Clinical Medicine Insights. Cardiology最新文献

{"title":"Longitudinal Analysis of Heparin-Binding Protein (HBP) and Serum Amyloid a Protein (SAA) Versus Interleukin 6 (IL-6), C-Reactive Protein (CRP), and Procalcitonin (PCT) During Both the Acute Postoperative Period and Recovery at Three Months From Non-emergent Cardiac Surgery.","authors":"Krzysztof Laudanski, Ahmed Sayed Ahmed, Mohamed A Mahmoud, Hossam Gad, Benjamin R E Harris, Ryan Smith, Dandan Zhu, Abdelhamed Elgazar, Anil Vasishta, Gajic Ognjen, Daniel A Diedrich, Juan Crestanello","doi":"10.1177/11795468261462607","DOIUrl":"10.1177/11795468261462607","url":null,"abstract":"<p><p>Variability in novel inflammatory markers (HBP and SAA) post-surgery could indicate ongoing perioperative inflammation. This pilot cohort study collected blood from 99 patients undergoing elective cardiac surgery at baseline, 24 hours, 7 days, and 3 months post-surgery. Inflammatory markers (HBP, SAA, PCT, CRP, IL-6) were measured with a point-of-care device. Demographic and clinical data were extracted from health records. Serum SAA increased significantly in the acute postoperative phase (M_e[IQR];SAA_baseline=81.1[87] vs SAA_24hr=232.65[88.02];U[72]=2343,p<0.0001), remained elevated at 7 days (Me_7d=252.6[88.56];U[57]=1484,p<0.0001) and were still more pronounced than baseline at t_3m (Me_3m=118.44[101.52];U[38]=448,p=0.0008). HBP showed a significant rise at seven days (HBP_baseline=45[26;89] vs HBP_7d=121[69.75;224.5]; U[56]=805,p<0.0001) then returned to near baseline by t_3m(Me_3m=32.5[15.75;98.5]). Traditional inflammatory markers PCT, CRP, and IL-6 demonstrated a rapid increase at t_24h and plateaued at t_7d. None of the biomarkers showed variability at baseline or postoperatively with preoperative status or postoperative complications. Cluster analysis of the inflammatory markers at 24 hours (t_24h) identified distinct subgroups. Cluster #1-patients with a modest increase in all markers; Cluster#2 characterized with a robust increase in IL-6; Cluster #3 showed increase in CRP and decline in HBP; Cluster #4 showed a modest increase in IL-6 and decline in HBP; Cluster #5 represented a decline in both CRP and SAA. Patients in these clusters differ with respect to age, pre-existing peripheral artery disease, and borderline differences in perioperative acetaminophen use. SAA and HBP remain elevated longer than IL-6, CRP, and PCT after surgery, suggesting that inflammation may persist beyond 3 months.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"20 ","pages":"11795468261462607"},"PeriodicalIF":2.0,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13354903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148419391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Evaluation of Guideline-Directed Treatments in Patients With Obstructive Hypertrophic Cardiomyopathy in Germany.","authors":"Farbod Sedaghat-Hamedani, Carla Zema, Michael Schultze, Tarcyane Barata Garcia, Nils Kossack, Ervant J Maksabedian Hernandez, Tobias Bluhmki, Taryn Krause, Johanna Schmoelders, Benjamin Meder","doi":"10.1177/11795468261455390","DOIUrl":"10.1177/11795468261455390","url":null,"abstract":"<p><strong>Background: </strong>Obstructive hypertrophic cardiomyopathy (HCM) is defined by left ventricular hypertrophy with outflow tract obstruction. Despite clear guideline-directed medical therapy recommendations from the European Society of Cardiology (ESC), it remains unclear whether real-world treatment aligns with these guidelines. This study evaluates adherence to ESC guidance in Germany, focusing on pharmacological and invasive therapies and identifying gaps in real-world care for patients with obstructive HCM.</p><p><strong>Methods: </strong>A retrospective cohort analysis was conducted using the WIG2 Benchmark database, containing administrative claims data from German statutory health insurers. Patients aged ≥18 years who received an International Classification of Diseases (ICD)-coded diagnosis of HCM between 2012 and 2018 were included. Treatment alignment was assessed against ESC guidelines on HCM.</p><p><strong>Results: </strong>Of 6793 patients with an HCM diagnosis, 1141 had obstructive HCM. Mean age was 59.7 years and 62% were male. Following initial HCM consultation, 18% received beta-blocker (BB) monotherapy and 12% received calcium channel blocker (CCB) monotherapy, in accordance with ESC guidelines. However, 43% of treatment combinations were not aligned with the ESC guidelines, including use of contraindicated dihydropyridine CCBs and vasodilating BBs, and 22% of patients did not receive any HCM-related pharmacological treatment. Overall, only 57% of the prescribed treatments were consistent with ESC guidelines for obstructive HCM management.</p><p><strong>Conclusions: </strong>This study reveals substantial gaps in alignment with the ESC guidelines for obstructive HCM management in Germany, underscoring the need for enhanced clinician education on existing therapies. Greater uptake of guideline-directed medical therapy is critical to improving patient well-being, functional status and outcomes.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"20 ","pages":"11795468261455390"},"PeriodicalIF":2.0,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13315285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148359747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current State of Computed Tomography Derived Fractional Flow Reserve (FFR-CT) and Its Diagnostic Advantages.","authors":"Ibrahim Mortada, Dalton Buckingham, Aaron W Lee, Esosa Odigie-Okon, Mostafa Shalaby, Afaq Motiwala, Amer Abdulla, Michael C Boyars, Thomas A Blackwell, Hani Jneid","doi":"10.1177/11795468261464355","DOIUrl":"10.1177/11795468261464355","url":null,"abstract":"<p><p>Coronary computed tomography angiography (CCTA) is widely used for noninvasive evaluation of coronary artery disease (CAD) and is highly sensitive for detecting anatomic coronary stenosis with a high negative predictive value. However, CCTA is limited in its ability to determine the physiological significance of lesions, resulting in reduced specificity and disagreement with invasive coronary angiography in a substantial proportion of cases. Fractional Flow Reserve derived from CCTA (FFR-CT) was developed to address this anatomic-physiologic discordance by providing noninvasive, lesion-specific functional assessment of ischemia. This narrative review summarizes the current state of FFR-CT technology, its diagnostic performance relative to CCTA alone and invasive FFR, and its evolving role in contemporary CAD evaluation. Across prospective trials and meta-analyses, FFR-CT consistently improves diagnostic accuracy for ischemia-producing lesions, driven primarily by gains in specificity, with favorable agreement to invasive FFR at clinically relevant thresholds. Advances in computational modeling and machine learning have substantially reduced processing times, improving feasibility and workflow integration. Clinical studies demonstrate that incorporation of FFR-CT following CCTA improves selection for invasive coronary angiography, reduces unnecessary diagnostic catheterization, and provides prognostic information beyond anatomic disease burden alone. Important limitations remain, including dependence on CCTA image quality, reduced reliability in heavily calcified or complex coronary anatomy, and uncertainty near ischemic thresholds, necessitating careful interpretation within the clinical context. When applied selectively after high-quality CCTA, FFR-CT offers a robust noninvasive surrogate for invasive coronary physiology and supports a more targeted, physiology-guided diagnostic pathway for patients with suspected CAD.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"20 ","pages":"11795468261464355"},"PeriodicalIF":2.0,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148344131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tirzepatide and the Cardiovascular Continuum: Metabolic, Cardiorenal and Heart Failure Evidence.","authors":"Antonio Lm Parlati, Luca Martini, Ermanno Nardi, Raffaele Carluccio, Luca Ep Parlati, Cristina Madaudo, Pasquale Perrone Filardi","doi":"10.1177/11795468261460202","DOIUrl":"10.1177/11795468261460202","url":null,"abstract":"<p><p>Tirzepatide is a first-in-class, once-weekly dual GIP and GLP-1 receptor agonist approved for type 2 diabetes and obesity. Given the tight link between hyperglycemia, adiposity, and cardiovascular disease, tirzepatide has rapidly gained interest as a broader cardiometabolic intervention. This narrative review summarizes mechanistic rationale and clinical evidence on cardiovascular risk-factor modification, cardiorenal signals, and outcome data. Across the SURPASS program in type 2 diabetes, tirzepatide produces large, dose-dependent reductions in HbA1c and substantial weight loss, with consistent benefits versus active comparators. In obesity, the SURMOUNT trials showed marked and durable weight reduction over long follow-up, with clinically relevant improvements in waist circumference, blood pressure, triglycerides, and inflammatory biomarkers. Beyond weight and glycaemia, available data suggest favorable effects on lipids, ambulatory blood pressure, inflammatory markers, and kidney-related endpoints in exploratory analyses. Tirzepatide also improves obstructive sleep apnea severity in adults with obesity. Regarding cardiovascular outcomes, SURPASS-CVOT supports cardiovascular safety by demonstrating noninferiority versus dulaglutide for 3-point major adverse cardiovascular events in patients with type 2 diabetes and established atherosclerotic cardiovascular disease (ASCVD). In obesity-related HFpEF, SUMMIT shows reductions in worsening heart failure (HF) events and improvements in health status, supporting a phenotype-specific role in HF. Overall, tirzepatide is emerging as a key therapeutic option for integrated cardiometabolic risk reduction, with ongoing research needed to define its incremental benefit versus established GLP-1 receptor agonists, long-term effectiveness in routine care, and optimal positioning across HF phenotypes.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"20 ","pages":"11795468261460202"},"PeriodicalIF":2.0,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13272863/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148276501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complex Cyanotic Congenital Heart Disease in Pregnancy: Survival With Unrepaired Pulmonary Atresia and Ventricular Septal Defect - A Case Report.","authors":"Sophia S Muhali, Lameck Marcel, Simon C Peter, Alex F Lwiza, Adnan M Sadiq, Abid M Sadiq","doi":"10.1177/11795468261460805","DOIUrl":"10.1177/11795468261460805","url":null,"abstract":"<p><p>Pulmonary atresia with ventricular septal defect and systemic-to-pulmonary collateral supply is a severe conotruncal malformation characterized by complete right ventricular outflow tract obstruction, a large ventricular septal defect, and absence of a main pulmonary artery. Without surgical repair, survival into adulthood is rare and depends on the adequacy of collateral pulmonary blood flow. Pregnancy in women with unrepaired cyanotic congenital heart disease carries extreme maternal and fetal risk and is classified as modified World Health Organization class IV when resting oxygen saturation is below 85%. We report a 22-year-old woman at 32 weeks' gestation who presented with progressive dyspnoea, severe hypoxaemia (oxygen saturation 74%), and heart failure. Echocardiography demonstrated a large perimembranous ventricular septal defect and pulmonary atresia. Cardiac computed tomography confirmed an overriding aorta, non-confluent pulmonary arteries arising from the descending thoracic aorta and aortic arch, and absence of a main pulmonary trunk, establishing the diagnosis of pulmonary atresia with ventricular septal defect and systemic-to-pulmonary collateral supply. She underwent caesarean delivery for maternal decompensation, complicated by postpartum haemorrhage requiring hysterectomy. Ten days postpartum, she developed an acute ischaemic stroke. Telemetry excluded atrial fibrillation, and imaging showed no intracardiac thrombus. She improved with antiplatelet therapy and supportive care and remained clinically stable at six-month follow-up. This case highlights the rare survival of unrepaired complex cyanotic congenital heart disease into adulthood, the extreme risks of pregnancy in this setting, and the need for preconception counselling, multidisciplinary management, and vigilant postpartum thromboembolic risk assessment, particularly in resource-limited settings.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"20 ","pages":"11795468261460805"},"PeriodicalIF":2.0,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13260777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward Precision in Myocardial Injury Management: A Critical Synthesis and the C.A.L.I.B.R.A.T.E. Framework for Biomarker Integration.","authors":"Chukwuemeka Nwokocha, Javier Palacios, Tolunigba Kolawole, Magdalene Nwokocha, Chinelo Anyaorah, Joel H Chiroma, Donovan McGrowder, Nelson Orie, Danladi C Husaini","doi":"10.1177/11795468261454738","DOIUrl":"10.1177/11795468261454738","url":null,"abstract":"<p><p>Cardiovascular diseases remain the leading cause of global mortality, necessitating precise strategies for diagnosing and managing myocardial injury. This review critically synthesizes the current biomarker landscape and proposes an integrative framework to address the significant translational gaps between biomarker science and clinical practice. We conducted a comprehensive critical review, analyzing established and emerging biomarkers, including cardiac troponins, natriuretic peptides, and inflammatory and fibrotic markers, within the context of biological confounders, etiology-specific challenges, and clinical implementation barriers. Through thematic synthesis, we developed the novel C.A.L.I.B.R.A.T.E. framework to structure biomarker integration. While high-sensitivity assays have improved detection, they reveal chronic elevations in conditions like renal dysfunction, aging, and heart failure, reducing specificity and complicating acute diagnosis. Emerging biomarkers (eg, sST2, galectin-3) offer prognostic insight but lack therapeutic guidance and specificity. Etiology-specific puzzles (eg, myocarditis, COVID-19, MINOCA) highlight the limitations of isolated biomarker interpretation. The C.A.L.I.B.R.A.T.E. framework addresses these gaps by integrating Clinical context, Assay characteristics, Likelihood, Injury mechanism, Biomarker profiles, Rule-out/in thresholds, Adjunctive tests, Time kinetics, and Etiologies & comorbidities. The future of myocardial injury management depends on shifting from isolated biomarker measurement to integrated, algorithm-driven interpretation. The C.A.L.I.B.R.A.T.E. framework provides a structured pathway for personalized diagnostic reasoning, bridging the translational chasm and advancing precision cardiology through context-dependent, multi-modal data synthesis.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"20 ","pages":"11795468261454738"},"PeriodicalIF":2.0,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13260791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Research Advances in Timing of Anticoagulant Therapy Following Cardioembolic Stroke.","authors":"Maisitula Rousidanmu, Niao Yang, Pan Yang, Nao Yan","doi":"10.1177/11795468261458755","DOIUrl":"10.1177/11795468261458755","url":null,"abstract":"<p><p>Cardioembolic stroke primarily results from thromboembolism caused by cardiac conditions such as atrial fibrillation, characterised by high recurrence rates, high rates of disability, and high mortality. Anticoagulation therapy is a key measure for the prevention of stroke recurrence, though the timing of its initiation remains debated, requiring a balance between the risk of thromboembolic recurrence and the risk of bleeding. The widely adopted \"1-3-6-12-day rule\" is based on expert consensus but lacks support from high-level evidence. In recent years, multiple randomized controlled trials (such as TIMING, ELAN, OPTIMAS, and START) have demonstrated that for patients with mild-to-moderate cardioembolic stroke, early initiation (within 2-4 days after stroke) of direct oral anticoagulants (DOACs) is not only safe but also significantly reduces the risk of early recurrence, without increasing the incidence of symptomatic intracranial hemorrhage. In particular, the recently completed individual participant data meta-analysis (CATALYST) has provided robust evidence for early anticoagulation. Unlike previous reviews that have focused solely on the timing of anticoagulation in non-valvular atrial fibrillation, this review provides a critical appraisal of the evidence gaps for severe stroke and post-reperfusion populations, a practical comparison of individual DOACs to guide drug selection, and a summary of management principles for other cardioembolic sources (mechanical valves, infective endocarditis, patent foramen ovale, left ventricular thrombus, and atrial flutter). This review summarises the pathophysiological mechanisms of cardioembolic stroke, clinical strategies for anticoagulation timing, characteristics of different anticoagulant agents and their indications for use. It emphasises the importance of individualised treatment and indicates that future research should further clarify the optimal timing of anticoagulation in patients with severe stroke and those undergoing reperfusion therapy.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"20 ","pages":"11795468261458755"},"PeriodicalIF":2.0,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13237456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148197389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long COVID and Cardiovascular Diseases Among U.S. Adults: Results From the U.S. Medical Expenditure Panel Survey.","authors":"Geoffrey Y Zhang, John C Lin, Dang Nguyen, Sameed Ahmed M Khatana, Thomas P Giordano","doi":"10.1177/11795468261455387","DOIUrl":"10.1177/11795468261455387","url":null,"abstract":"<p><strong>Objective: </strong>Long COVID is associated with persistent symptoms including cardiovascular complications; however, the epidemiology and directionality of this association remain unclear.</p><p><strong>Methods: </strong>Utilizing a retrospective cohort study design with cross-sectional analyses, 8,332 respondents aged 18 and older from the 2022 Medical Expenditure Panel Survey (MEPS) who had a prior COVID-19 infection, were analyzed to determine the temporal association between long COVID and cardiovascular disease (CVD), modeling each as both outcome and exposure in separate analyses.</p><p><strong>Results: </strong>Long COVID was associated with any CVD diagnosis (OR 1.37; 95% CI: 1.05-1.80), specifically angina (OR 1.81; 95% CI: 1.18-2.77) and myocardial infarction (OR 1.50; 95% CI: 1.01-2.23). Temporally, long COVID was associated with higher odds of CVD diagnoses in the same year or following year after COVID-19 (OR 2.62; 95% CI: 1.05-6.51) and in subsequent years only (OR 8.60; 95% CI: 1.53-48.3). Respondents with pre-existing CVD did not have statistically significant greater odds of reporting new long COVID symptoms.</p><p><strong>Conclusion: </strong>Our findings demonstrate that long COVID is associated with the subsequent development of CVD, underscoring the need for further research in this patient population to improve health interventions.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"20 ","pages":"11795468261455387"},"PeriodicalIF":2.0,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13201914/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148041406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Best Practices and Key Barriers for Amyloidosis Patient Care at US Specialized Amyloidosis Centers: An Analysis by ARC-ASPIRE.","authors":"Jose Nativi-Nicolau, Johana Fajardo, Alyssa Galloway, Sami Khella, Nisith Kumar, Michaela Liedtke, Isabelle Lousada, Tiffany Patrick, Colleen Moffitt, Lori Klein, Gabriela Tamariz, Karthikeyan Veeraraghavalu, Alexandra Haddad-Angulo","doi":"10.1177/11795468261444669","DOIUrl":"10.1177/11795468261444669","url":null,"abstract":"<p><strong>Objectives: </strong>Amyloidosis is a group of rare diseases that often manifest in multi-organ symptoms requiring an effective multidisciplinary team of care providers to manage. This study aimed to identify the best practices and key barriers to patient-centric care at US specialized amyloidosis centers (SACs) which have emerged as central hubs for multidisciplinary amyloidosis care.</p><p><strong>Methods: </strong>We conducted and analyzed interviews with 77 stakeholders of amyloidosis diseases, including specialist physicians from 17 SACs across the US, patients, patient advocacy group representatives, and referring physicians.</p><p><strong>Results: </strong>The most commonly mentioned best practices were patient-centric multidisciplinary care, timely intake of new high-risk patients, and responsiveness to patient questions. Expanding local physician education was noted as critical to earlier diagnosis. Fifteen out of 17 SACs are actively involved in clinical trials for amyloidosis treatments. Key barriers to care identified were patient distance to SACs, limited medical records and data sharing, and insurance hurdles. Most SACs keep track of metrics, such as patient volume, patient demographics, time to first appointment, as part of internal or in external registries to measure progress.</p><p><strong>Conclusion: </strong>These findings offer practical insights for optimizing amyloidosis care and highlight the structural and informational gaps that must be addressed to improve access and outcomes.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"20 ","pages":"11795468261444669"},"PeriodicalIF":2.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13133438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing Efficacy and Safety of Different Aldosterone Synthase Inhibitors for Hypertension: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials.","authors":"Muhammad Hassan Waseem, Zain Ul Abideen, Areeba Shoaib, Hafsa Arshad Azam Raja, Pawan Kumar Thada, Ameer Haider Cheema","doi":"10.1177/11795468261436180","DOIUrl":"10.1177/11795468261436180","url":null,"abstract":"<p><strong>Background: </strong>Hypertension affects over 1.3 billion globally, many remain uncontrolled, and aldosterone synthase inhibitors (ASIs) are emerging as a treatment. This network meta-analysis compared the effectiveness and safety of ASI regimens in hypertensive patients.</p><p><strong>Methods: </strong>PubMed, Cochrane Central, and ScienceDirect were searched till December 2025. We conducted a frequentist network meta-analysis using RStudio version 4.3.3 with the \"meta\" and \"netmeta\" packages. <i>P</i>-scores were used for treatment ranking.</p><p><strong>Results: </strong>Ten randomized controlled trials were included in the analysis. Baxdrostat 1 mg, 2 mg, lorundrostat 100 mg once daily, 12.5 mg twice daily, 25 mg twice daily, 50 mg once daily, 50 mg and escalation to 100 mg, osilodrostat 0.25, 0.5, and 1.0 mg once daily, vicadrostat 10, 20, and 3 mg plus empagliflozin, and 20 mg significantly reduced the systolic blood pressure (SBP), where the baxdrostat 2 mg (<i>P</i>-score = 0.89) was ranked best. Lorundrostat 50 mg once daily, Baxdrostat 1 and 2 mg significantly reduced the diastolic blood pressure (DBP) with Lorundrostat 50 mg once daily ranked best (<i>P</i>-score = 0.84). Adverse events were increased with lorundrostat regimens, but serious adverse events were similar across regimens. Hyperkalemia was more frequent with Baxdrostat 1 and 2 mg and all lorundrostat regimens. Symptomatic hypotension occurred mainly with lorundrostat 50 mg daily.</p><p><strong>Conclusion: </strong>The SBP and DBP were significantly reduced with the baxdrostat and lorundrostat regimens, although the risk of hyperkalemia increased. Adverse events were also higher in the lorundrostat regimens, whereas serious adverse events were comparable.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"20 ","pages":"11795468261436180"},"PeriodicalIF":2.0,"publicationDate":"2026-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13080199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147698018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}