Clinical Cardiology最新文献

{"title":"The Impact of Preprocedural Blood Pressure on Outcome After M-TEER: The Paradox or Something Else?","authors":"Marijana Tadic,&nbsp;Leonhard Schneider,&nbsp;Nicoleta Nita,&nbsp;Dominik Felbel,&nbsp;Michael Paukovitsch,&nbsp;Mathias Gröger,&nbsp;Mirjam Keßler,&nbsp;Wolfang Rottbauer","doi":"10.1002/clc.70062","DOIUrl":"10.1002/clc.70062","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The aim of this study was to investigate the influence of systolic blood pressure (SBP) values on admission on the outcome of mitral transcatheter edge-to-edge repair (M-TEER).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>We included all patients who underwent interventional MV repair in our institution between January 2010 and October 2020. All data are obtained from the MiTra ULM registry. Based on SBP values measured on admission, all patients were divided into four groups: &lt; 120, 120−129, 130−139, and ≥ 140 mmHg.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eight hundred and fifty-eight patients were included in this study. There were no major differences in demographic and clinical characteristics between the four observed groups. The patients with SBP on admission ≥ 140 mmHg had the lowest prevalence of functional MR and the highest LVEF. Higher SBP at admission (HR 0.74, 95% CI: 0.63−0.87) and preprocedural LVEF values (HR 0.99, 95% CI: 0.97−0.99) were predictors of lower 1-year mortality but did not impact 1-year hospitalization rate or MACE in the whole study population. When patients were separated into two groups according to the mechanisms of MR (functional and structural), the results showed that higher SBP on admission and better preprocedural LVEF were associated with significantly lower 1-year CV mortality in both groups of patients, with functional and structural MR. Higher SBP at admission was also associated with lower 1-year CV mortality (HR 0.73, 95% CI: 0.55−0.96) in patients with preserved ejection fraction (LVEF &gt; 50%), but not with 1-year rehospitalization and MACE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Higher SBP on admission (&gt; 140 mmHg) is an independent predictor of a better 1-year outcome in patients treated with M-TEER. The effect of higher SBP on outcome after M-TEER should be further investigated.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"47 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11626250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794288","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":"Physician and Patient Preferences for Oral Anticoagulation Therapy Decision Making in Atrial Fibrillation: Results From a National Best–Worst Scaling Survey in Türkiye","authors":"K. Kılıckesmez,&nbsp;D. Aras,&nbsp;M. Degertekin,&nbsp;N. Ozer,&nbsp;B. Hacibedel,&nbsp;K. Helvacioglu,&nbsp;U. Koc,&nbsp;B. Ozdengulsun,&nbsp;E. Dundar Ahi,&nbsp;O. Ergene","doi":"10.1002/clc.70038","DOIUrl":"10.1002/clc.70038","url":null,"abstract":"<p>Atrial fibrillation (AF) is the most common cardiac dysrhythmia and a common cause of ischemic stroke. Stroke prevention with oral anticoagulation (OAC) is the cornerstone of AF management. Patients and their treating physicians may have different views on different attributes of OACs. The objective of this study was to quantify the relative importance that patients and physicians in Turkey place on different OAC attributes when making treatment decisions in AF. A cross-sectional survey was administered to AF patients (≥ 50 years) receiving OAC and practising cardiologists, including residents with ≥ 2 years of experience in Turkey. For both patients (<i>N</i> = 230; 50% male) and physicians (<i>N</i> = 194; 74% male), the most important attributes for OAC treatment decision making in AF were “success in preventing stroke” (57% and 73.9% or overall importance, respectively) and “risk of major bleeding” (20% and 23.4%, respectively). For patients, other attributes were much less important, but not altogether unimportant: reversal agent availability (7%), monitoring (5%), food or drug interactions (3%), minor bleeding (3%), and ease of swallowing (2%). For physicians, among the other attributes, only the need for monitoring (1.3%) had a relative importance of &gt; 1%. For all Turkish participants, efficacy and safety were found to be the most important attributes influencing OAC choice in AF with these two attributes accounting for 77% and 97.3% of overall importance for patients and physicians, respectively. Certain considerations, especially reversal agent availability and monitoring appear to be more important to patients than to physicians This is the first study to use BWS to quantify patient and physician preferences for OAC treatments in AF in Turkey.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"47 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11628632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799650","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":"Critical Convex-Type ST Elevation Correlate With Ventricular Tachyarrhythmia in Takotsubo Cardiomyopathy","authors":"Jen-Te Hsu,&nbsp;Ju-Feng Hsiao,&nbsp;See-Khong Chin,&nbsp;Yu-Cheng Hsu,&nbsp;Meng-Huan Lei","doi":"10.1002/clc.70056","DOIUrl":"10.1002/clc.70056","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Ventricular tachyarrhythmia (VT) occasionally occurred in patients with Takotsubo cardiomyopathy (TC). Two convex-type ST elevations were significantly related to VT in coronary artery disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study assessed the correlation between VT and critical ECG patterns, as well other independent predictive factors of in-hospital outcome. Fifty-five consecutive patients fulfilled the diagnostic criteria of Takotsubo Italian Network (TIN) were retrospectively enrolled. The patients were classified into two groups according to their critical ECG patterns and VT occurrence. In-hospital outcomes and influencing factors were analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The incidence of VT was higher in the critical ECG group than in the Noncritical ECG group (43.8% vs. 2.6%, <i>p</i> &lt; 0.001). In-hospital death was more common in the critical ECG group than in the Noncritical ECG group (25.0% vs. 5.1%, <i>p</i> = 0.032). The composite end-point (combined VT and in-hospital death) revealed significant differences between these two groups (50.0% vs 7.7%, <i>p</i> &lt; 0.001). Multi-variate analysis proved critical ECG type as one independent risk factor of VT (odds ratio [OR] = 61.8, <i>p</i> = 0.009) and the composite end-point (OR = 12.4, <i>p</i> = 0.007). The prolong QRS width ( ≥ 105 ms) was another independent factor for predicting VT (OR = 1.06, <i>p</i> = 0.022) and composite end-point (OR = 1.05, <i>p</i> = 0.017).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Critical ECG types including tombstoning ST elevation and lambda-wave ST elevation have strong impact on short-term outcomes. Additionally, conduction disturbance with prolong QRS ≥ 105 ms also has independent predicting role for poor prognosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"47 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11626252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794273","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":"Effect of Postoperative Atrial Fibrillation After Cardiac Surgery: A Meta-Analysis","authors":"Fangzhou Qu,&nbsp;Wei Yang,&nbsp;Ni He,&nbsp;Shangcheng Qu,&nbsp;Xiao Zhou,&nbsp;Huayan Ma,&nbsp;Xin Jiang","doi":"10.1002/clc.70053","DOIUrl":"10.1002/clc.70053","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>A meta-analysis study was conducted to determine how to predict the effect of postoperative atrial fibrillation after cardiac surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>Long-term mortality and cardiovascular morbidity are linked to postoperative atrial fibrillation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Until August 2024, a comprehensive literature study was completed, and 3486 connected studies were revised. The 38 selected studies included 241 299 cardiac surgery participants at the beginning of the study. The odds ratio (OR) and 95% confidence intervals (CIs) were used to look at the effect of atrial fibrillation after heart surgery using two-sided methods and either a fixed or random model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Individuals with cardiac surgery with postoperative atrial fibrillation had significantly higher mortality at 1 year (OR, 1.39; 95% CI, 1.12–1.72, <i>p</i> &lt; 0.001), mortality at 5 years (OR, 1.61; 95% CI, 1.33–1.94, <i>p</i> &lt; 0.001), mortality at 10 years (OR, 1.61; 95% CI, 1.39–1.87, <i>p</i> &lt; 0.001), and overall stroke (OR, 1.61; 95% CI, 1.34–1.94, <i>p</i> &lt; 0.001) compared to without postoperative atrial fibrillation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Individuals with cardiac surgery with postoperative atrial fibrillation had significantly higher mortality at 1 year, mortality at 5 years, mortality at 10 years, and overall stroke compared to those without postoperative atrial fibrillation. To validate this discovery, more research and caution must be implemented when interacting with its values.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"47 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779468","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":"Insulin-Like Growth Factor Binding Protein 2 Predicts Right Ventricular Reverse Remodeling and Improvement of Concomitant Tricuspid Regurgitation After Transcatheter Edge-to-Edge Mitral Valve Repair","authors":"Matthias Gröger,&nbsp;Dominik Felbel,&nbsp;Michael Paukovitsch,&nbsp;Leonhard Moritz Schneider,&nbsp;Sinisa Markovic,&nbsp;Wolfgang Rottbauer,&nbsp;Mirjam Keßler","doi":"10.1002/clc.70048","DOIUrl":"10.1002/clc.70048","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Concomitant right ventricular (RV) failure and tricuspid regurgitation (TR) are common comorbidities in patients undergoing mitral valve transcatheter edge-to-edge repair (M-TEER) and are associated with worse prognosis. Improvement of TR after M-TEER occurs frequently, however determinants of this course are poorly understood. This study aimed to analyze serum biomarkers that are differentially regulated in patients with TR and to identify biomarkers predictive of the course of TR after M-TEER.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>Biomarker expression was analyzed in 242 prospectively included patients undergoing M-TEER. Patients with moderate-to-severe TR had significant comorbidities (median EuroSCORE II 5.2 in patients with severe TR, 4.9 in moderate TR, 3.2 in no/mild TR; <i>p</i> = 0.002) and a large number of biomarkers was upregulated including IGFBP-2 (1.4-fold in severe TR compared to no/mild TR, <i>p</i> = 0.005). Echocardiographic follow-up 3 months after M-TEER was carried out in 99 patients. RV reverse remodeling (RVRR) as defined by improvement of concomitant TR by at least one grade and/or RV diameter downsizing of at least 10% compared to baseline was seen in 50 patients (50.5%). IGFBP-2 (Odds Ratio 2.078) and presence of chronic pulmonary disease (Odds Ratio 15.341) proved independent predictors of non-development of RVRR within 3 months after M-TEER.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In patients undergoing M-TEER with concomitant moderate or severe TR, numerous cardiometabolic biomarkers including IGFBP-2 are upregulated. Higher levels of IGFBP-2 at baseline are independently associated with persistent TR and/or RV dilation after M-TEER.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"47 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70048","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726419","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":"Describing and Mapping the Research Trend of Scientific Publications on Arrhythmogenic Right Ventricular Cardiomyopathy Across Four Decades: A Bibliometric Analysis","authors":"Leitong Mo,&nbsp;Ching-Hui Sia,&nbsp;Weiqin Lin,&nbsp;Xifeng Zheng,&nbsp;Kaiyi Peng","doi":"10.1002/clc.70051","DOIUrl":"https://doi.org/10.1002/clc.70051","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To perform a bibliometric analysis of publications of arrhythmogenic right ventricular cardiomyopathy (ARVC) from 1981 to 2023 to summarize the current publications and explore frontiers on this topic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We integrated the scientific publications on ARVC in the Web of Science (WOS) Core Collection database from January 1981 to September 2023, using the retrieval strategy of medical subject headings combined with keywords. We focused on articles and reviews that were published in English. Relevant information such as the journal and publisher, the title, authors, organizations, abstract, keywords, published date, and number of citations, were collected. Bibliometric analysis was performed and visualized by the R software and Microsoft Excel.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The results revealed a total of 4792 records related to ARVC from the WOS database, and 2992 original articles or reviews which were selected for bibliometric analysis. There were 79 countries and regions, 3724 research institutions, and 12 157 scholars who have published in this topic. The number of scientific publications of ARVC increased year-by-year, with an annual growth rate of 12.12%. We also investigated the top 10 contributing countries, organizations with affiliations, most influential researchers, highest-cited articles, and highest-frequency keywords. In addition, the most active areas of research on ARVC included that of fatal complications, molecular pathological mechanisms, diagnosis, therapy, and prognosis respectively according to the keywords trend analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our study reports the publication landscape of ARVC during the past four decades based on bibliometric analysis. This study provides a deeper understanding of the published literature on ARVC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"47 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70051","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142724181","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":"Physician Preferences in Using Novel Digital Devices for the Management of Atrial Fibrillation—A DAS-CAM III Survey","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 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.24331","DOIUrl":"https://doi.org/10.1002/clc.24331","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>A recent European Heart Rhythm Association (EHRA) practical guide provides guidance on the use of novel digital devices for heart rhythm analysis using either electrocardiogram (ECG) or photoplethysmography (PPG) technology for the diagnosis of atrial fibrillation (AF). This survey assesses physicians' preferences to use digital devices in patients with possible AF and their impact on clinical decision-making.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>Participants of the DAS-CAM III initiated and distributed an online survey assessing physician preferences in using digital devices for the management of AF in different clinical scenarios. A total of 505 physicians (median age: 38 [IQR 33–46] years) from 30 countries completed the survey. A third of respondents were electrophysiologists, the others were cardiologists, cardiology residents, or general practitioners. Electrophysiologists were more likely to have experience with both ECG-based (92% vs. 68%, <i>p</i> &lt; 0.001) and PPG-based (60% vs. 34%, <i>p</i> &lt; 0.001) digital devices. The initial diagnostic approach to each scenario (symptomatic low-risk, symptomatic high-risk, or asymptomatic high-risk patient) was heterogeneous. Electrophysiologists preferred intermittent single-lead ECG monitoring to traditional Holter ECGs to screen for AF. Both electrophysiologists and non-electrophysiologists would rarely use PPG-based devices to diagnose and screen for AF (8.2%–9.8%). Electrophysiologists and non-electrophysiologists use ECG-based technology to confirm PPG-documented tracings suggestive of AF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>While PPG-based digital devices are rarely used for diagnosis and screening for AF, intermittent ECG-based digital devices are beginning to be implemented in clinical practice. More education on the potential of novel digital devices is required to achieve diagnostic pathways as suggested by the EHRA practical guide.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"47 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24331","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142708346","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":"Rationale and Design of Dual Antiplatelet Therapy in Patients with Coronary Multi-Vessel Disease (DAPT-MVD): A Multicenter, Randomized, Controlled Trial","authors":"Jinwei Tian,&nbsp;Zhuozhong Wang,&nbsp;Yan Wang,&nbsp;Fan Wang,&nbsp;Yini Wang,&nbsp;Peng Zhao,&nbsp;Xinyu Hou,&nbsp;Xiang Peng,&nbsp;Maoyi Tian,&nbsp;Duolao Wang,&nbsp;Bo Yu","doi":"10.1002/clc.70049","DOIUrl":"10.1002/clc.70049","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The optimal duration of dual antiplatelet therapy (DAPT) for patients with coronary multi-vessel disease (MVD) who have received drug-eluting stents (DES) remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis and Methods</h3>\u0000 \u0000 <p>The Dual Antiplatelet Therapy in Patients with Coronary Multi-Vessel Disease (DAPT-MVD) study is a multicenter, open-label, randomized controlled trial designed to assess the efficacy and safety of extended DAPT in MVD patients 12 months following DES implantation. We plan to enroll 8250 patients across approximately 100 sites in China. Participants will be randomized in a 1:1 ratio to receive either extended DAPT (75 mg clopidogrel plus 75–150 mg aspirin daily) or monotherapy (75–150 mg aspirin daily) beyond 12 months post-DES implantation. The follow-up period will last at least 12 months, with all potential endpoints adjudicated by a blinded Clinical Events Committee. The primary endpoint is major adverse cardiovascular and cerebrovascular events (MACCE), including cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>As of April 2024, a total of 8250 participants have been enrolled in the study. The mean age of the enrolled patients was 60.5 ± 8.8years, with 5753 (69.7%) being men.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The DAPT-MVD study is the first large-scale trial to evaluate the efficacy and safety of prolonged DAPT with clopidogrel plus aspirin beyond 12 months after DES implantation in MVD patients. The trial will provide novel insights into the optimal duration of DAPT for MVD patients (ClinicalTrials. gov ID: NCT04624854. Registered on 10/27/2020).</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"47 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70049","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715482","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":"Association Between Orthostatic Hypotension With Coronary Slow Flow in Patients With Chest Pain: A Single Center Experience","authors":"Lijun Han,&nbsp;Meng Li,&nbsp;Wenting Xie,&nbsp;Jianran Lu,&nbsp;Liang Yu,&nbsp;Xinying Liu,&nbsp;Na Lv,&nbsp;Lulu Zhang,&nbsp;Yan Zhang,&nbsp;Yanan Liu,&nbsp;Yanrong Li","doi":"10.1002/clc.70050","DOIUrl":"10.1002/clc.70050","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Orthostatic hypotension (OH) is associated with different cardiovascular diseases, however, the association between OH and coronary slow flow (CSF) has never been evaluated before.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Chest pain patients who underwent coronary angiography (CAG) and with normal coronary arteries in our department from January 1st, 2022 to August 31st, 2023 were retrospectively enrolled. Patients were divided into the CSF group and the normal blood flow (NBF) group. Relative clinical information, laboratory test results as well as the results of CAG were collected and analyzed. Both uni-variable and multi-variable logistic regression analyses were used to evaluate the association between OH and CSF in these patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four thousand six hundred and twenty-seven patients underwent CAG and 655 patients had normal coronary arteries. In which, sixty-nine patients were diagnosed with CSF while 586 patients were diagnosed with NBF. Uni-variable analysis revealed that higher body weight index, faster heart rate in sitting position, accompanied with chronic kidney disease, did not take Antidiabetic therapy, higher level of aspartate transaminase, uric acid, triglyceride, total cholesterol, ApoB1, low-density lipoprotein cholesterol, homocysteine, B-type natriuretic peptide as well as OH are the risk factors for CSF in these patients. Multi-variable logistic regressing analysis further demonstrated that OH was the independent risk factor for predicting CSF in these patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our finding suggests OH might be a useful predictor for CSF in patients with chest pain but normal coronary arteries.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"47 11","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70050","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667330","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":"Association Between State-Wide Cardiac Quality Improvement Program and Costs Following Intervention for Coronary Artery Disease","authors":"Edwin S. Wong,&nbsp;Joshua Nelson,&nbsp;Richard Whitten,&nbsp;Charles Maynard,&nbsp;Jeannie Collins-Brandon,&nbsp;Kristin Sitcov,&nbsp;Ravi S. Hira","doi":"10.1002/clc.70030","DOIUrl":"10.1002/clc.70030","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Since 2010, all non-VA hospitals performing cardiac surgeries and percutaneous interventions in Washington State have participated in the Cardiac Care Outcomes Assessment Program (COAP), a data-driven, physician-led collaborative quality improvement (QI) collaborative. Prior literature has demonstrated QI programs such as COAP can avert avoidable utilization such as hospital readmissions. However, it is unknown whether such improvements translate into economic benefits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>This study compared downstream healthcare costs between patients undergoing cardiac interventions for coronary artery disease (CAD) at hospitals that were and were not participating in COAP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Post hoc analysis of Medicare administrative and claims data examined 2.5 million randomly selected deidentified beneficiaries receiving a percutaneous coronary intervention or coronary artery bypass grafting between 2013 and 2020. Total costs were defined as all reimbursements paid by Medicare for up to 5 years following cardiac intervention. Because all non-VA hospitals in Washington State participated in COAP, we compared respective groups of patients receiving intervention in Washington State with all non-Washington states, adjusting for patient demographics and comorbidity. To model costs, we applied a multipart estimator, which distinguishes the impact of QI program participation due to survival and utilization while accounting for censoring.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Total 5-year downstream costs were $3861 lower (95% confidence interval [CI] = $1794 to $5741) among patients receiving cardiac intervention at COAP-exposed hospitals. Lower costs were largely driven by lower utilization during calendar quarters where death was not observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Participation in this state-wide cardiac quality improvement program was associated with economic benefits in patients receiving intervention for CAD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"47 11","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667331","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}