Clinical Cardiology最新文献

{"title":"C-Reactive Protein–Albumin–Lymphocyte (CALLY) Index as an Independent Risk Factor for Postoperative Atrial Fibrillation Recurrence","authors":"Ye Deng,&nbsp;Jianya Huang,&nbsp;Li Deng,&nbsp;Yuxuan Zhou,&nbsp;Lu Pan,&nbsp;Jingyi Wang,&nbsp;Qianwen Chen,&nbsp;Qingqing Gu,&nbsp;Yang Zhang,&nbsp;Jun Wei,&nbsp;Ruxing Wang,&nbsp;Ling Sun,&nbsp;Yuan Ji,&nbsp;Qingjie Wang","doi":"10.1002/clc.70157","DOIUrl":"https://doi.org/10.1002/clc.70157","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Atrial fibrillation (AF) recurrence after catheter ablation remains a clinical challenge despite guideline-recommended efficacy. Emerging evidence implicates inflammatory biomarkers in predicting arrhythmia recurrence. This study investigated the novel CALLY index, a composite inflammatory marker, as a prognostic indicator for postablation AF recurrence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospective cohort study, 556 consecutive AF patients undergoing catheter ablation (June 2018–June 2023) were stratified into recurrence and sinus rhythm (SR) maintenance groups. Cox regression and Kaplan–Meier analyses evaluated associations between the CALLY index and recurrence risk. Predictive accuracy was assessed via receiver operating characteristic (ROC) curves and area under the curve (AUC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Over a median 12-month follow-up, 102 patients (18.3%) experienced recurrence. The SR group exhibited significantly higher CALLY indices than the recurrence group (3.24 ± 1.68 vs. 1.89 ± 0.57; <i>p</i> &lt; 0.001). Univariate Cox regression identified the CALLY index as inversely associated with recurrence (HR: 0.439, 95% CI: 0.292–0.659; <i>p</i> &lt; 0.001), with persistence after multivariable adjustment (HR: 0.887, 95% CI: 0.789–0.956; <i>p</i> = 0.031). Tertile-based stratification revealed a 29% lower recurrence risk in the high-CALLY group versus the low-CALLY group (HR: 0.71, 95% CI: 0.68–0.76; <i>p</i> = 0.017). ROC analysis demonstrated optimal discrimination at a CALLY threshold ≥ 1.433 (AUC: 0.7899; sensitivity: 76.4%; specificity: 74.8%; <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The CALLY index independently predicts AF recurrence postablation, offering potential utility in risk stratification. These findings support its integration into clinical decision-making to optimize post-procedural 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.70157","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190784","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":"Real-World Health Care Resource Utilization and Costs Associated With First-Line Dronedarone Versus First-Line Ablation in Adults With Atrial Fibrillation","authors":"Stephen J. Greene,&nbsp;Samantha Schilsky,&nbsp;Andrew W. Roberts,&nbsp;Shaum M. Kabadi,&nbsp;David S. McKindley,&nbsp;Ron Preblick,&nbsp;Jason Rashkin,&nbsp;Reno C. Leeming,&nbsp;Renee M. Sajedian,&nbsp;Andrea M. Russo","doi":"10.1002/clc.70145","DOIUrl":"https://doi.org/10.1002/clc.70145","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Rhythm control therapy with antiarrhythmic drugs (AADs) or catheter ablation is recommended for treatment of atrial fibrillation (AF). The impact of first-line AAD therapy (including dronedarone) or ablation on health care resource utilization (HCRU) is unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Optum's de-identified Clinformatics Data Mart Database (January 1, 2012 to January 31, 2022) was used to assess US adults with AF (within 1 year) and no prior AADs who received first-line dronedarone or first-line ablation (including non-dronedarone AADs then ablation within 90 days) using a comparative cohort design. Dronedarone and ablation cohorts were propensity score matched. HCRU and per-patient per-month (PPPM) payer costs were compared over 24-months' follow-up. Sensitivity analyses assessing first-line ablation with no prior AADs were conducted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Post-matching, dronedarone and ablation cohorts (<i>n</i> = 1440) were similar. Event rate ratios (ERR; [95% CI]) for inpatient (0.85 [0.77–0.93]), any outpatient (0.95 [0.94–0.96]), or emergency room (0.91 [0.85–0.97]) visits, or atrial tachyarrhythmia (ATA)/AF–related procedures (0.72 [0.71–0.74]) were significantly lower with first-line dronedarone versus ablation (all <i>p</i> &lt; 0.01). Dronedarone was associated with reduced mean PPPM costs for total HCRU (−$2603), any outpatient visits (−$2401), and ATA/AF–related procedures (−$1880) versus ablation (all <i>p</i> &lt; 0.01). In contrast to the primary analysis, sensitivity analyses showed no significant difference in ERR for all-cause inpatient or any outpatient visits, but dronedarone remained associated with significantly lower mean PPPM total costs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Over 24-months' follow-up in patients with AF, first-line dronedarone was associated with comparable rates of inpatient/outpatient visits, and lower total payer costs compared with an ablation-based approach.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 6","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70145","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144171619","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":"Meta-Analysis of Thermal Versus Pulse Field Ablation for Pulmonary Vein Isolation Durability in Atrial Fibrillation: Insights From Repeat Ablation","authors":"Jin-Cheng Chen,&nbsp;Yin-Jun Mao,&nbsp;Qun-Ying Huang,&nbsp;Zhen-Dong Cheng,&nbsp;Shao-Bin He,&nbsp;Qiu-Xia Xu,&nbsp;Yin Zhang","doi":"10.1002/clc.70151","DOIUrl":"https://doi.org/10.1002/clc.70151","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Pulsed field ablation (PFA) represents an innovative technique for pulmonary vein isolation (PVI), exhibiting promising efficacy and safety in initial clinical studies. However, the long-term durability of PVI and reconnection patterns following PFA are not as well-characterized compared to those associated with thermal energy sources such as cryoballoon ablation (CBA) or radiofrequency ablation (RFA). The objective of this study is to compare the durability of lesions resulting from repeat ablation after index PVI using PFA versus thermal ablation (TA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a comprehensive search of multiple databases to identify relevant studies published before January 2025. PVI durability was assessed on a per patient and per vein level.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This study included 14 trials involving a total of 7,367 patients. PFA demonstrated a trend toward reduced rates of repeat ablation in comparison to TA (OR 0.77; 95% CI, 0.59–1.00). Durability of PVI per patient (OR 1.42; 95% CI, 0.92–2.19) or per vein (OR 1.42; 95% CI, 0.92–2.19) were similar after PFA and TA. The most common site of reconnection was the right inferior PV for both PFA and TA (39.7% and 38.1%, respectively). Subgroup analyses demonstrated that PVI durability per vein was significantly higher with PFA compared to RFA (OR 1.32; 95% CI, 1.03–1.70).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>At the time of repeat ablation, PFA exhibited a trend toward a reduced incidence of repeat procedures compared to CBA or RFA. PFA is comparable to CBA in achieving durable isolation of all veins but demonstrates superiority over RFA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 6","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70151","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144171694","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":"Immune Checkpoint Inhibitor-Related Myocarditis: A Single Center Observational Registry","authors":"Grace Alexander,&nbsp;Ibrahim Mortada,&nbsp;Mohammed Mhanna,&nbsp;Stefano Byer,&nbsp;Udhayvir Singh Grewal,&nbsp;Shareef Mansour","doi":"10.1002/clc.70154","DOIUrl":"https://doi.org/10.1002/clc.70154","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Immune checkpoint inhibitors (ICIs) are associated with myocarditis, which is rare but has a high mortality. This study aimed to describe cases of ICI-related myocarditis at the University of Iowa Hospitals &amp; Clinics and, in doing so, provide valuable insights into patient characteristics, treatment, and outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center observational registry included cases of ICI-related myocarditis identified from 2009 to 2024. Data were collected retrospectively from electronic medical records and included demographics, cardiovascular risk factors, medications, and cancer characteristics. Between-group comparisons for continuous data were conducted using unpaired Student's <i>t</i>-tests or the Wilcoxon rank-sum test. Categorical data were analyzed with Fisher's exact test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighteen patients were included. The mean age was 74 ± 9.4 years with 61% being male. Compared to controls, patients with ICI-related myocarditis had a significantly higher prevalence of coronary artery disease (36.8% vs. 7.5%, <i>p</i> = 0.01) and obstructive sleep apnea (33% vs. 10%, <i>p</i> = 0.03). They were less likely to have a normal sinus rhythm on baseline electrocardiogram (50% vs. 70%, <i>p</i> &lt; 0.01) and more likely to suffer from a major adverse cardiac event (MACE) (38.9% vs. 2.5%, <i>p</i> &lt; 0.01). Twelve (66.7%) of patients with ICI-related myocarditis also had myasthenia gravis-like overlap syndrome and 9 (50%) had myositis/rhabdomyolysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>ICI-related myocarditis at a tertiary care center is rare with a calculated incidence of 0.48%. Despite this, the disease has a high incidence of MACE. Patients with pre-existing cardiovascular disease are at higher risk of developing ICI-related myocarditis. Careful cardiovascular monitoring in patients undergoing ICI therapy is warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 5","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70154","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144108892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comprehensive Review of Two-Dimensional Speckle-Tracking Echocardiography in Assessing Right and Left Ventricular Function in Diabetic Patients","authors":"Azin Alizadehasl,&nbsp;Mahshid Mokhayeri,&nbsp;Zeynab Sohani,&nbsp;Mohammad Yasin Zamanian,&nbsp;Parai Shahbazi,&nbsp;Shiva Borzouei","doi":"10.1002/clc.70153","DOIUrl":"https://doi.org/10.1002/clc.70153","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Two-dimensional speckle-tracking echocardiography (2D-STE) has emerged as a valuable tool for assessing cardiac function in patients with type 1 (T1DM) and type 2 diabetes mellitus (T2DM).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>This review synthesizes recent studies utilizing 2D-STE in diabetic patients, highlighting its clinical applications and findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this review, relevant studies were identified through comprehensive searches of major scientific databases, including PubMed, Scopus, Google Scholar, ScienceDirect, and other reputable sources.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The results of this study indicate that 2D-STE is capable of detecting subclinical cardiac dysfunction in patients with both T1DM and T2DM, even in instances where conventional echocardiographic parameters appear to be within normal limits. Assessment of right ventricular (RV) function through 2D-STE has demonstrated impaired right ventricular free wall longitudinal strain (RVFWLS) and global longitudinal strain (RVGLS) in individuals with T2DM, which correlates with suboptimal glycemic control. Furthermore, evaluation of left ventricular (LV) function has revealed decreased global longitudinal strain (GLS) and impaired LV twist mechanics in T2DM patients, particularly under conditions of physiological stress.</p>\u0000 \u0000 <p>In T1DM patients, 2D-STE has identified early changes in myocardial deformation, with studies reporting reduced LV and RV strain values compared to healthy controls. The technique has also been effective in assessing the impact of disease duration and glycemic control on cardiac function in both T1DM and T2DM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These findings underscore the potential of 2D-STE as a sensitive and comprehensive tool for early detection of cardiac dysfunction in both T1DM and T2DM, potentially guiding management strategies and improving outcomes in these high-risk populations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 5","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70153","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144117831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Efficacy of Outpatient Parenteral Antibiotic Therapy (OPAT) in Patients With Infective Endocarditis: A Systematic Review and Meta-Analysis","authors":"Hamza Ashraf,&nbsp;Zain Ali Nadeem,&nbsp;Khawaja Abdul Rehman,&nbsp;Shanzay Akhtar,&nbsp;Haider Ashfaq,&nbsp;Muhammad Sohaib Khan,&nbsp;Mahad Butt,&nbsp;Ibrahim Nagmeldin,&nbsp;Eeshal Fatima,&nbsp;Muhammad Waqas,&nbsp;Aalaa Saleh,&nbsp;Hritvik Jain,&nbsp;Raheel Ahmed","doi":"10.1002/clc.70147","DOIUrl":"https://doi.org/10.1002/clc.70147","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Infective endocarditis (IE) is a life-threatening infection requiring prolonged intravenous antimicrobial therapy. Outpatient parenteral antibiotic therapy (OPAT) has emerged as an alternative to prolonged hospitalization, but its safety and efficacy in IE remain debated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>This systematic review and meta-analysis aimed to evaluate the outcomes of OPAT in IE patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We systematically searched MEDLINE, Cochrane CENTRAL, Google Scholar, and Scopus for studies assessing OPAT in IE. Eligible studies included randomized controlled trials and observational studies reporting at least one relevant outcome (mortality, relapse, readmission, valve surgery, and adverse events). Pooled estimates were calculated using a random-effects model, and heterogeneity was assessed using the I² statistic. Risk of bias was evaluated using the ROBINS-I tool.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 25 studies involving 2654 patients were included in the analysis. Patients treated with OPAT had a mortality rate of 0% during the treatment period and 5% during follow-up. The readmission rate was 16% during the treatment period, 4% of the patients had relapse, while 16% of patients underwent cardiac surgery. During follow-up, the readmission rate was 19%, with a relapse rate of 2%, and 14% of patients underwent cardiac surgery. Sensitivity analyses did not significantly affect the results, highlighting the robustness of the findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>OPAT appears to be safe and effective for IE patients, with low mortality and relapse rates. However, increased readmission rates and IV-line complications warrant careful patient selection and monitoring. Further prospective trials are needed to refine OPAT protocols.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 5","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70147","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143944610","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":"KCNQ1 Polymorphism in the Context of Ischemic Cardiomyopathy: A Potential Key to Decision-Making for Device Implantation","authors":"Uğur Özkan,&nbsp;Metin Budak,&nbsp;Muhammet Gürdoğan,&nbsp;Gülnur Öztürk,&nbsp;Mustafa Yildiz,&nbsp;Gökay Taylan,&nbsp;Servet Altay,&nbsp;Kenan Yalta","doi":"10.1002/clc.70148","DOIUrl":"https://doi.org/10.1002/clc.70148","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Ventricular tachyarrhythmia (VTA) in ischemic cardiomyopathy (ICM) is a life-threatening condition influenced by genetic factors and electrical remodeling. This study investigated the association between KCNQ1 gene polymorphisms (rs2237892 and rs2237895) and the development of VTA in ICM patients to improve risk stratification and guide device implantation decisions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center study included 213 ICM patients with implantable cardioverter-defibrillators (ICD) for primary prevention of VTA. Patients were divided into arrhythmia and control groups based on device interrogation findings. Genetic analysis for rs2237892 and rs2237895 polymorphisms was performed using real-time polymerase chain reaction (PCR). Clinical, electrocardiographic, and laboratory parameters were analyzed. Correlation and logistic regression analyses evaluated the association between KCNQ1 polymorphisms and VTA risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The arrhythmia group demonstrated significantly higher QT dispersion, frontal QRS-T angle, and T-wave peak-to-end interval compared to the control group. The TT genotype of rs2237892 and the AC genotype of rs2237895 were significantly associated with increased VTA risk (<i>p</i> &lt; 0.001). Multivariate analysis confirmed these genotypes as independent predictors of VTA. No significant differences in other clinical or laboratory risk factors were observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>KCNQ1 gene polymorphisms (rs2237892 and rs2237895) are strongly associated with VTA in ICM patients, suggesting a potential role as biomarkers for risk stratification. These findings may assist in tailoring ICD implantation decisions and improving patient outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 5","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70148","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143944654","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":"Outcomes of Left Atrial Appendage Occlusion in Hispanic/Latino Patients: Insights From the National Inpatient Sample","authors":"Mashli Fleurestil,&nbsp;Ayush Mohan,&nbsp;Ian Ergui,&nbsp;Jacklyn Samaha,&nbsp;Rosario Colombo,&nbsp;Raul Mitrani,&nbsp;Eduardo de Marchena,&nbsp;Pedro Villablanca,&nbsp;Jose Wiley,&nbsp;Yiannis S. Chatzizisis,&nbsp;Pedro Cox","doi":"10.1002/clc.70152","DOIUrl":"https://doi.org/10.1002/clc.70152","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Left atrial appendage occlusion (LAAO) is an established therapy for stroke prevention in non-valvular atrial fibrillation (NVAF), but outcomes in Hispanic populations remain underexplored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The objective of our study was to evaluate the inpatient outcomes of Hispanic patients undergoing LAAO as compared to non-Hispanic white patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study using the National Inpatient Sample (NIS). From 157 434 LAAO hospitalizations identified, 133 517 were non-Hispanic white and 6814 were Hispanic/Latino. The primary outcome was in-hospital mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Unadjusted odds in the Hispanic/Latino group were higher for mortality (OR 1.78, 95% CI 1.18−2.68, <i>p</i> 0.006), stroke (OR 1.64, 95% CI 1.26−2.14, <i>p</i> &lt; 0.001), infectious complications (OR 3.89, 95% CI 3.03−4.99, <i>p</i> &lt; 0.001), major bleeding (OR 1.22, 95% CI 1.11−1.33, <i>p</i> &lt; 0.001), DVT/PE (OR 2.15, 95% CI 1.58−2.93, <i>p</i> &lt; 0.001), and vascular complications (OR 1.81, 95% CI 0.53−0.93, <i>p</i> &lt; 0.001). After adjusting for covariates and comorbidities, Hispanic/Latino patients had still greater odds of mortality (aOR 1.20, 95% CI 0.75−1.92, <i>p</i> 0.445), infectious complications (aOR 3.54, 95% CI 2.62−4.55, <i>p</i> &lt; 0.001), and vascular complications (aOR 1.57, 95% CI 1.22−2.03, <i>p</i> &lt; 0.001). Non-Hispanic white patients had higher adjusted odds of pericardial effusion/tamponade (aOR 0.64, 95% CI 0.52−0.95, <i>p</i> 0.03), while Hispanic/Latino patients also had higher adjusted odds of cardiac arrest (aOR 1.99, 95% CI 1.15−3.42, <i>p</i> 0.46).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Hispanic/Latino patients undergoing LAAO experience higher odds of infectious and vascular complications compared to non-Hispanic white patients. These findings highlight the need to further investigate disparities in procedural outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 5","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70152","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143944592","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 Characteristics and Outcomes of Catheter Ablation in Young Patients With Atrial Fibrillation","authors":"Xuewen Wang,&nbsp;Qiqi Cao,&nbsp;Tao Liu,&nbsp;Fan Zhang,&nbsp;Shujuan Zhang,&nbsp;Shaobo Shi,&nbsp;Qingyan Zhao,&nbsp;He Huang,&nbsp;Congxin Huang","doi":"10.1002/clc.70144","DOIUrl":"https://doi.org/10.1002/clc.70144","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Data concerning young patients with atrial fibrillation (AF) are currently limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>This study aimed to assess the clinical characteristics and risk factors for AF recurrence in young patients following catheter ablation (CA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All AF patients aged ≤ 45 years who underwent CA were identified from the China Atrial Fibrillation Center database between September 2018 and September 2023. Baseline clinical characteristics, procedural details, and follow-up outcomes were compared between the paroxysmal and non-paroxysmal cohorts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 6,531 young patients with AF were included in the final analysis, with an average age of 37.7 ± 5.5 years, 77.1% were male, and 65.2% with paroxysmal AF. The primary comorbidities were hypertension (16.2%), heart failure (8.4%), valvular heart disease (3.5%), diabetes mellitus (3.2%), peripheral arterial disease (2.8%), stroke/transient ischemic attack (2.5%), and cardiomyopathy (2.2%). Following CA, the recurrence rate of AF post-CA was 14.4% across the entire cohort, with a lower recurrence rate in the paroxysmal AF group compared to the non-paroxysmal AF group (10.6% vs. 19.7%, <i>p</i> &lt; 0.001). Non-paroxysmal AF (HR 2.34, 95% CI 1.62 to 3.36, <i>p</i> &lt; 0.001) and hypertension (HR 1.69, 95% CI 1.09 to 2.63, <i>p</i> = 0.019) were identified as independent predictors for AF recurrence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Young AF patients who undergo CA exhibit a low recurrence rate and a notable improvement in symptoms post-CA. Non-paroxysmal AF and hypertension emerge as primary contributors to AF recurrence following CA in this population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 5","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70144","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143939285","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":"Questioning the Rhythm: A Closer Look at Heart Rate Trends in Atrial Fibrillation","authors":"Ibrahim Nagmeldin Hassan","doi":"10.1002/clc.70150","DOIUrl":"https://doi.org/10.1002/clc.70150","url":null,"abstract":"<p>Kodani et al.'s recent post hoc analysis of the J-RHYTHM Registry adds an important perspective to heart rate (HR) management in non-valvular atrial fibrillation (NVAF), suggesting that both excessive increases and consistently high HR are associated with adverse outcomes [<span>1</span>]. While the findings are provocative, they rest on several methodological and interpretive weaknesses that warrant a more cautious interpretation.</p><p>First, the use of only two time points—baseline HR and the final HR before an event or last follow-up—as the basis for trend analysis is an oversimplification. Atrial fibrillation is inherently dynamic, and HR can fluctuate markedly with physical activity, stress, or medication changes. Capturing HR trends through just two snapshots neglects the nuances of temporal variation and patient trajectories, potentially masking critical intermediate changes or transient arrhythmias that may carry their own prognostic weight.</p><p>Second, the study does not adequately account for medication titration, adherence, or adjustments during the 2-year follow-up. Patients with rising HRs may have experienced worsening clinical status, necessitating reduced beta-blocker doses or shifts to rhythm-control strategies. Without addressing these changes, it's difficult to determine whether HR elevation is a causative factor or merely a marker of underlying decompensation [<span>2</span>].</p><p>Moreover, stratifying patients into rigid HR quartiles introduces arbitrariness. A uniform cut-off of ≥ 80 bpm may not carry the same prognostic significance across age groups or comorbidity profiles. Such one-size-fits-all stratification may oversimplify risk and obscure clinically relevant thresholds [<span>3</span>]. Additionally, although the authors suggest a benefit from modest HR reductions, several hazard ratios carry wide confidence intervals that approach non-significance—raising concerns about multiple comparisons and type I error.</p><p>Crucially, as an observational study, causal inference is inherently limited. The observed associations may reflect reverse causality—where increased HR signals frailty, subclinical illness, or impending adverse events—rather than modifiable targets. Prior trials, such as RACE II, failed to show superiority of strict over lenient rate control for major outcomes, reinforcing the importance of individualized therapy based on symptoms and clinical context [<span>4</span>].</p><p>Future studies should employ continuous monitoring or longitudinal modeling to better characterize HR variability and its prognostic value. Until then, clinicians should interpret these findings as hypothesis-generating rather than practice-changing.</p><p>Ibrahim Nagmeldin Hassan conceptualized the idea. Ibrahim Nagmeldin Hassan wrote the main manuscript text.</p><p>The author declares no conflicts of interest.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 5","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70150","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143939284","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}