Clinical Cardiology最新文献

{"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}

{"title":"Phenomapping the Response of Patients With Ischemic Cardiomyopathy With Reduced Ejection Fraction to Surgical Revascularization","authors":"Tejus Satish,&nbsp;Nicholas S. Hendren,&nbsp;Matthias Peltz,&nbsp;Christopher A. Heid,&nbsp;Maryjane Farr,&nbsp;Anthony Bavry,&nbsp;Saket Girotra,&nbsp;Dharam J. Kumbhani,&nbsp;Mark H. Drazner,&nbsp;W. H. Wilson Tang,&nbsp;Justin L. Grodin","doi":"10.1002/clc.70094","DOIUrl":"https://doi.org/10.1002/clc.70094","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Coronary artery bypass grafting (CABG) has demonstrated long-term mortality benefits in patients with HFREF and obstructive coronary artery disease (CAD), but whether phenotypic heterogeneity influences the benefits of CABG is unknown. We applied clustering analysis to STICHES (Surgical Treatment for Ischemic Heart Failure Extension Study) to identify phenogroups with different long-term risk profiles and investigate differences in CABG benefits between phenogroups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>STICHES was a randomized controlled trial evaluating the effect of CABG in addition to medical therapy versus medical therapy alone. We split the STICHES participants into derivation (<i>n</i> = 753) and validation (<i>n</i> = 459) cohorts. We phenomapped the derivation cohort using penalized model-based clustering. We fit multivariable Cox models to investigate long-term differences in all-cause mortality, cardiovascular (CV) mortality, and a composite of all-cause mortality/CV hospitalization between phenogroups and whether phenogroup assignment modified the effects of CABG on these outcomes. Findings were internally validated on the validation cohort. Four phenogroups were identified in the derivation cohort. The highest-risk group was at a twofold greater risk of death (HR: 2.0, 95% CI: 1.4–2.9, <i>p</i> &lt; 0.001) and CV death (HR: 2.0, 95% CI: 1.3–3.1, <i>p</i> = 0.002), and a 1.5-fold greater risk for death/CV hospitalization (HR: 1.5, 95% CI: 1.1–2.1, <i>p</i> = 0.016). Phenogroup assignment did not modify the effects of CABG on the outcomes (<i>p</i> &gt; 0.05 for all). Similar results were obtained in the validation cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The beneficial effects of CABG on all-cause mortality, CV mortality, and a composite of all-cause mortality and CV hospitalization persist despite phenotypic heterogeneity in HFREF and CAD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70094","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143111093","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":"Predictive Value of Lung Ultrasound Combined With ACEF Score for the Prognosis of Acute Myocardial Infarction","authors":"Ziheng Lun,&nbsp;Jiexin He,&nbsp;Ming Fu,&nbsp;Shixin Yi,&nbsp;Haojian Dong,&nbsp;Ying Zhang","doi":"10.1002/clc.70077","DOIUrl":"https://doi.org/10.1002/clc.70077","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Lung ultrasound (LUS) and the ACEF score (age, creatinine, and ejection fraction) have been shown to be pivotal in predicting an unfavorable prognosis in acute myocardial infarction (AMI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>The aim of this study is to investigate the prognostic value of LUS combined with ACEF score in AMI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The ACEF score and the total number of B-lines in eight thoracic regions of LUS were calculated. Adverse events were recorded during hospitalization and follow-up, defined as all-cause death and other cardiovascular events. Multivariate logistic regression identified predictors of adverse events during hospitalization. Multivariate Cox regression identified predictors of adverse events during follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We enrolled 204 patients. The B-lines (adjusted OR 1.08, [95% CI: 1.03–1.13], <i>p</i> &lt; 0.01) and the ACEF score (adjusted OR 2.71 [95% CI: 1.07–6.81], <i>p</i> &lt; 0.05) independently predicted adverse events during hospitalization. The C-index values were 0.81 (<i>p</i> &lt; 0.01) for the ACEF score, 0.81 (<i>p</i> &lt; 0.01) for LUS, and 0.86 (<i>p</i> &lt; 0.01) for their combination. One hundred seventy-one patients were followed up for 12 months (IQR, 8.13–15.93). Both the B-lines (adjusted HR 1.06 [95% CI: 1.03–1.09], <i>p</i> &lt; 0.05) and the ACEF score (adjusted HR 1.95 [95% CI: 1.10–3.43], <i>p</i> &lt; 0.05) remained associated with an increased risk of adverse events during follow-up. The C-index values were 0.74 (<i>p</i> &lt; 0.01) for the ACEF score, 0.73 (<i>p</i> &lt; 0.01) for LUS, and 0.80 (<i>p</i> &lt; 0.01) for their combined predictive ability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The B-lines and ACEF score are associated with adverse events in AMI patients. When combined, they provide increasing value in assessing the risk of adverse events, which has significant implications for risk stratification.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70077","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143111090","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":"Prognosis of Out-of-Hospital Cardiac Arrest in Underserved Rural Area","authors":"Dor Ezon,&nbsp;Hagay Shwartz,&nbsp;Sagi Gleitman,&nbsp;Zeev Israeli,&nbsp;Asaf Miller,&nbsp;Edo Y. Birati","doi":"10.1002/clc.70059","DOIUrl":"https://doi.org/10.1002/clc.70059","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Epidemiological data are lacking on patients in the rural areas who are being admitted after out-of-hospital cardiac arrest (OHCA). We report here the first descriptive analysis study of patients who were hospitalized and treated after OHCA at an academic medical center in the Lower Galilee which located in the north part of Israel.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a descriptive, retrospective analysis of all patients admitted after OHCA to Tzafon Medical Center between the years 2017 and 2023. The analysis consists of the epidemiological, social, and clinical data based on the electronic medical records.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 62 patients were included in this analysis, 82% were men with a median age of 61.5 years old. Thirty-four percent had history of ischemic heart disease (IHD) and 60% history of hypertension. Twenty-seven (44%) patients died during their admission. In 49 (79%) patients the first rhythm on emergency medical service (EMS) arrival was a shockable rhythm and 30 (48%) patients had a ST-elevation myocardial infarction (STEMI) on electrocardiogram (ECG). Patients who were admitted to the hospital after OHCA were more likely to be discharged alive if they had no history of IHD (<i>n</i> = 27; <i>p</i> = 0.037), hypertension, or hyperlipidemia. Moreover, the presence of first shockable rhythm on the first ECG that performed by EMS was associated with higher rates of survival (<i>n</i> = 33; <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We present the first single-center epidemiological analysis of patients admitted after OHCA at a rural area in Israel, with an in-hospital survival rate of 56%. Patients without history of IHD, hypertension, hyperlipidemia, and acute kidney injury and those with first shockable rhythm were more likely to discharged alive.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70059","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143111092","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}