Clinical Cardiology最新文献

{"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}

{"title":"Endothelial Dysfunction in Acute Myocardial Infarction: A Complex Association With Sleep Health, Traditional Cardiovascular Risk Factors and Prognostic Markers","authors":"Mohamed Ali Hbaieb,&nbsp;Salma Charfeddine,&nbsp;Tarak Driss,&nbsp;Laurent Bosquet,&nbsp;Benoit Dugué,&nbsp;Ahmed Makni,&nbsp;Mouna Turki,&nbsp;Leila Abid,&nbsp;Omar Hammouda","doi":"10.1002/clc.70080","DOIUrl":"10.1002/clc.70080","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Endothelial function (EndFx) is a core component of cardiovascular (CV) health and cardioprotection following acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention (PCI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>AMI patients experience endothelial dysfunction (EndDys), associated with traditional CV risk factors and sleep patterns. EndFx may also predict short and mid-term outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>EndFx was assessed in <span>63</span> patients (56.2 ± 7.6 years) using the Endothelium Quality Index (EQI). Sleep quality and quantity were evaluated using objective (actigraphy) and subjective (Pittsburgh Sleep Quality Index questionnaire) measures. Cardiorespiratory fitness was quantified through the 6-min walking test. Cardiac function was assessed using the left ventricular ejection fraction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Following AMI, patients tended to experience EndDys (EQI = 1.4 ± 0.7). A severe EndDys was observed in 23.8% of patients (<i>n</i> = 15), while a mild EndDys was present in 63.49% (<i>n</i> = 40). Furthermore, EndDys was significantly associated with traditional CV risk factors (i.e., low physical activity level [12.8%], age [−4.2%], and smoking [−0.7%]) (R² adjusted = 0.50, <i>p</i> &lt; 0.001). Patients with EndDys had poor sleep quality (<i>p</i> = 0.001) and sleep efficiency (<i>p</i> = 0.016) compared to healthy persons. Patients with severe EndDys exhibited lower cardiorespiratory fitness compared to those with healthy EndFx (<i>p</i> = 0.017). Furthermore, during a follow-up period (nearly 4 months) following PCI, major adverse cardiac events were observed in four patients with severe EndDys.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our results emphasize the importance of adequate sleep and an active lifestyle, notably physical activity practice, as modifiable elements to enhance EndFx, which is regarded as a predictive tool following AMI. However, other factors remain to be elucidated as predictors of CV risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>The study protocol was registered in the Pan African Clinical Trial Registry under the trial ID: PACTR202208834230748.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11773158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051722","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":"Advancements in Artificial Intelligence in Noninvasive Cardiac Imaging: A Comprehensive Review","authors":"Oluwaremilekun Zeth Tolu-Akinnawo,&nbsp;Francis Ezekwueme,&nbsp;Olukunle Omolayo,&nbsp;Sasha Batheja,&nbsp;Toluwalase Awoyemi","doi":"10.1002/clc.70087","DOIUrl":"10.1002/clc.70087","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Technological advancements in artificial intelligence (AI) are redefining cardiac imaging by providing advanced tools for analyzing complex health data. AI is increasingly applied across various imaging modalities, including echocardiography, magnetic resonance imaging (MRI), computed tomography (CT), and nuclear imaging, to enhance diagnostic workflows and improve patient outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>Integrating AI into cardiac imaging enhances image quality, accelerates processing times, and improves diagnostic accuracy, enabling timely and personalized interventions that lead to better health outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive literature review was conducted to examine the impact of machine learning and deep learning algorithms on diagnostic accuracy, the detection of subtle patterns and anomalies, and key challenges such as data quality, patient safety, and regulatory barriers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Findings indicate that AI integration in cardiac imaging enhances image quality, reduces processing times, and improves diagnostic precision, contributing to better clinical decision-making. Emerging machine learning techniques demonstrate the ability to identify subtle cardiac abnormalities that traditional methods may overlook. However, significant challenges persist, including data standardization, regulatory compliance, and patient safety concerns.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>AI holds transformative potential in cardiac imaging, significantly advancing diagnosis and patient outcomes. Overcoming barriers to implementation will require ongoing collaboration among clinicians, researchers, and regulatory bodies. Further research is essential to ensure the safe, ethical, and effective integration of AI in cardiology, supporting its broader application to improve cardiovascular health.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051718","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":"Serum Urate and Atrial Fibrillation: A Bidirectional Mendelian Randomization Study","authors":"Shandong Yu,&nbsp;Wei Wang,&nbsp;Yulian Gao,&nbsp;Jun Zhou,&nbsp;Yanpeng Chu","doi":"10.1002/clc.70089","DOIUrl":"10.1002/clc.70089","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Observational studies indicate that serum urate level is associated with atrial fibrillation (AF). However, whether this association is causal remains controversial, due to confounding factors and reverse causality. We aim to evaluate the causal relationship of genetically predicted serum urate level with AF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A bidirectional Mendelian randomization (MR) study was performed. Instrumental variables were obtained from the Global Urate Genetics Consortium (110347 individuals). We obtained summary statistics of AF from two genome-wide association studies (GWAS) data sets for AF. Inverse-variance-weighted method was applied to obtain MR estimates and other statistical methods were conducted in the sensitivity analyses. The reverse MR analysis was performed to evaluate the effect of AF on serum urate levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Genetically determined serum urate level was not associated with AF in two studies (OR, 1.03; 95% CI, 0.95–1.11; <i>p</i> = 0.47); (OR, 1.06; 95% CI, 0.99–1.12; <i>p</i> = 0.09). The main results kept robust in the most sensitivity analyses. Multivariable MR analyses suggested that the association pattern did not change, after adjusting for body mass index (BMI), HbA1c: hemoglobin A1c (HbA1c), hypertension, low-density lipoprotein cholesterol (LDL-C) and coronary heart disease. No causal effect of AF on serum urate levels was found in two studies (OR, 1.02; 95% CI, 0.98–1.05; <i>p</i> = 0.30); (OR, 1.00; 95% CI, 0.98–1.03; <i>p</i> = 0.95).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our MR study supports no bidirectional causal effect of serum urate levels and AF. This implies that treatments aimed at lowering uric acid may not reduce the risk of AF.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051759","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":"Incidence and Predictors of Clinical Outcomes in Real-Life Patients With Atrial Fibrillation Treated With Oral Factor Xa Inhibitors: The Follow-Up Results of the ANATOLIA-AF Study","authors":"Umut Kocabaş,&nbsp;Isil Ergin,&nbsp;Sadi Can Sönmez,&nbsp;Veysel Yavuz,&nbsp;Selda Murat,&nbsp;Ibrahim Halil Özdemir,&nbsp;Ömer Genç,&nbsp;Haşim Tüner,&nbsp;Bengisu Keskin Meriç,&nbsp;Onur Aslan,&nbsp;Ahmet Dal,&nbsp;Uğur Taşkın,&nbsp;Taner Şen,&nbsp;Ersin İbişoğlu,&nbsp;Aslan Erdoğan,&nbsp;Mehmet Özgeyik,&nbsp;Mevlüt Demir,&nbsp;Örsan Deniz Urgun,&nbsp;Mustafa Doğduş,&nbsp;Sinem Çakal,&nbsp;Sercan Çayırlı,&nbsp;Arda Güler,&nbsp;Dilay Karabulut,&nbsp;Onur Dalgıç,&nbsp;Bektaş Murat,&nbsp;Umut Karabulut,&nbsp;Gülsüm Meral Yılmaz Öztekin,&nbsp;Halil İbrahim Biter,&nbsp;Ümit Yaşar Sinan,&nbsp;Veysel Özgür Barış,&nbsp;Mehmet Kaplan,&nbsp;Cihan Altın,&nbsp;Tarık Kıvrak","doi":"10.1002/clc.70088","DOIUrl":"10.1002/clc.70088","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The main objective of this study is to determine the incidence and predictors of clinical outcomes in patients with AF treated with factor Xa inhibitors in a real-world setting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The present study was a multicentre and observational study that included patients with AF who were treated with factor Xa inhibitors. The primary outcome was the composite of ischemic stroke, TIA, systemic embolism, major bleeding, and all-cause mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1162 patients from 26 cardiology centers were included in this study, with a median age of 72 years. During the median 12-month follow-up period, the primary outcome occurred in 195 patients (16.8%). Treatment with rivaroxaban compared with apixaban and edoxaban showed a lower rate of ischemic stroke, TIA, and/or systemic embolism (2.2% vs. 4.7% vs. 6.5%, respectively, <i>p</i> = 0.014). The major bleeding rate was similar between all three factor Xa inhibitors. The all-cause mortality rate in the rivaroxaban group was lower compared with the apixaban and edoxaban groups (9.8% vs. 15.1% vs. 12.4%, respectively, <i>p</i> = 0.042). Overall, the frequency of primary outcome was 13.8%, 19.6%, and 20.6% for patients treated with rivaroxaban, apixaban, and edoxaban, respectively (<i>p</i> = 0.019). Older age, male sex, low body weight, high bleeding risk, heart failure, hypertension, liver failure, and treatment with apixaban 2.5 mg b.i.d. were independently associated with the development of primary outcome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The follow-up data from the ANATOLIA-AF study provides detailed data about the incidence and independent predictors of adverse clinical outcomes in patients with AF treated with factor Xa inhibitor treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11773160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051734","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":"Comparative Effectiveness of Calcium-Channel Blockers, Angiotensin-Converting Enzyme/Angiotensin Receptor Blockers and Diuretics on Cardiovascular Events Likelihood in Hypertensive African-American and Non-Hispanic Caucasians: A Retrospective Study Across HCA Healthcare","authors":"Anil Harrison,&nbsp;Sushil Rayamajhi,&nbsp;Farhad Shaker,&nbsp;Schwartz Thais,&nbsp;Melissa Moreno,&nbsp;Kaveh Hosseini","doi":"10.1002/clc.70075","DOIUrl":"10.1002/clc.70075","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hypertension, a leading global risk factor for mortality and disability, disproportionately affects racial and ethnic minorities. Our study investigates the association between the type of prior antihypertensive medication use and the likelihood of cardiovascular events (CVE) and assesses whether the patient's race influences this relationship.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective study of 14 836 hypertension cases aged ≥ 40 years was conducted using data from HCA Healthcare between 2017 and 2023. Logistic regression was employed to predict the likelihood of CVE and mortality at admission, adjusting for baseline comorbidities, with Race added as an effect modifier. Interaction analysis was performed among races based on antihypertensive medication types.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>African American patients on ACE inhibitors (ACE) or angiotensin receptor blockers (ARBs) were 1.7 times more likely to have cardiovascular events (CVE) compared to those on calcium channel blockers (CCBs) and 0.66 times as likely compared to diuretics. CCB users had a lower CVE risk than diuretic users. Among White patients, ACE/ARB users had a 1.18 times higher CVE risk than CCB users and 0.45 times lower compared to diuretics, while CCBs offered a 0.38 times lower risk than diuretics. Only ACE/ARB use showed significantly higher CVE odds for African Americans compared to White patients, with similar risks across racial groups for CCBs and diuretics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Prior antihypertensive type significantly influenced CVE risk, with race as an effect modifier. CCB users had lower CVE odds than ACE/ARBs or diuretics, and ACE/ARBs showed reduced CVE likelihood compared to diuretics in both racial groups.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11747351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001161","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 Prevent Arrhythmias Following Acute Coronary Syndrome","authors":"Naoya Kataoka,&nbsp;Teruhiko Imamura","doi":"10.1002/clc.70086","DOIUrl":"10.1002/clc.70086","url":null,"abstract":"<p>Ventricular arrhythmias (VAs) following acute coronary syndrome (ACS) are strongly associated with hemodynamic instability and increased mortality, underscoring the importance of accurate prediction for implementing prophylactic strategies. Giubertoni and colleagues demonstrated that the PRAISE score effectively identifies high-risk patients for atrial fibrillation (AF) or VAs during hospitalization for ACS [<span>1</span>]. Nevertheless, several points warrant further consideration.</p><p>The authors employed clinical parameters required for calculating the PRAISE score [<span>1</span>], a tool originally developed using machine learning to predict 1-year adverse cardiovascular and bleeding events following ACS [<span>2</span>]. However, additional potential predictors are known to influence arrhythmogenesis. For example, hyperuricemia and chronic obstructive pulmonary disease have been implicated in the development of AF, while specific electrocardiographic and echocardiographic parameters are associated with ischemia-induced ventricular tachycardia [<span>3-5</span>]. Incorporating these established risk factors into a revised risk score may enhance its clinical utility.</p><p>Another critical consideration involves the hazard ratios of individual variables. Identifying modifiable risk factors provides actionable therapeutic targets to mitigate the incidence of AF and VAs post-ACS. For instance, anemia emerged as a significant predictor in the original PRAISE cohort, alongside age and left ventricular ejection fraction [<span>2</span>]. Notably, anemia is widely recognized as a contributor to the pathogenesis of AF and may represent a practical focus for intervention.</p><p>The clinical implications of these findings remain ambiguous [<span>1</span>]. Cardiac reverse remodeling often occurs within approximately 30 days following ACS. During this period, the use of wearable cardioverter-defibrillators may be appropriate, whereas implantable cardioverter-defibrillators are typically not recommended. A pertinent question arises: how can referencing the PRAISE score inform strategies to improve mid- and long-term clinical outcomes following ACS?</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 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11742098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001162","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":"Clinical Implication of Prone Position Electrocardiograms in Patients With COVID-19","authors":"Naoya Kataoka,&nbsp;Teruhiko Imamura","doi":"10.1002/clc.70082","DOIUrl":"10.1002/clc.70082","url":null,"abstract":"<p>The posterior lead can be estimated in the supine position using a specific electrocardiogram (ECG) algorithm. Makarawate and colleagues directly measured the posterior lead ECG in the prone position [<span>1</span>]. They demonstrated that a prolonged QTc interval in the prone position correlated with higher APACHE II scores in patients with COVID-19. Several concerns have been raised regarding their findings.</p><p>The QTc interval is strongly correlated with heart rate, as heart rate is a factor in the formula used to calculate the QTc interval. With a fixed QT interval, the QTc interval increases with an elevated heart rate. The authors observed an increase in heart rate in the prone position compared to the standard position [<span>1</span>]. Caution must be exercised in interpreting QTc interval in the prone position, because most of the evidence is constructed from QTc interval in the standard position.</p><p>The authors evaluated the impact of ECG findings obtained in the prone position in patients with COVID-19 [<span>1</span>]. However, some of these patients had acute coronary syndrome, which likely influenced the ECG patterns [<span>2</span>]. It would be more ideal to exclude such patients from the analysis to focus on the primary concern. Additionally, patients with atrial fibrillation were included. The QTc interval is generally overestimated during atrial fibrillation when calculated using the Bazett formula [<span>3</span>].</p><p>The authors identified a QTc interval cutoff of 460 ms to predict an APACHE II score &gt; 12. A QTc interval exceeding 460 ms is typically indicative of long QT syndrome, which is commonly observed in patients with electrical disorders or myocardial injury. These individuals likely exhibit severe systemic conditions, explaining why they were treated in the prone position. The clinical utility of ECG measurements in the prone position remains unclear.</p><p>The authors have nothing to report.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11742099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001240","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}