Clinical Cardiology最新文献

{"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}

{"title":"Lipid-Lowering Effect and Safety of Ezetimibe and Atorvastatin 5 mg in Patients With Primary Hypercholesterolemia or Mixed Dyslipidemia: A Randomized, Double-Blind, Parallel, Multicenter, Phase 3 Clinical Trial","authors":"You-Jeong Ki,&nbsp;Weon Kim,&nbsp;Ki Hong Lee,&nbsp;Sang-Jin Han,&nbsp;Yong-Hyun Kim,&nbsp;Joon-Hyung Doh,&nbsp;Tae Nyun Kim,&nbsp;Choon Hee Chung,&nbsp;Do Young Kim,&nbsp;Jin-Man Cho,&nbsp;Hyuck-Jun Yoon,&nbsp;In-Kyung Jeong,&nbsp;Sungha Park,&nbsp;Kee-Ho Song,&nbsp;Cheol Woong Yu,&nbsp;Deok-Kyu Cho,&nbsp;Sung Hee Choi,&nbsp;Seung-Jin Oh,&nbsp;Sanghoon Shin,&nbsp;Hyeonju Jeong,&nbsp;Yongwhi Park,&nbsp;Hyo-Soo Kim","doi":"10.1002/clc.70138","DOIUrl":"https://doi.org/10.1002/clc.70138","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to compare the lipid-lowering effect and safety of low-intensity atorvastatin (5 mg) plus ezetimibe (10 mg) combination therapy (A5E10) with monotherapy regimens–atorvastatin 5 mg [A5], ezetimibe 10 mg [E10], and atorvastatin 10 mg [A10])–in dyslipidemia patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A randomized, double-blind, placebo-controlled trial involving 252 dyslipidemia patients was conducted at 25 centers in South Korea (NCT05970679). Participants aged ≥ 19 years were randomized into four groups: A5E10, A5, E10, and A10. The primary endpoint was the percentage change in low-density lipoprotein cholesterol (LDL-C) levels from baseline to 8 weeks. Secondary endpoints included changes in other lipid parameters, lipid ratios, LDL-C goal achievement rates and safety assessments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean age of the patients was 63 years, and 51.2% were male. The A5E10 group showed significantly greater LDL-C reduction (47.6%) compared with A5 (33.4%), E10 (19.4%), and A10 (40.1%) at 8 weeks (<i>p</i> &lt; 0.0001). A5E10 also significantly reduced triglyceride, non-high-density lipoprotein cholesterol, and apolipoprotein B levels. In addition, a significant reduction in LDL-C levels was observed over the 4 weeks, with a 46.7% reduction in LDL-C levels after 4 weeks of A5E10 administration. No severe adverse events were observed in the A5E10 group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The combination of low-intensity atorvastatin and ezetimibe was more effective than moderate-intensity atorvastatin monotherapy in lowering LDL-C levels and improving other lipid parameters. It was well-tolerated and demonstrated rapid benefits within a month, offering a promising alternative for patients with low to moderate cardiovascular risk who do not achieve adequate control with statin monotherapy.</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.70138","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143939286","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":"Lipoprotein(a) Concentration and Cardiovascular Disease in a Group of Patients With Familial Hypercholesterolemia—A Lipid Clinic Experience","authors":"J. Kurdziel,&nbsp;A. Fedak,&nbsp;E. Kawalec,&nbsp;P. Miarka,&nbsp;A. Micek,&nbsp;M. Małecki,&nbsp;M. Walus-Miarka","doi":"10.1002/clc.70125","DOIUrl":"https://doi.org/10.1002/clc.70125","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>High Lp(a) concentrations are linked to an increased risk of cardiovascular disease (CVD). However, more evidence is needed to assess the association of Lp(a) with CVD in different vascular beds.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>The aim was to assess the prevalence of increased Lp(a) levels and the association between Lp(a) levels and CVD in hypercholesterolemic patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We examined 220 patients (110 women) with suspicion of FH. The mean (SD) age was 49.1 (15.02) years, LDL-C 3.49 (1.75) mmol/L, and the median (IR) Lp(a) concentration 0.15 (0.53) g/L.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>CVD was present in 24.5%, coronary artery disease (CAD) in 21.4% of the examined individuals. Patients with CVD and patients with CAD had higher Lp(a) levels than patients without these diseases (<i>p</i> = 0.0403 and <i>p</i> = 0.0063, respectively); however, after adjustment for age and sex, only the difference in Lp(a) concentrations between persons with and without CAD remained significant. In total, 42.3% of patients who underwent carotid ultrasound examination had carotid plaques. We did not observe differences in Lp(a) levels between patients with or without plaques or correlations between Lp(a) and carotid IMT. In total, 28.3% of patients had Lp(a) concentrations in the high (&gt; 0.5 g/dL), and 9.9% in the moderate-risk category (0.3–0.5 g/L). We observed an association between Lp(a) risk categories and the presence of CVD (<i>p</i> = 0.003) and CAD (<i>p</i> = 0.0004) but not with the presence of carotid plaques.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We found a high prevalence of increased Lp(a) levels in a group of hyperlipidemic persons and strong associations of Lp(a) risk categories with CAD but not with carotid atherosclerosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 5","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70125","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143914052","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":"Lipid Control and Social Determinants: Their Association With LDL and Non-HDL Cholesterol Goals in Older Adults—A Population-Based Study","authors":"Cristian Orlando Porras Bueno,&nbsp;Jesús Andrés Beltrán España,&nbsp;Carolina Murgueitio Guzmán,&nbsp;Cándida Diaz-Brochero,&nbsp;Ángel Alberto García Peña","doi":"10.1002/clc.70146","DOIUrl":"https://doi.org/10.1002/clc.70146","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Social determinants of health (SDH) significantly influence cardiovascular outcomes; however, their role in achieving lipid profile goals in older adults remains underexplored. This study aimed to evaluate the association between SDH and nonachievement of LDL cholesterol (LDL-C) and non-HDL cholesterol (non-HDL-C) targets in Colombian adults aged ≥ 60 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional analysis was conducted using data from 1270 participants in the SABE Colombia 2015 study. Logistic regression was applied to estimate odds ratios (ORs) for not achieving LDL-C and non-HDL-C goals on the basis of the Framingham, ASCVD 2013, and SCORE2 models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Non achieving LDL-C goals were associated with female sex, lack of affiliation with the health system and physical inactivity. Physical inactivity was associated with noncompliance on non-HDL-C goals, among others.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>SDH are strongly associated with poor lipid control. Addressing modifiable SDHs could enhance cardiovascular risk management in older adults.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 5","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70146","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143919808","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 Outcomes, Healthcare Utilization, and Cost Following Implementation of a High-Sensitivity Cardiac Troponin Assay","authors":"Indu Poornima,&nbsp;Teigan Dwyer,&nbsp;Tyson Barrett,&nbsp;Tyler Moore,&nbsp;Corey Clarke,&nbsp;Brent A. Williams","doi":"10.1002/clc.70133","DOIUrl":"https://doi.org/10.1002/clc.70133","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>High-sensitivity troponin (Hs-trop) protocols have been developed for the cardiac evaluation of chest pain patients presenting to emergency departments (ED), but uptake has been suboptimal.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study sought to evaluate the effects of an Hs-trop protocol (Roche Gen-5 troponin assay) implementation on patient outcomes, healthcare utilization, and costs. Patients presenting to EDs with chest pain following implementation of an Hs-trop protocol (POST) were compared to control patients presenting in the year prior (PRE). Study endpoints included troponin elevations, cardiac diagnostic testing, and ED disposition. Among patients discharged directly from the ED, 30- and 90-day death, new myocardial infarction (MI), ED returns, and hospital admissions were compared. In a subset with insurance data, post-discharge healthcare costs and utilization were compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 15 015 patients meeting study criteria, there were no differences in MI diagnoses POST versus PRE, but myocardial injury without MI was more frequent POST (aOR = 9.03; 95% CI: 7.44, 10.96). Noninvasive cardiac testing at the index ED encounter was less frequent POST (aOR = 0.72; 0.67, 0.78), with no difference for invasive angiography. Among patients directly discharged from the ED, no differences were observed for death, but POST patients had fewer ED returns (aOR = 0.70; 0.59, 0.83) and hospital admissions (aOR = 0.62; 0.45, 0.85) within 30 days. Overall healthcare utilization was 8.4% lower in the POST group (<i>p</i> &lt; 0.001) but costs were not different.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Following implementation of an Hs-trop protocol, decreases were observed in noninvasive cardiac testing, and ED returns and hospital admissions within 90 days of discharge, without compromising outcomes. Overall healthcare utilization declined.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 5","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70133","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143909197","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":"Prognostic Impact of Implementation of Heart Team Approach on Cardiovascular Outcomes in Patients With Complex Coronary Artery Disease","authors":"Po-Hsueh Su,&nbsp;Ya-Lin Huang,&nbsp;Po-Wei Chen,&nbsp;Hsien-Yuan Chang,&nbsp;Jun-Neng Roan,&nbsp;Ting-Hsing Chao","doi":"10.1002/clc.70141","DOIUrl":"https://doi.org/10.1002/clc.70141","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In patients with stable coronary artery disease (CAD), treatment options include medical therapy, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG). The decision between PCI and CABG depends on disease severity and revascularization risk. Guidelines promote a heart team approach (HTA) with shared decision-making, yet PCI remains prevalent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>We conducted a retrospective analysis of 753 patients with complex CAD (left main or multivessel disease and SYNTAX score ≥ 33) between January 2019 and April 2022. We evaluated a quality improvement program featuring a clinical decision flow map, a support system for risk score calculations, and a standard operating procedure for HTA. We compared HTA activation, revascularization strategy choices, and long-term cardiovascular outcomes (composite endpoint: death, myocardial infarction, or unplanned revascularization) between patients treated with HTA (HTA group, <i>n</i> = 448) and without HTA (non-HTA group, <i>n</i> = 304). The program significantly increased HTA activation (from 26.4% to 61.7%) and CABG selection (from 11.1% to 20.4%). The HTA group had better CABG recommendations and choices (75.5% vs. 37.2%, and 26.8% vs. 7.2%, respectively), with a lower incidence of the primary composite endpoint (18.1% vs. 42.4%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A quality improvement program enhances HTA activation and revascularization strategies, leading to improved cardiovascular outcomes in complex CAD patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 5","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70141","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143896902","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 Assess the Functional Impact of Atrial Fibrillation in Patients With Heart Failure","authors":"Naoya Kataoka,&nbsp;Teruhiko Imamura","doi":"10.1002/clc.70140","DOIUrl":"https://doi.org/10.1002/clc.70140","url":null,"abstract":"<p>A well-established interplay exists between atrial fibrillation (AF) and heart failure (HF). However, the specific adverse impact of AF on quality of life among HF patients remains incompletely elucidated. The authors demonstrated that the presence of AF and reduced ejection fraction was associated with a lesser degree of improvement in functional class and the physical dimension of a quality-of-life questionnaire [<span>1</span>]. Several concerns merit consideration.</p><p>In the present study, patients with HF were included regardless of their left ventricular ejection fraction (LVEF) [<span>1</span>]. Prior studies focusing on HF populations over 60 years of age have shown that quality-of-life profiles and depressive symptoms differ significantly between cohorts with preserved versus reduced LVEF [<span>2</span>]. To better delineate the target population, it may be more appropriate to restrict the LVEF range.</p><p>The study did not differentiate between paroxysmal and persistent forms of AF [<span>1</span>]. Patients with paroxysmal AF may experience a more favorable quality of life, particularly when sinus rhythm is intermittently or spontaneously restored [<span>3</span>]. Stratification by AF subtype and burden may provide deeper insight into the differential impact on patient-reported outcomes.</p><p>The definition of arrhythmia-induced cardiomyopathy warrants clarification. This condition is typically diagnosed by the observation of reverse remodeling following the resolution of the causative arrhythmia [<span>4</span>]. It may be reasonable to consider arrhythmia-induced cardiomyopathy within the broader category of idiopathic cardiomyopathies, given its distinct pathophysiological trajectory.</p><p>In the current era, catheter ablation has emerged as a standard therapeutic option for AF in patients with HF [<span>5</span>]. Notably, in the present study, great improvement in New York Heart Association functional class was achieved with pharmacological therapy alone. A discussion regarding the therapeutic approach—namely, rhythm control versus rate control—would enhance the clinical relevance of the study's findings in the context of contemporary HF management.</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 5","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70140","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143888926","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}