European Journal of Clinical Investigation最新文献

{"title":"Trends and disparities in atrial fibrillation-related mortality among adults with co-morbid diabetes mellitus in the United States.","authors":"Usama Qamar, Farhan Naeem, Siddharth Agarwal","doi":"10.1111/eci.14393","DOIUrl":"https://doi.org/10.1111/eci.14393","url":null,"abstract":"<p><p>From 1999 to 2020, age-adjusted mortality rates (AAMR) for atrial fibrillation-related deaths among U.S. adults (age ≥25) with comorbid diabetes mellitus increased significantly with an annual percent change of 6.5%. The highest mortality rates were observed in males, older adults, non-Hispanic Whites, and residents of urban areas and the West region, underscoring the urgent need for targeted public health strategies.</p>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":" ","pages":"e14393"},"PeriodicalIF":4.4,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of the Crohn's disease exclusion diet (CDED) in adults with Crohn's disease: A randomized controlled trial.","authors":"Andrea Pasta, Elena Formisano, Francesco Calabrese, Monica Apollonio, Maria Giulia Demarzo, Elisa Marabotto, Manuele Furnari, Edoardo Giovanni Giannini, Livia Pisciotta, Giorgia Bodini","doi":"10.1111/eci.14389","DOIUrl":"https://doi.org/10.1111/eci.14389","url":null,"abstract":"<p><strong>Background: </strong>The Crohn's disease exclusion diet (CDED) has been shown to induce remission in adult Crohn's disease (CD) patients. The aim of the study is to provide additional evidence-based validation.</p><p><strong>Methods: </strong>We conducted an open-label, randomized trial on adult CD patients with mild-to-moderate symptoms to assess CDED efficacy in inducing symptomatic remission using Mediterranean diet as control. We evaluate demographic data, body mass index (BMI), Harvey-Bradshaw Index (HBI), faecal calprotectin, and serum inflammatory indices at baseline, 12, and 24 weeks. Bioelectrical impedance analysis (BIA) was used to ensure the safety of the CDED group every 12 weeks.</p><p><strong>Results: </strong>Twenty-four patients were assigned to CDED, and 21 to controls, with no baseline differences among the parameters considered. Five CDED patients dropped out due to intolerance within the first 6 weeks. At 12 weeks, CDED patients showed significantly lower HBI and higher remission rates than controls. By 24 weeks, remission rates increased (70.8% vs. 38.1% at 12 weeks and 79.2% vs. 42.9% at 24 weeks; p = .027 and p < .0001, respectively), with significantly lower fibrinogen levels in the CDED group. The administration of CDED was associated with a significant decrease in BMI (25.8 kg/m²-24.5 kg/m², p = .047), although BIA analysis showed a decrease in fat mass (18.2%-15.5%, p < .0001), while fat-free mass and body cellular mass significantly increased at 12 weeks (p = .001 and p = .042, respectively) and remained stable at 24 weeks.</p><p><strong>Conclusions: </strong>The CDED was effective in inducing remission among patients with mild-to-moderate CD and appeared to be safe and well-accepted.</p>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":" ","pages":"e14389"},"PeriodicalIF":4.4,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143032899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Imaging predictors of adverse prognosis in Fabry disease cardiomyopathy: A systematic review and meta-analysis.","authors":"Kamil Stankowski, Stefano Figliozzi, Thanakorn Rojanathagoon, Dimitrios Bampatsias, Dimitrios Klettas, Lorenzo Monti, Renato Bragato, Pier-Giorgio Masci, Marco Francone, Gianluigi Condorelli, Massimo Imbriaco, Maurizio Pieroni, Antonia Camporeale, Georgios Georgiopoulos","doi":"10.1111/eci.14388","DOIUrl":"https://doi.org/10.1111/eci.14388","url":null,"abstract":"<p><strong>Background: </strong>Cardiac involvement represents the main cause of death in patients with Fabry disease (FD). Echocardiography and cardiovascular magnetic resonance (CMR) have an established diagnostic role, but their prognostic value remains unresolved. This systematic review and meta-analysis sought to assess the prognostic implications of imaging parameters in FD.</p><p><strong>Methods: </strong>PubMed, ClinicalTrials.gov, Embase, Cochrane Library and Web of Science databases were searched for studies from inception through 1 May 2024. Studies including FD patients undergoing baseline imaging assessment and clinical follow-up were selected. Pre-defined study outcomes were a cardiovascular endpoint and a composite clinical endpoint. The study protocol was registered in PROSPERO (ID CRD42022342394).</p><p><strong>Results: </strong>Fourteen studies, including 1713 FD patients (44.7% males), were selected. At pooled analysis, late gadolinium enhancement (hazard ratio [HR]: 4.45; 95% CI: 2.82-7.02), left atrium volume indexed (HR: 1.02 per mL/m²; 95% CI: 1.01-1.03), E/e' (HR: 1.14 per unit increase; 95% CI: 1.08-1.21), left ventricular (LV) mass indexed (HR: 1.01 per mg/m²; 95% CI: 1.00-1.02), maximum LV wall thickness (HR: 1.19 per mm, 95% CI: 1.04-1.36) and LV-global longitudinal strain (HR: 1.20 per unit increase; 95% CI: 1.16-1.25) were significantly associated with the cardiovascular endpoint, whereas T1-mapping and LV-ejection fraction were not. T1-mapping was associated with the composite endpoint (HR: 0.99 per msec increase; 95% CI: 0.98-1.00). Meta-regression analysis did not show any significant interaction between each of the potential effect modifiers.</p><p><strong>Conclusions: </strong>Several imaging parameters were significant predictors of adverse clinical outcomes in patients with FD. Late gadolinium enhancement showed the strongest association with adverse prognosis.</p>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":" ","pages":"e14388"},"PeriodicalIF":4.4,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myths and challenges around anticoagulation in atrial fibrillation: A practicing clinician's perspective","authors":"K. E. Juhani Airaksinen,&nbsp;Ville Langén,&nbsp;Konsta Teppo,&nbsp;Gregory Y. H. Lip","doi":"10.1111/eci.14390","DOIUrl":"10.1111/eci.14390","url":null,"abstract":"<p>\u0000 \u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure>\u0000 </p>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":"55 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Altered fibrin clot properties and elevated von Willebrand factor are associated with progression to permanent atrial fibrillation: A cohort study","authors":"Karol Witold Nowak,&nbsp;Michal Zabczyk,&nbsp;Joanna Natorska,&nbsp;Maciej Polak,&nbsp;Jaroslaw Zalewski,&nbsp;Anetta Undas","doi":"10.1111/eci.14384","DOIUrl":"10.1111/eci.14384","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The role of a prothrombotic state in atrial fibrillation (AF) progression to permanent arrythmia (PerAF) is unclear. Formation of denser and poorly lysable fibrin clots has been observed in AF patients also with sinus rhythm in association with higher stroke risk. We investigated whether altered fibrin clot properties and other prothrombotic state markers may contribute to AF transition to PerAF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In the cohort study, in 226 anticoagulated patients (median age 69 years, median CHA₂DS₂-VASc of 3) with paroxysmal (<i>n</i> = 83, 36.7%) or persistent (<i>n</i> = 143, 63.3%) AF, we assessed at baseline plasma clot permeability (K_s), clot lysis time (CLT), proteins involved in fibrinolysis and von Willebrand factor (vWF) antigen. We recorded patients with PerAF during a median follow-up of 58 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During follow-up, PerAF was documented in 62 (27.4%, 5.7%/year) subjects, who had higher prevalence of heart failure, higher body mass index and longer history of arrhythmia. AF transition to PerAF was associated with 25.7% longer CLT in relation to 21.3% higher plasminogen activator inhibitor type 1, and 29% higher vWF compared to the remainder, with no differences in K_s, plasminogen or α2-antiplasmin. By multivariable analysis, CLT (per 10 min, odds ratio [OR] 2.734, 95% confidence interval [CI] 1.788–4.180, <i>p</i> &lt; .001), vWF (per 10%, OR 1.352, 95% CI 1.145–1.596, <i>p</i> &lt; .001) and heart failure (OR 2.637, 95% CI 1.008–6.900, <i>p</i> = .048) were associated with progression to PerAF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Suppressed fibrin clot susceptibility to lysis and elevated vWF could contribute to progression to PerAF despite anticoagulation, which suggests links between blood coagulation and AF progression.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":"55 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Meteorin-like protein plasma levels are associated with worse outcomes in de novo heart failure","authors":"Laura Anido-Varela,&nbsp;Alana Aragón-Herrera,&nbsp;Adrián González-Maestro,&nbsp;Carlos Tilves Bellas,&nbsp;Estefanía Tarazón,&nbsp;Eduard Solé-González,&nbsp;Manuel Martínez-Sellés,&nbsp;José María Guerra-Ramos,&nbsp;Anna Carrasquer,&nbsp;Laura Morán-Fernández,&nbsp;David García-Vega,&nbsp;Ana Seoane-Blanco,&nbsp;María Moure-González,&nbsp;Jose Seijas-Amigo,&nbsp;Diego Rodríguez-Penas,&nbsp;Javier García-Seara,&nbsp;Sandra Moraña-Fernández,&nbsp;Xocas Vázquez-Abuín,&nbsp;Esther Roselló-Lletí,&nbsp;Manuel Portolés,&nbsp;Sonia Eiras,&nbsp;Rosa M. Agra,&nbsp;Ezequiel Álvarez,&nbsp;José R. González-Juanatey,&nbsp;Sandra Feijóo-Bandín,&nbsp;Francisca Lago,&nbsp;The REDINSCOR III registry","doi":"10.1111/eci.14380","DOIUrl":"10.1111/eci.14380","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Meteorin-like protein (Metrnl) has been recently suggested as a new adipokine with protective cardiovascular effects. Its circulating levels in patients seem to be associated with heart failure (HF), although with contradictory results. Our aim was to ascertain whether this adipokine could estimate the prognosis of HF in <i>de novo</i> HF (DNHF) patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Metrnl plasma levels of 400 patients hospitalized with DNHF (55% of patients with HF with reduced ejection fraction, 17.3% HF with mid-range ejection fraction, 27.8% HF with preserved ejection fraction) were measured by enzyme-linked immunosorbent assay. We performed both sex-pooled and sex-specific analyses. A 12-month follow-up was conducted, during which clinical outcomes such as all-cause mortality, cardiovascular death and re-hospitalization due to HF were collected.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After a 12-month follow up, higher plasma Metrnl levels were associated with an increased risk for all-cause death and cardiovascular death after adjusting by sex, age, LVEF, hypertension, diabetes, ischemic aetiology, chronic renal failure, NT-proBNP and troponin (hazard ratio [HR] = 1.003, 95% confidence interval [CI] = 1.000–1.005; <i>p</i>-value&lt;.05 and HR = 1.004, 95% CI = 1.001–1.007, <i>p</i>-value&lt;.05, respectively). In line with this, DNHF patients with increased levels of circulating Metrnl had a higher number of occurrences of cardiovascular events. Regarding Metrnl associations with parameters implicated in the development and progression of HF, we found that Metrnl circulating levels were positively correlated with age (<i>r</i> = .322, <i>p</i>-value&lt;.0001), NT-proBNP (<i>r</i> = .281, <i>p</i>-value&lt;.0001) and with the renal dysfunction markers urea (<i>r</i> = .322, <i>p</i>-value&lt;.0001) and creatinine (<i>r</i> = .353, <i>p</i>-value&lt;.0001) and higher in women than men (473.7 [385.9–594.0] pg/mL vs. 428.7 [349.1–561.3] pg/mL, <i>p</i>-value&lt;.006). Finally, concerning the subtype of HF, Metrnl plasma levels were higher in HF with preserved ejection fraction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients with higher Metrnl levels have a worse prognosis in DNHF. Our results reinforce the association of Metrnl plasma levels with HF progression and outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":"55 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sexual dimorphism in exercise-induced response on steroid hormones to a 24-week supervised concurrent training intervention","authors":"Lourdes Herrera-Quintana,&nbsp;Héctor Vázquez-Lorente,&nbsp;Jonatan R. Ruiz,&nbsp;Francisco J. Amaro-Gahete","doi":"10.1111/eci.14377","DOIUrl":"10.1111/eci.14377","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Steroid hormones are key mediators of adaptative responses to exercise, a stimulus that may concurrently affect their blood concentrations. However, the chronic endocrine adaptations and whether these potential changes are dependent on exercise intensity remain undetermined. Moreover, it is also unknown if the exercise-induced effects on steroid hormonal status are related to the participant' sex.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study aimed to investigate the intensity effects of a 24-week supervised concurrent training intervention on steroid hormones in sedentary young men and women. A total of 106 untrained young adults (68% women) aged 18–25 years were randomly assigned to one of the three groups: (I) Control group (no exercise; <i>n</i> = 35); (II) Ex-Moderate group (concurrent training at moderate intensity; <i>n</i> = 36); (III) Ex-Vigorous group (concurrent training at vigorous intensity; <i>n</i> = 35). Steroid hormones (i.e. cortisol, testosterone and dehydroepiandrosterone sulfate (DHEAS)) were measured in plasma through a chemiluminescent method. Body composition parameters were determined using a dual-energy X-ray absorptiometry scanner.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>No significant changes in steroid hormones levels were observed after the intervention (all <i>p</i> ≥ .129). However, a time x group interaction was noted in the testosterone/cortisol ratio (T/C ratio) only in women (<i>p</i> = .044). Concretely, our data showed a significant decrement of T/C ratio in both the Ex-Moderate group and in the Ex-Vigorous compared with the control group (Δ = −24.2 ± 2.0% and Δ = −38.9 ± 45.4%, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our 24-week supervised concurrent training intervention showed no significant changes in steroid hormone levels. However, a significant decrement of T/C ratio was observed only in women, indicating a sexual dimorphism in the effect on T/C ratio.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":"55 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sotatercept in pulmonary hypertension and beyond.","authors":"Rosalinda Madonna, Sandra Ghelardoni","doi":"10.1111/eci.14386","DOIUrl":"https://doi.org/10.1111/eci.14386","url":null,"abstract":"<p><p>Sotatercept binds free activins by mimicking the extracellular domain of the activin receptor type IIA (ACTRIIA). Additional ligands are BMP/TGF-beta, GDF8, GDF11 and BMP10. The binding with activins leads to the inhibition of the signalling pathway and the deactivation of the bone morphogenic protein (BMP) receptor type 2. In this way, sotatercept activates an antiproliferative signalling to the cells of the pulmonary arteries and arterioles with the aim of rebalancing the proliferative and antiproliferative pathway that characterizes the pulmonary arterial hypertension (PAH). Sotatercept is indicated for the treatment of group 1 PAH in combination with drugs that act through the endothelin receptor, nitric oxide or prostacyclin. Its effects, demonstrated in the STELLAR study, are the improvement of exercise capacity and the FC-WHO functional class, together with the reduction of the risk of clinical worsening events. In addition to its antiremodeling effects on the pulmonary circulation, sotatercept has several haematological effects that could suggest its use in the treatment of some blood disorders other than PAH. In this review, we will discuss the effects of the drug on PAH and in parallel provide an in-depth overview of its application in haematological disorders, focusing on clinical and preclinical studies.</p>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":" ","pages":"e14386"},"PeriodicalIF":4.4,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Care pathway for patients hospitalized with venous thromboembolism","authors":"Isabelle Mahé,&nbsp;Yara Skaff,&nbsp;Hélène Helfer,&nbsp;Samuel Benarroch,&nbsp;Florent Happe,&nbsp;Adam Remaki,&nbsp;Kankoe Sallah","doi":"10.1111/eci.14383","DOIUrl":"10.1111/eci.14383","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), is a potentially fatal disease with a multifactorial nature, impacting different medical and surgical specialties. Recently, new guidelines and direct oral anticoagulants facilitated early discharge for most DVT patients and non-severe PE patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The aim of this study is to illustrate the distribution of VTE patients throughout the hospital and map their care pathway from Emergency Department (ED) to hospital discharge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicenter retrospective cross-sectional study included all hospitalized patients with a VTE code from 39 hospitals between 2018 and 2019. Data were analysed using JupyterLab, with subgroup analyses based on mode of entry, diagnosis location and thrombosis site.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 23,199 hospitalizations were analysed, involving 17,718 patients a median age 66 years [52–78] and man-to-women ratio 1.05. Among these, 10,747(46.3%) had PE and 4176(18.0%) had lower limb DVT. The ED was the primary entry point for 31.2% of cases, followed by gastroenterology, surgery, geriatrics, and internal medicine. Patients admitted through ED patients were most frequently transferred to internal medicine, cardiovascular and intensive care units (ICU). The median hospital stay was 9 days [4–21], with ICU stays being the longest (mean 15 days [8–27]). Notably, 1357 patients (18.8%) of VTE patients were discharged within 48 h of ED admission.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study is the first to portray the distribution and care pathways of VTE patients across hospital departments. Despite recent clinical guidelines, many patients still require inpatient management, highlighting the need for dedicated care pathway.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":"55 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/eci.14383","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002702","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":"The impact of clinical phenotypes of coronary artery disease on outcomes in patients with atrial fibrillation: A post-hoc analysis of GLORIA-AF registry","authors":"Bi Huang,&nbsp;Yang Liu,&nbsp;Ho Man Lam,&nbsp;Hironori Ishiguchi,&nbsp;Tze-Fan Chao,&nbsp;Menno V. Huisman,&nbsp;Gregory Y. H. Lip,&nbsp;the GLORIA-AF Investigators","doi":"10.1111/eci.14378","DOIUrl":"10.1111/eci.14378","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Coronary artery disease (CAD) and atrial fibrillation (AF) often coexist, but the impact of clinical phenotypes of CAD on outcomes in AF patients in the non-vitamin K antagonist oral anticoagulant drugs (NOACs) era is less well understood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a post-hoc of the GLORIA-AF registry, a global, multicenter, prospective AF registry study. Patients were divided into three groups: prior history of myocardial infarction (MI)/unstable angina group (Group 1); stable angina group (Group 2); and a control group without stable angina or history of MI/unstable angina. The primary endpoint was the composite of all-cause death or stroke, and the safety endpoint was major bleeding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 24,827 patients were included in this analysis (median age was 71 (IQR, 64–78) years; 55% male) and 5394 (21.7%) had CAD. During a follow-up of 2 years, the incidence of the primary endpoint was 5.99 (95% CI, 5.33, 6.71) per 100 patient-years in Group 1, 4.04 (95% CI, 3.55, 4.70) per 100 patient-years in Group 2, and 2.79 (95% CI, 2.62, 2.96) per 100 patient-years in the control group (<i>p</i> &lt; .001). Compared the control group, the adjusted hazard ratio of the primary composite endpoint in Groups 1 and 2 were 1.58 (95% CI, 1.37, 1.83, <i>p</i> &lt; .001) and 1.22 (95% CI, 1.04, 1.43, <i>p</i> = .012), respectively. Among anticoagulated patients with AF and CAD, NOACs were associated with a reduced risk of the primary composite endpoint and major bleeding, compared with vitamin K antagonists (VKA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CAD was prevalent in patients with AF, and clinical phenotypes of CAD influenced outcomes in patients with AF, with a history of MI/unstable angina being associated with a significantly increased risk of CV events, compared to stable angina. NOACs were superior to VKA in terms of the effectiveness and safety outcomes in patients with AF and concomitant CAD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":"55 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/eci.14378","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142978053","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}