Clinical Cardiology最新文献

{"title":"Utilizing machine learning for predicting heart failure outcomes: A path toward developing a patient-centered approach","authors":"Rayyan Nabi MBBS,&nbsp;Tabeer Zahid MBBS,&nbsp;Hanzala A. Farooqi MBBS","doi":"10.1002/clc.24260","DOIUrl":"10.1002/clc.24260","url":null,"abstract":"<p>Heart failure (HF)—a global pandemic—poses a huge burden to healthcare systems, with a staggering 64.3 million people worldwide estimated to suffer from the ailment in 2017. Projections suggest a total cost of around $69.8 billion for HF by the year 2030 in the United States.<span>¹</span> This highlights the immense economic burden of the disease and calls for effective strategies vis-à-vis its treatment and more importantly, prevention. Recent studies have outlined how machine learning (ML) can be used to build predictive models from multidimensional datasets. This has led to the establishment of the role of AI in early detection of future mortality and destabilizing episodes, therefore allowing for the optimization of cardiovascular disease outcomes.<span>²</span></p><p>A recent study published by Ketabi et al. analyzed the performance of 10 ML algorithms and chose the best algorithm to predict mortality and readmission of HF patients.<span>³</span> Two thousand four hundred and eighty-eight patients' information was documented after their first hospital admission and they were then followed to determine three outcomes: hospital readmission, 1-month mortality, and 1-year mortality. 14.7% of these patients were readmitted to the hospital, 3.9% died within a month and 13.7% died within a year. To determine this, 57 different factors were considered independent variables to predict outcomes and were entered into and evaluated using ML algorithms. The data were divided into two sets: training sets for the machine algorithm to teach itself, and test sets for evaluating the classifier's prediction error rate after learning. The five metrics utilized to compare the models were accuracy, sensitivity, specificity, F1 score, and AUC. Out of the 10 ML algorithms, CatBoost (CAT) had the best performance in terms of predicting heart failure outcomes. It identified length of stay in the hospital, haemoglobin level, and family history of MI as the most important predictors for readmission, 1-month mortality, and 1-year mortality, respectively. These findings can thus be significant in helping doctors individualize HF patients at high risk of readmission or death.</p><p>We can therefore conclude that early detection of patients at risk of HF—through the use of ML—will allow for timely interventions to be made. Intensive monitoring of patients predicted to experience a negative outcome will help ensure the development of a more patient-centered approach, forcing clinicians to ensure such patients are of utmost priority and tailor their treatment plans with caution and vigilance. The COACH trial found that using a tool in the emergency department to guide management plans for HF patients, combined with providing standardized transitional care, improved outcomes for such patients.<span>⁴</span> This supports the idea that a ML-based predictive model will aid in risk-based decision-making leading to better HF patient","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24260","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140287086","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":"Detailed causality between coronavirus disease-2019 and atrial fibrillation","authors":"Naoya Kataoka MD,&nbsp;Teruhiko Imamura MD, PhD","doi":"10.1002/clc.24258","DOIUrl":"10.1002/clc.24258","url":null,"abstract":"<p>Niu et al. investigated the clinical implication of atrial fibrillation (AF) in patients with coronavirus disease-2019 (COVID-19).<span>¹</span> According to their findings, AF was prevalent in patients hospitalized for COVID-19 and was associated with worse in-hospital mortality, more disease-related complication, and increased healthcare utilization. Several concerns have been raised.</p><p>COVID-19 is a systemic inflammatory disease that induces various cardiovascular conditions.<span>²</span> AF may be triggered by this inflammatory cascade. Consequently, the presence of AF may be a confounding factor for in-hospital mortality rather than a prognostic factor. Did the authors observe obvious differences in the severity and inflammatory status of COVID-19 between those with and without AF?</p><p>It is widely acknowledged that AF is a robust predictor of cardiovascular diseases and mortality.<span>³</span> Did the authors identify any distinct profiles in individuals who had both COVID-19 and AF when compared to those with AF alone?</p><p>In the authors' study, the incidence of ventricular arrhythmia was higher in individuals with AF.<span>¹</span> However, the detailed types of ventricular arrhythmia remain uncertain. For instance, did the authors include premature ventricular contractions? It is plausible that the dominant causes of in-hospital cardiac arrest were ventricular tachycardia and ventricular fibrillation. Ventricular fibrillation is often encountered in younger patients with acute coronary syndrome, while extra-cardiac abnormalities such as anemia and advanced age are associated with pulseless electrical activity.<span>⁴</span> Could the authors provide more clarity on the relationship between COVID-19, AF, and cardiac arrest?</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24258","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140287085","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":"Knowledge, attitude, and practice toward postoperative self-management among patients after percutaneous coronary intervention: A structural equation modeling analysis","authors":"Hailing Lei,&nbsp;Lin Zhu,&nbsp;Xin Zhang","doi":"10.1002/clc.24232","DOIUrl":"https://doi.org/10.1002/clc.24232","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The knowledge, attitude, and practice (KAP) toward post-percutaneous coronary intervention (PCI) self-management among Chinese patients remains unknown. This study investigated the KAP toward postoperative self-management among patients after PCI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>Patients exhibit poor knowledge, attitudes, and practices regarding post-PCI self-management, requiring enhanced education strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional study recruited patients after PCI at Jishuitan Hospital, Beijing, between November 2022 and May 2023. Inclusion criteria comprised patients 1–3 months post-PCI, those capable of self-care, and those willingly participating. The questionnaire (49 items) was designed with reference to current guidelines (the Cronbach <i>α</i> = .829). The final questionnaire included four dimensions with 49 items. The Pearson correlation analysis and structural equation modeling (SEM) were used to determine the relationship among knowledge, attitude, and practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 476 valid questionnaires were included. The knowledge, attitude, and practice scores were 8.24 ± 2.78 (possible range: 0–12), 21.61 ± 3.15 (possible range: 9–45), and 32.62 ± 3.75 (possible range: 10–50). The Pearson correlation analysis showed only knowledge scores were correlated with the attitude scores (<i>r</i> = .446, <i>p</i> &lt; .001). The SEM showed that knowledge directly affects attitude (<i>β</i> = .616, <i>p</i> &lt; .001) but had no influence on practice (<i>β</i> = .119, <i>p</i> = .155); attitude had no influence on practice (<i>β</i> = .015, <i>p</i> = .809).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study indicated that patients had poor knowledge, unfavorable attitudes, and unsatisfied practice toward post-PCI self-management. Strengthening patient health education through diverse approaches is imperative.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24232","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140139187","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":"Response to Nguyen et al.'s letter regarding “Anteriolateral versus anterior–posterior electrodes in external cardioversion of atrial fibrillation: A systematic review and meta-analysis of clinical trials”","authors":"Karam R. Motawea MD,&nbsp;Abdulqadir J. Nashwan RN, MSc, PhD(c)","doi":"10.1002/clc.24253","DOIUrl":"10.1002/clc.24253","url":null,"abstract":"<p>We would like to thank Nguyen et al. for engaging with our systematic review and meta-analysis<span>¹</span> and for your critical observations.<span>²</span> Regarding the omission of four studies, our inclusion criteria were rigorously followed, which led to the exclusion of studies that did not meet these predefined standards. Specifically, three of these studies were either not in English or inaccessible in full text, preventing their inclusion.<span>^{3, 4}</span> The fourth study focused primarily on a subgroup analysis of patients with obesity, which did not align with our broader inclusion criteria encompassing all patient demographics, not limited to specific conditions like obesity.<span>⁵</span></p><p>Concerning the inclusion of a prospective study, it appears there was a misunderstanding about the nature of the study we included. The study in question was a prospective interventional study, effectively functioning as a non-randomized clinical trial, which falls within our criteria of including both randomized and non-randomized clinical trials.<span>⁶</span> This inclusion aligns with our commitment to a comprehensive analysis of clinical trials relevant to our research question.</p><p>As for the issue of data extraction, particularly regarding the studies by Alp et al.<span>⁷</span> and Botto et al.,<span>⁸</span> our methodology adhered strictly to the principles of accurate data appraisal. The overall cardioversion rates utilized in our analysis were directly reflective of the outcomes post-application of DC shock and high energy, consistent with the intentions of the original studies. We believe this approach maintains the integrity of our analysis and supports the validity of our findings.</p><p>We acknowledge the value of constructive critique and the importance of rigorous debate in advancing scientific understanding. As the field moves forward, especially with ongoing trials like NCT05511389, we anticipate further clarification on optimal practices, including electrode pad placement. Our study contributes to this ongoing dialogue, and we advocate for continued research that incorporates best practices alongside new interventions.</p><p>The authors declare no conflict of interest.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24253","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140118937","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 combination of high-frequency QRS and ST-segment alterations during exercise stress tests enhanced the diagnostic efficacy for coronary artery disease","authors":"Long Liu MM,&nbsp;Xinyue Du MM,&nbsp;Xue Wei MM,&nbsp;Wei Dong MB,&nbsp;Hong Lu MM,&nbsp;Guishen Jiang MM,&nbsp;Guolan Deng MM","doi":"10.1002/clc.24254","DOIUrl":"10.1002/clc.24254","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>High-frequency QRS (HF-QRS) manifests as a novel adjunct electrocardiographic marker with potential utility in coronary artery disease (CAD) detection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>We hypothesize that HF-QRS analysis may be superior to conventional ST-segment analysis in detecting CAD, and the combination of these two analyses in the exercise stress test may enhance the diagnostic efficacy for CAD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study incorporated a sample of 157 patients (mean age 62 <math>\u0000 <semantics>\u0000 <mrow>\u0000 <mo>±</mo>\u0000 </mrow>\u0000 <annotation> $pm $</annotation>\u0000 </semantics></math> 9 years) referred for nonemergent angiography. Before angiography, patients underwent exercise stress testing utilizing an upright bicycle. High-resolution electrocardiogram (ECG) data were collected during the exercise test, facilitating both HF-QRS and conventional ST-segment analyses. The diagnostic efficacy of HF-QRS and ST-segment analysis were compared, utilizing angiographic outcomes as the gold standard. The study design integrated HF-QRS analysis and ST-segment analysis via sequential and concurrent testing protocols.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In terms of CAD detection, HF-QRS analysis displayed superior sensitivity compared to conventional ST-segment analysis (63% vs. 37%, <i>p</i> = .002). The serial test significantly increased specificity from 79% to 97% (<i>p</i> = .002) compared to ST-deviation analysis alone. It showed a markedly low sensitivity of 26%. The parallel test significantly increased sensitivity from 37% to 77% (<i>p</i> &lt; .001), while retaining a moderate level of specificity of 51%. The quantity of ECG leads exhibiting a positive HF-QRS response demonstrated a correlation with the severity of CAD (<i>p</i> &lt; .001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>HF-QRS analysis exhibited superior sensitivity in detecting angiographically confirmed CAD relative to conventional ST-segment analysis. Moreover, the combination of HF-QRS and ST-segment alterations during exercise stress test enhanced the diagnostic efficacy for CAD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24254","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140109443","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":"Risk of supranormal left ventricular ejection fraction in patients with aortic stenosis","authors":"Naoya Inoue MD,&nbsp;Hayato Ohtani PhD,&nbsp;Shuji Morikawa MD,&nbsp;Yohei Takayama MD,&nbsp;Takashi Ogane MD,&nbsp;Takehiro Hiramatsu MD,&nbsp;Hiroki Kumihashi MD,&nbsp;Toyoaki Murohara PhD","doi":"10.1002/clc.24255","DOIUrl":"10.1002/clc.24255","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cardiovascular events are increasing in patients with supranormal left ventricular ejection fraction (snLVEF). However, the effect of snLVEF in patients with aortic stenosis (AS) remains unclear, especially in patients with moderate AS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>This study aimed to evaluate the prognosis of mortality and heart failure (HF) in patients with LVEF ≥ 50% and moderate or severe AS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study targeted patients with moderate or severe AS and LVEF &gt; 50%. LVEF of 50%–65% was classified as normal LVEF (nLVEF, nEF group) and &gt;65% as snLVEF (snEF group). AS severity was stratified based on the aortic valve area into moderate (1.0–1.5 cm²) and severe (&lt;1.0 cm²). Primary outcomes included all-cause mortality and HF hospitalization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 226 participants were included in this study. There were 67 and 65 participants with moderate AS in snEF (m-snEF) and nEF groups (m-nEF), respectively, and 41 and 53 participants with severe AS in the snEF (s-snEF) and nEF groups (s-nEF), respectively. During the observation period (median: 554 days), the primary composite outcome occurred in 108 individuals. Cox hazard analysis revealed no significant differences among the four groups in primary composite outcomes. With respect to HF hospitalization, the adjusted hazard ratios (95% confidence intervals) with m-snEF as the reference were as follows: m-nEF, 0.41 (0.19–0.89); s-nEF, 1.43 (0.76–2.67); and s-snEF, 1.83 (1.00–3.35).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The risk of HF hospitalization for m-snLVEF was higher than m-nLVEF and not significantly different from s-nLVEF.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24255","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140101124","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":"Smoking and outcomes following personalized antiplatelet therapy in chronic coronary syndrome patients: A substudy from the randomized PATH-PCI trial","authors":"Ying Pan MD,&nbsp;Ting-Ting Wu MD, PhD,&nbsp;Chang-Jiang Deng MD,&nbsp;Yi Yang MD,&nbsp;Xian-Geng Hou MD,&nbsp;Tuo Yan BS,&nbsp;Shun Wang BS,&nbsp;Ying-Ying Zheng MD, PhD, FACC,&nbsp;Xiang Xie MD, PhD, FACC","doi":"10.1002/clc.24214","DOIUrl":"10.1002/clc.24214","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This is a sub-analysis of the Personalized Antithrombotic Therapy for Coronary Heart Disease after PCI (PATH-PCI) trial in China to explore the relationship between smoking and outcomes following personalized antiplatelet therapy (PAT) in chronic coronary syndrome (CCS) patients undergoing percutaneous coronary intervention (PCI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>As a single-center, prospective, randomized controlled and open-label trial, the PATH-PCI trial randomized CCS patients undergoing PCI into standard group or personalized group guided by a novel platelet function test (PFT), from December 2016 to February 2018. All patients were divided into smokers and nonsmokers according to their smoking status. Subsequently, we underwent a 180-day follow-up evaluation. The primary endpoint was the net adverse clinical events (NACE).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Regardless of smoking status, in the incidence of NACE, there was a reduction with PAT but that the reductions are not statistically significant. In the incidence of bleeding events, we found no statistically significant difference between two groups (smokers: 2.0% vs. 1.4%, HR = 1.455, 95% confidence interval [CI]: 0.595−3.559, <i>p</i> = .412; nonsmokers: 2.2% vs. 1.8%, HR = 1.228, 95% CI: 0.530−2.842, <i>p</i> = .632). In smokers, PAT reduced major adverse cardiac and cerebrovascular events (MACCE) by 48.7% (3.0% vs. 5.9%, HR = 0.513, 95% CI: 0.290−0.908, <i>p</i> = .022), compared with standard antiplatelet therapy (SAT). PAT also reduced the major adverse cardiovascular events (MACE) but there was no statistically difference in the reductions (<i>p</i> &gt; .05). In nonsmokers, PAT reduced MACCE and MACE by 51.5% (3.3% vs. 6.7%, HR = 0.485, 95% CI: 0.277−0.849, <i>p</i> = .011) and 63.5% (1.8% vs. 4.9%, HR = 0.365, 95% CI: 0.178−0.752, <i>p</i> = .006), respectively. When testing p-values for interaction, we found there was no significant interaction of smoking status with treatment effects of PAT (<i>p</i>_int-NACE = .184, <i>p</i>_int-bleeding = .660).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Regardless of smoking, PAT reduced the MACE and MACCE, with no significant difference in bleeding. This suggests that PAT was an recommendable regimen to CCS patients after PCI, taking into consideration both ischemic and bleeding risk.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24214","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140109442","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":"Differentiating electrocardiographic indications of massive and submassive pulmonary embolism: A cross-sectional study in Southern Iran from 2015 to 2020","authors":"Zahra Bahreini MD,&nbsp;Maliheh Kamali MD,&nbsp;Fatemeh Kheshty MD,&nbsp;Hamed Bazrafshan Drissi MD,&nbsp;Shahrokh Sadeghi Boogar MD,&nbsp;Mehdi Bazrafshan MD, MPH","doi":"10.1002/clc.24252","DOIUrl":"10.1002/clc.24252","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Although using electrocardiogram (ECG) for pulmonary embolism (PE) risk stratification has shown mixed results, it is currently used as supplementary evidence in risk stratification. This cross-sectional study aimed to assess and compare ECG findings of massive and submassive PE versus segmental PE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional study included 250 hospitalized patients with a confirmed diagnosis of acute PE from 2015 to 2020 in Southern Iran. Demographic variables, clinical data, troponin levels, on-admission ECG findings, echocardiography findings, and ECG findings 24 h after receiving anticoagulants or thrombolytics were extracted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients diagnosed with submassive or massive PE exhibited significantly higher rates of right axis deviation (<i>p</i> = .010), abnormal ST segment (<i>p</i> &lt; .0001), S1Q3T3 pattern (<i>p</i> &lt; .0001), inverted T wave in leads V1–V3 (<i>p</i> &lt; .0001), inverted T wave in leads V4–V6 (<i>p</i> &lt; .0001), and inverted T wave in leads V1-V6 (<i>p</i> &lt; .0001). In a multivariable model, inverted T wave in leads V1–V3, inverted T wave in leads V4–V6, pulse rate, and positive troponin test were the statistically independent variables for predicting submassive or massive PE. Furthermore, inverted T wave in leads V1–V3 (sensitivity: 85%, specificity: 95%, accuracy: 93%, AUC: 0.902) and troponin levels (sensitivity: 72%, specificity: 86%, accuracy: 83%, AUC: 0.792) demonstrated the best diagnostic test performance for discriminating submassive or massive PE from segmental PE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In addition to clinical rules, ECG can serve as an ancillary tool for assessing more invasive testing and earlier aggressive treatments among patients with PE, as it can provide valuable information for the diagnosis and risk stratification of submassive or massive PE.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24252","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140093511","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 continuous 24‑hour and 14‑day ECG monitoring for the detection of cardiac arrhythmias in patients with ischemic stroke or syncope","authors":"Wei-Cheng Chen MD,&nbsp;Yu-Lin Wu PhD, RN,&nbsp;Yu-Cheng Hsu MD,&nbsp;Jen-Te Hsu MD,&nbsp;Hung-Pin Tseng MD,&nbsp;Chao-Chin Chen MD,&nbsp;Meng-Hsiu Chiang MD,&nbsp;Ju-Feng Hsiao MD,&nbsp;See-Khong Chin MD,&nbsp;Ying-Li Huang BS,&nbsp;Meng-Huan Lei MD","doi":"10.1002/clc.24247","DOIUrl":"10.1002/clc.24247","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Previous studies show that using 12-lead electrocardiogram (ECG) or 24-h ECG monitor for the detection of cardiac arrhythmia events in patients with stroke or syncope is ineffective.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>The 14-day continuous ECG patch has higher detection rates of arrhythmias compared with conventional 24-h ECG monitoring in patients with ischemic stroke or syncope.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional study of patients with newly diagnosed ischemic stroke or syncope received a 24-h ECG monitoring and 14-day continuous cardiac monitoring patch and the arrhythmia events were measured.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This study enrolled 83 patients with ischemic stroke or syncope. The detection rate of composite cardiac arrhythmias was significantly higher for the 14-day ECG patch than 24-h Holter monitor (69.9% vs. 21.7%, <i>p</i> = .006). In patients with ischemic stroke, the detection rates of cardiac arrhythmias were 63.4% for supraventricular tachycardia (SVT), 7% for ventricular tachycardia (VT), 5.6% for atrial fibrillation (AF), 4.2% for atrioventricular block (AVB), and 1.4% for pause by 14-day ECG patch, respectively. The significant difference in arrhythmic detection rates were found for SVT (45.8%), AF (6%), pause (1.2%), AVB (2.4%), and VT (9.6%) by 14-day ECG patch but not by 24-h Holter monitor in patients with ischemic stroke or syncope.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A 14-day ECG patch can be used on patients with ischemic stroke or syncope for the early detection of AF or other cardiac arrhythmia events. The patch can be helpful for physicians in planning medical or mechanical interventions of patients with ischemic stroke and occult AF.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24247","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140048897","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":"Single catheter approach for treatment of premature ventricular contractions","authors":"Patrick Dilk MD,&nbsp;Borislav Dinov MD,&nbsp;Angeliki Darma MD,&nbsp;Andreas Bollmann,&nbsp;Nikolas Dagres MD,&nbsp;Gerhard Hindricks,&nbsp;Arash Arya","doi":"10.1002/clc.24250","DOIUrl":"10.1002/clc.24250","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Catheter ablation has become one of the main treatment strategies in patients with premature ventricular complexes (PVC). The successful mapping and ablation can be performed with an ablation catheter without additional diagnostic catheters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>We hypothesize that using a single catheter for PVC ablation may decrease complications, procedure time, and fluoroscopy exposure while maintaining comparable success rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Sixty-nine consecutive patients with PVC were treated with a single catheter approach compared to a historical cohort, in which a conventional setup was used. Propensity score matching was conducted with a 1:1 ratio. Outcome parameters included acute procedural success with elimination of all premature ventricular contractions after catheter ablation, procedural data as well as complication rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients treated with a single catheter approach had shorter total procedure (60 minutes [IQR: 47,5–69,0 minutes] vs. 90 minutes [IQR 60–120 minutes]; <i>p</i> = 0.001) and fluoroscopy times (218 seconds [IQR: 110,5–446 seconds] vs. 310 seconds [IQR 190–640 seconds]; <i>p</i> = 0.012), which consecutively leads to a reduction of radiation exposure signified by a lower dose area product (155 cGycm² [IQR 74.4–334.5 cGycm²] vs. 368.4 cGycm² [IQR: 126–905.4 cGycm²]; <i>p</i> value 0.009). Acute procedural success rates were comparable in both groups (54 [84.3%] in the single catheter approach group and 58 [90.6%] in the conventional group; <i>p</i>: 0.287).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A single catheter approach for the treatment of PVC is associated with a reduction of procedure- and fluoroscopy time, as well as a lesser radiation exposure, while maintaining equivalent acute success and complication rates compared with a conventionally used catheter setup.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24250","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140048898","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}