Clinical Research in Cardiology最新文献

{"title":"Prevalence and prognosis of multimorbidity in heart failure with mildly reduced ejection fraction.","authors":"Marielen Reinhardt, Michael Behnes, Mohammad Abumayyaleh, Thomas Bertsch, Michelle Goertz, Noah Abel, Alexander Schmitt, Felix Lau, Jonas Dudda, Kathrin Weidner, Ibrahim Akin, Tobias Schupp","doi":"10.1007/s00392-025-02840-z","DOIUrl":"10.1007/s00392-025-02840-z","url":null,"abstract":"<p><strong>Background and objective: </strong>Related to ongoing demographic, the number of patients with cardiac and non-cardiac comorbidities increases. Heart failure with mildly reduced ejection fraction (HFmrEF) represents a heterogeneous population with diverse clinical profiles. The study investigates the prevalence and prognostic impact of multimorbidity in patients hospitalized with HFmrEF.</p><p><strong>Methods: </strong>Consecutive patients with HFmrEF were retrospectively included at one institution from 2016 to 2022 and divided into four groups based on the number of concomitant comorbidities taking into account 12 comorbidities (i.e., 0-1, 2-3, 4-5, ≥ 6 comorbidities). The prognostic impact of the number of comorbidities was investigated with regard to the primary endpoint all-cause mortality at 30 months.</p><p><strong>Results: </strong>From 2,184 patients hospitalized with HFmrEF, 37% presented with 4-5 comorbidities, 17% with ≥ 6 comorbidities. Compared to patients with 4-5, 2-3, 0-1 comorbidities, patients with ≥ 6 comorbidities were more frequently discharged with beta-blockers (83.6% vs. 78.7% vs. 77.6% vs. 64.7%; p = 0.001) and mineralocorticoid receptor antagonists (MRA) (17.2% vs. 15.7% vs. 12.8% vs. 7.9%; p = 0.004). The risk of all-cause mortality at 30 months was higher in patients with ≥ 6 comorbidities compared to patients with less comorbidities (i.e., 4-5, 2-3, 0-1) (59.5% vs. 38.6% vs. 17.0% vs. 7.9%, p = 0.001). Both cardiovascular (HR = 1.106; 95% CI 1.030 - 1.188; p = 0.006) and non-cardiovascular (HR = 1.564; 95% CI 1.470 - 1.664; p = 0.001) comorbidities predicted the risk of long-term all-cause mortality.</p><p><strong>Conclusion: </strong>In patients hospitalized with HFmrEF, more than 50% had at least 4 comorbidities. Both cardiovascular and non-cardiovascular comorbidities predicted the risk of long-term all-cause mortality in HFmrEF.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1615-1628"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13457439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145997347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuously elevated plasma ketone bodies are linked to adverse outcomes in patients with heart failure.","authors":"Constantin L Palm, Niels T B Scholte, Lirong Lu, Sabrina Abou Kamar, Barbara M Bakker, Suzanne N Voorrips, Belend Mahmoud, Margery A Connelly, Navin Suthahar, Rudolf A de Boer, Victor A Umans, K Martijn Akkerhuis, Hans Hillege, Eric Boersma, Isabella Kardys, B Daan Westenbrink","doi":"10.1007/s00392-026-02992-6","DOIUrl":"https://doi.org/10.1007/s00392-026-02992-6","url":null,"abstract":"<p><strong>Background: </strong>Elevated plasma ketone bodies (KBs) are linked to poor outcomes in heart failure (HF), yet the prognostic value of repeated KB measurements is uncertain.</p><p><strong>Objective: </strong>To study temporal changes in plasma KBs in HF patients in relation to prognosis.</p><p><strong>Methods: </strong>Plasma KBs were measured by nuclear magnetic resonance spectroscopy in 467 patients from the TRIUMPH study. Blood was obtained up to seven times during 1-year follow-up after HF hospitalization. Associations between serial KB measurements and the endpoint of death and HF rehospitalization were investigated by joint modeling. Similar analyses were conducted in the Bio-SHiFT study, including 397 chronic HF patients with up to 10 repeated blood samples during a median follow-up of 2.1 years. The endpoint in Bio-SHiFT was a composite of cardiovascular death, HF hospitalization, left ventricular device implantation and heart transplantation.</p><p><strong>Results: </strong>In TRIUMPH, median age was 74 years, 37% of patients were female and 82% were in NYHA class III/IV. Estimated KBs were continuously higher in the 185 (40%) patients reaching the combined endpoint. Hazard ratios (HR) (95% confidence interval [CI]) for the endpoint per doubling of total KBs (TKBs), acetone, and β-hydroxybutyrate were 2.10 (1.27-3.71), 1.62 (1.08-2.44) and 1.62 (1.22-2.23), respectively, at any time during follow-up after adjustment for clinical characteristics and NT-proBNP at baseline. In Bio-SHiFT, median age was 64 years, 28.5% of patients were female, and 124 (31.2%) patients reached the primary endpoint. KBs were higher in patients reaching the endpoint. The HR per doubling of TKB was 5.36 (95% CI 2.18-14.0) and 4.24 (31.4-5.95) for acetone.</p><p><strong>Conclusion: </strong>Serially measured KB levels were associated with adverse events in two independent HF cohorts. Patients with adverse events displayed consistently higher KBs, potentially reflecting ongoing metabolic stress.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PVI-SHAM-AF: what does this trial tell us about catheter ablation and symptoms in patients with atrial fibrillation?","authors":"Ulrich Laufs, Michael Böhm, Felix Mahfoud, Rolf Wachter","doi":"10.1007/s00392-026-03016-z","DOIUrl":"https://doi.org/10.1007/s00392-026-03016-z","url":null,"abstract":"","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ventricular arrhythmia inducibility predicts clinical events in mitral valve prolapse syndrome.","authors":"Benjamin Rath, Julian Wolfes, Christian Ellermann, Fatih Güner, Felix Wegner, Julia Köbe, Florian Reinke, Gerrit Frommeyer, Lars Eckardt","doi":"10.1007/s00392-026-03008-z","DOIUrl":"https://doi.org/10.1007/s00392-026-03008-z","url":null,"abstract":"<p><strong>Background: </strong>Mitral valve prolapse (MVP) is commonly benign, but an arrhythmic phenotype (AMVP) with increased risk for sudden cardiac death has been described. Current risk stratification is mainly based on clinical data and imaging markers, while the role of programmed ventricular stimulation (PVS) remains uncertain.</p><p><strong>Methods: </strong>In this prospective single-center cohort study, 42 patients fulfilling the EHRA consensus criteria for AMVP underwent an electrophysiological study with programmed ventricular stimulation between 2016 and 2025. Stimulation was performed from the right ventricular apex and outflow tract using up to two extra stimuli. Following shared decision-making, patients received either an implantable cardioverter-defibrillator (ICD) or an implantable loop recorder (ILR). The endpoint was the occurrence of clinically significant ventricular arrhythmias (VAs), defined as appropriate ICD therapies, ILR-documented sustained VT, or arrhythmic syncope.</p><p><strong>Results: </strong>Sustained ventricular arrhythmias were inducible in 20 patients (47.6%). ICD implantation was performed in 14 patients (70%) with inducible VA and in 6 patients (27.3%) without VA inducibility. During a mean follow-up of 38.0 ± 24.6 months, clinically significant VA occurred in 45.0% of patients with inducible VA vs. 9.1% of patients with nonpathological PVS (p = 0.01).</p><p><strong>Conclusion: </strong>Inducible ventricular arrhythmias during PVS were associated with subsequent clinically significant VA in AMVP. PVS may serve as an additional risk stratification tool in this entity.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148825718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atrial fibrillation associated with renal tubular injury in acute chest pain: N-acetyl-β-D-glucosaminidase, kidney injury molecule 1, and NT-proBNP as predictive markers.","authors":"F I Lang, J Hupf, M Schlossbauer, S Staudner, S Leininger, M Vogel, S Wallner, R Burkhardt, M Zimmermann, U Hubauer, A Luchner, L Maier, C Jungbauer","doi":"10.1007/s00392-026-03001-6","DOIUrl":"https://doi.org/10.1007/s00392-026-03001-6","url":null,"abstract":"<p><strong>Introduction: </strong>Acute heart disorders are often characterized by the coexistence of atrial fibrillation (AF) and cardiorenal syndrome. This study focused on evaluating the potential cardiorenal biomarkers N-acetyl-β-D-glucosaminidase (uNAG) and kidney injury molecule 1 (uKIM) in a real-world chest pain cohort according to the presence of sinus rhythm (SR) and AF.</p><p><strong>Methods: </strong>The urinary concentrations of uNAG and uKIM were measured in 601 patients presenting with acute chest pain in the emergency department of the University Hospital Regensburg.</p><p><strong>Results: </strong>Significantly increased uNAG, uKIM, and NT-proBNP concentrations were observed among 68 patients presenting with AF compared to 533 presenting with SR (each p < 0.001, AUC_uNAG = 0.730, AUC_uKIM = 0.634). Furthermore, patients diagnosed with acute coronary syndrome (ACS) showed significantly increased biomarker concentrations when presenting with AF compared to SR (each p < 0.05). Logistic regression revealed that uNAG, NT-proBNP and high-sensitivity troponin T were independent predictors of AF (p < 0.05), whereas eGFR and uKIM were not (each p = ns).</p><p><strong>Conclusions: </strong>In conclusion, NT-proBNP, uNAG, and to a lesser extent uKIM correlated with AF. NT-proBNP and uNAG presented as independent predictors of AF. The observational findings may be compatible with higher concentrations of tubular injury biomarkers in patients with acute heart disease presenting with AF compared to SR; however, causality cannot be established from this study design.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148825650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantifying the inclusion of cardiovascular research into clinical guidelines.","authors":"Johan Skov Bundgaard, Jonas Skjold Raaschou-Pedersen, Kasper Iversen, Henning Bundgaard, Mark P Khurana, Daniel Raaschou-Oddershede","doi":"10.1007/s00392-026-03011-4","DOIUrl":"https://doi.org/10.1007/s00392-026-03011-4","url":null,"abstract":"<p><strong>Background: </strong>The number of cardiovascular research articles is growing rapidly, but the subsequent incorporation into newer guidelines remains uncertain. We aimed to quantify the proportion of topic-relevant literature published between consecutive European Society of Cardiology (ESC) guideline editions that was cited in the later edition.</p><p><strong>Methods: </strong>Using PubMed Medical Subject Heading (MeSH) searches and OpenAlex citation graphs, we identified all publications published between two ESC guideline editions across eight topics. We quantified the proportion of inter-guideline publications that were cited in the subsequent guideline.</p><p><strong>Results: </strong>Across the eight topics, a mean of 2.2% (SD = 2.0) of inter-guideline publications were directly cited in the successive guideline. Clinical trials were more frequently cited than non-clinical trial publications (8.5% [SD = 6.8] vs 2.0% [SD = 2.0]) in a topic-adjusted logistic regression; the odds were roughly fivefold higher (OR 5.45, 95% CI 4.87-6.10).</p><p><strong>Conclusions: </strong>ESC guidelines cite a small proportion of the cardiovascular literature published since their preceding edition, drawing disproportionately on clinical trials.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stress CMR versus SPECT for the detection of coronary artery disease: meta-analysis and implications for the German healthcare.","authors":"Marios Sagris, Andreas Tzoumas, Norbert Frey, Grigorios Korosoglou","doi":"10.1007/s00392-026-03004-3","DOIUrl":"https://doi.org/10.1007/s00392-026-03004-3","url":null,"abstract":"","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Late cardiac effects of anthracycline-based therapy in childhood cancer survivors: a CMR study of cardiac strain and function.","authors":"Mary Luz Mojica-Pisciotti, Roman Panovský, Tomáš Holeček, Věra Feitová, Lukáš Opatřil, Vladimír Kincl, Tomáš Kepák","doi":"10.1007/s00392-026-03003-4","DOIUrl":"https://doi.org/10.1007/s00392-026-03003-4","url":null,"abstract":"<p><p>Anthracycline-based therapies cause cancer therapy-related cardiac dysfunction (CTRCD) in childhood cancer survivors (CCS). This cross-sectional observational study aimed to assess the potential of cardiac strain, evaluated with cardiovascular magnetic resonance feature tracking (CMR-FT), as a marker of subclinical CTRCD in CCS treated with anthracyclines. We prospectively included 117 CCS examined approximately 12 years after treatment and retrospectively selected 79 age- and sex-matched controls. Cardiac strain was assessed with CMR-FT, including global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS) for both ventricles, and longitudinal strain for both atria. CCS were further divided into CCS-low (< 250 mg/m²) and CCS-high (≥ 250 mg/m²) based on cumulative anthracycline dose. Compared to controls, CCS had lower but preserved left ventricular (LV) ejection fraction (EF), lower indexed LV myocardial mass, higher indexed end-diastolic and end-systolic LV volumes, and impaired LV strain parameters, which were further worsened in the CCS-high subgroup. In multivariable analysis, a higher cumulative dose was independently associated with reduced LVEF and worse LV circumferential and radial strain, after adjustment for age and sex. These findings suggest a dose-dependent effect on subclinical cardiac function. Incorporating CMR-FT strain assessment into the cardiac monitoring of CCS may help identify subclinical CTRCD in this population.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-expanding intraannular transcatheter heart valve in tapered LVOT morphology - impact on deployment precision and periprocedural aortic prosthesis migration.","authors":"C Eckel, J Schlüter, S Bargon, D Anastasoudis, C Mues, D Sötemann, J Blumenstein, A Elsässer, H Möllmann, C Grothusen","doi":"10.1007/s00392-026-02990-8","DOIUrl":"https://doi.org/10.1007/s00392-026-02990-8","url":null,"abstract":"<p><strong>Background: </strong>A tapered left ventricular outflow tract (LVOT) may influence outcomes in transcatheter aortic valve implantation (TAVI), especially regarding valve positioning and conduction disturbances. While this is established in cases of pure aortic regurgitation and stenosis with balloon-expandable valves, its effect in native high-grade aortic stenosis (AVS) using self-expandable (SE) valves remains unclear. This study evaluated the impact of tapered LVOT morphology on peri-procedural outcomes with a SE intraannular (IA) TAVI prosthesis.</p><p><strong>Methods: </strong>Between June 2021 and April 2025, 354 patients with severe native AVS underwent TAVI using the SE IA TAVI prosthesis. Patients were stratified based on LVOT morphology (tapered vs. non-tapered). Clinical and hemodynamic outcomes, including incomplete periprocedural device migration (IPDM) and embolization, were compared between groups.</p><p><strong>Results: </strong>Technical success (96.9% tapered vs. 97.8% non-tapered, p = 0.727) and device success (92.9% vs. 89.4%, p = 0.373) were similarly high. IPDM occurred significantly more often in patients with a tapered LVOT (18.9% vs. 6.6%, p = 0.001). Overall, rates of embolization (0.8% vs. 2.6%, p = 0.429) and Valve-in-Valve procedures (0.8% vs. 1.8%, p = 0.658) were rare. Multivariate logistic regression identified a tapered LVOT morphology (OR 2.47; 95% CI 1.26-4.87; p = 0.009) and severe aortic valve eccentricity (OR 2.16; 95% CI 1.03-4.57; p = 0.042) as independent predictors for IPDM and embolization. The rate of permanent pacemaker implantation was comparable (17.4% vs. 18.0%; p = 1.000).</p><p><strong>Conclusion: </strong>TAVI with the SE IA prosthesis demonstrated high procedural success across anatomical subgroups. However, a tapered LVOT was associated with a significantly increased risk of incomplete periprocedural device migration. In such cases, a slightly deeper implantation may enhance anchoring and stability. These findings highlight the critical importance of preprocedural anatomical assessment, particularly LVOT morphology, in optimizing outcomes for TAVI in native AVS.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of echocardiographic response in the Budapest-CRT upgrade trial.","authors":"Eperke Merkel, Richárd Masszi, Bálint Lakatos, Robert Hatala, Boglárka Veres, Alexandra Fábián, István Osztheimer, László Gellér, Tamás Urbán, Csaba Horváth, Scott D Solomon, Valentina Kutyifa, Attila Kovács, Béla Merkely, Annamária Kosztin","doi":"10.1007/s00392-026-02963-x","DOIUrl":"https://doi.org/10.1007/s00392-026-02963-x","url":null,"abstract":"<p><strong>Background and aims: </strong>Up to 30% of patients fail to respond after cardiac resynchronization therapy (CRT). While echocardiographic predictors of response are well described in de novo CRT, evidence in CRT upgrade populations remains limited. We investigated predictors of echocardiographic response in the BUDAPEST-CRT Upgrade trial cohort.</p><p><strong>Methods: </strong>In this randomized trial, 360 patients with heart failure and reduced ejection fraction (HFrEF) with priorly implanted pacemaker or ICD, ≥ 20% right ventricular (RV) pacing burden, and wide-paced QRS (≥ 150 ms) were randomized to CRT-D upgrade (n = 215) or ICD upgrade (n = 145). Echocardiographic response was defined as ≥ 15% reduction in left ventricular end-systolic volume (LVESV) at 12 months.</p><p><strong>Results: </strong>Among 275 patients with paired echocardiographic data, 161 (59%) were responders. Responders had fewer HF hospitalizations (0.6% vs. 7.0%, p = 0.003), more often received mineralocorticoid receptor antagonists (71% vs. 59%, p = 0.038), and showed a higher baseline RV pacing burden (88.9% vs. 83.4%, p = 0.025) than non-responders. Independent predictors of echocardiographic response were randomization to CRT-D (OR 5.57, 95% CI 2.56-12.12, p < 0.0001), greater RV pacing burden (OR 1.02 per %, 95% CI 1.00-1.04, p = 0.024), non-ischemic cardiomyopathy (OR 2.50, 95% CI 1.15-5.26, p = 0.021), and a lateral LV lead position (OR 8.79, 95% CI 1.28-60.39, p = 0.027).</p><p><strong>Conclusions: </strong>In patients with pacing-induced cardiomyopathy, CRT-D upgrade significantly improved echocardiographic outcomes. Non-ischemic etiology, higher RV pacing burden, and lateral LV lead positioning were associated with greater benefit. These results underscore the importance of tailored patient selection and lead placement strategies to optimize CRT-D upgrade outcomes.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}