70164","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Coronary artery disease (CAD) and diabetes mellitus (DM) significantly increase the risk after acute coronary syndrome. This study evaluated adherence to guideline-directed secondary prevention strategies and demonstrated their substantial impact on reducing rehospitalization and mortality in this population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study was conducted on 987 CAD and DM patients admitted for ACS between 2015 and 2018. Adherence to seven evidence-based secondary prevention strategies was assessed: smoking cessation, physical activity, antiplatelet therapy, statins, blood pressure control, ACEi/ARB therapy, and SGLT-2i therapy. Patients were categorized into groups based on the number of recommendations followed (0–2, 3–4, and 5+). Primary outcomes included rehospitalization and all-cause mortality over a 3-year follow-up period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At baseline, only 12.4% of patients adhered to five or more recommendations, which dramatically increased to 71.9% by the 3-year follow-up. Individual adherence to each of blood pressure control (HR = 0.81, 95% CI: 0.70–0.94), ACEi/ARB therapy (HR = 0.77, 95% CI: 0.67–0.89), and SGLT-2i therapy (HR = 0.79, 95% CI: 0.68–0.92) significantly reduced rehospitalization risk. Similarly, adherence to these therapies individually reduced mortality risk (HR = 0.78, 95% CI: 0.67–0.91; HR = 0.74, 95% CI: 0.63–0.87; and HR = 0.72, 95% CI: 0.61–0.85, respectively). Importantly, a stepwise increase in adherence was associated with a dose-dependent reduction in mortality (HR = 0.65, 95% CI: 0.52–0.81, <i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study highlights the critical role of comprehensive, multifactorial secondary prevention in its association with improved long-term outcomes in patients with CAD and DM following ACS.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 6","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70164","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144197190","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":"Prevalence and Determinants of Coronary Artery Calcification in Adults With Metabolic Syndrome: A Systematic Review and Meta-Analysis","authors":"Aftab Ullah,&nbsp;Asif Jan,&nbsp;Hasan Naeem Kareem,&nbsp;Wahby Mohammed Ahmed Babaresh,&nbsp;Abdur Rahim,&nbsp;Syed Shaukat Ali,&nbsp;Waheed Ali Shah,&nbsp;Salim K. Hajwal,&nbsp;Alaa Hamza Hermis,&nbsp;Mustafa Kareem Jawad,&nbsp;Sajjad Sadeq Salman,&nbsp;Murtadha Abdulridha Ajel,&nbsp;Fatimah Saleh Alsuwayidi,&nbsp;Fadhilah N. Alobaidan,&nbsp;Ameer Hasan Kadhem","doi":"10.1002/clc.70156","DOIUrl":"https://doi.org/10.1002/clc.70156","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Metabolic syndrome (MetS) is a recognized risk factor for coronary artery calcification (CAC), a subclinical marker of atherosclerosis associated with elevated cardiovascular risk. However, the prevalence and determinants of CAC in individuals with MetS have not been comprehensively synthesized. This systematic review and meta-analysis aimed to estimate the pooled prevalence of CAC and identify associated factors among adults with MetS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive search was conducted in PubMed, LILACS, Web of Science, Embase, Scopus, AJOL, and gray literature through December 2024, following PRISMA 2020 guidelines. Eligible studies included adults (≥ 18 years) with MetS, defined by established criteria, and reported CAC scores via validated CT imaging techniques. Observational studies and RCTs were included. Study quality was assessed using the Joanna Briggs Institute checklist. Pooled estimates were derived using a random-effects model, and heterogeneity was assessed with the <i>I</i>² statistic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 17 studies comprising 20 745 individuals were included. The pooled prevalence of CAC in adults with MetS was 39.8% (95% CI: 28.4%–52.5%), with wide variation across study design, geography, and imaging modality. Males had a higher CAC prevalence (RR: 2.00), and MetS was linked to increased CAC scores (SMD: 0.10) and odds of calcification (OR: 1.34–1.50). Subgroup analyses showed variability by region and CT modality. High CAC scores were associated with elevated cardiovascular event rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CAC affects ~40% of adults with MetS and is associated with higher cardiovascular risk. These findings support the integration of CAC screening in MetS management strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 6","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70156","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190780","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":"Effectiveness of Cardiac Rehabilitation in Enhancing Adherence and Improving Clinical Outcomes Post-Acute Coronary Syndrome: A Randomized Controlled Trial","authors":"Haşim Tüner,&nbsp;Fuat Polat,&nbsp;Enes Alıç,&nbsp;Ali Nail Kaya,&nbsp;Çiğdem Bahar Çakmak,&nbsp;Ferhat Coşkun,&nbsp;Emrah Özbek","doi":"10.1002/clc.70160","DOIUrl":"https://doi.org/10.1002/clc.70160","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Acute coronary syndrome (ACS) remains a major contributor to cardiovascular morbidity and mortality. Cardiac rehabilitation programs have shown promise in improving adherence to lifestyle and medical recommendations, yet their impact on clinical outcomes and complications requires further investigation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective, randomized, single-center study evaluated the effects of cardiac rehabilitation on adherence and clinical outcomes in ACS patients. A total of 340 patients were randomized into a Cardiac Rehabilitation Group or Control Group. The Cardiac Rehabilitation Group underwent supervised exercise, dietary counseling, and education, while the Control Group received standard recommendations. Outcomes, including adherence rates and complications, were assessed over 1 year, with additional interim analyses to evaluate early sustainability of behavioral changes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients in the Cardiac Rehabilitation Group demonstrated significant improvements in adherence to dietary recommendations (73.5% vs. 52.4%, <i>p</i> &lt; 0.01) and physical activity (85.3% vs. 68.2%, <i>p</i> &lt; 0.01). Cardiac Rehabilitation Group patients also experienced fewer instances of weight gain (22.9% vs. 34.7%, <i>p</i> = 0.017) and access site complications (21.2% vs. 40%, <i>p</i> &lt; 0.01). Hospital readmissions were reduced in the Cardiac Rehabilitation Group compared to the Control Group (18.8% vs. 31.2%, <i>p</i> = 0.015). Non-adherence to dietary recommendations (HR: 2.42, 95% CI: 1.08–5.41, <i>p</i> = 0.032) and medical treatments (HR: 2.84, 95% CI: 1.32–6.11, <i>p</i> = 0.007) were significantly associated with increased risk of revascularization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Cardiac rehabilitation significantly enhances adherence to medical and lifestyle recommendations, reduces complications, and improves outcomes in ACS patients. These findings emphasize the critical role of structured rehabilitation in post-ACS management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 6","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70160","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190661","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":"Authors' Reply to “Questioning the Rhythm: A Closer Look at Heart Rate Trends”","authors":"Eitaro Kodani,&nbsp;Takeshi Yamashita,&nbsp;Hiroshi Inoue,&nbsp;Hirotsugu Atarashi,&nbsp;Ken Okumura,&nbsp;Hideki Origasa,&nbsp;J-RHYTHM Registry Investigators","doi":"10.1002/clc.70158","DOIUrl":"https://doi.org/10.1002/clc.70158","url":null,"abstract":"&lt;p&gt;We would like to thank Dr. Hassan for your interest in our recently published study “Association between changes in heart rate and adverse events in patients with non-valvular atrial fibrillation: A post hoc analysis of the J-RHYTHM Registry.” [&lt;span&gt;1&lt;/span&gt;] There were several limitations in our study as already mentioned in the article [&lt;span&gt;1&lt;/span&gt;]. Our replies to the comments are as follows.&lt;/p&gt;&lt;p&gt;First, we agree that heart rate (HR) fluctuation may have influenced the incidence of adverse events. However, the present study was based on the results of our previous analysis that HR at the time closest to an event or at the last visit during the follow-up period (HR-end) was more strongly associated with the incidence of adverse events than the baseline HR in patients with nonvalvular atrial fibrillation (AF) [&lt;span&gt;2&lt;/span&gt;]. Specifically, the highest quartile of HR-end (≥ 80 bpm) was independently associated with the incidence of major hemorrhage, all-cause death, and cardiovascular death compared with the second quartile (64–71 bpm), even after adjusting for known confounding factors and HR-controlling drug use [&lt;span&gt;2&lt;/span&gt;]. Therefore, we adopted the changes in HR from the baseline to the end instead of HR fluctuation during the whole follow-up period in the present analysis [&lt;span&gt;1&lt;/span&gt;]. We had HR data at each time when patients visited their outpatient clinic. We could have analyzed visit-to-visit changes in HR for each patient; however, for simplicity, we analyzed changes in HR from the baseline to the end of follow-up [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In addition, when patients were divided into four baseline HR groups (&lt; 60, 60–79, 80–109, and ≥ 110 bpm) using clinically relevant cutoff HR values based on the Rate Control Efficacy in Permanent Atrial Fibrillation II (RACE II) trial [&lt;span&gt;3&lt;/span&gt;], no significant trend in the rate of any adverse event was observed across these baseline HR groups in our cohort [&lt;span&gt;2&lt;/span&gt;]. Therefore, we decided to use the HR quartiles in the present study [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Second, as you pointed out, changes in drugs including oral anticoagulants and HR-controlling drugs, their dosages, and adherence were not considered during the follow-up period in this study. We recognize this is a limitation of this study. However, hazard ratios were adjusted for the use of HR-controlling drugs including β-blocker, K channel blocker, Ca channel blocker, and digitalis in a multivariable Cox regression model in this study [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Third, since the J-RHYTHM Registry was an observational study, the causal relationship between changes in HR and adverse events, as well as the underlying mechanisms, could not be determined from this study. That is known as a general limitation of the observational study. Indeed, we indicated only the association between changes in HR and adverse events and did not mention causality throughout the article. Of course, there is a possibility that the changes ","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 6","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70158","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190781","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":"Right Heart Contrast Echocardiography Microbubble Count and Migraine Severity: A Dose–Effect Relationship Study","authors":"Haijuan Gu,&nbsp;Wenjun Fan,&nbsp;Jiesheng Xia,&nbsp;Jianwei Shi","doi":"10.1002/clc.70155","DOIUrl":"https://doi.org/10.1002/clc.70155","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to investigate whether a dose–effect relationship exists between the number of microbubbles detected on right heart contrast echocardiography (RHCE) and the clinical severity of migraine.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a cross-sectional study of 190 adult patients diagnosed with migraine who underwent RHCE. Microbubble counts were categorized into four grades per frame (Grades 0–III) based on their appearance in the left atrium within three to six cardiac cycles after right atrial opacification. Migraine severity was assessed using the Migraine Disability Assessment (MIDAS) score and the Headache Impact Test (HIT-6). Multivariate linear regression was used to evaluate the association between microbubble grades and migraine severity. The predictive ability of the model was assessed using the residual plots and variance inflation factors. Sensitivity analyses were performed to test the robustness of the findings by adjusting for potential confounders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A clear dose–response relationship was identified, with patients in higher microbubble-grade groups demonstrating significantly elevated MIDAS and HIT-6 scores (<i>p</i> &lt; 0.001). Patients with Grade III microbubbles reported the highest mean MIDAS (18.2 ± 6.1) and HIT-6 (64.8 ± 4.9) scores, compared to those in lower grades (<i>p</i> &lt; 0.001). Regression analyses confirmed that the higher microbubble burden independently predicted migraine severity (<i>β</i> = 0.46, <i>p</i> &lt; 0.001). Sensitivity analyses yielded consistent findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our results suggest a notable dose–effect relationship between RHCE microbubble count and migraine severity. These findings highlight the potential role of right-to-left shunting as a physiological contributor to migraine.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 6","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70155","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190782","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 Integrate Echocardiographic Risk Factors for Atrial Fibrillation Following Acute Myocardial Infarction","authors":"Naoya Kataoka,&nbsp;Teruhiko Imamura","doi":"10.1002/clc.70163","DOIUrl":"https://doi.org/10.1002/clc.70163","url":null,"abstract":"<p>De novo atrial fibrillation (AF) following cardiac interventions frequently recurs, and early detection is particularly crucial in patients with acute myocardial infarction (AMI). The authors of the present study demonstrated that several echocardiographic parameters reflecting left atrial function were associated with the subsequent development of AF following AMI [<span>1</span>]. However, several concerns merit discussion.</p><p>Defining true de novo AF can be inherently challenging, as asymptomatic or subclinical AF may go undetected. How did the authors exclude the possibility of pre-existing silent AF before the onset of AMI? Such undiagnosed episodes may have contributed to the observed left atrial remodeling.</p><p>The study population was limited to patients with AMI [<span>1</span>], in whom AF development is often precipitated by systemic inflammation or left atrial ischemia [<span>2, 3</span>]. Did the authors identify any supportive evidence for these mechanisms? For example, occlusion of the right coronary artery or left circumflex artery—both of which may involve atrial branches—could plausibly be linked to AF onset.</p><p>From a practical standpoint, how might these findings be applied in real-world clinical settings? Even if we succeed in identifying patients at high risk, continuous rhythm monitoring using standard modalities would still be required for AF detection. Alternatively, could prophylactic catheter ablation be considered in select high-risk individuals? Additionally, given that patients routinely receive antiplatelet therapy after AMI, the timing and feasibility of left atrial appendage closure following AF detection warrant further clarification [<span>4</span>].</p><p>The authors have nothing to report.</p><p>The authors have nothing to report.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 6","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70163","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190783","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}