Clinical Cardiology最新文献

{"title":"Strauss-Defined LBBB Identifies Patients With Improved Outcomes After CRT-D: A Comparative Cohort Study","authors":"Athanasios Saplaouras,&nbsp;Konstantinos Pamporis,&nbsp;Panagiotis Mililis,&nbsp;Stavroula Koskina,&nbsp;Athanasios Makris,&nbsp;Sokratis Oikonomou,&nbsp;Theodoros Efremidis,&nbsp;Athena Batsouli,&nbsp;Ourania Kariki,&nbsp;George Bazoukis,&nbsp;Sotirios Xydonas,&nbsp;Stylianos Dragasis,&nbsp;Theodoros Karamitsos,&nbsp;Christodoulos Papadopoulos,&nbsp;Nikolaos Fragakis,&nbsp;Michael Efremidis,&nbsp;Konstantinos P. Letsas","doi":"10.1002/clc.70408","DOIUrl":"10.1002/clc.70408","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Left bundle branch block (LBBB) is a well-established predictor of response to cardiac resynchronization therapy (CRT) in heart failure with reduced ejection fraction. However, several electrocardiographic definitions are used, and their relative significance remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>Stricter electrocardiographic definitions of LBBB are associated with improved response to CRT and more favorable clinical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective single-center cohort study including 109 patients who underwent CRT-defibrillator implantation. Baseline electrocardiograms were classified according to six commonly used LBBB definitions. The primary endpoint was echocardiographic response at 6 months, defined as a ≥ 10% absolute increase in left ventricular ejection fraction or a ≥ 15% reduction in left ventricular end-systolic volume. Secondary endpoints included heart failure hospitalization and all-cause mortality. Multivariable logistic, Cox, and negative binomial regression models were used, with odds ratios (OR), hazard ratios (HR), incidence rate ratios (IRR), and 95% confidence intervals (CI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Strauss-defined LBBB was independently associated with echocardiographic response (adjusted OR, 7.47; 95% CI, 2.52–25.0; <i>p</i> &lt; 0.001) and showed the highest discriminative performance (area under the curve, 0.728; 95% CI, 0.643–0.814). Strauss was also associated with lower heart failure hospitalization rates (adjusted IRR, 0.30; 95% CI, 0.13–0.64; <i>p</i> = 0.002) and reduced mortality (adjusted HR, 0.14; 95% CI, 0.02–0.99; <i>p</i> = 0.049). Median follow-up was 30 months (IQR 14–60).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Different LBBB definitions are associated with differences in CRT response and outcomes. Stricter criteria appear to better identify patients more likely to respond, with more favorable outcomes. These findings may help refine patient selection for CRT.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70408","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148390015","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":"Real-World National Databases Versus Hypothesis-Driven Cohort Studies: A Reply to the Critique on the TURK-HF Registry Design","authors":"Umut Kocabaş","doi":"10.1002/clc.70385","DOIUrl":"https://doi.org/10.1002/clc.70385","url":null,"abstract":"&lt;p&gt;We thank Çağrı Zorlu, MD, for his comments concerning the design and methodology of the Türkiye Heart Failure (TURK-HF) Registry and are grateful for the opportunity to elucidate some key methodological features of the database [&lt;span&gt;1, 2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;We believe that some of the issues raised can be attributed to differences in thinking about the methodological gap between a national registry infrastructure and a hypothesis-driven registry-based cohort study. The European Medicines Agency (EMA) has stated that there are relevant methodological differences between registry databases and registry-based studies [&lt;span&gt;3&lt;/span&gt;]. A patient registry is a well-organized system for collecting uniform data to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure. Registry-based studies use the infrastructure, patient population, or data generated from these registries to answer specific research questions. Therefore, although patient registry databases, such as the TURK-HF Registry, collect standardized data according to predefined protocols, coding systems, and operational procedures, hypothesis-driven registry-based cohort studies are usually constructed around specific research questions, predetermined confounders, and effect modifiers with dedicated statistical assumptions. Therefore, estimates of sample size, power calculations, and analysis plans should be primarily viewed in the context of analyses to be performed subsequent to registry enrollment and not in the context of the registry infrastructure [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Bias and representativeness considerations: Bias is a key issue in any multicenter observational study, and yet, its presence does not preclude a prospective study. However, representativeness, as referred to in registry science, is not synonymous with population-based random sampling. The selection of the centers that participated followed the principles of the Nomenclature of Territorial Units for Statistics and the projections of the Health Statistics Yearbook; this selection reflected geographical spread as well as different types of healthcare providers [&lt;span&gt;4, 5&lt;/span&gt;]. Participation in registration is a voluntary matter, and the mandatory spell of a “complete” registration of all relevant persons, as in the case method, should not be anticipated. Modern cardiovascular registries are largely based on the unsolicited contributions of centers, as mandatory inclusion is almost never feasible in large-scale, real-life endeavors. Therefore, it should not be assumed that voluntary enrollment undermines the validity of the registry methodology; rather, it represents a reflection of pragmatic requirements for the prospective collection of nationwide data.&lt;/p&gt;&lt;p&gt;Data quality and reliability: The authors recognize that heterogeneity among the participating sites is an unavoidable challenge in multicenter registries. Thus, data collection was harmonized through a centralized el","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70385","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148386709","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":"Comment on Wang et al.: Unaddressed Multiple Comparisons Risk Inflating Type, Error in Cardiovascular Specialty Nursing Research","authors":"Awais Mehmood,&nbsp;Abdulrehman Bajwa","doi":"10.1002/clc.70409","DOIUrl":"https://doi.org/10.1002/clc.70409","url":null,"abstract":"<p>We read with interest the recent article by Wang et al. in Clinical Cardiology, examining humanistic concept-based cardiovascular specialty care across medication adherence, glycolipid metabolism, psychological status, self-management, and quality of life [<span>1</span>]. The multidimensional evaluation of patient-centered nursing outcomes is a genuine strength, and the clinical question is timely.</p><p>We do, however, have a concern about the multiple testing strategy. The authors simultaneously tested 16 or more outcomes: six glycolipid parameters, two anxiety subscales, four ESCA domains, and four GQOLI-74 domains each against <i>α</i> = 0.05, with no correction applied. When conducting 16 independent tests at this threshold, the familywise probability of at least one false positive exceeds 56% (1−[0.95]¹⁶). Several reported <i>p</i> values including medication adherence (<i>p</i> = 0.026), FPG (<i>p</i> = 0.013), TC (<i>p</i> = 0.005), and LDL-C (<i>p</i> = 0.009) would not survive Bonferroni correction (adjusted threshold: <i>p</i> &lt; 0.003). Even the more lenient Benjamini−Hochberg false discovery rate procedure would likely render some of these nonsignificant. The authors acknowledge this in their discussion, but acknowledgment without adjustment leaves the findings materially vulnerable to overinterpretation.</p><p>This issue is well-documented. Bender and Lange [<span>2</span>] have outlined practical frameworks for multiplicity adjustment in clinical studies, and Bland and Altman [<span>3</span>] have long cautioned against applying simultaneous significance thresholds across correlated endpoints without accounting for inflation.</p><p>We suggest that future work pre-specify one or two primary outcomes for confirmatory analysis, apply false discovery rate correction to secondary comparisons, and report effect sizes with 95% confidence intervals alongside <i>p</i> values. These steps would considerably strengthen what is otherwise a well-conceived and clinically relevant contribution.</p><p>The data that support the findings of this study are available in the Supporting Material of this article.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70409","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148386710","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":"Methodological and Statistical Confounding in Comparing Patient-Reported Outcomes Between Cardioversion and Ablation for Atrial Fibrillation","authors":"Faizan Raza","doi":"10.1002/clc.70407","DOIUrl":"https://doi.org/10.1002/clc.70407","url":null,"abstract":"<p>I read with great interest the article by Oren et al. [<span>1</span>] evaluating patient-reported outcome measures (PROMs) following elective electrical cardioversion versus catheter ablation for atrial fibrillation. While I commend the authors for investigating clinically relevant endpoints like sleep, health, and anxiety, several structural inconsistencies and methodological confounding factors limit the finality of their conclusions.</p><p>To enhance future comparison of rhythm control strategies, the investigator should implement a minimum of 6−12 months follow-up timeline to outlast the blanking period. Furthermore, utilizing ANCOVA modeling is essential to properly account for pre-existing baseline psychometric variations.</p><p>Data sharing is not applicable to this article as no data sets were generated or analyzed during the current study.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70407","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148386715","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":"Interpreting the Association Between Diuretic Intensity Score and Mortality: The Potential Roles of Diuretic Responsiveness and Mineralocorticoid Receptor Antagonist Therapy","authors":"Teruhiko Imamura","doi":"10.1002/clc.70404","DOIUrl":"10.1002/clc.70404","url":null,"abstract":"<p>We read with great interest the article, which developed a novel Diuretic Intensity Score (DIS) and reported an inverse association between higher DIS and short-term mortality among hospitalized patients with heart failure [<span>1</span>]. Several concerns have been raised.</p><p>The DIS reflects prescribed treatment intensity but does not account for actual diuretic responsiveness [<span>1</span>]. Patients receiving high-intensity diuretic therapy may represent a subgroup with preserved natriuretic capacity and adequate renal reserve, allowing clinicians to continue escalating therapy. In contrast, patients with advanced cardio-renal syndrome, hypotension, severe renal dysfunction, or marked diuretic resistance may be unable to tolerate intensive decongestive treatment despite having greater congestion severity. Previous studies have demonstrated that diuretic responsiveness, assessed by urine output, weight loss, or natriuresis per unit of loop diuretic administered, is strongly associated with clinical outcomes in acute heart failure [<span>2</span>]. Therefore, the favorable prognosis observed in patients with higher DIS may partly reflect preserved responsiveness to diuretics rather than a direct benefit of intensive diuretic exposure itself.</p><p>The construction of the DIS includes spironolactone as one of the score components [<span>1</span>]. Unlike loop and thiazide diuretics, spironolactone is not merely a decongestive agent but also a guideline-directed disease-modifying therapy with established prognostic benefits in selected heart failure populations, particularly those with reduced ejection fraction [<span>3</span>]. Consequently, a higher DIS may partly capture greater exposure to mineralocorticoid receptor antagonist therapy rather than greater diuretic intensity alone. This issue is particularly relevant because the score assigns additive value to combination therapy, potentially increasing DIS among patients receiving spironolactone-containing regimens. Additional analyses excluding spironolactone from the scoring system or adjusting for mineralocorticoid receptor antagonist use separately may help clarify whether the observed association is attributable to intensified decongestion, disease-modifying pharmacotherapy, or both.</p><p>The author has nothing to report.</p><p>The author has nothing to report.</p><p>The author has nothing to report.</p><p>The author declares no conflicts of interest.</p><p>The author has nothing to report.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70404","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148350919","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":"In-Hospital Cardiac Arrest Detection Performance Analysis and Comparison on Effective Feature Selection","authors":"Tianxin Jiang,&nbsp;Junbiao Liu,&nbsp;Dinghan Hu,&nbsp;Mengyuan Diao,&nbsp;Jiuwen Cao","doi":"10.1002/clc.70395","DOIUrl":"10.1002/clc.70395","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>How to reduce the occurrence of in-hospital cardiac arrest (IHCA), screen potential IHCA patients, and advance the treatment of IHCA are urgent problems to be solved in clinic. In this study, we tried to develop a model to predict whether patients will develop IHCA based on the data of patients who have just been admitted to hospital and evaluate the influence of different feature selection methods on machine learning (ML) models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>A total of 25 149 patients were included in the study; 320 developed IHCA. We chose three feature selection methods (Student's <i>t</i>-test and Chi-square test, regression analysis and correlation analysis) and four ML models (AdaBoost, XGBoost, Random Forest, and Logistic Regression). Each ML model was trained and evaluated using raw and feature-selected data; as a result, we got 16 models. AUROC, AUPRC, accuracy, recall, precision, and specificity are used to evaluate the model. The XGBoost model has the best performance with an AUROC of 0.987 (95% CI 0.984–0.988), an AUPRC of 0.763, an accuracy of 0.992, a recall of 0.695, a precision of 0.723, and a specificity of 0.996. The most significant predictors are age, albumin, sinus arrhythmia, activated partial thromboplastin time, and protein.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Different feature selection methods have different effects on different ML models. The predictive model developed using the XGBoost algorithm is the best predictor of whether patients will develop IHCA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70395","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148350899","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":"Heart Failure With Preserved Ejection Fraction-Like Phenotype in Coronary Artery Disease and Obstructive Sleep Apnea: Insights From the RICCADSA Cohort","authors":"Erik Thunström,&nbsp;Helena Glantz,&nbsp;Aylin Pihtili,&nbsp;Yüksel Peker","doi":"10.1002/clc.70402","DOIUrl":"10.1002/clc.70402","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Heart failure with preserved ejection fraction (HFpEF) is closely linked to aging and cardiometabolic risk factors and frequently coexists with obstructive sleep apnea (OSA). We aimed to investigate the prevalence and clinical correlates of an HFpEF-like phenotype in a revascularized coronary artery disease (CAD cohort), focusing on OSA and its severity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 435 patients with preserved left ventricular ejection fraction from the RICCADSA cohort were included. OSA was defined as apnea–hypopnea index (AHI) ≥ 15 events/h. HFpEF-like phenotype was defined by ≥ 2 of the following: elevated filling pressures (E/e′ ≥ 15), left atrial enlargement, increased left ventricular mass index, elevated pulmonary artery systolic pressure (≥ 35 mmHg), and elevated NT-proBNP (≥ 125 pg/mL). Multivariable logistic regression analyses included age, sex, obesity, hypertension, diabetes, and OSA status. Additional models evaluated AHI and oxygen desaturation index (ODI) as continuous variables and assessed the impact of excluding body mass index (BMI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Mean age was 63.6 ± 8.6 years and BMI 28.1 ± 4.1 kg/m²; 69.9% met HFpEF-like criteria. Age and obesity were independently associated with HFpEF-like phenotype, whereas categorical OSA was not. AHI and ODI were not independently associated after adjustment; however, in models excluding BMI, both AHI (OR 1.019, 95% CI 1.005–1.033) and ODI (OR 1.030, 95% CI 1.010–1.050) were significant predictors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>HFpEF-like phenotype is highly prevalent in CAD and primarily associated with aging and adiposity. The relationship between OSA severity and cardiac remodeling appears dependent on obesity, underscoring the interplay between cardiometabolic and sleep-related factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Pre-registered Clinical Trial Number</h3>\u0000 \u0000 <p>The RICCADSA trial is registered at ClinicalTrials.gov (NCT00519597) and in the Swedish national research registry (FoU i Sverige—Research and Development in Sweden; registration no. VGSKAS-4731; April 29, 2005).</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70402","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148344047","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":"Methodological Considerations Regarding Diuretic Intensity Score and Mortality in Hospitalized Heart Failure Patients","authors":"Noor-ul-Eman Haider,&nbsp;Uzair Ali Khan,&nbsp;Laraib Saleem,&nbsp;Masood Khan,&nbsp;Muhammad Hassan Fayaz","doi":"10.1002/clc.70403","DOIUrl":"10.1002/clc.70403","url":null,"abstract":"&lt;p&gt;Dear Esteemed Editor,&lt;/p&gt;&lt;p&gt;The investigation by Zhou et al., focused on exploring the relationship between Diuretic Intensity Score (DIS) and the probability of short-term survival increase among heart failure patients, is particularly interesting for us due to the new approach introduced by the scientists regarding the assessment of the treatment intensity [&lt;span&gt;1&lt;/span&gt;]. Despite the fact that the development of the standardized measures of the exposure level to the drug under analysis can be regarded as an innovation in the field, there are two possible methodological problems that might have an adverse impact on the accuracy of the results provided by the scientists.&lt;/p&gt;&lt;p&gt;The first problem concerns the possibility of the existence of exposure definition bias that can be compared to immortal time bias [&lt;span&gt;2&lt;/span&gt;]. The distinction between the traditional exposure definition and the DIS score estimation is the fact that the latter depends on the amount of exposure to the medicine during the patient's stay at the hospital. It means that only those patients who were placed into the moderate and severe categories were alive long enough to escalate their therapy and use more diuretics or intravenous therapy [&lt;span&gt;3&lt;/span&gt;]. It is especially critical taking into account the large scale of estimated hazard ratios. Thus, the hazard ratio for the most severe DIS group turned out to be exceptionally large, which would result in a more pronounced decrease in mortality compared with other modern approaches to treating heart failure. The reason why it can be explained by the so-called “survival paradox in an exposure-defined setting” since the real impact is due to various probabilities of treatment but not to its effectiveness [&lt;span&gt;4, 5&lt;/span&gt;]. Despite the possible survivorship bias mentioned by the authors themselves, the inability to perform a time-varying exposure analysis makes its detection difficult [&lt;span&gt;6&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The second point to consider in the context of the current research is the issue of DIS construct validity. Prognostic markers should provide maximum predictive accuracy in the clinical environment, and the capability of such markers to identify biological differences among patients in terms of their response to the treatment and additional prediction value as compared to other markers should be evaluated [&lt;span&gt;7&lt;/span&gt;]. When it comes to DIS, one has to mention various dimensions associated with the therapy including the mode of drug delivery, drugs employed, intensity of the treatment, and combination of treatment. All those dimensions are empirically weighted, but there is no explanation as for why those weights were selected in the framework of pharmacological approach. The main thing is that the predictive power in the current study does not indicate superiority of empirically weighted DIS to simply the number of prescribed diuretics. Thus, the question arises whether this weighting involves some knowledge abou","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70403","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148344021","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":"Ethanol Infusion Into the Vein of Marshall for Atrial Fibrillation: Clinical Efficacy and Technical Limitations","authors":"Xuepeng Zheng,&nbsp;Hongliang Yang,&nbsp;Huan Sun,&nbsp;Ming Yu,&nbsp;Lujia Ni,&nbsp;Daoyuan Si,&nbsp;Yuquan He","doi":"10.1002/clc.70398","DOIUrl":"10.1002/clc.70398","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Despite advancements in radiofrequency ablation (RFCA) technology and strategy, the long-term rhythm outcomes of persistent atrial fibrillation (PeAF) remain suboptimal. Since the vein of Marshall (VOM) is situated within the mitral isthmus (MI) area and covers local neural innervation and fiber networks, its pathophysiological role in mediating and maintaining atrial fibrillation (AF) and causing arrhythmia recurrence has garnered increasing attention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>Ethanol infusion into the vein of Marshall (EIVOM) may complement RFCA by delivering anatomically targeted chemical injury along the VOM course, thereby facilitating contiguous MI lesion formation and durable MI block.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a narrative review of mechanistic, procedural, and clinical evidence regarding EIVOM in AF ablation, with emphasis on MI block, rhythm outcomes, technical limitations, complications, and its potential role in pulsed field ablation (PFA)-based workflows.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Available evidence indicates that EIVOM facilitates durable MI block by targeting VOM-related epicardial connections and may improve rhythm outcomes when combined with RFCA in selected PeAF ablation strategies. Its clinical application is influenced by procedural and anatomical factors, while safety considerations and its potential complementary role in PFA-based workflows remain important areas for further evaluation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>EIVOM is a promising adjunct to RFCA, particularly for facilitating durable MI block and reducing residual epicardial conduction. Further standardized multicenter studies are needed to refine patient selection, procedural integration, safety optimization, and its role in contemporary AF ablation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70398","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148344023","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":"Inpatient Outcomes and Complications After Left Atrial Appendage Occlusion in Rural Versus Urban Hospitals in the United States","authors":"Amanda Nguyen,&nbsp;Muhammad Zia Khan,&nbsp;Joseph Neely,&nbsp;Waleed Alruwaili,&nbsp;Muhammad Abdullah Naveed,&nbsp;Justin Lim Devera,&nbsp;William E. Leon,&nbsp;Siddharth Agarwal,&nbsp;Zain Ul Abideen Asad,&nbsp;Samrina Khan,&nbsp;Karthik Gonuguntla,&nbsp;Daniel Ice,&nbsp;Muhammad Bilal Munir","doi":"10.1002/clc.70397","DOIUrl":"https://doi.org/10.1002/clc.70397","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Disparities in management of atrial fibrillation in rural and urban hospitals across the U.S. have been reported. However, studies investigating disparities regarding outcomes and complications after left atrial appendage occlusion (LAAO) based on hospital location are lacking.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate differences in outcomes and complications related to LAAO among rural and urban hospitals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The National Inpatient Sample was used to identify patients who underwent LAAO implantations in the U.S. from 2016−2020. Study endpoints assessed included inpatient complications, outcomes, and resource utilization after LAAO procedures among rural and urban hospitals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 2016−2020, there were a total of 87 315 and 1985 LAAO device placements in urban and rural hospitals, respectively. Baseline characteristics were similar among both groups, with a few exceptions. After multivariable adjustment for confounders, odds of inpatient complications and mortality were similar among both groups. However, rural LAAO recipients experienced greater rates of discharge to an acute care facility (3.3% vs 2.4%, <i>p</i> = 0.01), as well as lower costs (aOR: 0.58, 95% CI: 0.49–0.69) and length of stay (aOR: 0.89, 95% CI: 0.81–0.98).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A majority of LAAO implantations occurred in urban hospitals in the U.S. Baseline characteristics and adjusted odds of inpatient complications and mortality were similar in rural and urban recipients. However, important differences were described regarding resource utilization and disposition. Further investigation into the specific factors driving these inequities is encouraged to promote improved access to and outcomes of cardiovascular care for rural residents.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70397","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148324784","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}