Clinical Cardiology最新文献

{"title":"Urate-lowering therapy in patients with hyperuricemia and heart failure: A retrospective cohort study using the UK Clinical Practice Research Datalink","authors":"Steven J. Kiddle PhD,&nbsp;Karolina Andersson Sundell PhD,&nbsp;Shira Perl MD,&nbsp;Stephen Nolan PhD,&nbsp;Magnus Bjursell PhD","doi":"10.1002/clc.24297","DOIUrl":"10.1002/clc.24297","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Elevated serum uric acid (sUA) is associated with heart failure (HF).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>Urate-lowering therapy (ULT) in HF is associated with lower risk of HF hospitalization (hHF) and mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data on patients with HF and gout or hyperuricemia in the Clinical Practice Research Datalink database linked to the Hospital Episode Statistics and the Office for National Statistics in the United Kingdom were analyzed. Risks of hHF and all-cause mortality or cardiovascular-related mortality by ULT exposure (ULT initiated within ≤6 months of gout or hyperuricemia diagnosis) were analyzed in a propensity score-matched cohort using adjusted Cox proportional hazards regression models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 2174 propensity score-matched pairs, patients were predominantly male, aged &gt;70 years, with mean ± standard deviation sUA 9.3 ± 1.8 (ULT-exposed) and 9.4 ± 1.9 mg/dL (ULT-unexposed). At 5 years, ULT-exposed patients had a 43% lower risk of hHF or all-cause mortality (adjusted hazard ratio [HR]: 0.57; 95% confidence interval [CI]: 0.51–0.65) and a 19% lower risk of hHF or cardiovascular-related mortality (adjusted HR: 0.81; 95% CI: 0.71–0.92) versus no ULT exposure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ULT was associated with reduced risk of adverse clinical outcomes in patients with HF and gout or hyperuricemia over 5 years.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24297","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141316823","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":"Predictors of developing renal dysfunction following diagnosis of transthyretin cardiac amyloidosis","authors":"Malcolm L. McDonald MD,&nbsp;Yosef Manla MD,&nbsp;Alice Sonnino MD,&nbsp;Mileydis Alonso DO,&nbsp;Radhika K. Neicheril MD,&nbsp;Alejandro Sanchez MD,&nbsp;Gabrielle Lafave MD,&nbsp;Yelenis Seijo De Armas MD,&nbsp;Antonio Lewis Camargo MD,&nbsp;Dipan Uppal MD,&nbsp;Armaan Handa MS,&nbsp;David Wolinsky MD,&nbsp;Nina Thakkar Rivera DO, PhD,&nbsp;Mauricio Velez MD,&nbsp;David A. Baran MD,&nbsp;Jerry D. Estep MD,&nbsp;David Snipelisky MD","doi":"10.1002/clc.24298","DOIUrl":"10.1002/clc.24298","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In patients with transthyretin cardiac amyloidosis (ATTR-CA), renal dysfunction is a poor prognostic indicator. Limited data are available on variables that portend worsening renal function (wRF) among ATTR-CA patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study assesses which characteristics place patients at higher risk for the development of wRF (defined as a drop of ≥10% in glomerular filtration rate [GFR]) within the first year following diagnosis of ATTR-CA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included patients with ATTR-CA (<i>n</i> = 134) evaluated between 2/2016 and 12/2022 and followed for up to 1 year at our amyloid clinic. Patients were stratified into two groups: a group with maintained renal function (mRF) and a group with wRF and compared using appropriate testing. Significant variables in the univariate analysis were included in the multivariable logistic regression model to determine characteristics associated with wRF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Within a follow-up period of 326 ± 118 days, the median GFR% change measured −6% [−18%, +8]. About 41.8% (<i>n</i> = 56) had wRF, while the remainder had mRF. In addition, in patients with no prior history of chronic kidney disease (CKD), 25.5% developed de novo CKD. On multivariable logistic regression, only New York Heart Association (NYHA) class ≥III (odds ratio [OR]: 3.9, 95% confidence interval [CI]: [1.6–9.3]), history of ischemic heart disease (IHD) (OR: 0.3, 95% CI: [0.1–0.7]), and not receiving SGLT-2i (OR: 0.1, 95% CI: [0.02–0.5]) were significant predictors of wRF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study demonstrated that the development of de novo renal dysfunction or wRF is common following the diagnosis of ATTR-CA. Additionally, we identified worse NYHA class and no prior history of IHD as significant predictors associated with developing wRF, while receiving SGLT-2i therapy appeared to be protective in this population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24298","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141316821","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":"Home Heart Hospital Associated With Reduced Hospitalizations and Costs Among High-Cost Patients With Cardiovascular Disease","authors":"Michael Shen,&nbsp;Kareem Osman,&nbsp;Daniel M. Blumenthal,&nbsp;Kaelin DeMuth,&nbsp;Yixiang Liu","doi":"10.1002/clc.24302","DOIUrl":"10.1002/clc.24302","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>There is no widely accepted care model for managing high-need, high-cost (HNHC) patients. We hypothesized that a Home Heart Hospital (H3), which provides longitudinal, hospital-level at-home care, would improve care quality and reduce costs for HNHC patients with cardiovascular disease (CVD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate associations between enrollment in H3, which provides longitudinal, hospital-level at-home care, care quality, and costs for HNHC patients with CVD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective within-subject cohort study used insurance claims and electronic health records data to evaluate unadjusted and adjusted annualized hospitalization rates, total costs of care, part A costs, and mortality rates before, during, and following H3.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ninety-four patients were enrolled in H3 between February 2019 and October 2021. Patients' mean age was 75 years and 50% were female. Common comorbidities included congestive heart failure (50%), atrial fibrillation (37%), coronary artery disease (44%). Relative to pre-enrollment, enrollment in H3 was associated with significant reductions in annualized hospitalization rates (absolute reduction (AR): 2.4 hospitalizations/year, 95% confidence interval [95% CI]: −0.8, −4.0; <i>p</i> &lt; 0.001; total costs of care (AR: −$56 990, 95% CI: −$105 170, −$8810; <i>p</i> &lt; 0.05; and part A costs (AR: −$78 210, 95% CI: −$114 770, −$41 640; <i>p</i> &lt; 0.001). Annualized post-H3 total costs and part A costs were significantly lower than pre-enrollment costs (total costs of care: −$113 510, 95% CI: −$151 340, −$65 320; <i>p</i> &lt; 0.001; part A costs: −$84 480, 95% CI: −$121 040, −$47 920; <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Longitudinal home-based care models hold promise for improving quality and reducing healthcare spending for HNHC patients with CVD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24302","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141316819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relationship between ambulatory arterial stiffness index and incident atrial fibrillation","authors":"Christopher J. Boos MBBS Dip, IMC, MD, PhD,&nbsp;Aung Hein MBBS, MSc, PGDip (Cardiology),&nbsp;Tom Wardill MBChB, BSc, MRCP,&nbsp;Sadaf Diamondali MBBS, BSc Hons, MRCP,&nbsp;Su Wai MBBS,&nbsp;Peter O'Kane BSc (Hons), MBBS, MD,&nbsp;Ahmed Khattab MBChB, PhD","doi":"10.1002/clc.24299","DOIUrl":"10.1002/clc.24299","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The ambulatory arterial stiffness index (AASI) is an indirect measure of blood pressure variability and arterial stiffness which are atrial fibrillation (AF) risk factors. The relationship between AASI and AF development has not been previously investigated and was the primary aim of this study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was an observational cohort study of adults (aged 18–85 years) in sinus rhythm, who underwent 24-h ambulatory blood pressure monitoring (ABPM) for the diagnosis of hypertension or its control.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eight hundred and twenty-one patients (49% men) aged 58.7 ± 15.3 years were followed up for a median of 4.0 years (3317 patient-years). In total, 75 patients (9.1%) developed ≥1 AF episode during follow-up. The mean AASI was 0.46 ± 0.17 (median 0.46). AASI values (0.52 ± 0.16 vs. 0.45 ± 0.17; <i>p</i> &lt; .001) and the proportion of AASI values above the median (65.3% vs. 48.4%; <i>p</i> = .005) were greater among the patients who developed AF versus those that did not respectively. AASI significantly correlated with age (<i>r</i> = .49; 95% confidence interval: 0.44–0.54: <i>p</i> &lt; .001). On Kaplan–Meier analysis, higher baseline AASI by median, tertiles, and quartiles were all significantly associated with AF development (<i>X</i>²: 10.13; <i>p</i> &lt; .001). On Cox regression analyses, both a 1-standard deviation increase and AASI &gt; median were independent predictors of AF, but this relationship was no longer significant when age was included in the model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>AASI is an independent predictor of AF development. However, this relationship becomes insignificant after adjustment for age which is higher correlated with AASI.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24299","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141316822","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":"Spontaneous coronary artery dissection (SCAD): A contemporary review","authors":"Sophie Offen MD, PhD,&nbsp;Cathevine Yang MD,&nbsp;Jacqueline Saw MD, FRCPC, FACC, FAHA, FSCAI, FSCCT","doi":"10.1002/clc.24236","DOIUrl":"10.1002/clc.24236","url":null,"abstract":"<p>Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of myocardial infarction that most frequently affects younger women, making it an important cause of morbidity and mortality within these demographics. The evolution of intracoronary imaging, improved diagnosis with coronary angiography, and ongoing research efforts and attention via social media, has led to increasing recognition of this previously underdiagnosed condition. In this review, we provide a summary of the current body of knowledge, as well as focused updates on the pathogenesis of SCAD, insights on genetic susceptibility, contemporary diagnostic tools, and immediate, short- and long-term management.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24236","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141300161","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":"PREDICT HF: Risk stratification in advanced heart failure using novel hemodynamic parameters","authors":"Nicole Cyrille-Superville MD,&nbsp;Sriram D. Rao MBBS,&nbsp;Jason P. Feliberti MD,&nbsp;Priyesh A. Patel MD,&nbsp;Kamala Swayampakala PhD,&nbsp;Shashank S. Sinha MD, MSc,&nbsp;Eric I. Jeng MD,&nbsp;Rohan M. Goswami MD,&nbsp;David F. Snipelisky MD,&nbsp;Aubrie M. Carroll MD,&nbsp;Samer S. Najjar MD,&nbsp;Mark Belkin MD,&nbsp;Jonathan Grinstein MD, FACC,&nbsp;the FLIGHT Working Group","doi":"10.1002/clc.24277","DOIUrl":"https://doi.org/10.1002/clc.24277","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Invasive hemodynamics are fundamental in assessing patients with advanced heart failure (HF). Several novel hemodynamic parameters have been studied; however, the relative prognostic potential remains ill-defined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>Advanced hemodynamic parameters provide additional prognostication beyond the standard hemodynamic assessment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients from the PRognostic Evaluation During Invasive CaTheterization for Heart Failure (PREDICT-HF) registry who underwent right heart catheterization (RHC) were included in the analysis. The primary endpoint was survival to orthotopic heart transplant (OHT) or durable left ventricular assist device (LVAD), or death within 6 months of RHC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 846 patients included, 176 (21%) met the primary endpoint. In a multivariate model that included traditional hemodynamic variables, pulmonary capillary wedge pressure (PCWP) (OR: 1.10, 1.04−1.15, <i>p</i> &lt; .001), and cardiac index (CI) (OR: 0.86, 0.81−0.92, <i>p</i> &lt; .001) were shown to be predictive of adverse outcomes. In a separate multivariate model that incorporated advanced hemodynamic parameters, cardiac power output (CPO) (OR: 0.76, 0.71−0.83, <i>p</i> &lt; .001), aortic pulsatility index (API) (OR: 0.94, 0.91−0.96, <i>p</i> &lt; .001), and pulmonary artery pulsatility index (OR: 1.02, 1.00−1.03, <i>p</i> .027) were all significantly associated with the primary outcome. Positively concordant API and CPO afforded the best freedom from the endpoint (94.7%), whilst negatively concordant API and CPO had the worst freedom from the endpoint (61.5%, <i>p</i> &lt; .001). Those with discordant API and CPO had similar freedom from the endpoint.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The advanced hemodynamic parameters API and CPO are independently associated with death or the need for OHT or LVAD within 6 months. Further prospective studies are needed to validate these parameters and elucidate their role in patients with advanced HF.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24277","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141251482","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":"Plasma triglyceride is associated with the recurrence of atrial fibrillation after radiofrequency catheter ablation: A retrospective study","authors":"Qingqing Gu MD,&nbsp;Ye Deng MD,&nbsp;Jun Wei MD,&nbsp;Qianwen Chen MD,&nbsp;Dabei Cai MD,&nbsp;Tingting Xiao MD,&nbsp;Li Deng MD,&nbsp;Yu Wang MD,&nbsp;Qingjie Wang MD, PhD,&nbsp;Ling Sun MD,&nbsp;Yuan Ji MD","doi":"10.1002/clc.24276","DOIUrl":"10.1002/clc.24276","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The purpose of this study was to explore the association between triglycerides (TGs) and the risk of atrial fibrillation (AF) recurrence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>Included were adult patients with AF who underwent radiofrequency catheter ablation in the Affiliated Changzhou Second People's Hospital of Nanjing Medical University. The enrolled patients were divided into the AF recurrence group and the sinus rhythm (SR) maintenance group. The univariate Cox regression analysis and Kaplan–Meier survival curve were performed estimate the association between TG and the risk of AF recurrence. Of the 402 patients, 79 (19.7%) experienced recurrence of AF after ablation. The TG level was significantly higher in the AF recurrence group than in the SR-maintaining group. Patients were grouped by quartile of TG levels, with Quartile 1 and Quartile 2 defined as the low concentration group, Quartile 3 as the moderate concentration group, and Quartile 4 as the high concentration group. Multivariate Cox regression analysis showed that the moderate concentration group (<i>p</i> = .02, hazard ratio [HR]: 2.331, 95% confidence interval [CI]: 1.141–4.762) and high concentration group (<i>p</i> = .007, HR: 2.873, 95% CI: 1.332–6.199) were associated with an increased risk of AF recurrence compared with the low concentration group. The median follow-up was 1.17 years, it is indicated that a higher risk of recurrent AF was observed in the moderate concentration and high concentration group (log-rank: <i>χ</i>² = 7.540, <i>p</i> = .023).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our data suggest that an elevated TG level measured before catheter ablation is associated with an increased risk of AF recurrence.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24276","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141175132","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 of ultra-low contrast coronary angiography in patients with acute kidney injury","authors":"Zach Rozenbaum MD,&nbsp;Mailing Flores Chang MD,&nbsp;Jose Wiley MD, MPH,&nbsp;Ali Gholam MD,&nbsp;Anand Irimpen MD,&nbsp;Ali A. Alsaad MD","doi":"10.1002/clc.24282","DOIUrl":"10.1002/clc.24282","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Ultra-low contrast administration during coronary angiography has been previously shown to be feasible and safe among patients with stable chronic kidney disease. In the present study, we investigate the safety of ultra-low contrast coronary angiography in patients with pre-existing acute kidney injury (AKI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study was a retrospective single-center evaluation of hospitalized patients who had AKI and required coronary angiography. Ultra-low contrast use was defined as ≤18 mL of contrast media.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The cohort consisted of a case series of eight inpatients with AKI who required coronary angiography. The mean age was 57 (±16) years and half were females. All patients had chronic kidney disease with a mean baseline estimated glomerular filtration rate of 34 (±17) mL/min/1.73 m². The mean creatinine before angiography was 3 (±1) mg/dL and volume of contrast administered was 14 (±4) mL. One patient had a 0.1 mg/dL increase in creatinine during admission, and no patients had further AKI up to 1-week postprocedure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The current data suggest that ultra-low contrast coronary angiography can be safely performed in patients with pre-existing AKI The study should be viewed as hypothesis-generating due to its small sample size. A larger cohort is required to validate the results.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24282","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141154909","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 demonstrate the prognostic impact of interdialytic home blood pressure variability in dialytic patients","authors":"Nanako Marubayashi,&nbsp;Kota Kakeshita MD,&nbsp;Teruhiko Imamura MD, PhD","doi":"10.1002/clc.24279","DOIUrl":"10.1002/clc.24279","url":null,"abstract":"<p>Dong et al.<span>¹</span> investigated the prognostic impact of interdialytic home blood pressure variability (BPV) in individuals undergoing maintenance hemodialysis. They demonstrated that an incremental interdialytic home BPV was associated with mortality in this cohort. Several concerns have been raised.</p><p>In the authors' study, home blood pressure was recorded four times a day for a week on a nondialysis day and their variability was calculated.<span>¹</span> Another concern is the prognostic impact of intraday BPV during a day or interday BPV during several days.</p><p>Blood pressure recorded either predialysis or postdialysis displays a U-shaped curve with mortality among dialysis patients.<span>²</span> In the authors' study, they did not adjust for systolic blood pressure to evaluate the prognostic impact of BPV.<span>¹</span> Patients with low systolic blood pressure may have incremental mortality even though they have high BPV.</p><p>Incremental BPV was associated with not only cardiac death but also all-cause death.<span>¹</span> Could the authors state detailed causes of noncardiac death? Also, an incremental number of dialysis patients are found to have severe aortic stenosis, which can be treated by transcatheter aortic valve replacement, if applicable.<span>³</span> The prevalence of such diseases may increase as incremental BPV. Did the authors' patients have any valvular diseases?</p><p>Accurate measurement of blood pressure is challenging in patients with atrial fibrillation. However, the prevalence of atrial fibrillation is high in dialysis patients.<span>⁴</span> Atrial fibrillation is associated with mortality and morbidity. The indication of anti-coagulants in dialysis patients with atrial fibrillation is controversial. Moreover, percutaneous left atrial appendage closure in this cohort has recently become available with acceptable feasibility.<span>⁵</span> Do the authors have any individuals with atrial fibrillation?</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24279","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141075471","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":"Predicting the risk of mortality and rehospitalization in heart failure patients: A retrospective cohort study by machine learning approach","authors":"Reza Tabrizi PHD,&nbsp;Marzieh Ketabi MSc,&nbsp;Aref Andishgar MD,&nbsp;Mohebat Vali PHD,&nbsp;Zhila Fereidouni PHD,&nbsp;Maryam Mojarrad Sani MD-MPH,&nbsp;Ashkan Abdollahi MD,&nbsp;Abdulhakim Alkamel MD","doi":"10.1002/clc.24280","DOIUrl":"10.1002/clc.24280","url":null,"abstract":"<p>We welcome and appreciate the comments raised by Nabi et al. related to our recent publication “Predicting the risk of mortality and rehospitalization in heart failure patients: A retrospective cohort study by machine learning approach.”<span>¹</span> In this article, we used machine learning algorithms to predict mortality and readmission among heart failure patients has the potential to significantly improve patient care and outcomes. Our emphasis on the importance of early detection of high-risk heart failure patients through machine learning models aligns with the current trend toward personalized and patient-centered healthcare. By using predictive analytics, clinicians can identify individuals at risk of adverse events and provide tailored interventions, ultimately leading to better patient outcomes.</p><p>In response to the comments raised in this letter, we present a few clarifications here. The study evaluated the performance of various machine learning algorithms in predicting heart failure outcomes and provided valuable insights into the potential of AI in healthcare. The identification of important predictors such as length of hospital stay, hemoglobin levels, and family history of MI highlights the significance of these factors in predicting readmission and mortality among heart failure patients.</p><p>As we have previously mentioned, you also discussed the limitations of the study, including the necessity for prospective studies to address potential selection bias and broader geographical studies to enhance the generalizability of the findings.<span>²</span> These aspects highlight the bias that is inherent in observational studies and is not within our control.</p><p>In conclusion, integrating machine learning to predict heart failure outcomes offers a promising way to enhance patient care, optimize resource allocation, and reduce healthcare costs. Continued research and implementation of AI-based predictive models in various geographical locations have the potential to revolutionize the management of heart failure and improve patient outcomes globally.</p><p>Future studies should be conducted prospectively to confirm the generalizability of these machine learning algorithms. Additionally, other advanced artificial intelligence models can be used in future studies that can improve the management of heart failure patients.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24280","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141064402","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}