Clinical Cardiology最新文献

{"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}

{"title":"Outcomes of Bolus Dose Furosemide Versus Continuous Infusion in Patients With Acute Decompensated Left Ventricular Failure and Atrial Fibrillation","authors":"Babar Khan,&nbsp;Darab Shuja,&nbsp;Burhan ul Haq Saqib,&nbsp;Maria Liaquat,&nbsp;Jahanzeb Malik,&nbsp;Amna Ashraf,&nbsp;Ali Karim,&nbsp;Iftikhar Ahmed,&nbsp;Waheed Akhtar,&nbsp;Amin Mehmoodi","doi":"10.1002/clc.70033","DOIUrl":"10.1002/clc.70033","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This prospective, randomized trial aimed to compare the efficacy and safety of different intravenous diuretic regimens in acute decompensated heart failure (ADHF) patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>ADHF patients were enrolled and randomized into three groups: continuous intravenous furosemide infusion (cIV), bolus furosemide injection (bI), and furosemide plus hypertonic saline solution (HSS). Clinical outcomes were assessed over 48 h.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In a study involving 1276 patients admitted for ADHF, three therapeutic regimens (T × 1, T × 2, and T × 3) were compared. T × 1 administered an 80 mg furosemide intravenous bolus infusion twice daily to 479 patients, while T × 2 involved a continuous 16-h infusion of 160 mg furosemide daily to 420 patients. T × 3 treated 377 patients with 160 mg furosemide combined with 150 mL of HSS containing 1.95% NaCl over 30 min. Yet, overall changes in renal markers such as BUN, Na, K, and serum creatinine did not differ significantly. Analysis of prespecified study endpoints revealed notable variations in hospitalization length among the treatment arms. T × 1 demonstrated a significantly shorter hospital stay (3.7 days) compared to T × 2 (6.6 days) and T × 3 (7.9 days). Conversely, alterations in serum creatinine at 48 h, overall changes in serum creatinine, body weight loss, and serum potassium levels did not significantly differ among the treatment groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>While intravenous bolus of furosemide showed potential benefits in reducing hospitalization duration, limitations such as a small sample size and short-term observation emphasize the need for larger studies to validate these outcomes further.</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.70033","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667362","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":"Evaluation of Small Vessel Bifurcation Stenting Using the Double-Kissing Culotte and Culotte Technique in Acute Coronary Syndrome: 12-Month Clinical Outcomes","authors":"Mateusz Barycki,&nbsp;Piotr Rola,&nbsp;Adrian Włodarczak,&nbsp;Szymon Włodarczak,&nbsp;Maciej Pęcherzewski,&nbsp;Piotr Włodarczak,&nbsp;Artur Jastrzębski,&nbsp;Łukasz Furtan,&nbsp;Andrzej Giniewicz,&nbsp;Adrian Doroszko,&nbsp;Maciej Lesiak","doi":"10.1002/clc.70043","DOIUrl":"10.1002/clc.70043","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Patients with small vessels who undergo percutaneous coronary intervention (PCI) with subsequent multiple implantation of drug-eluting stents remain at a higher risk of unfavorable outcomes. In complex cases where maintaining flow to all side branches is part of contemporary practice, using two-stent techniques may be appropriate. This study aims to evaluate the efficacy of double-kissing (DK) culotte technique in comparison to culotte technique in the context of small-vessel therapy in patients with acute coronary syndrome (ACS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This substudy of the Lower Silesia culotte Bifurcation Registry retrospectively analyzed patients who underwent ACS-PCI using DK culotte or culotte technique for bifurcation lesions in small vessels, defined as having at least one branch with a diameter of 2.75 mm or less. The primary endpoint was target lesion failure (TLF), a composite of cardiovascular death, target vessel myocardial infarction, or clinically driven target lesion revascularization (TLR) at 1-year follow-up. The secondary endpoint included major adverse cardiac events (MACE).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The DK culotte group (<i>n</i> = 49) and the culotte group (<i>n</i> = 52) were compared, with 12-month follow-up showing lower TLF in the DK culotte group (8.2% vs. 19.2%, <i>p</i> = 0.082). Similar results were observed for TLR (6.1% vs. 13.5%; <i>p</i> = 0.161), stent restenosis (4.1% vs. 9.6%; <i>p</i> = 0.203), and MACE (18.4% vs. 25%; <i>p</i> = 0.344).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>For bifurcation lesions with a small-diameter artery, the DK culotte technique may reduce TLF and MACE compared to the culotte technique. However, given the limited sample size and the absence of statistical significance, these findings remain preliminary and require further investigation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"47 11","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615763","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":"A Comparison Between Culprit Versus Complete Revascularization in Diabetic Patients With Acute Myocardial Infarction","authors":"Naser Aslanabadi,&nbsp;Sina Mashayekhi,&nbsp;Maziar Rezvani,&nbsp;Ali Abdollahzadeh,&nbsp;Amirhossein Hajialigol","doi":"10.1002/clc.70046","DOIUrl":"10.1002/clc.70046","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The benefit of complete revascularization in diabetic patients with myocardial infarction remains unclear. this study aims to find the optimal strategy of total vascular repair for diabetic patients with acute myocardial infarction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In an analysis of a cohort, we assigned diabetic patients with myocardial infarction who were undergoing percutaneous coronary intervention (PCI) of the culprit lesion to receive either staged complete revascularization of nonculprit lesions or to receive no further revascularization in Madani Hospital (Tabriz, Iran). Functionally significant nonculprit lesions were identified either by angiography. The primary outcome was rates of readmission, cardiac deaths, nonfatal myocardial re-infarction, and overall mortality at 1 year.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In our center, a total of 1186 patients underwent primary-PCI treatment, among which 521 were diagnosed with diabetes. Ultimately, 393 patients were selected for inclusion in the study. Within this cohort, 271 individuals (68.9%) underwent repair of only the culprit vessels (group 1), while 122 individuals (31.1%) received a comprehensive staged restoration of the vessels (group 2). During this time, group 1 in comparison with group 2 experienced 204 (75.3%) versus 97 (79.5%) cases of readmission, 48 (17.7%) versus 8 (6.5%) instances of cardiac death, 22 (8.1%) versus 18 (14.7%) occurrences of nonfatal myocardial re-infarction. Notably, the incidence of cardiac death in group 2 were significantly lower than that in group 1 (<i>p</i> ≤ 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>For individuals diagnosed with diabetes, staged complete revascularization demonstrated a lower frequency of readmission, cardiac deaths, nonfatal myocardial reinfarction, and overall mortality, in contrast to revascularization that targeted only the culprit lesion.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"47 11","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11561520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615837","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":"Precision Management of Complex Coronary Lesions: Drug-Coated Balloons and Computational Cardiology at the Forefront of Nanotechnology","authors":"Yashendra Sethi,&nbsp;Inderbir Padda,&nbsp;Sneha Annie Sebastian,&nbsp;Arsalan Moinuddin,&nbsp;Talha Bin Emran,&nbsp;Sunny Goel,&nbsp;Gurpreet Johal","doi":"10.1002/clc.70045","DOIUrl":"10.1002/clc.70045","url":null,"abstract":"&lt;p&gt;Complex coronary lesions present formidable challenges in interventional cardiology, necessitating innovative approaches for effective management. From myocardial bridging (MB) to ostial lesions and bifurcations, each poses unique anatomical and physiological hurdles. Despite advancements in coronary interventions, addressing these lesions remains a clinical conundrum owing to their diverse characteristics and associated complications. Traditionally, drug-eluting stents (DES) are the primary choice for treating coronary artery stenosis, including lesions with myocardial bridges; however, such stents may exacerbate potential risks, including major adverse cardiac events, in-stent restenosis, and postimplantation stent fracture; further compounded by prolonged dual antiplatelet therapy and its associated bleeding risks.&lt;/p&gt;&lt;p&gt;Stemmed from the theorized concept of “intervention without implantation” – drug-coated balloons (DCB)—provide a simple yet pivotal alternative to DES (Figure 1). Employing semi-compliant balloons loaded with antiproliferative drugs, DCBs penetrate into the local vessel wall, inhibiting intimal hyperplasia and promoting long-term vessel patency. Previous studies like those by Xu et al. and Jeger Rv et al. have demonstrated their safety and efficacy in various coronary artery conditions, such as in-stent restenosis, bifurcation lesions, small-sized vessels, considerable lesion lengths [&gt; 50 mm], high bleeding risk patients, de-novo lesions, and patients planned for major surgery, e.g., coronary artery bypass graft [&lt;span&gt;1, 2&lt;/span&gt;]. Table 1 summarizes the most recent (last 5 years) and relevant literature employing DCBs in complex coronary lesions. However, the considerations below are essential to understanding the underlying challenges and why their application has not gained traction.&lt;/p&gt;&lt;p&gt;Of late, MBs have garnered significant attention for their association with acute coronary syndromes, coronary artery spasms, ventricular arrhythmias, and sudden cardiac death. Typically, MB denotes a congenital variation wherein a segment of a coronary artery traverses through the myocardium rather than taking its classic epicardial route. Given they are commonly hitched with atherosclerosis of proximal coronary arteries, DCBs offer a promising avenue; however, their precise delivery and long-term efficacy are still to be determined [&lt;span&gt;2, 8&lt;/span&gt;]. Recent reports have indicated DCBs as a potential treatment for atherosclerosis in the myocardial bridging segment, highlighting the benefits of the “leave nothing behind” strategy [&lt;span&gt;10&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Ostial lesion analogs (OLAs): aorto-ostial lesions, non-aorto-ostial lesions, and branch-ostial lesions are typically found close to the ostium (≤ 3 mm) of the coronary artery. They are characterized by a rigid fibrotic texture (with pronounced sclerosis) which significantly enhances its propensity to recoil. Lesions at coronary ostia present unique challenges due to their anato","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"47 11","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11546244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603378","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":"Obesity Paradox and the Effect of NT-proBNP on All-Cause and Cause-Specific Mortality","authors":"Rupinder Kaur Bahniwal,&nbsp;Nargiza Sadr,&nbsp;Colleen Schinderle,&nbsp;Cynthia J. Avila,&nbsp;Julie Sill,&nbsp;Rehan Qayyum","doi":"10.1002/clc.70044","DOIUrl":"10.1002/clc.70044","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In heart failure patients, obesity is associated with better outcomes as compared to normal weight, a phenomenon called the obesity paradox.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine if obesity modifies the relationship between NT-proBNP and all-cause and cause-specific mortality in adults without coronary artery disease or heart failure history.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used the National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2004 and linked it with mortality through December 31, 2019. Participants &gt; 18 years were categorized into normal weight (BMI ≤ 25 kg/m²), overweight (BMI &gt; 25–29.9 kg/m²) and obese (BMI &gt; 29.9 kg/m²). NT-proBNP levels were categorized as low (&lt; 126 pg/mL) or high (≥ 126 pg/mL). Using Cox proportional hazard models, we examined effect modification by obesity using interaction, without and with adjusting for potential confounders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 12 621 participants, 2794 (22%) died during 202 859 person-years follow-up. In adjusted models, normal-weight participants with high NT-proBNP had 2 times higher all-cause mortality risk than those with low NT-proBNP (HR = 2.05; 95%CI = 1.74, 2.41; <i>p</i> &lt; 0.001); however, this mortality risk was 27% lower in obese participants (HR interaction = 0.73; 95%CI = 0.59, 0.92; <i>p</i> = 0.008). Similarly, in normal-weight participants, the difference in other-cause mortality risk between high and low NT-proBNP participants was significant in adjusted models (HR = 2.27; 95%CI = 1.81, 2.85; <i>p</i> &lt; 0.001) and obese participants had 48% lower other-cause mortality risk between those with high and low NT-proBNP (interaction HR = 0.52; 95%CI = 0.36, 0.77; <i>p</i> = 0.001). Conversely, obesity did not modify the relationship between NT-proBNP and cardiovascular or cancer mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In patients free of heart failure or coronary artery disease, obesity may be protective against mortality associated with high NT-proBNP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"47 11","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11546245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603361","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":"A Comprehensive Nomogram Integrating Phonocardiogram and Echocardiogram Features for the Diagnosis of Heart Failure With Preserved Ejection Fraction","authors":"Linchun Cao,&nbsp;Xingming Guo,&nbsp;Kangla Liao,&nbsp;Jian Qin,&nbsp;Yineng Zheng","doi":"10.1002/clc.70022","DOIUrl":"10.1002/clc.70022","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Heart failure with preserved ejection fraction (HFpEF) is associated with high hospitalization and mortality rates, representing a significant healthcare burden. This study aims to utilize various information including echocardiogram and phonocardiogram to construct and validate a nomogram, assisting in clinical decision-making.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study analyzed 204 patients (68 HFpEF and 136 non-HFpEF) from the First Affiliated Hospital of Chongqing Medical University. A total of 49 features were integrated and used, including phonocardiogram, echocardiogram features, and clinical parameters. The least absolute shrinkage and selection operator (LASSO) regression was used to select the optimal matching factors, and a stepwise logistic regression was employed to determine independent risk factors and develop a nomogram. Model performance was evaluated by the area under receiver operating characteristic (ROC) curve (AUC), calibration curve, decision curve analysis (DCA), and clinical impact curve (CIC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The nomogram was constructed using five significant indicators, including NT-proBNP (OR = 4.689, <i>p</i> = 0.015), <i>E</i>/<i>e</i>′ (OR = 1.219, <i>p</i> = 0.032), LAVI (OR = 1.088, <i>p</i> &lt; 0.01), D/S (OR = 0.014, <i>p</i> &lt; 0.01), and QM1 (OR = 1.058, <i>p</i> &lt; 0.01), and showed a better AUC of 0.945 (95% CI = 0.908–0.982) in the training set and 0.933 (95% CI = 0.873–0.992) in the testing set compared to conventional nomogram without phonocardiogram features. The calibration curve and Hosmer–Lemeshow test demonstrated no statistical significance in the training and testing sets (<i>p</i> = 0.814 and <i>p</i> = 0.736), indicating the nomogram was well-calibrated. The DCA and CIC results confirmed favorable clinical usefulness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The nomogram, integrating phonocardiogram and echocardiogram features, enhances HFpEF diagnostic efficiency, offering a valuable tool for clinical decision-making.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"47 11","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70022","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496157","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":"Toluene Inhalant Addiction and Cardiac Functions in Young Adults: A Comparison of Electrocardiographic and Echocardiographic Parameters","authors":"Gürkan Karaca,&nbsp;Erdinç Hatipsoylu,&nbsp;Ahmet Ekmekci,&nbsp;Ömer Kamil Yazıcı,&nbsp;Ali Kimiaei,&nbsp;Seyedehtina Safaei,&nbsp;Ahmet Bilge Sözen","doi":"10.1002/clc.70037","DOIUrl":"10.1002/clc.70037","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Volatile substance (thinner) addiction can cause serious cardiac events, such as malignant ventricular arrhythmias, acute coronary syndromes, sudden death syndrome, and dilated cardiomyopathy, as reported in many case studies. We aimed to find echocardiographic and electrocardiographic parameters that could foresee these adverse outcomes in clinical settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We enrolled 32 healthy young adult patients with at least 1 year of thinner addiction and no cardiac symptoms. We also recruited a control group of 30 healthy individuals without any medical problems. Both groups received standard echocardiography and ECG tests. We analyzed the following echocardiographic parameters: LVEDd (left ventricular end-diastolic diameter), LVESd (left ventricular end-systolic diameter), mitral valve EF slope, E/A ratio, and aortic and pulmonary valve VTI (velocity time integral). We also measured the corrected (QTc), uncorrected QT intervals, and widest P-wave values in the ECG. We used the SPSS 13 software for statistical analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The echocardiographic findings did not differ significantly between the groups. However, the ECG results showed that the thinner addicts had higher values of corrected (QTc), uncorrected QT intervals, and widest P-wave values than the control group, according to Mann–Whitney <i>U</i> and Student's <i>T</i> test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Corrected QT (QTc) and P-wave duration are increased in individuals with a thinner addiction. These findings may suggest a higher risk of sudden cardiac death, atrial, and ventricular dysrhythmias in the future.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"47 11","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11500041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496160","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}