Clinical Cardiology最新文献

{"title":"Right Ventricular Systolic Dysfunction Predicts Recovery of Left Ventricular Systolic Function and Reduced Quality of Life in Patients With Arrhythmia-Induced Cardiomyopathy","authors":"Thomas Körtl,&nbsp;Franziska Mühleck,&nbsp;Paul Baum,&nbsp;Markus Resch,&nbsp;Christine Meindl,&nbsp;Ekrem Üçer,&nbsp;Lars S. Maier,&nbsp;Rolf Wachter,&nbsp;Samuel Sossalla,&nbsp;Christian Schach","doi":"10.1002/clc.70070","DOIUrl":"https://doi.org/10.1002/clc.70070","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Arrhythmia-induced cardiomyopathy (AIC) is an underrecognized condition resulting in left ventricular systolic dysfunction (LVSD) that is primarily caused by atrial fibrillation (AFib). The relationship between AIC, right ventricular (RV) function, and quality of life (QoL) has not been well studied.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a post-hoc analysis of our AIC trial in which we prospectively screened for patients with tachyarrhythmia and newly diagnosed, otherwise unexplained LVSD. Following rhythm restoration, patients were followed up at 2, 4, and 6 months. Only patients with persistent sinus rhythm were analyzed. RV function was assessed via echocardiography (tricuspid annular plane systolic excursion [TASPE] and fractional area change [FAC]) and QoL by the Minnesota Living with Heart Failure Questionnaire.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of a total of 50 patients recovering from LVSD, 41 were diagnosed with AIC and 9 with non-AIC. Initially, RV function was reduced in the AIC group and recovered after rhythm restoration, whereas no relevant changes were noted in the non-AIC group. QoL was reduced in both groups and also improved after rhythm restoration. Regression analysis identified low TAPSE as a predictive parameter for AIC diagnosis and worse QoL in AIC patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We demonstrated that RV function and QoL are impaired in patients with AIC. Six months after rhythm restoration, TAPSE may serve as an early indicator of AIC while also correlating with QoL. This underscores the importance of detailed echocardiographic evaluation with a focus on RV function in patients with concomitant tachyarrhythmia and LVSD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70070","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466280","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 Neutrophil-to-Lymphocyte Ratio Is an Independent Inflammatory Biomarker for Adverse Events in Patients With Atrial Fibrillation: Insights From the Murcia AF Project II (MAFP-II) Cohort Study","authors":"Eva Soler-Espejo,&nbsp;Francisco Marín,&nbsp;Raquel López-Gálvez,&nbsp;María Pilar Ramos-Bratos,&nbsp;María Sánchez-Villalobos,&nbsp;María Asunción Esteve-Pastor,&nbsp;Gregory Y. H. Lip,&nbsp;José Miguel Rivera-Caravaca,&nbsp;Vanessa Roldán","doi":"10.1002/clc.70102","DOIUrl":"https://doi.org/10.1002/clc.70102","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Systemic inflammation plays a central role in atrial fibrillation (AF). The neutrophil-to-lymphocyte ratio (NLR) is a simple hematological index that has been shown to be associated with prognosis in different pathologies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>The NLR is associated with an increased risk of adverse events in patients with AF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included a prospective cohort of AF patients who started vitamin K antagonists (VKAs) therapy between July 2016 and June 2018. NLR was assessed at baseline and classified into three categories: low (&lt; 3), moderate (3–5), and high (&gt; 5). During a 2-year follow-up period, all cardiovascular deaths, all-cause deaths, and net clinical outcomes (NCO; either ischemic stroke/transient ischemic attack, major bleeding or all-cause death), were recorded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1050 patients were included (51.4% women; median age 77 years). NLR was available in 936 patients: 507 (54.2%) had low NLR (&lt; 3), 239 (25.5%) had moderate NLR (3–5), and 190 (20.3%) had high NLR (&gt; 5). The primary endpoint was significantly increased in the high NLR category (<i>p</i> = 0.002 for cardiovascular death; <i>p</i> &lt; 0.001 for all-cause mortality, and <i>p</i> &lt; 0.001 for NCO), with higher IRRs (all <i>p</i> &lt; 0.001). Multivariate Cox regression analyses showed that high NLR was independently associated with an increased risk of cardiovascular death (aHR: 2.02; 95% CI: 1.04–3.92), all-cause mortality (aHR: 2.51; 95% CI: 1.58–3.97), and NCO (aHR: 1.99; 95% CI: 1.37–2.87), compared to low NLR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this prospective AF cohort receiving VKAs, elevated NLR was significantly associated with an increased risk of adverse clinical outcomes. NLR has independent prognostic value beyond other classical risk factors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70102","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466281","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 Scoring Model to Predict ICU Stay and Mortality After Emergency Admissions in Atrial Fibrillation: A Retrospective Study of 30 366 Patients","authors":"Tao Hong,&nbsp;Jian Huang,&nbsp;Jiewen Deng,&nbsp;Lirong Kuang,&nbsp;Mengyan Sun,&nbsp;Qianqian Wang,&nbsp;Chao Luo,&nbsp;Jikai Zhao,&nbsp;Xiaozhu Liu,&nbsp;Huishan Wang","doi":"10.1002/clc.70101","DOIUrl":"https://doi.org/10.1002/clc.70101","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The rapid assessment of the conditions is crucial for the prognosis of atrial fibrillation (AF) patients admitted to the emergency department (ED). We aim to derive and validate a more accurate and simplified scoring model to optimize the triage of AF patients in the ED.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We conducted a retrospective study using data from the Medical Information Mart for Intensive Care (MIMIC-IV) database and developed scoring models employing the Random Forest algorithm. The area under the receiver operating characteristic (ROC) curve (AUC) was used to measure the performance of the prediction for intensive care unit (ICU) stay, and the death likelihood within 3, 7, and 30 days following the ED admission.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 30 366 AF patients, randomly divided into training, validation, and testing cohorts at a 7:1:2 ratio. The training set consisted of 21 257 patients, the validation set included 3036 patients, and the remaining 6073 patients were classified as the validation set. Among the cohorts, 9594 patients (32%) required ICU transfers, with mortality rates of 1% at 3 days, 3% at 7 days, and 6% at 30 days. In the testing set, the scoring models demonstrated strong discriminative ability with AUCs of 0.724 for ICU stay, 0.782 for 3-day mortality, 0.755 for 7-day mortality, and 0.767 for 30-day mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We derived and validated novel simplified scoring models with good discriminative performance to predict the likelihood of ICU stay, 3-day, 7-day, and 30-day death in AF patients after ED admission.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70101","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143455753","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":"Management of Echocardiography Requests for the Detection and Follow-Up of Heart Valve Disease: A Consensus Statement From the British Heart Valve Society","authors":"John Chambers,&nbsp;Benoy N. Shah,&nbsp;Madalina Garbi,&nbsp;Brian Campbell,&nbsp;Vassilios S. Vassiliou,&nbsp;Dominik Schlosshan","doi":"10.1002/clc.70099","DOIUrl":"https://doi.org/10.1002/clc.70099","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In the aftermath of the Covid19 pandemic and lockdowns, there has been a growing population awaiting transthoracic echocardiograms for potential valvular heart disease. Conducting comprehensive echocardiograms for all individuals may no longer be practical, leading to substantial delays in obtaining the necessary scans. This paper explores an alternative approach, suggesting the consideration of dedicated and shorter scans specifically for patients suspected of having valvular heart disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>To address the increasing waiting times and improve heart valve disease detection, the British Heart Valve Society recommends a tiered approach to echocardiograms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This approach includes basic/level 1, focused, minimum standard, and disease-specific scans. Urgency recommendations vary, with individuals experiencing exertional chest pain or pre-syncope requiring prompt scanning within 2 weeks, ideally at a valve clinic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients without known valve disease but with a murmur and stable breathlessness should be scanned as soon as possible, within a maximum of 6 weeks, balancing local demand and capacity. For those with an asymptomatic murmur and no prior scan, a basic/level 1 study is recommended to triage the necessity for a minimum standard study. Emphasizing appropriate triage for all requests, the statement guides decisions on the necessity for echocardiography, urgency level, and the required scan type.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This practical Consensus Statement from the British Heart Valve Society aims to support appropriate shorter transthoracic echocardiography for patients referred for suspected valvular heart disease. The goal is to enhance capacity in a secure manner, thereby minimizing the risks associated with delays in obtaining timely scans.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70099","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439149","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":"Reply to “How to Prevent Arrhythmias Following Acute Coronary Syndrome”","authors":"Luca Cumitini,&nbsp;Ailia Giubertoni,&nbsp;Giuseppe Patti","doi":"10.1002/clc.70098","DOIUrl":"https://doi.org/10.1002/clc.70098","url":null,"abstract":"&lt;p&gt;We would like to thank Naoya Kataoka and Teruhiko Imamura for their thoughtful comments regarding our clinical research, and we would like to take the opportunity to point out some aspects.&lt;/p&gt;&lt;p&gt;We fully agree that including additional predictors, such as hyperuricemia, chronic obstructive pulmonary disease, and specific electrocardiographic/echocardiographic parameters may potentially improve the ability of detecting atrial fibrillation (AF) and ventricular arrhythmias (VA) [&lt;span&gt;1&lt;/span&gt;]. However, in our study we focused on the application of the PRAISE (PRedicting with Artificial Intelligence riSk aftEr acute coronary syndrome) score model [&lt;span&gt;2&lt;/span&gt;] to ensure consistency with the original validation and clinical interpretability of the results. This approach allowed us to evaluate the performance of the model in a real-world context without introducing additional variables that, if incorporated in the score, would have required its recalibration and revalidation. We recognize that the addition of these factors may be an interesting direction for future research.&lt;/p&gt;&lt;p&gt;Anemia increases the risk of arrhythmias [&lt;span&gt;3&lt;/span&gt;], alongside other variables, such as older age and reduced left ventricular ejection fraction (LVEF). In our clinical research, at univariate analysis LVEF was associated with the development of AF and VA, and age with the occurrence of VA. However, at multivariate analysis LVEF and age were not independent predictors of early arrhythmic complications [&lt;span&gt;4&lt;/span&gt;]. Moreover, we believe that the comprehensive use of the PRAISE score overcomes the inherent limitations of stratification based solely on traditional, individual parameters.&lt;/p&gt;&lt;p&gt;Finally, we found that the PRAISE score is a machine learning-based risk stratification tool with high specificity for predicting arrhythmic complications during hospitalization. By identifying patients at elevated risk for arrhythmias, the PRAISE score can allow for targeted interventions, such as enhanced rhythm monitoring or optimizing pharmacological treatments. These strategies are particularly relevant within the first 30 days postacute coronary syndrome (ACS), that is, during the critical phase of cardiac reverse remodeling. We demonstrated an early predictive value of the PRAISE score for arrhythmias, but its role in guiding long-term interventions remains under investigation [&lt;span&gt;4&lt;/span&gt;]. Incorporating the PRAISE score into post-ACS management could potentially improve outcomes even over the longer-term, by facilitating early detection of high-risk patients, promoting tailored use of secondary prevention measures (e.g., intensive lifestyle modifications, stricter rhythm monitoring, or extended pharmacological therapy), and optimizing resource allocation for arrhythmia prevention. However, this needs to be evaluated in future, prospective protocols. Further studies are also welcome to evaluate the utility of the PRAISE score in selecting patients candidates t","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70098","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143404451","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":"Author's Reply to “Digital Devices for Arrhythmia Detection: What Is Still Missing?”","authors":"Martin Manninger,&nbsp;David Zweiker,&nbsp;Tatevik Hovakimyan,&nbsp;Paweł T. Matusik,&nbsp;Sergio Conti,&nbsp;Pierre Ollitrault,&nbsp;Aapo Aro,&nbsp;Bart A. Mulder,&nbsp;Wolfgang Dichtl,&nbsp;Christian-Hendrik Heeger,&nbsp;Rachel M. A. ter Bekke,&nbsp;Enes Elvin Gul,&nbsp;Bob Weijs,&nbsp;Ann-Kathrin Rahm,&nbsp;Angeliki Darma,&nbsp;Banu Evranos,&nbsp;Avi Sabbag,&nbsp;Kgomotso Moroka,&nbsp;Vassil Traykov,&nbsp;Jacob Moesgaard Larsen,&nbsp;Gisella Rita Amoroso,&nbsp;Stijn Evens,&nbsp;William F. McIntyre,&nbsp;Dominik Linz","doi":"10.1002/clc.70092","DOIUrl":"https://doi.org/10.1002/clc.70092","url":null,"abstract":"<p>We thank Kataoka and Imamura for their interest in our recently published survey on physician's preferences in the use of novel digital devices in the management of patients with atrial fibrillation (AF) [<span>1, 2</span>].</p><p>Our survey shows, that digital devices are beginning to be implemented in clinical practice. We respectfully disagree with Kataoka and Imamura that the debate on the type of monitoring technology is not critical at the moment. Our international group of authors strongly believe that the switch to increased patient involvement, to patient-initiated rhythm monitoring and to telemedical care require physician (and not industry) driven education on the technologies used, recommendations for specific diagnostic pathways, cost-effectiveness analyses and outcome-centered research [<span>3-8</span>].</p><p>The clinical scenarios presented in this survey do not aim to give specific recommendations on diagnostic pathways but aim to reflect common clinical scenarios we experience as physicians in daily clinical practice. Diagnostic pathways for these scenarios are reflected in current clinical practice guidelines: There is a clear recommendation to confirm AF in symptomatic patients and to screen for AF in patients at risk [<span>5, 6</span>]. We agree with the Kataoka and Imamura that the duration of monitoring is crucial and still one of the unanswered questions, but first, there is evolving data in this field and second, screening duration using novel digital devices is often self-determined by patients [<span>9, 10</span>].</p><p>We agree with Kataoka and Imamura's opinion that AF screening in the general population shows questionable benefit. As the Apple Heart Study showed, even the number needed to screen to diagnose AF is exceptionally high [<span>11</span>]. Consequently, the number needed to screen to show clinical benefit in this population are expected to be even higher. However, the presented patient scenarios reflect opportunistic testing for AF in patients with risk factors for adverse outcomes as a result of under-detected AF, which represents a clinical challenge in several outpatient clinics [<span>6</span>].</p><p>We believe that novel digital devices for rhythm monitoring provide important diagnostic tools for screening, diagnosis and management of AF when used in the right populations at risk/patients. These devices may increase patient's adherence to treatment and even decrease anxiety related to known recurrences of benign arrhythmias. Referring to the author's question: “Digital Devices for Arrhythmia Detection: What is Still Missing?”: More physician and patient education on the potential of novel digital devices is required to achieve diagnostic pathways as suggested by the EHRA practical guide [<span>5</span>].</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70092","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143362661","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":"Cardiovascular Efficacy and Safety of Finerenone: A Meta-Analysis of Randomized Controlled Trials","authors":"Mushood Ahmed,&nbsp;Areeba Ahsan,&nbsp;Aimen Shafiq,&nbsp;Muhammad Talha Maniya,&nbsp;Hritvik Jain,&nbsp;Javed Iqbal,&nbsp;Muhammad Abdullah Naveed,&nbsp;Raheel Ahmed,&nbsp;Jamal S. Rana,&nbsp;Marat Fudim,&nbsp;Gregg C. Fonarow","doi":"10.1002/clc.70065","DOIUrl":"https://doi.org/10.1002/clc.70065","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Finerenone, a nonsteroidal mineralocorticoid receptor antagonist, has emerged as a novel therapeutic option for the management of patients with diabetes, chronic kidney disease, or heart failure. We seek to summarize the evidence on the drug's effectiveness regarding cardiovascular (CV) outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a literature search of Pubmed, Cochrane CENTRAL, Embase, and ClinicalTrials.gov from inception to September 2024. Trials exploring the effects of finerenone on CV outcomes were extracted and analyzed. The results of pooled analyses were presented as risk ratios (RRs) with 95% confidence intervals (CIs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of eight trials, incorporating 21 200 patients, were included. The pooled analysis demonstrated a significant reduction in all-cause death (RR 0.92, 95% CI: 0.85–0.99), major adverse CV events (RR 0.85, 95% CI: 0.81–0.90), heart failure-related hospitalizations or unplanned hospital visits (RR 0.82, 95% CI: 0.76–0.87) with finerenone administration compared to control. Finerenone use was associated with a trend of reduced risk of CV death without reaching statistical significance (RR 0.90, 95% CI: 0.81–1.00). The risk of myocardial infarction (RR 0.91, 95% CI: 0.74–1.12), adverse events (RR 0.96, 95% CI: 0.89–1.03), adverse events leading to discontinuation (RR 1.06, 95% CI: 0.96–1.17) remained comparable across both groups. However, an increased risk of hyperkalemia (RR 2.07, 95% CI: 1.88–2.27) was observed with finerenone therapy compared to the control group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Finerenone administration was associated with improved CV outcomes in the CV-renmetabolic conditions compared to the control group.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70065","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143248846","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":"Comparison of Single-Coil Versus Dual-Coil Implantable Cardioverter Defibrillator Devices: A Systematic Review and Meta-Analysis of Efficacy and Extraction-Related Outcomes","authors":"Muhammad Fawad Tahir,&nbsp;Adeena Maryyum,&nbsp;Zainab Mubbashir,&nbsp;Abdul Moiz Khan,&nbsp;Syed Irtiza Imam,&nbsp;Fatima Mustafa,&nbsp;Syeda Zahra Hasan,&nbsp;Umer Shoaib,&nbsp;Areej Iqbal,&nbsp;Osama Saeed,&nbsp;Manisha Purushotham,&nbsp;Maimoona Khan,&nbsp;Shahtaj Tariq,&nbsp;Muhammad Omar Larik,&nbsp;Muhammad Umair Anjum,&nbsp;Muhammad Hasanain,&nbsp;Tanesh Ayyalu,&nbsp;Mah I. Kan Changez,&nbsp;Javed Iqbal","doi":"10.1002/clc.70083","DOIUrl":"https://doi.org/10.1002/clc.70083","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Implantable cardioverter defibrillators (ICD) are battery-operated devices used to manage irregular heart rhythms and deliver therapeutic shocks to the heart. This updated systematic review and meta-analysis compares the efficacy and extraction-related outcomes of single-coil versus dual-coil ICDs in view of conflicting data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Several databases, including PubMed, Cochrane Library, and Google Scholar, were comprehensively explored dating from inception to April 1, 2024. Data were compared using odds ratio (OR), hazard ratio (HR), and mean differences (MD). A value of <i>p</i> &lt; 0.05 indicated statistical significance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ultimately, 28 studies were included in this quantitative synthesis. Defibrillation threshold (DFT) indicated statistical superiority in the dual-coil cohort (MD: 0.58; 95% confidence interval [CI]: 0.07–1.09; <i>p</i> = 0.03). In addition, all-cause mortality was significantly elevated in the dual-coil cohort (HR: 0.91; 95% CI: 0.87–0.97; <i>p</i> = 0.001). Furthermore, implant time was significantly lower in the single-coil group (MD: −7.44; 95% CI: −13.44 to −1.43; <i>p</i> = 0.02). Other outcomes, including first shock efficacy, cardiac mortality, post-extraction major complications, post-extraction procedural success, and post-extraction mortality, did not demonstrate any significant statistical differences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In conclusion, despite the desirable safety profile of single-coil ICDs, the use of dual-coil ICDs continues to hold merit due to their superior efficacy and advanced sensing capabilities, especially in complex cases. In addition, the perceived risk of a greater adverse profile in dual-coil lead extraction can be refuted by preliminary aggregate results generated within this meta-analysis. However, further robust studies are warranted before arriving at a valid conclusion.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70083","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143248771","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":"Phenomapping the Response of Patients With Ischemic Cardiomyopathy With Reduced Ejection Fraction to Surgical Revascularization","authors":"Tejus Satish,&nbsp;Nicholas S. Hendren,&nbsp;Matthias Peltz,&nbsp;Christopher A. Heid,&nbsp;Maryjane Farr,&nbsp;Anthony Bavry,&nbsp;Saket Girotra,&nbsp;Dharam J. Kumbhani,&nbsp;Mark H. Drazner,&nbsp;W. H. Wilson Tang,&nbsp;Justin L. Grodin","doi":"10.1002/clc.70094","DOIUrl":"https://doi.org/10.1002/clc.70094","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Coronary artery bypass grafting (CABG) has demonstrated long-term mortality benefits in patients with HFREF and obstructive coronary artery disease (CAD), but whether phenotypic heterogeneity influences the benefits of CABG is unknown. We applied clustering analysis to STICHES (Surgical Treatment for Ischemic Heart Failure Extension Study) to identify phenogroups with different long-term risk profiles and investigate differences in CABG benefits between phenogroups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>STICHES was a randomized controlled trial evaluating the effect of CABG in addition to medical therapy versus medical therapy alone. We split the STICHES participants into derivation (<i>n</i> = 753) and validation (<i>n</i> = 459) cohorts. We phenomapped the derivation cohort using penalized model-based clustering. We fit multivariable Cox models to investigate long-term differences in all-cause mortality, cardiovascular (CV) mortality, and a composite of all-cause mortality/CV hospitalization between phenogroups and whether phenogroup assignment modified the effects of CABG on these outcomes. Findings were internally validated on the validation cohort. Four phenogroups were identified in the derivation cohort. The highest-risk group was at a twofold greater risk of death (HR: 2.0, 95% CI: 1.4–2.9, <i>p</i> &lt; 0.001) and CV death (HR: 2.0, 95% CI: 1.3–3.1, <i>p</i> = 0.002), and a 1.5-fold greater risk for death/CV hospitalization (HR: 1.5, 95% CI: 1.1–2.1, <i>p</i> = 0.016). Phenogroup assignment did not modify the effects of CABG on the outcomes (<i>p</i> &gt; 0.05 for all). Similar results were obtained in the validation cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The beneficial effects of CABG on all-cause mortality, CV mortality, and a composite of all-cause mortality and CV hospitalization persist despite phenotypic heterogeneity in HFREF and CAD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70094","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143111093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive Value of Lung Ultrasound Combined With ACEF Score for the Prognosis of Acute Myocardial Infarction","authors":"Ziheng Lun,&nbsp;Jiexin He,&nbsp;Ming Fu,&nbsp;Shixin Yi,&nbsp;Haojian Dong,&nbsp;Ying Zhang","doi":"10.1002/clc.70077","DOIUrl":"https://doi.org/10.1002/clc.70077","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Lung ultrasound (LUS) and the ACEF score (age, creatinine, and ejection fraction) have been shown to be pivotal in predicting an unfavorable prognosis in acute myocardial infarction (AMI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>The aim of this study is to investigate the prognostic value of LUS combined with ACEF score in AMI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The ACEF score and the total number of B-lines in eight thoracic regions of LUS were calculated. Adverse events were recorded during hospitalization and follow-up, defined as all-cause death and other cardiovascular events. Multivariate logistic regression identified predictors of adverse events during hospitalization. Multivariate Cox regression identified predictors of adverse events during follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We enrolled 204 patients. The B-lines (adjusted OR 1.08, [95% CI: 1.03–1.13], <i>p</i> &lt; 0.01) and the ACEF score (adjusted OR 2.71 [95% CI: 1.07–6.81], <i>p</i> &lt; 0.05) independently predicted adverse events during hospitalization. The C-index values were 0.81 (<i>p</i> &lt; 0.01) for the ACEF score, 0.81 (<i>p</i> &lt; 0.01) for LUS, and 0.86 (<i>p</i> &lt; 0.01) for their combination. One hundred seventy-one patients were followed up for 12 months (IQR, 8.13–15.93). Both the B-lines (adjusted HR 1.06 [95% CI: 1.03–1.09], <i>p</i> &lt; 0.05) and the ACEF score (adjusted HR 1.95 [95% CI: 1.10–3.43], <i>p</i> &lt; 0.05) remained associated with an increased risk of adverse events during follow-up. The C-index values were 0.74 (<i>p</i> &lt; 0.01) for the ACEF score, 0.73 (<i>p</i> &lt; 0.01) for LUS, and 0.80 (<i>p</i> &lt; 0.01) for their combined predictive ability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The B-lines and ACEF score are associated with adverse events in AMI patients. When combined, they provide increasing value in assessing the risk of adverse events, which has significant implications for risk stratification.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70077","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143111090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}