Background: Cardiovascular diseases (CVDs) are a group of heart and blood vessel disorders and the leading causes of death worldwide. Few studies have focused on whether there is an interaction between the Composite Dietary Antioxidant Index (CDAI) combined with alcohol consumption on CVDs. We aimed to explore the association between CDAI, alcohol consumption, and CVDs, and whether there was an interaction.
Methods: A total of 29459 participants aged over 20 years from the National Health and Nutrition Examination Survey (NHANES) in 2005-2018 were involved in the study. Six dietary factors were selected to score the CDAI. The association between CDAI, alcohol consumption, and CVDs were analyzed using binary logistic regression. Subgroup analysis and interaction tests were used to investigate whether this association was stable across populations.
Results: The interaction between CDAI and alcohol consumption in relation to CVDs was observed. There was a statistically significant increased prevalence of CVDs in the CDAI 2 combined never-drinking subgroups and in the CDAI 1 combined never-drinking subgroups compared with the CDAI 3 combined moderate drinking group. Low CDAI levels were significantly and positively linked to CVDs prevalence within the never-drinking subgroup.
Conclusion: The interaction between CDAI and alcohol consumption was found in our study. High levels of CDAI combined with moderate alcohol consumption may reduce the odds of CVDs.
{"title":"Interaction Between Composite Dietary Antioxidant Index and Alcohol Consumption on Cardiovascular Diseases: NHANES 2005-2018.","authors":"Yingjie Zhu, Lili Zheng, Jia Bing, Xiaoyu Teng, Pengkai Hao, Ping Song, Lixin Wan","doi":"10.1002/clc.70274","DOIUrl":"10.1002/clc.70274","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular diseases (CVDs) are a group of heart and blood vessel disorders and the leading causes of death worldwide. Few studies have focused on whether there is an interaction between the Composite Dietary Antioxidant Index (CDAI) combined with alcohol consumption on CVDs. We aimed to explore the association between CDAI, alcohol consumption, and CVDs, and whether there was an interaction.</p><p><strong>Methods: </strong>A total of 29459 participants aged over 20 years from the National Health and Nutrition Examination Survey (NHANES) in 2005-2018 were involved in the study. Six dietary factors were selected to score the CDAI. The association between CDAI, alcohol consumption, and CVDs were analyzed using binary logistic regression. Subgroup analysis and interaction tests were used to investigate whether this association was stable across populations.</p><p><strong>Results: </strong>The interaction between CDAI and alcohol consumption in relation to CVDs was observed. There was a statistically significant increased prevalence of CVDs in the CDAI 2 combined never-drinking subgroups and in the CDAI 1 combined never-drinking subgroups compared with the CDAI 3 combined moderate drinking group. Low CDAI levels were significantly and positively linked to CVDs prevalence within the never-drinking subgroup.</p><p><strong>Conclusion: </strong>The interaction between CDAI and alcohol consumption was found in our study. High levels of CDAI combined with moderate alcohol consumption may reduce the odds of CVDs.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 3","pages":"e70274"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12966993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147372313","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}
Background: Exploring accurate and noninvasive methods for detecting pulmonary hypertension (PH) has always been a focal point of research. Owing to its exceptional spatiotemporal resolution, magnetocardiography (MCG) has demonstrated potential value in cardiovascular diseases.
Aims: This exploratory study aims to investigate the characteristics of MCG variations in PH patients and evaluate their potential utility in distinguishing healthy subjects from those with PH.
Methods: This study analyzed 175 PH patients and 333 healthy subjects who underwent MCG examination. The training cohort consisted of patients with PH previously diagnosed by right heart catheterization (RHC) and age-frequency-matched healthy controls (HC). The testing cohort comprised age- and frequency-matched HC and PH patients who underwent both MCG and RHC on the same day. Nine MCG parameters were included. Logistic regression was used to screen for significant parameters and develop a model.
Results: By comparing the pseudo-current density maps, it was found that the current vector at the R-wave peak of HC points toward the lower-left quadrant, whereas in PH patients, it points toward the lower-right quadrant. The MCG detection model demonstrated robust performance, achieving a sensitivity of 86.1% and a specificity of 94.1% in the testing cohort. Compared to the ECG of PH patients, MCG demonstrated greater sensitivity; however, it exhibited slightly lower specificity. Furthermore, MCG can detect PH in patients with normal ECG findings.
Conclusion: MCG demonstrates highly promising potential for the noninvasive detection of PH.
{"title":"Exploring the Application Value of Magnetocardiography in Detecting Pulmonary Hypertension: A Noninvasive and Visual Approach.","authors":"Yuankun Qi, Jiaqi Liang, Yu Zhang, Jianzhi Yang, Fuzhi Cao, Xu Zhang, Haijun Li, Xiaopei Cui, Hongyu Zhang, Min Xiang","doi":"10.1002/clc.70277","DOIUrl":"https://doi.org/10.1002/clc.70277","url":null,"abstract":"<p><strong>Background: </strong>Exploring accurate and noninvasive methods for detecting pulmonary hypertension (PH) has always been a focal point of research. Owing to its exceptional spatiotemporal resolution, magnetocardiography (MCG) has demonstrated potential value in cardiovascular diseases.</p><p><strong>Aims: </strong>This exploratory study aims to investigate the characteristics of MCG variations in PH patients and evaluate their potential utility in distinguishing healthy subjects from those with PH.</p><p><strong>Methods: </strong>This study analyzed 175 PH patients and 333 healthy subjects who underwent MCG examination. The training cohort consisted of patients with PH previously diagnosed by right heart catheterization (RHC) and age-frequency-matched healthy controls (HC). The testing cohort comprised age- and frequency-matched HC and PH patients who underwent both MCG and RHC on the same day. Nine MCG parameters were included. Logistic regression was used to screen for significant parameters and develop a model.</p><p><strong>Results: </strong>By comparing the pseudo-current density maps, it was found that the current vector at the R-wave peak of HC points toward the lower-left quadrant, whereas in PH patients, it points toward the lower-right quadrant. The MCG detection model demonstrated robust performance, achieving a sensitivity of 86.1% and a specificity of 94.1% in the testing cohort. Compared to the ECG of PH patients, MCG demonstrated greater sensitivity; however, it exhibited slightly lower specificity. Furthermore, MCG can detect PH in patients with normal ECG findings.</p><p><strong>Conclusion: </strong>MCG demonstrates highly promising potential for the noninvasive detection of PH.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 3","pages":"e70277"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147503316","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}
Background: HCM-AF score is a novel risk stratification tool for atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM). N-terminal pro-brain natriuretic peptide (NT-proBNP) has shown promise in predicting AF. We aim to explore the incremental value of NT-proBNP over HCM-AF score.
Methods: In this retrospective cohort study, 778 HCM patients were included. The primary endpoint was new-onset AF. Spline curve analysis was conducted to identify the cut-off value of NT-proBNP. Harrell's C-index and likelihood ratio test were conducted to explore the incremental value.
Results: After a follow-up of 3.4 ± 2.3 years, AF occurred in 65 (8.4%) patients. The cut-off of NT-proBNP was 240 pg/mL. Incidence rates of AF per 1000 person-years for the low, intermediate, and high HCM-AF score groups were 8.7 (95% confidence interval [CI]: 3.5-17.7), 18.0 (95% CI: 7.7-48.8), and 59.6 (95% CI: 27.1-157.1), respectively, with the high HCM-AF score group significantly higher. For the low and high NT-proBNP groups, incidence rates were 9.2 (95% CI: 4.6-16.1) and 38.1 (95% CI: 20.3-79.4), respectively. High HCM-AF score (hazard ratio [HR]: 3.55, 95% CI: 1.33-9.48; p = 0.011) and high NT-proBNP (HR: 2.49, 95% CI: 1.21-5.10; p = 0.013) are independent predictors for AF. Addition of NT-proBNP improved models based on HCM-AF score, with C-index increasing from 0.709 to 0.768 and likelihood ratio increasing from 33.15 to 51.02.
Conclusion: HCM-AF score is reliable and robust for Asian HCM patients. NT-proBNP demonstrated incremental value over HCM-AF score in the prediction of new-onset AF in patients with HCM. Future studies are warranted to incorporate HCM-AF score and NT-proBNP.
{"title":"Incremental Value of NT-proBNP Over HCM-AF Score in Risk Stratification for Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy.","authors":"Yi-Peng Gao, Ya-Ting Fan, Xue-Qing Cheng, Pei-Na Huang, Hong-Yun Liu, Xiao-Jun Bi, Jie Sun, Ying Zhu, Wei Zhou, Ya-Ni Liu, You-Bin Deng","doi":"10.1002/clc.70276","DOIUrl":"10.1002/clc.70276","url":null,"abstract":"<p><strong>Background: </strong>HCM-AF score is a novel risk stratification tool for atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM). N-terminal pro-brain natriuretic peptide (NT-proBNP) has shown promise in predicting AF. We aim to explore the incremental value of NT-proBNP over HCM-AF score.</p><p><strong>Methods: </strong>In this retrospective cohort study, 778 HCM patients were included. The primary endpoint was new-onset AF. Spline curve analysis was conducted to identify the cut-off value of NT-proBNP. Harrell's C-index and likelihood ratio test were conducted to explore the incremental value.</p><p><strong>Results: </strong>After a follow-up of 3.4 ± 2.3 years, AF occurred in 65 (8.4%) patients. The cut-off of NT-proBNP was 240 pg/mL. Incidence rates of AF per 1000 person-years for the low, intermediate, and high HCM-AF score groups were 8.7 (95% confidence interval [CI]: 3.5-17.7), 18.0 (95% CI: 7.7-48.8), and 59.6 (95% CI: 27.1-157.1), respectively, with the high HCM-AF score group significantly higher. For the low and high NT-proBNP groups, incidence rates were 9.2 (95% CI: 4.6-16.1) and 38.1 (95% CI: 20.3-79.4), respectively. High HCM-AF score (hazard ratio [HR]: 3.55, 95% CI: 1.33-9.48; p = 0.011) and high NT-proBNP (HR: 2.49, 95% CI: 1.21-5.10; p = 0.013) are independent predictors for AF. Addition of NT-proBNP improved models based on HCM-AF score, with C-index increasing from 0.709 to 0.768 and likelihood ratio increasing from 33.15 to 51.02.</p><p><strong>Conclusion: </strong>HCM-AF score is reliable and robust for Asian HCM patients. NT-proBNP demonstrated incremental value over HCM-AF score in the prediction of new-onset AF in patients with HCM. Future studies are warranted to incorporate HCM-AF score and NT-proBNP.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 3","pages":"e70276"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147484889","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":"Mortality Trends Associated With Acute Myocardial Infarction and Psychoactive Substance Use in Older Adults: A US Nationwide Analysis (1999-2020).","authors":"Noor-Ul-Ain Alias Aini, Hasnat Pirzada","doi":"10.1002/clc.70281","DOIUrl":"https://doi.org/10.1002/clc.70281","url":null,"abstract":"","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 3","pages":"e70281"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147509314","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":"Critique on \"Epicardial Fat Thickness as a Marker of Coronary Artery Disease in Diabetics: A Single Center Study\".","authors":"Vishan Das, Rehab Bint E Tahir, Safia Bibi, Hasnain Wajeeh Saqib","doi":"10.1002/clc.70273","DOIUrl":"10.1002/clc.70273","url":null,"abstract":"","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 3","pages":"e70273"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12961714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147353909","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}
Peter Bond, Diederik L. Smit, Tijs Verdegaal, Willem de Ronde
Background
Androgen abuse among young men is a prevalent yet under recognized risk factor for atherosclerotic cardiovascular disease (ASCVD). Supraphysiological androgen exposure adversely affects lipoprotein profiles, blood pressure, and vascular function, potentially accelerating atherosclerosis even in otherwise healthy individuals. Conventional cardiovascular risk prediction models may underestimate risk in this population due to fluctuating biomarker profiles and other unaccounted risk-increasing factors that are not captured in these models.
Objectives
To review the mechanisms by which androgen abuse contributes to ASCVD, to highlight limitations of traditional risk stratification tools in this population, and to propose tailored approaches to risk assessment and prevention.
Methods
Narrative review of epidemiological, imaging, and mechanistic studies examining cardiovascular risk factors and subclinical atherosclerosis in androgen abusers.
Results
Available evidence indicates that androgen abuse adversely affects lipid profiles, blood pressure, and vascular endothelial function, and is associated with increased subclinical atherosclerosis. Conventional risk prediction models may underestimate risk in this population due to young age, fluctuating biomarker profiles, and cumulative exposure effects not captured by standard algorithms.
Conclusions
Androgen abuse should be recognized as a cardiovascular risk-enhancing factor in young men. Individualized risk assessment beyond traditional calculators may be warranted to guide preventive strategies in selected patients.
{"title":"Preventing Atherosclerotic Cardiovascular Disease in Young Male Androgen Abusers","authors":"Peter Bond, Diederik L. Smit, Tijs Verdegaal, Willem de Ronde","doi":"10.1002/clc.70257","DOIUrl":"10.1002/clc.70257","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Androgen abuse among young men is a prevalent yet under recognized risk factor for atherosclerotic cardiovascular disease (ASCVD). Supraphysiological androgen exposure adversely affects lipoprotein profiles, blood pressure, and vascular function, potentially accelerating atherosclerosis even in otherwise healthy individuals. Conventional cardiovascular risk prediction models may underestimate risk in this population due to fluctuating biomarker profiles and other unaccounted risk-increasing factors that are not captured in these models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To review the mechanisms by which androgen abuse contributes to ASCVD, to highlight limitations of traditional risk stratification tools in this population, and to propose tailored approaches to risk assessment and prevention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Narrative review of epidemiological, imaging, and mechanistic studies examining cardiovascular risk factors and subclinical atherosclerosis in androgen abusers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Available evidence indicates that androgen abuse adversely affects lipid profiles, blood pressure, and vascular endothelial function, and is associated with increased subclinical atherosclerosis. Conventional risk prediction models may underestimate risk in this population due to young age, fluctuating biomarker profiles, and cumulative exposure effects not captured by standard algorithms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Androgen abuse should be recognized as a cardiovascular risk-enhancing factor in young men. Individualized risk assessment beyond traditional calculators may be warranted to guide preventive strategies in selected patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12917856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146225687","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}
Muhammad Aqib Faizan, Tooba Rehman, Mrunalini Dandamudi, Jaivardhan A. Menon, Victoria Zecchin Ferrara, Zeyad Kholeif, Alina Tanvir, Fatima Saeed, Jibran Ikram, Moiuz Chaudhri, Carlos Espiche, Main Muhammad Salman Aslam, Zainab Humayun, Ahmad Mustafa Khalid, Saad Ahmad Waqas, Raheel Ahmad, Luis Cerna
Background
Factor XI/XIa inhibitors are emerging anticoagulants with potential to reduce bleeding complications in atrial fibrillation (AF) patients. This meta-analysis evaluated their efficacy and safety compared to direct oral anticoagulants (DOACs) and explored dose optimization.
Methods
A systematic search of PubMed, Cochrane, and Embase was conducted through March 2025 following PRISMA guidelines. Randomized controlled trials (RCTs) comparing Factor XI/XIa inhibitors with DOACs in AF patients were included. Outcomes assessed were major bleeding, stroke, systemic embolism, all-cause and cardiovascular mortality and serious adverse events. Risk ratios (RR) with 95% confidence intervals (CI) were pooled using a Mantel-Haenszel random-effects model. Heterogeneity was evaluated with the I² statistic, and evidence certainty assessed by the GRADE approach. Trial Sequential Analysis (TSA) was performed.
Results
Three RCTs including 16,772 patients (mean age 73 years, CHA₂DS₂-VASc 3.9–5) were analyzed. Factor XI/XIa inhibitors significantly reduced major bleeding (RR: 0.41, 95% CI: 0.36–0.46, I² = 0%) compared to DOACs. However, stroke risk was increased (RR: 3.42, 95% CI: 2.62–4.46), particularly with asundexian 50 mg (RR: 4.02). No significant differences were observed in all-cause mortality (RR: 0.82) or cardiovascular death (RR: 1.05). Systemic embolism risk was higher (RR: 4.26), while serious adverse events were comparable (RR: 0.95). TSA indicated encouraging safety outcomes but highlighted the need for further large-scale studies.
Conclusion
Factor XI/XIa inhibitors lower major bleeding risk in AF patients but increase stroke and systemic embolism rates without impacting mortality.
{"title":"Dose-Response Efficacy and Safety of Factor XI/XIa Inhibitors in Atrial Fibrillation; a Systematic Review and Meta-Analysis With Subgroup Exploration and Trial Sequential Validation","authors":"Muhammad Aqib Faizan, Tooba Rehman, Mrunalini Dandamudi, Jaivardhan A. Menon, Victoria Zecchin Ferrara, Zeyad Kholeif, Alina Tanvir, Fatima Saeed, Jibran Ikram, Moiuz Chaudhri, Carlos Espiche, Main Muhammad Salman Aslam, Zainab Humayun, Ahmad Mustafa Khalid, Saad Ahmad Waqas, Raheel Ahmad, Luis Cerna","doi":"10.1002/clc.70263","DOIUrl":"10.1002/clc.70263","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Factor XI/XIa inhibitors are emerging anticoagulants with potential to reduce bleeding complications in atrial fibrillation (AF) patients. This meta-analysis evaluated their efficacy and safety compared to direct oral anticoagulants (DOACs) and explored dose optimization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search of PubMed, Cochrane, and Embase was conducted through March 2025 following PRISMA guidelines. Randomized controlled trials (RCTs) comparing Factor XI/XIa inhibitors with DOACs in AF patients were included. Outcomes assessed were major bleeding, stroke, systemic embolism, all-cause and cardiovascular mortality and serious adverse events. Risk ratios (RR) with 95% confidence intervals (CI) were pooled using a Mantel-Haenszel random-effects model. Heterogeneity was evaluated with the I² statistic, and evidence certainty assessed by the GRADE approach. Trial Sequential Analysis (TSA) was performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three RCTs including 16,772 patients (mean age 73 years, CHA₂DS₂-VASc 3.9–5) were analyzed. Factor XI/XIa inhibitors significantly reduced major bleeding (RR: 0.41, 95% CI: 0.36–0.46, I² = 0%) compared to DOACs. However, stroke risk was increased (RR: 3.42, 95% CI: 2.62–4.46), particularly with asundexian 50 mg (RR: 4.02). No significant differences were observed in all-cause mortality (RR: 0.82) or cardiovascular death (RR: 1.05). Systemic embolism risk was higher (RR: 4.26), while serious adverse events were comparable (RR: 0.95). TSA indicated encouraging safety outcomes but highlighted the need for further large-scale studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Factor XI/XIa inhibitors lower major bleeding risk in AF patients but increase stroke and systemic embolism rates without impacting mortality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12895463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146164529","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}
David Golombeck, Radiah Khandokar, Joanna Fishbein, Allison Provenzale, Melodie Lin, Marsha McGee, Dora Rossi, Simon Maybaum
Background
Limited studies have evaluated lung ultrasound (LUS) in ambulatory heart failure (HF). A six-zone LUS assesses B-lines, a marker of congestion. The Butterfly IQ+ probe features an automated B-line counter (ABLC), eliminating manual counting. We evaluated LUS quality by novice HF providers after training, compared expert manual counts to ABLC, and explored associations between LUS and clinical HF metrics.
Methods
Three novice providers underwent 2 h of didactics and 30 proctored exams. Image quality was independently reviewed by two LUS experts. B-lines were counted manually by experts and ABLC. We assessed associations between LUS and four clinical metrics: provider-assessed volume status, > 30% NT-proBNP increase, > 5 lb weight gain, and PAD above goal (CardioMEMS).
Results
Seventy-five subjects were enrolled. Overall, LUS quality was excellent, with 88% good quality. Surprisingly, agreement between expert B-line counts was moderate (Gwet's AC1: 0.49, 95% CI: 0.27 to 0.71) while the accuracy of experts as compared to ABLC was modest (Expert 1 = 61.2%, Expert 2 = 40.3%). Experts correctly identified 93% of positive studies but only 19% of negative studies versus ABLC. Provider volume assessments substantially agreed with LUS (Gwet's AC1: 0.76, 95% CI: 0.61 to 0.91), but providers identified only half of positive LUS cases, suggesting utility in detecting mild volume overload. Only volume overload correlated with positive LUS. Only 25% of subjects had a CardioMEMS.
Conclusion
Novice providers can perform high-quality LUS after brief training. ABLC reduces B-line counting variability. LUS detects mild pulmonary congestion undetectable by clinical exam, potentially preventing worsening in HF patients.
{"title":"Assessment of Point of Care Lung Ultrasound in the Ambulatory Heart Failure Setting","authors":"David Golombeck, Radiah Khandokar, Joanna Fishbein, Allison Provenzale, Melodie Lin, Marsha McGee, Dora Rossi, Simon Maybaum","doi":"10.1002/clc.70244","DOIUrl":"10.1002/clc.70244","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Limited studies have evaluated lung ultrasound (LUS) in ambulatory heart failure (HF). A six-zone LUS assesses B-lines, a marker of congestion. The Butterfly IQ+ probe features an automated B-line counter (ABLC), eliminating manual counting. We evaluated LUS quality by novice HF providers after training, compared expert manual counts to ABLC, and explored associations between LUS and clinical HF metrics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Three novice providers underwent 2 h of didactics and 30 proctored exams. Image quality was independently reviewed by two LUS experts. B-lines were counted manually by experts and ABLC. We assessed associations between LUS and four clinical metrics: provider-assessed volume status, > 30% NT-proBNP increase, > 5 lb weight gain, and PAD above goal (CardioMEMS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventy-five subjects were enrolled. Overall, LUS quality was excellent, with 88% good quality. Surprisingly, agreement between expert B-line counts was moderate (Gwet's AC1: 0.49, 95% CI: 0.27 to 0.71) while the accuracy of experts as compared to ABLC was modest (Expert 1 = 61.2%, Expert 2 = 40.3%). Experts correctly identified 93% of positive studies but only 19% of negative studies versus ABLC. Provider volume assessments substantially agreed with LUS (Gwet's AC1: 0.76, 95% CI: 0.61 to 0.91), but providers identified only half of positive LUS cases, suggesting utility in detecting mild volume overload. Only volume overload correlated with positive LUS. Only 25% of subjects had a CardioMEMS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Novice providers can perform high-quality LUS after brief training. ABLC reduces B-line counting variability. LUS detects mild pulmonary congestion undetectable by clinical exam, potentially preventing worsening in HF patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12892298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146156148","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}
Alexander J. Blood, Ozan Unlu, John W. Ostrominski, Shahzad Hassan, Hunter Nichols, Samantha Subramaniam, Daniel Gabovitch, Jacqueline Chasse, Marian McPartlin, Christian Figueroa, Emma Collins, Megan Twining, Matthew Varugheese, Kavishwar Wagholikar, Christopher P. Cannon, Akshay S. Desai, Benjamin M. Scirica
Background
Despite overwhelming evidence of clinical benefit for patients with heart failure (HF), the uptake of guideline-directed medical therapies (GDMT) has been slow. Collaborative approaches are critically needed to improve alignment between evidence and clinical practice. Many strategies proposed to improve GDMT implementation have been either ineffective or too resource-intensive to implement at scale across different practice contexts. Furthermore, most existing approaches focus primarily on patients with HF and reduced EF, despite growing evidence for effective pharmacologic therapy in those with HF and mildly reduced or preserved ejection fraction (HFpEF).
Hypothesis
Based on this experience, we designed the Cooperative Program for ImpLementation of Optimal Therapy in Heart Failure (COPILOT-HF) study (NCT05734690).
Methods
This is a pragmatic, randomized, open-label intervention trial to compare a comprehensive, remote, navigator-led, algorithm-driven strategy for optimization of GDMT prescribing in patients with HF across the full spectrum of ejection fraction with a control intervention focused on patient and provider education regarding the importance of GDMT optimization.
Results
The primary efficacy endpoint of the study is the proportion of patients receiving optimal HF treatment at 3 months. Additional outcomes of interest include the proportion of patients with optimal HF therapy at 6 months and 12 months as well as health resource utilization, including hospitalizations and deaths.
Conclusions
COPILOT-HF will evaluate the effectiveness of an early implementation of a remote pharmacist-led medication titration strategy across the HF spectrum.
{"title":"Rationale and Design of the Cooperative Program for ImpLementation of Optimal Therapy in Heart Failure","authors":"Alexander J. Blood, Ozan Unlu, John W. Ostrominski, Shahzad Hassan, Hunter Nichols, Samantha Subramaniam, Daniel Gabovitch, Jacqueline Chasse, Marian McPartlin, Christian Figueroa, Emma Collins, Megan Twining, Matthew Varugheese, Kavishwar Wagholikar, Christopher P. Cannon, Akshay S. Desai, Benjamin M. Scirica","doi":"10.1002/clc.70222","DOIUrl":"10.1002/clc.70222","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Despite overwhelming evidence of clinical benefit for patients with heart failure (HF), the uptake of guideline-directed medical therapies (GDMT) has been slow. Collaborative approaches are critically needed to improve alignment between evidence and clinical practice. Many strategies proposed to improve GDMT implementation have been either ineffective or too resource-intensive to implement at scale across different practice contexts. Furthermore, most existing approaches focus primarily on patients with HF and reduced EF, despite growing evidence for effective pharmacologic therapy in those with HF and mildly reduced or preserved ejection fraction (HFpEF).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>Based on this experience, we designed the Cooperative Program for ImpLementation of Optimal Therapy in Heart Failure (COPILOT-HF) study (NCT05734690).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a pragmatic, randomized, open-label intervention trial to compare a comprehensive, remote, navigator-led, algorithm-driven strategy for optimization of GDMT prescribing in patients with HF across the full spectrum of ejection fraction with a control intervention focused on patient and provider education regarding the importance of GDMT optimization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The primary efficacy endpoint of the study is the proportion of patients receiving optimal HF treatment at 3 months. Additional outcomes of interest include the proportion of patients with optimal HF therapy at 6 months and 12 months as well as health resource utilization, including hospitalizations and deaths.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>COPILOT-HF will evaluate the effectiveness of an early implementation of a remote pharmacist-led medication titration strategy across the HF spectrum.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12881208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146131418","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}
Shahzaib Ahmed, Zain Ali Nadeem, Aimen Nadeem, Hamza Ashraf, Umar Akram, Eeman Ahmad, Shoaib Ahmad, Ibrahim Nagmeldin Hassan, Irfan Ullah, Raheel Ahmed, Anwar A. Chahal, Rui Bebiano Da Providencia E. Costa, Chadi Alraies
Objective
Hypertension is a key risk factor for aortic dissection (AD). AD, if left untreated, carries significant mortality rates. Our aim is to analyse trends in mortality due to AD in adults with primary hypertension in the United States (US).
Methods
We used the CDC WONDER database to extract mortality data for patients with primary hypertension who died due to AD. Age-adjusted mortality rates (AAMRs) and crude mortality rates (CMRs) were extracted per 100 000 persons. Annual percentage changes (APCs) and average APCs (AAPCs) in AAMRs and CMRs were calculated using Joinpoint regression.
Results
From 1999 to 2020, a total of 13 128 deaths due to AD were reported in patients with primary hypertension in the US. Males displayed a higher overall AAMR (0.3) than females (0.2) throughout the study period. Slight regional variations were observed, with the West showing the highest overall AAMR (0.4), followed by the Midwest (0.3), and the Northeast and South (0.2). In urban areas, AAMRs were higher than in rural areas until 2008. From 2009 to 2020, AAMRs remained stable in urban areas (0.3) but increased in rural areas from 2010 to 2020 (4.7). The highest state-level AAMRs were observed in Hawaii, Oregon, and Oklahoma.
Conclusion
Significant differences were observed in AAPCs compared to AD-related mortality trends in the general population. Mortality trends revealed an initial decline followed by a gradual rise. Clinicians should focus on high-risk groups and raise awareness about the disease in these populations.
{"title":"Mortality Due to Aortic Dissection in Adults With Primary Hypertension: A Nationwide Analysis Over Two Decades","authors":"Shahzaib Ahmed, Zain Ali Nadeem, Aimen Nadeem, Hamza Ashraf, Umar Akram, Eeman Ahmad, Shoaib Ahmad, Ibrahim Nagmeldin Hassan, Irfan Ullah, Raheel Ahmed, Anwar A. Chahal, Rui Bebiano Da Providencia E. Costa, Chadi Alraies","doi":"10.1002/clc.70269","DOIUrl":"10.1002/clc.70269","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Hypertension is a key risk factor for aortic dissection (AD). AD, if left untreated, carries significant mortality rates. Our aim is to analyse trends in mortality due to AD in adults with primary hypertension in the United States (US).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used the CDC WONDER database to extract mortality data for patients with primary hypertension who died due to AD. Age-adjusted mortality rates (AAMRs) and crude mortality rates (CMRs) were extracted per 100 000 persons. Annual percentage changes (APCs) and average APCs (AAPCs) in AAMRs and CMRs were calculated using Joinpoint regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 1999 to 2020, a total of 13 128 deaths due to AD were reported in patients with primary hypertension in the US. Males displayed a higher overall AAMR (0.3) than females (0.2) throughout the study period. Slight regional variations were observed, with the West showing the highest overall AAMR (0.4), followed by the Midwest (0.3), and the Northeast and South (0.2). In urban areas, AAMRs were higher than in rural areas until 2008. From 2009 to 2020, AAMRs remained stable in urban areas (0.3) but increased in rural areas from 2010 to 2020 (4.7). The highest state-level AAMRs were observed in Hawaii, Oregon, and Oklahoma.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Significant differences were observed in AAPCs compared to AD-related mortality trends in the general population. Mortality trends revealed an initial decline followed by a gradual rise. Clinicians should focus on high-risk groups and raise awareness about the disease in these populations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12877423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146123920","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号