Clinical Cardiology最新文献

{"title":"Comparative Efficacy and Safety of Clevidipine Versus Nicardipine in Hypertensive Emergencies: A Systematic Review and Meta-Analysis","authors":"Tahir Ullah,&nbsp;Hamed Khan,&nbsp;Anfal Khan,&nbsp;Syed Asad Ullah Agha,&nbsp;Aleena Amir Malik,&nbsp;Aieman Naeem,&nbsp;Hamza Nasir,&nbsp;Abdul Qayum Khan,&nbsp;Muhammad Zaib,&nbsp;Kashif Yousaf","doi":"10.1002/clc.70419","DOIUrl":"https://doi.org/10.1002/clc.70419","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hypertensive emergencies require prompt blood pressure reduction to prevent acute target-organ damage. Clevidipine and nicardipine are commonly used intravenous dihydropyridine calcium channel blockers, but their comparative efficacy and safety remain uncertain. We performed a systematic review and meta-analysis comparing clinical outcomes associated with clevidipine versus nicardipine.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>PubMed, the Cochrane Library, and ClinicalTrials.gov were searched from inception through July 3, 2026. Comparative studies evaluating intravenous clevidipine and nicardipine in adults requiring acute systolic blood pressure (SBP) control were included. Primary outcomes were time to target SBP and percentage of time within the target SBP range. Secondary outcomes included intensive care unit (ICU) and hospital length of stay, infusion drug volume, hypotension, tachycardia, acute kidney injury, rescue antihypertensive therapy, and in-hospital mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Nine studies involving 1378 patients (eight retrospective cohort studies and one randomized controlled trial) were included. No significant differences were observed between clevidipine and nicardipine in time to target SBP, percentage of time within the target SBP range, ICU or hospital length of stay, hypotension, tachycardia, acute kidney injury, rescue antihypertensive therapy, or in-hospital mortality. Subgroup analyses demonstrated significantly faster target SBP attainment with clevidipine in stroke/neurocritical care and general hypertensive crisis populations. Clevidipine was associated with significantly lower infusion drug volume.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Clevidipine and nicardipine demonstrate comparable efficacy and safety for hypertensive emergencies. Although clevidipine achieved lower infusion volumes and faster target SBP attainment in subgroup analyses, no consistent overall clinical superiority was observed. Larger randomized trials are needed to confirm these findings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70419","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148467493","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":"Tricuspid Regurgitation After Leadless Pacemaker Implantation: The Role of Atrioventricular Synchrony","authors":"Zachary Alvis Seal,&nbsp;Debanshu Roy,&nbsp;Jorge Alejandro Irizarry Caro,&nbsp;Ivan Alfredo Mijares Rojas,&nbsp;Osamah Basil Ibrahim Altaee,&nbsp;Binish Qureshi,&nbsp;Tam Nguyen,&nbsp;Robert Chilton","doi":"10.1002/clc.70413","DOIUrl":"https://doi.org/10.1002/clc.70413","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Tricuspid regurgitation (TR) is a recognized complication of cardiac implantable electronic devices (CIEDs), driven by both mechanical lead interference and pacing-induced dyssynchrony. Leadless pacemakers eliminate transvalvular leads; however, the role of atrioventricular (AV) synchrony in mitigating TR progression remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This narrative review was informed by a structured literature search of PubMed, EMBASE, and the Cochrane Library through June 2025 using the search terms “leadless pacemaker,” “Micra,” “tricuspid regurgitation,” “atrioventricular synchrony,” and “conduction system pacing.” Original studies, systematic reviews, and major guideline or review articles relevant to leadless pacing and TR were considered. Articles were selected based on relevance to the review objectives rather than predefined systematic review criteria. Formal risk-of-bias assessment or quality appraisal was not performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Leadless pacemakers generally demonstrate neutral effects on TR severity compared with baseline, although worsening of TR has been reported in approximately 9%–33% of patients across observational studies. Available evidence suggests that loss of AV synchrony is associated with TR progression independent of device type; however, pacing-associated TR is multifactorial and likely also reflects ventricular dyssynchrony, right ventricular pacing burden, papillary muscle discoordination, right ventricular dysfunction, and progressive right-heart remodeling. Direct comparative data evaluating Micra AV versus Micra VR with respect to TR outcomes remain unavailable.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>AV synchrony is biologically plausible for mitigating TR progression, but direct comparative evidence between Micra AV and Micra VR is lacking. Emerging dual-chamber leadless systems may improve preservation of AV synchrony while maintaining the advantages of leadless pacing, although their long-term effects on TR remain to be established. Prospective studies incorporating standardized echocardiographic endpoints are needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70413","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148467378","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":"Long-Term Follow-up After Percutaneous Coronary Interventions for Chronic Total Occlusions","authors":"Rémi Arnold,&nbsp;Richard Gervasoni,&nbsp;Bertrand Ledermann,&nbsp;Lionel Moulis,&nbsp;Sonia Soltani,&nbsp;Benoit Lattuca,&nbsp;Pierre Robert,&nbsp;Florence Leclercq","doi":"10.1002/clc.70414","DOIUrl":"https://doi.org/10.1002/clc.70414","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Percutaneous coronary interventions (PCI) for chronic total occlusions (CTO) remain challenging procedures with controversial long-term clinical benefits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted an observational monocentric study including consecutive patients who underwent PCI for CTO by experienced operators in a French University Hospital between January 2015 and December 2022. All patients had symptoms and/or proven myocardial ischemia. Patients were divided into two groups based on PCI success or failure. The primary endpoint was the occurrence of MACE, defined as the composite of cardiac death, non-fatal myocardial infarction, and target vessel revascularization up to 8 years of follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 448 patients who underwent a CTO-PCI, 401 (89.5%) had a successful procedure, while 47 (10.5%) experienced a failed intervention. During a mean follow-up of 3.7 years, MACE occurred in 71 patients (15.8%), including 12 patients (25.5%) in the failed group and 59 patients (14.7%) in the successful group (HR 2.68 [1.42; 5.06]; <i>p</i> &lt; 0.01). While both groups had similar baseline clinical risk profiles, the failed CTO-PCI group had a lower overall survival rate (74.5% vs. 88.8%; HR 2.23 [1.17; 4.27]; <i>p</i> = 0.02). The successful CTO-PCI group showed significant improvements in left ventricular ejection fraction (LVEF) (<i>p</i> &lt; 0.01) and NYHA class (<i>p</i> &lt; 0.01). The J-CTO score was the only predictor of procedural failure (1.96 [1.44; 2.67]; <i>p</i> &lt; 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Failed CTO-PCI was associated with increased incidence of MACE. LVEF and NYHA class was improved in successful CTO-PCI, supporting the pursuit of this procedure in selected cases.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70414","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148467377","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 Association of Hypertension Based on Systolic and Diastolic Blood Pressure (SBP and DBP) With Dental Visits in the Population Aged 45 and Older: Cross-Section Study Results From the China Health and Retirement Longitudinal Study (CHARLS)","authors":"Man Ao,&nbsp;Wei Li,&nbsp;Shiyi Luo,&nbsp;Jukun Song,&nbsp;Xuanyan Gu,&nbsp;Jiangling Sun,&nbsp;Zhu Chen","doi":"10.1002/clc.70406","DOIUrl":"10.1002/clc.70406","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Systemic diseases increasingly complicate oral treatment, particularly in hypertensive patients requiring comprehensive care. Using nationally representative cross-sectional data, this study investigated the association between hypertension and oral health in Chinese adults aged ≥ 45 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were drawn from the 2013 and 2015 CHARLS, including 4770 participants aged ≥ 45 years. Linear and logistic regression examined blood pressure–oral disease associations, with systolic/diastolic pressure first as continuous, then categorical variables. Curve fitting and restricted cubic splines further validated the cross‑sectional associations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 4770 participants were included in this study, including 1568 patients with hypertension. The characteristics of the hypertensive population are married elderly men who enjoy smoking and drinking, suffer from other chronic diseases, and low to moderate level of self-reported health. Logistic regression revealed positive associations of systolic and diastolic blood pressure with dental visits, and a stable positive correlation between hypertension and dental visits persisted across multiple adjustment models, further validated by curve fitting and restricted cubic spline analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Hypertension is significantly and positively associated with oral health issues in a nationally representative sample of middle-aged and older Chinese adults. Healthcare providers should prioritize integrated blood pressure and oral health management in this population to mitigate the mutual exacerbation of chronic diseases.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70406","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410846","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 Barthel Index in Predicting Response to Cardiac Resynchronization Therapy and Clinical Outcomes in Patients With Heart Failure","authors":"Kailun Zhu,&nbsp;Haojie Zhu,&nbsp;Xiaofei Li,&nbsp;Jiawei Chen,&nbsp;Dingkun Lu,&nbsp;Xiaohan Fan","doi":"10.1002/clc.70389","DOIUrl":"10.1002/clc.70389","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cardiac resynchronization therapy (CRT) response in heart failure (HF) patients is multifactorial, with limited data on its association with activities of daily living assessed by the Barthel index (BI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This prospective observational study investigated the predictive value of BI for CRT response and long-term clinical outcomes in non-ischemic HF patients with left bundle branch block (LBBB).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 271 consecutive non-ischemic HF patients undergoing CRT with left ventricular ejection fraction (LVEF) ≤ 35% and LBBB were enrolled. BI was evaluated pre-implantation. The primary endpoint was CRT response (absolute LVEF improvement ≥ 5% at 6 months). The secondary composite endpoint included all-cause mortality and HF hospitalization (HFH).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 249 patients completing 6-month follow-up, the CRT response rate was 68.67%. Multivariate logistic regression identified BI (per 5-point increment; OR = 1.37, 95% CI:1.12−1.67, <i>p</i> = 0.002) as an independent predictor of CRT response, with an optimal cutoff of 95. Combining BI with left ventricular end-diastolic diameter and left bundle branch area pacing achieved the highest predictive efficacy (AUC = 0.78). Over a median 33.94-month follow-up, BI &gt; 95 was associated with an 88% reduced risk of the composite endpoint (adjusted HR = 0.116, <i>p</i> &lt; 0.001), driven primarily by marked HFH reduction. A non-significant trend toward lower all-cause mortality was observed, accompanied by sustained LVEF improvement (29.81% ± 5.01% to 51.71% ± 11.30%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>BI might be a simple, cost-effective independent predictor for CRT response and improved LVEF and prognosis in non-ischemic HF patients with LBBB.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70389","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410864","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 Association Between Bending Photoplethysmography Waveform Area Index and Congestive Heart Failure","authors":"Xianghui Zeng,&nbsp;Qingfeng Zeng,&nbsp;Chunqing Xiao,&nbsp;Hengqing Zhu,&nbsp;Jianping Luo","doi":"10.1002/clc.70400","DOIUrl":"10.1002/clc.70400","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Congestive heart failure (CHF) is closely associated with a decrease in cardiac output, and photoplethysmography (PPG) parameters can experimentally assess cardiac output. It is unclear whether there is an association between the change of bending photoplethysmography waveform area index (BPWAI) due to postural changes and CHF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We enrolled patients with suspected CHF. Patients completed physical examination, echocardiography, and pro-brain natriuretic peptide (NT-proBNP) test during their visit, and finger-end PPG waveform area was measured in the sitting and bending positions using PPG. We then used logistic regression to analyze the association between BPWAI and CHF, and the receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to assess the event risk association strength.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 523 patients with suspected CHF were included in this study, of whom 291 (55.6%) had a final diagnosis of CHF. The association between BPWAI and CHF decreased 0.45-fold for per 1 standard deviation increase in BPWAI (OR: 0.55 [95% CI, 0.44−0.68]). The AUC for BPWAI associated with CHF was 0.736 (95% CI, 0.689−0.782), with a corresponding sensitivity of 67.4% and specificity of 71.5%, and a cut-off value of 0.85 for the diagnosis of CHF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>When patients bend over, their PPG waveform area decreases, which is closely associated with patients with CHF. BPWAI is significantly associated with CHF and may serve as a potential associated indicator for CHF.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70400","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410880","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":"Beyond Rural Versus Urban: Referral Pathways and Structural Heart Programs May Influence Outcomes After Left Atrial Appendage Occlusion","authors":"Teruhiko Imamura","doi":"10.1002/clc.70412","DOIUrl":"10.1002/clc.70412","url":null,"abstract":"&lt;p&gt;I read with great interest the article, evaluating inpatient outcomes following left atrial appendage occlusion (LAAO) in rural versus urban hospitals across the United States [&lt;span&gt;1&lt;/span&gt;]. The adjusted inpatient mortality and complication rates following LAAO were comparable despite substantial differences in procedural volume. Several concerns have been raised.&lt;/p&gt;&lt;p&gt;Referral pathways may substantially influence the observed comparison between rural versus urban hospitals. Patients undergoing LAAO at rural hospitals may represent a carefully selected population with relatively straightforward anatomy and lower anticipated procedural complexity, whereas patients with challenging left atrial appendage morphology, multiple comorbidities, or greater procedural risk may be preferentially referred to tertiary urban centers [&lt;span&gt;2&lt;/span&gt;]. Consequently, hospital location may partly represent differences in referral patterns rather than intrinsic differences in procedural performance. This possibility may also explain why unadjusted complication rates were numerically higher in urban hospitals despite their greater procedural experience. Future studies evaluating referral networks, interhospital transfer patterns, or characteristics of patients referred from rural to urban institutions may provide valuable insight into this issue.&lt;/p&gt;&lt;p&gt;The higher frequency of discharge to acute care facilities among rural patients deserves additional discussion [&lt;span&gt;1&lt;/span&gt;]. Although inpatient mortality and procedural complications were comparable after adjustment [&lt;span&gt;1&lt;/span&gt;], the greater need for transfer following discharge may represent differences in post-procedural care pathways rather than differences in procedural safety. Rural hospitals may appropriately perform LAAO while relying on affiliated facilities for continued monitoring, rehabilitation, or management of complex comorbid conditions [&lt;span&gt;3&lt;/span&gt;]. Accordingly, discharge disposition may reflect regional organization of healthcare delivery and resource allocation rather than adverse procedural outcomes alone. Understanding these post-procedural care pathways may be pivotal when evaluating equity in structural heart disease care.&lt;/p&gt;&lt;p&gt;The comparison based solely on rural versus urban hospital location may not fully capture institutional expertise in contemporary LAAO practice. LAAO has increasingly become integrated into comprehensive structural heart disease programs alongside trans-catheter aortic valve replacement, trans-catheter mitral interventions, and other advanced catheter-based interventions. The availability of multidisciplinary heart-valve teams, dedicated cardiac imaging specialists, standardized patient selection protocols, and experienced peri-procedural support may have a greater influence on clinical outcomes than geographic location itself [&lt;span&gt;4&lt;/span&gt;]. Future investigations incorporating measures of structural heart program maturity or multidisciplinary infrast","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70412","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148396094","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":"Comparing Ferric Carboxymaltose Versus Iron Sucrose in Patients with Heart Failure","authors":"Kazuhiko Kido","doi":"10.1002/clc.70405","DOIUrl":"10.1002/clc.70405","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Limited evidence comparing different intravenous (IV) iron products is available to guide the optimal IV iron product in patients with heart failure (HF) and iron deficiency (IDef).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To compare ferric carboxymaltose (FCM) with iron sucrose in patients with HF with reduced or mildly reduced ejection fraction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center retrospective cohort study included patients with HF with reduced or mildly reduced ejection fraction and IDef who received either FCM or iron sucrose. The primary outcome was IDef therapy goal achievement (defined as ferritin 100–300 mcg/L and iron saturation &gt; 20%; ferritin &gt; 300 mcg/L; or hemoglobin &gt; 15 mg/dL regardless of iron study).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 78 patients in the FCM group and 21 in the iron sucrose group were included. The use of FCM was significantly associated with a higher rate of IDef treatment goal achievement after the induction course than iron sucrose (70.1 vs. 41.2%, <i>p</i> = 0.026). After adjusting for multiple variables, FCM use was significantly associated with a higher rate of the primary outcome than iron sucrose (adjusted OR 5.8 [95% CI 1.3-26.1], <i>p</i> = 0.022). No significant difference in adherence to the IV iron criteria was found between the two groups (80.8 vs. 81.0%, <i>p</i> = 0.985).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Ferric carboxymaltose use was associated with a higher iron repletion rate than iron sucrose in patients with HF with reduced or mildly reduced ejection fraction and IDef.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70405","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148396032","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":"Associations of the C-Reactive Protein−Albumin−Lymphocyte Index, Red Cell Distribution Width−Albumin Ratio, and Blood Urea Nitrogen−Albumin Ratio With All-Cause and Cardiovascular Mortality Among Adults With Preclinical Heart Failure","authors":"Huifang Su,&nbsp;Xiandong Liu","doi":"10.1002/clc.70401","DOIUrl":"10.1002/clc.70401","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Preclinical heart failure (PHF) is an early stage in the heart failure continuum, yet practical indices for mortality risk assessment remain understudied.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>The C-reactive protein–albumin–lymphocyte index (CALLY), red cell distribution width–albumin ratio (RAR), and blood urea nitrogen–albumin ratio (BAR) are associated with mortality and provide additional predictive information among adults with PHF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed adults aged ≥ 20 years with PHF from the National Health and Nutrition Examination Survey (NHANES) 1999–2010. PHF was defined by hypertension, diabetes, obesity, atherosclerotic cardiovascular disease, or prior myocardial infarction, without diagnosed heart failure. The indices were derived from baseline laboratory measurements and log-transformed. Mortality was ascertained through December 31, 2019. Associations were assessed using survey-weighted Cox models; nonlinearity, subgroup consistency across different PHF compositions, incremental predictive performance, and sensitivity analyses, including competing-risk models, were evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 14 717 adults with PHF contributing 186 678.5 person-years, 3801 all-cause and 1226 cardiovascular deaths occurred. Per standard deviation increase, ln CALLY was associated with lower all-cause and cardiovascular mortality (HRs, 0.85 and 0.87), whereas ln RAR (HRs, 1.28 and 1.24) and ln BAR (HRs, 1.09 and 1.18) were associated with higher mortality. ln RAR showed the most consistent improvement in exploratory incremental predictive performance beyond the base model. The directions of association were broadly consistent across different PHF compositions, and the findings remained robust in sensitivity analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CALLY, RAR, and BAR were independently associated with mortality in adults with PHF; RAR may improve mortality risk assessment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70401","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148389979","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":"Does Serum γKlotho Truly Provide Incremental Prognostic Value Beyond Established Risk Predictors in Multivessel Coronary Artery Disease?","authors":"Mustafa Tunahan Öz,&nbsp;Umut Şahin,&nbsp;Adnan Kaya","doi":"10.1002/clc.70410","DOIUrl":"10.1002/clc.70410","url":null,"abstract":"&lt;p&gt;We read with great interest the recently published study by Naman et al. evaluating serum γKlotho as a prognostic biomarker and incorporating it into a nomogram for predicting long-term major adverse cardiovascular events (MACEs) in patients with multivessel coronary artery disease (MVD). The authors should be congratulated for assembling a relatively large cohort with both internal and external validation and for exploring an emerging biomarker that has received limited attention in cardiovascular medicine. Their work represents an important step toward identifying novel biological pathways associated with adverse outcomes in patients with complex coronary artery disease [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Nevertheless, we believe that one important issue deserves further discussion before serum γKlotho can be considered clinically useful as a prognostic biomarker.&lt;/p&gt;&lt;p&gt;Although γKlotho remained independently associated with MACEs after multivariable Cox regression and improved the discrimination of the proposed nomogram, the study did not determine whether γKlotho provides meaningful incremental prognostic information beyond conventional clinical variables already used in routine cardiovascular risk assessment. Demonstrating statistical significance within a multivariable model is not equivalent to demonstrating clinical usefulness [&lt;span&gt;2, 3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Current recommendations for biomarker evaluation emphasize that a novel marker should improve risk prediction beyond established clinical models. In addition to receiver operating characteristic analysis and C-index assessment, contemporary studies are encouraged to evaluate metrics such as the Net Reclassification Improvement (NRI), Integrated Discrimination Improvement (IDI), and likelihood ratio testing. These analyses determine whether the addition of a new biomarker meaningfully reclassifies patients into more appropriate risk categories and provides clinically actionable information rather than merely statistical significance.&lt;/p&gt;&lt;p&gt;Another consideration relates to the biological interpretation of γKlotho. Unlike α-Klotho, whose cardiovascular protective properties have been extensively investigated, γKlotho remains poorly characterized in cardiovascular disease. The present study interprets elevated circulating γKlotho as a marker of poor prognosis; however, it remains uncertain whether increased concentrations represent a causal pathogenic mechanism, a compensatory response to oxidative stress, or simply an epiphenomenon reflecting greater disease severity. Consequently, before incorporating γKlotho into clinical risk prediction models, mechanistic studies are required to clarify its biological role within ischemic cardiovascular disease [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Furthermore, the reported nomogram contains traditional predictors including age, diabetes mellitus, LDL cholesterol, left ventricular dimensions, and antiplatelet therapy, all of which already possess well-established prognostic val","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70410","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148390001","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}