Yanglulu Su, Yi Ning, Zhiyuan Jiang, Guoqiang Zhong
Background and Objective
Atrial fibrillation (AF), a common arrhythmic disorder, is increasing in prevalence annually and has become an important public health problem that jeopardizes human health. Metabolites are small molecules produced in the process of metabolic reactions, and they can affect the risk of disease and possibly become targets for disease management.
Methods
We used two-sample and bidirectional MR to explore potential causal associations between lipid groups and AF. Two-step MR analysis was used to explore whether plasma metabolites mediated a causal effect from lipidomes to AF.
Result
We assessed the effect of 179 lipids on AF using IVW models and observed that 8 lipids were associated significantly with AF (p < 0.05). Likewise, we assessed the effect of 1091 metabolites and 309 metabolite ratios on AF and observed that 22 metabolites were significantly associated with AF (p < 0.05). We analyzed the blood metabolites above as mediators in the pathway from the lipidomes above to AF. We found that levels. Of lipid sterol ester (27:1/18:3) were associated with lower homoarginine levels, and lower metabolite homoarginine levels were associated with an increased risk of AF.
Conclusion
Our study identified a causal relationship between plasma liposomes and AF, and additionally found that the plasma metabolite homoarginine levels can act as a mediator of the lipid sterol ester in its effect on AF.
{"title":"Blood Metabolome Mediates the Effect of the Plasma Lipidome on the Risk of Atrial Fibrillation: A Mendelian Randomization Study","authors":"Yanglulu Su, Yi Ning, Zhiyuan Jiang, Guoqiang Zhong","doi":"10.1002/clc.70112","DOIUrl":"https://doi.org/10.1002/clc.70112","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objective</h3>\u0000 \u0000 <p>Atrial fibrillation (AF), a common arrhythmic disorder, is increasing in prevalence annually and has become an important public health problem that jeopardizes human health. Metabolites are small molecules produced in the process of metabolic reactions, and they can affect the risk of disease and possibly become targets for disease management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used two-sample and bidirectional MR to explore potential causal associations between lipid groups and AF. Two-step MR analysis was used to explore whether plasma metabolites mediated a causal effect from lipidomes to AF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Result</h3>\u0000 \u0000 <p>We assessed the effect of 179 lipids on AF using IVW models and observed that 8 lipids were associated significantly with AF (<i>p</i> < 0.05). Likewise, we assessed the effect of 1091 metabolites and 309 metabolite ratios on AF and observed that 22 metabolites were significantly associated with AF (<i>p</i> < 0.05). We analyzed the blood metabolites above as mediators in the pathway from the lipidomes above to AF. We found that levels. Of lipid sterol ester (27:1/18:3) were associated with lower homoarginine levels, and lower metabolite homoarginine levels were associated with an increased risk of AF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study identified a causal relationship between plasma liposomes and AF, and additionally found that the plasma metabolite homoarginine levels can act as a mediator of the lipid sterol ester in its effect on AF.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70112","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143564728","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}
Ai Wang, Huilin Hu, Dai Zhang, Gang Qian, Haihua Pan, Changlin Zhai, Yan Yan
Background
Left atrium (LA) is an integral component of left heart remodeling, reflecting hemodynamics and ventricular status. It remains uncertain whether left atrial diameter (LAD) can be utilized for predicting and evaluating the occurrence of heart failure (HF) in middle-aged and elderly individuals.
Methods
The study aimed to explore the correlation between LAD and HF in middle-aged and elderly individuals, elucidating the timing of occurrence HF in relation to LAD. The retrospective-prospective study investigated 4025 patients who underwent echocardiography at Zhongshan Hospital's Cardiovascular Department from January 2015 to December 2017. Patients were continuously monitored for HF until January 31, 2024. Cox regression analyses related baseline LAD to HF incidence, adjusted for known risk factors.
Results
A total of 4025 individuals (mean age: 55 years, 45.29% male) were studied, spanning ages 45–91. Fifty-one developed HF during a median follow-up of 4.36 years. Cox regression model demonstrated the association between HF and LAD (HR = 5.721, 95% CI 3.768–8.687, p < 0.001) even after adjusting for covariates (age, weight, eGFR, HDL-C, lymphocyte count, systolic blood pressure, FPG, HbA1C, waist circumference, hip circumference, valvular disease history, atrial fibrillation history).
Conclusions
The link between LAD and future HF occurrence risk among middle-aged and older adults shows a dose–response pattern. This relationship persists post-adjustment for HF-related factors, highlighting the predictive value of LAD in forecasting HF incidence.
{"title":"Investigating Left Atrial Diameter and Heart Failure Onset in Middle-Aged and Elderly: A Retrospective-Prospective Study","authors":"Ai Wang, Huilin Hu, Dai Zhang, Gang Qian, Haihua Pan, Changlin Zhai, Yan Yan","doi":"10.1002/clc.70085","DOIUrl":"https://doi.org/10.1002/clc.70085","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Left atrium (LA) is an integral component of left heart remodeling, reflecting hemodynamics and ventricular status. It remains uncertain whether left atrial diameter (LAD) can be utilized for predicting and evaluating the occurrence of heart failure (HF) in middle-aged and elderly individuals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study aimed to explore the correlation between LAD and HF in middle-aged and elderly individuals, elucidating the timing of occurrence HF in relation to LAD. The retrospective-prospective study investigated 4025 patients who underwent echocardiography at Zhongshan Hospital's Cardiovascular Department from January 2015 to December 2017. Patients were continuously monitored for HF until January 31, 2024. Cox regression analyses related baseline LAD to HF incidence, adjusted for known risk factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 4025 individuals (mean age: 55 years, 45.29% male) were studied, spanning ages 45–91. Fifty-one developed HF during a median follow-up of 4.36 years. Cox regression model demonstrated the association between HF and LAD (HR = 5.721, 95% CI 3.768–8.687, <i>p</i> < 0.001) even after adjusting for covariates (age, weight, eGFR, HDL-C, lymphocyte count, systolic blood pressure, FPG, HbA1C, waist circumference, hip circumference, valvular disease history, atrial fibrillation history).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The link between LAD and future HF occurrence risk among middle-aged and older adults shows a dose–response pattern. This relationship persists post-adjustment for HF-related factors, highlighting the predictive value of LAD in forecasting HF incidence.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70085","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143564727","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}
Junxian Wang, Shengzhi Zhou, Xiaoming Xie, Wenlin Liu
Objectives
To elucidating the linkage between obesity-associated body fat indicators and atrial fibrillation (AF) using Mendelian Randomization (MR) and mediation analysis.
Methods
The study utilized three independent genome-wide association study (GWAS) datasets, with containing over 450 000 individuals each, to represent body fat indicators as the exposure variable. Additionally, two summary genetic datasets of AF were utilized as the clinical outcome. Single nucleotide polymorphisms (SNPs) with p-values less than 5 × 10−10 were identified as instrumental variables (IVs) for MR analysis. The primary analysis method employed was the inverse-variance weighting (IVW) model, supplemented by three additional models: MR-Egger regression, weighted median, and maximum likelihood. Sensitivity analysis was conducted, encompassing tests for heterogeneity and horizontal pleiotropy, utilizing Cochran's Q, MR-Egger intercept, and MR-PRESSO tests to validate the reliability of the findings. Furthermore, a mediation analysis was conducted to explore potential mediators involved in the pathogenesis of AF.
Results
The IVW model demonstrated that per 1-SD increase in body fat indicators (body fat percentage, whole body fat mass, and trunk fat mass) is associated with an elevated risk of AF, with values of 63.1%, 55.0%, and 55.8% respectively. All three supplementary models arrived comparable conclusions with IVW model. The sensitivity analysis confirmed the absence of horizontal pleiotropy, thereby validating the reliability of the findings. Additionally, the mediation study indicates that hypertension and sleep apnea syndrome are identified as significant mediators during the pathogenesis of AF.
Conclusions
The study reveals that individuals with a higher body fat percentage tend to exhibit a heightened genetic predisposition for susceptibility to AF. Meanwhile, hypertension and sleep apnea syndrome have been identified as key mediators contributing to the pathogenesis of AF.
{"title":"Elucidating the Linkage Between Obesity-Related Body Fat Indicators and Atrial Fibrillation: Supported by Evidence From Mendelian Randomization and Mediation Analyses","authors":"Junxian Wang, Shengzhi Zhou, Xiaoming Xie, Wenlin Liu","doi":"10.1002/clc.70103","DOIUrl":"https://doi.org/10.1002/clc.70103","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To elucidating the linkage between obesity-associated body fat indicators and atrial fibrillation (AF) using Mendelian Randomization (MR) and mediation analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study utilized three independent genome-wide association study (GWAS) datasets, with containing over 450 000 individuals each, to represent body fat indicators as the exposure variable. Additionally, two summary genetic datasets of AF were utilized as the clinical outcome. Single nucleotide polymorphisms (SNPs) with <i>p</i>-values less than 5 × 10<sup>−10</sup> were identified as instrumental variables (IVs) for MR analysis. The primary analysis method employed was the inverse-variance weighting (IVW) model, supplemented by three additional models: MR-Egger regression, weighted median, and maximum likelihood. Sensitivity analysis was conducted, encompassing tests for heterogeneity and horizontal pleiotropy, utilizing Cochran's Q, MR-Egger intercept, and MR-PRESSO tests to validate the reliability of the findings. Furthermore, a mediation analysis was conducted to explore potential mediators involved in the pathogenesis of AF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The IVW model demonstrated that per 1-SD increase in body fat indicators (body fat percentage, whole body fat mass, and trunk fat mass) is associated with an elevated risk of AF, with values of 63.1%, 55.0%, and 55.8% respectively. All three supplementary models arrived comparable conclusions with IVW model. The sensitivity analysis confirmed the absence of horizontal pleiotropy, thereby validating the reliability of the findings. Additionally, the mediation study indicates that hypertension and sleep apnea syndrome are identified as significant mediators during the pathogenesis of AF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The study reveals that individuals with a higher body fat percentage tend to exhibit a heightened genetic predisposition for susceptibility to AF. Meanwhile, hypertension and sleep apnea syndrome have been identified as key mediators contributing to the pathogenesis of AF.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70103","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143554534","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}
Bazil Azeem, Laiba Khurram, Bakhtawar Sharaf, Arwa Khan, Ayesha Habiba, Rabia Asim, Muskan Khelani, Hamza Ali, Abdul Hadi Ansari, Tazheen Saleh Muhammad, Muhammad Abdullah Naveed, Mata-e-Alla Dogar, Aalaa Saleh, Hamza Ashraf
Background
Arrhythmias are a significant cause of cardiovascular mortality in the U.S. This study examines trends in arrhythmia-related mortality from 1999 to 2023, focusing on gender, racial, regional disparities, and specific arrhythmic conditions.
Objective
To analyze trends and disparities in arrhythmia-related mortality among U.S. adults aged ≥ 35 years from 1999 to 2023, with a focus on the impact of sex, race, geographic location, and urbanization.
Methods
We analyzed mortality data from the CDC WONDER database, focusing on deaths where arrhythmias were a contributing cause. Age-adjusted mortality rates (AAMRs) were calculated and stratified by sex, race/ethnicity, state, and region. The annual percentage change (APC) and average annual percentage change (AAPC) were estimated using Joinpoint regression.
Results
A total of 5,050,271 arrhythmia-related deaths were recorded, with the overall AAMR increasing from 111.4 in 1999 to 137.3 in 2023. Mortality rates declined significantly from 1999 to 2009 (APC: −1.04%; p = 0.003) but rose sharply from 2009 to 2018 (APC: 1.69%; p = 0.003), peaking in 2021 during the COVID-19 pandemic (APC: 8.63%; p < 0.001). A subsequent decline was observed from 2021 to 2023 (APC: −3.91%; p = 0.044). Males consistently exhibited higher AAMRs than females (137.2 vs. 95.3), as did non-Hispanic White individuals compared to other racial groups. Geographic disparities revealed higher mortality rates in Nonmetropolitan areas and the Midwest, with the highest AAMR observed in Oregon and the lowest in Hawaii.
Conclusion
Despite an overall decline in arrhythmia-related mortality, recent increases, especially in West Virginia and among certain racial groups, highlight the need for targeted public health interventions.
{"title":"Unmasking Arrhythmia Mortality: A 25-Year Analysis of Trends and Disparities in the United States (1999–2023)","authors":"Bazil Azeem, Laiba Khurram, Bakhtawar Sharaf, Arwa Khan, Ayesha Habiba, Rabia Asim, Muskan Khelani, Hamza Ali, Abdul Hadi Ansari, Tazheen Saleh Muhammad, Muhammad Abdullah Naveed, Mata-e-Alla Dogar, Aalaa Saleh, Hamza Ashraf","doi":"10.1002/clc.70109","DOIUrl":"https://doi.org/10.1002/clc.70109","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Arrhythmias are a significant cause of cardiovascular mortality in the U.S. This study examines trends in arrhythmia-related mortality from 1999 to 2023, focusing on gender, racial, regional disparities, and specific arrhythmic conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To analyze trends and disparities in arrhythmia-related mortality among U.S. adults aged ≥ 35 years from 1999 to 2023, with a focus on the impact of sex, race, geographic location, and urbanization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed mortality data from the CDC WONDER database, focusing on deaths where arrhythmias were a contributing cause. Age-adjusted mortality rates (AAMRs) were calculated and stratified by sex, race/ethnicity, state, and region. The annual percentage change (APC) and average annual percentage change (AAPC) were estimated using Joinpoint regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 5,050,271 arrhythmia-related deaths were recorded, with the overall AAMR increasing from 111.4 in 1999 to 137.3 in 2023. Mortality rates declined significantly from 1999 to 2009 (APC: −1.04%; <i>p</i> = 0.003) but rose sharply from 2009 to 2018 (APC: 1.69%; <i>p</i> = 0.003), peaking in 2021 during the COVID-19 pandemic (APC: 8.63%; <i>p</i> < 0.001). A subsequent decline was observed from 2021 to 2023 (APC: −3.91%; <i>p</i> = 0.044). Males consistently exhibited higher AAMRs than females (137.2 vs. 95.3), as did non-Hispanic White individuals compared to other racial groups. Geographic disparities revealed higher mortality rates in Nonmetropolitan areas and the Midwest, with the highest AAMR observed in Oregon and the lowest in Hawaii.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Despite an overall decline in arrhythmia-related mortality, recent increases, especially in West Virginia and among certain racial groups, highlight the need for targeted public health interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70109","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143535840","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}
Okasha Tahir, Ali Bin Nasir, Sonam Lohana, Taha Naveed, Muhammad Abdullah
We read the recent study by Lun et al. [1] on the “Predictive value of lung ultrasound (LUS) combined with the ACEF score for the prognosis of acute myocardial infarction (AMI)” with great interest. The authors provide a novel approach to risk stratification, yet several methodological and clinical concerns warrant discussion.
The study's exclusion of patients older than 80, those with significant pulmonary disease, and those without LUS within 48 h of admission substantially limits its external validity. Elder patients and those with chronic lung conditions constitute a substantial proportion of AMI cases, and their exclusion raises concerns about the findings' real-world applicability [2, 3]. The single-center design with a relatively small sample size (n = 204) further restricts generalizability. By addressing this limitation, future research could improve the external validity of LUS as a prognostic tool for a broader patient population.
While the study suggests that combining LUS with the ACEF score improves predictive performance, it does not adequately account for key confounders. For instance, diuretic use was significantly associated with adverse outcomes (OR 4.79, p < 0.01), yet its impact on B-line counts and overall prognostication was not thoroughly explored. Without rigorous adjustment, the study may overestimate the independent predictive value of LUS [3]. A more rigorous multivariate analysis or propensity score matching would strengthen the study's conclusions and ensure that LUS retains its predictive value independent of other clinical interventions.
The median follow-up period of 12 months is insufficient to capture long-term cardiovascular outcomes, particularly for AMI patients at risk of late heart failure events. Additionally, the reliance on telephone follow-ups introduces potential reporting bias, as clinical outcomes were not objectively verified through imaging or biomarker assessments [4]. Extending the follow-up period and incorporating objective clinical data would enhance the reliability of LUS and ACEF score-based prognostication.
Despite these limitations, the study introduces an important concept by integrating LUS into AMI risk stratification. Future studies with more extensive, multicenter cohorts, improved statistical adjustments, and extended follow-up are necessary to confirm the robustness of this approach. We commend the authors for their valuable contribution to the evolving landscape.
The authors declare no conflicts of interest.
{"title":"Predictive Value of Lung Ultrasound Combined With ACEF Score for the Prognosis of Acute Myocardial Infarction","authors":"Okasha Tahir, Ali Bin Nasir, Sonam Lohana, Taha Naveed, Muhammad Abdullah","doi":"10.1002/clc.70111","DOIUrl":"https://doi.org/10.1002/clc.70111","url":null,"abstract":"<p>We read the recent study by Lun et al. [<span>1</span>] on the “Predictive value of lung ultrasound (LUS) combined with the ACEF score for the prognosis of acute myocardial infarction (AMI)” with great interest. The authors provide a novel approach to risk stratification, yet several methodological and clinical concerns warrant discussion.</p><p>The study's exclusion of patients older than 80, those with significant pulmonary disease, and those without LUS within 48 h of admission substantially limits its external validity. Elder patients and those with chronic lung conditions constitute a substantial proportion of AMI cases, and their exclusion raises concerns about the findings' real-world applicability [<span>2, 3</span>]. The single-center design with a relatively small sample size (<i>n</i> = 204) further restricts generalizability. By addressing this limitation, future research could improve the external validity of LUS as a prognostic tool for a broader patient population.</p><p>While the study suggests that combining LUS with the ACEF score improves predictive performance, it does not adequately account for key confounders. For instance, diuretic use was significantly associated with adverse outcomes (OR 4.79, <i>p</i> < 0.01), yet its impact on B-line counts and overall prognostication was not thoroughly explored. Without rigorous adjustment, the study may overestimate the independent predictive value of LUS [<span>3</span>]. A more rigorous multivariate analysis or propensity score matching would strengthen the study's conclusions and ensure that LUS retains its predictive value independent of other clinical interventions.</p><p>The median follow-up period of 12 months is insufficient to capture long-term cardiovascular outcomes, particularly for AMI patients at risk of late heart failure events. Additionally, the reliance on telephone follow-ups introduces potential reporting bias, as clinical outcomes were not objectively verified through imaging or biomarker assessments [<span>4</span>]. Extending the follow-up period and incorporating objective clinical data would enhance the reliability of LUS and ACEF score-based prognostication.</p><p>Despite these limitations, the study introduces an important concept by integrating LUS into AMI risk stratification. Future studies with more extensive, multicenter cohorts, improved statistical adjustments, and extended follow-up are necessary to confirm the robustness of this approach. We commend the authors for their valuable contribution to the evolving landscape.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70111","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530318","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}
Abolfazl Sam Daliri, Nima Goudarzi, Arshia Harati, Kourosh Kabir
Background
Heart failure as an advanced cardiac disease has a high incidence and prevalence in all societies nowadays. Many drugs and treatment methods have been discovered for improving heart failure patients' conditions till now in this way melatonin therapy is one of the less-known methods rarely used by clinicians.
Methods
To investigate the positive effect of melatonin on heart failure development, we conducted a systematic review and meta-analysis by searching valid databases with keywords based on the protocol. Based on the eligible criteria, four articles were selected for data synthesis and analysis after scanning the title and/or abstract and reading full-text.
Results
As a result of analysis, increasing ejection fraction (Mean difference: 2.39 [−1.82, 6.59] p = 0.27), NYHA (New York Heart Association Functional Class) (Odds ratio: 4.84 [1.00, 23.44] p = 0.05), and significant elevation of quality of life (Mean difference: −5.95 [−9.54, −2.35] p = 0.001) were observed. As the effect of melatonin, fatigue, and NT-Pro BNP were reduced but on the contrary sleep quality, appetite, and FMD (Flow-Mediated Dilation) significantly increased.
Conclusion
Thus, melatonin, by increasing psychologic parameters and cardiac potency, could be advised as a novel drug for treatment and palliating heart failure patients.
{"title":"Melatonin as a Novel Drug to Improve Cardiac Function and Quality of Life in Heart Failure Patients: A Systematic Review and Meta-Analysis","authors":"Abolfazl Sam Daliri, Nima Goudarzi, Arshia Harati, Kourosh Kabir","doi":"10.1002/clc.70107","DOIUrl":"https://doi.org/10.1002/clc.70107","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Heart failure as an advanced cardiac disease has a high incidence and prevalence in all societies nowadays. Many drugs and treatment methods have been discovered for improving heart failure patients' conditions till now in this way melatonin therapy is one of the less-known methods rarely used by clinicians.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>To investigate the positive effect of melatonin on heart failure development, we conducted a systematic review and meta-analysis by searching valid databases with keywords based on the protocol. Based on the eligible criteria, four articles were selected for data synthesis and analysis after scanning the title and/or abstract and reading full-text.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>As a result of analysis, increasing ejection fraction (Mean difference: 2.39 [−1.82, 6.59] <i>p</i> = 0.27), <i>NYHA</i> (New York Heart Association Functional Class) (Odds ratio: 4.84 [1.00, 23.44] <i>p</i> = 0.05), and significant elevation of quality of life (Mean difference: −5.95 [−9.54, −2.35] <i>p</i> = 0.001) were observed. As the effect of melatonin, fatigue, and <i>NT-Pro BNP</i> were reduced but on the contrary sleep quality, appetite, and <i>FMD</i> (Flow-Mediated Dilation) significantly increased.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Thus, melatonin, by increasing psychologic parameters and cardiac potency, could be advised as a novel drug for treatment and palliating heart failure patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70107","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530317","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}
Akbulut Muge, Izci Cenan, Ozyuncu Nil, K. Esenboga
Introduction
Acute heart failure (AHF) is associated with a dismal prognosis that is even poorer than the majority of cancer types. Therefore, clinical indicators that can aid in determining the prognosis of heart failure are of interest. Multiple risk prediction tools with varying sensitivity and specificities have been introduced before. In the current study, we aimed to evaluate whether the HALP score could accurately predict in-hospital mortality in patients with AHF.
Methods
We evaluated the medical records of a total of 153 patients admitted to our institution between August 2016–May 2018 for acute heart failure. The patients were divided into two groups: Group 1 (patients who died during hospital admission) and Group 2 (patients who were discharged from the hospital). The HALP score was calculated as: hemoglobin (g/L) x albumin (g/L) x lymphocytes (/L)/platelets (/L) for each patient. The two groups were compared in terms of HALP scores. The receiver operator characteristic (ROC) curve was utilized to assess the predictive performance of HALP on in-hospital mortality in AHF.
Results
Patients who died during admission had lower HALP scores compared with the patients who were discharged uneventfully. A ROC curve analysis was performed to predict the optimal cut-off value of the HALP score. The area under the curve (AUC), sensitivity, specificity, and the cut-off value were 0.650, 43%, 57%, 21,5 respectively (p = 0.014).
Conclusion
Despite all evolving treatment modalities, heart failure-related mortality rates remain high. Prompt recognition of patients with an unfavorable prognosis is vital for the timely implementation of disease-modifying therapeutic interventions. The HALP score, being a readily calculable tool, serves as an effective means to pinpoint individuals at a heightened risk of in-hospital mortality. We believe that the HALP score holds promise as a practical tool for predicting in-mortality among patients admitted for AHF.
{"title":"A Potential Relationship Between HALP Score and In-Hospital Mortality in Acute Heart Failure","authors":"Akbulut Muge, Izci Cenan, Ozyuncu Nil, K. Esenboga","doi":"10.1002/clc.70108","DOIUrl":"https://doi.org/10.1002/clc.70108","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Acute heart failure (AHF) is associated with a dismal prognosis that is even poorer than the majority of cancer types. Therefore, clinical indicators that can aid in determining the prognosis of heart failure are of interest. Multiple risk prediction tools with varying sensitivity and specificities have been introduced before. In the current study, we aimed to evaluate whether the HALP score could accurately predict in-hospital mortality in patients with AHF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We evaluated the medical records of a total of 153 patients admitted to our institution between August 2016–May 2018 for acute heart failure. The patients were divided into two groups: Group 1 (patients who died during hospital admission) and Group 2 (patients who were discharged from the hospital). The HALP score was calculated as: hemoglobin (g/L) x albumin (g/L) x lymphocytes (/L)/platelets (/L) for each patient. The two groups were compared in terms of HALP scores. The receiver operator characteristic (ROC) curve was utilized to assess the predictive performance of HALP on in-hospital mortality in AHF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients who died during admission had lower HALP scores compared with the patients who were discharged uneventfully. A ROC curve analysis was performed to predict the optimal cut-off value of the HALP score. The area under the curve (AUC), sensitivity, specificity, and the cut-off value were 0.650, 43%, 57%, 21,5 respectively (<i>p</i> = 0.014).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Despite all evolving treatment modalities, heart failure-related mortality rates remain high. Prompt recognition of patients with an unfavorable prognosis is vital for the timely implementation of disease-modifying therapeutic interventions. The HALP score, being a readily calculable tool, serves as an effective means to pinpoint individuals at a heightened risk of in-hospital mortality. We believe that the HALP score holds promise as a practical tool for predicting in-mortality among patients admitted for AHF.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70108","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143521812","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}
Hamidreza Soleimani, Babak Sattartabar, Bahar Parastooei, Reza Eshraghi, Roozbeh Nazari, Soroush Najdaghi, Sara Hobaby, Ali Etemadi, Mehrdad Mahalleh, Maryam Taheri, Adrian V. Hernandez, Toshiki Kuno, Homa Taheri, Robert J. Siegel, Florian Rader, Behnam N. Tehrani, Mohammad Hossein Mandegar, Ehsan Safaee, Pouya Ebrahimi, Kaveh Hosseini
Background
Although some guidelines recommend Renal denervation (RDN) as an alternative to anti-HTN medications, there are concerns about its efficacy and safety. We aimed to evaluate the benefits and harms of RDN in a systematic review and meta-analysis of sham-controlled randomized clinical trials (RCT).
Methods
Databases were searched until September 10th, 2024, to identify RCTs evaluating RDN for treating URH versus sham control. The primary outcomes were the change in office and ambulatory 24-h systolic (SBP) and diastolic blood pressure (DBP). Secondary outcomes were changes in daytime and nighttime SBP and DBP, home BP, number of anti-HTN drugs, and related complications. Mean differences (MD) and relative risks (RR) described the effects of RDN on BP and complications, respectively, using random effects meta-analyses. GRADE methodology was used to assess the certainty of evidence (COE).
Results
We found 16 included sham-controlled RCTs [RDN (n = 1594) vs. sham (n = 1225)]. RDN significantly reduced office SBP (MD −4.26 mmHg, 95% CI: −5.68 to −2.84), 24 h ambulatory SBP (MD −2.63 mmHg), office DBP (MD −2.15 mmHg), 24-h ambulatory DBP (MD −1.27 mmHg), and daytime SBP and DBP (MD −3.29 and 2.97 mmHg), compared to the sham. The rate of severe complications was low in both groups (0%–2%). The heterogeneity was high among most indices, and CoE was very low for most outcomes.
Conclusion
RDN significantly reduced several SBP and DBP outcomes versus sham without significantly increasing complications. This makes RDN a potentially effective alternative to medications in URH.
{"title":"Renal Denervation Effects on Blood Pressure in Resistant and Uncontrolled Hypertension: A Meta-Analysis of Sham-Controlled Randomized Clinical Trials","authors":"Hamidreza Soleimani, Babak Sattartabar, Bahar Parastooei, Reza Eshraghi, Roozbeh Nazari, Soroush Najdaghi, Sara Hobaby, Ali Etemadi, Mehrdad Mahalleh, Maryam Taheri, Adrian V. Hernandez, Toshiki Kuno, Homa Taheri, Robert J. Siegel, Florian Rader, Behnam N. Tehrani, Mohammad Hossein Mandegar, Ehsan Safaee, Pouya Ebrahimi, Kaveh Hosseini","doi":"10.1002/clc.70104","DOIUrl":"https://doi.org/10.1002/clc.70104","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Although some guidelines recommend Renal denervation (RDN) as an alternative to anti-HTN medications, there are concerns about its efficacy and safety. We aimed to evaluate the benefits and harms of RDN in a systematic review and meta-analysis of sham-controlled randomized clinical trials (RCT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Databases were searched until September 10th, 2024, to identify RCTs evaluating RDN for treating URH versus sham control. The primary outcomes were the change in office and ambulatory 24-h systolic (SBP) and diastolic blood pressure (DBP). Secondary outcomes were changes in daytime and nighttime SBP and DBP, home BP, number of anti-HTN drugs, and related complications. Mean differences (MD) and relative risks (RR) described the effects of RDN on BP and complications, respectively, using random effects meta-analyses. GRADE methodology was used to assess the certainty of evidence (COE).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We found 16 included sham-controlled RCTs [RDN (<i>n</i> = 1594) vs. sham (<i>n</i> = 1225)]. RDN significantly reduced office SBP (MD −4.26 mmHg, 95% CI: −5.68 to −2.84), 24 h ambulatory SBP (MD −2.63 mmHg), office DBP (MD −2.15 mmHg), 24-h ambulatory DBP (MD −1.27 mmHg), and daytime SBP and DBP (MD −3.29 and 2.97 mmHg), compared to the sham. The rate of severe complications was low in both groups (0%–2%). The heterogeneity was high among most indices, and CoE was very low for most outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>RDN significantly reduced several SBP and DBP outcomes versus sham without significantly increasing complications. This makes RDN a potentially effective alternative to medications in URH.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70104","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143521857","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}
Raffaele De Caterina, Martin Unverdorben, Cathy Chen, Eue-Keun Choi, Yukihiro Koretsune, Doralisa Morrone, Ladislav Pecen, Peter Bramlage, Chun-Chieh Wang, Takeshi Yamashita, Paulus Kirchhof
Background
Randomized clinical trials demonstrated similar efficacy and improved safety of direct oral anticoagulants versus warfarin in patients with atrial fibrillation (AF). Long-term data in routine clinical practice are needed.
Hypothesis
Patients with AF receiving edoxaban at baseline continue to have low annualized effectiveness and safety event rates in the second year of follow-up, with regional variations observed.
Methods
The Global ETNA-AF program is a prospective, noninterventional study of patients with AF receiving edoxaban. Patient characteristics and annualized clinical event rates were assessed overall and by region across the 2-year follow-up. Annualized event rates of bleeding and thromboembolic events were assessed within the first year and conditionally in patients who were event-free up to 12 months in the second year.
Results
This analysis comprised 26 805 patients from Europe (n = 13 164), Japan (n = 10 342), and non-Japanese Asian regions (n = 3299). Patients from Europe had the highest burden of comorbidities. The annualized event rates for major bleeding, any stroke, all-cause death, and cardiovascular death varied by region. The global annualized event rates in the first and second year were 1.31%/year and 0.86%/year for major bleeding, 1.06%/year and 0.65%/year for any stroke, 0.84%/year and 0.73%/year for cardiovascular death, and 3.05%/year and 3.18%/year for all-cause death.
Conclusion
Annualized event rates for any stroke and major bleeding remained low through 2-year follow-up for patients with AF receiving edoxaban at baseline. Differences in annualized event rates for all-cause and cardiovascular mortality between Europe, Japan, and non-Japanese Asian regions may reflect variations in baseline characteristics.
Trial Registration
Europe, NCT02944019; Japan, UMIN000017011; Korea/Taiwan, NCT02951039; Hong Kong, NCT03247582; and Thailand, NCT03247569.
{"title":"Two-Year Follow-Up of Patients With Atrial Fibrillation Receiving Edoxaban in Routine Clinical Practice: Results From the Global ETNA-AF Program","authors":"Raffaele De Caterina, Martin Unverdorben, Cathy Chen, Eue-Keun Choi, Yukihiro Koretsune, Doralisa Morrone, Ladislav Pecen, Peter Bramlage, Chun-Chieh Wang, Takeshi Yamashita, Paulus Kirchhof","doi":"10.1002/clc.70091","DOIUrl":"https://doi.org/10.1002/clc.70091","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Randomized clinical trials demonstrated similar efficacy and improved safety of direct oral anticoagulants versus warfarin in patients with atrial fibrillation (AF). Long-term data in routine clinical practice are needed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>Patients with AF receiving edoxaban at baseline continue to have low annualized effectiveness and safety event rates in the second year of follow-up, with regional variations observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The Global ETNA-AF program is a prospective, noninterventional study of patients with AF receiving edoxaban. Patient characteristics and annualized clinical event rates were assessed overall and by region across the 2-year follow-up. Annualized event rates of bleeding and thromboembolic events were assessed within the first year and conditionally in patients who were event-free up to 12 months in the second year.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This analysis comprised 26 805 patients from Europe (<i>n</i> = 13 164), Japan (<i>n</i> = 10 342), and non-Japanese Asian regions (<i>n</i> = 3299). Patients from Europe had the highest burden of comorbidities. The annualized event rates for major bleeding, any stroke, all-cause death, and cardiovascular death varied by region. The global annualized event rates in the first and second year were 1.31%/year and 0.86%/year for major bleeding, 1.06%/year and 0.65%/year for any stroke, 0.84%/year and 0.73%/year for cardiovascular death, and 3.05%/year and 3.18%/year for all-cause death.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Annualized event rates for any stroke and major bleeding remained low through 2-year follow-up for patients with AF receiving edoxaban at baseline. Differences in annualized event rates for all-cause and cardiovascular mortality between Europe, Japan, and non-Japanese Asian regions may reflect variations in baseline characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>Europe, NCT02944019; Japan, UMIN000017011; Korea/Taiwan, NCT02951039; Hong Kong, NCT03247582; and Thailand, NCT03247569.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70091","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143513658","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}
Postural orthostatic tachycardia syndrome (POTS) is characterized by symptoms of orthostatic intolerance and is frequently observed in post-COVID conditions.
Objectives
We conducted controlled, prospective, and randomized clinical trials to explore the potential therapeutic benefits of low-level tragus stimulation (LL-TS) in patients with POTS following COVID-19 infection.
Methods
This study enrolled 57 participants with confirmed post-acute COVID-19 who had been diagnosed with POTS. The ear clip was attached to the right tragus of the patients for stimulation (20 Hz with a 1-ms duration) or sham stimulation. They were divided into two groups: the sham LL-TS group (sham stimulation, n = 26) and the LL-TS group (stimulation for 1 month, n = 31). LL-TS was performed 1 h twice daily for 1 month. Postural tachycardia was evaluated at baseline, 1-month visit, and 1-year visit. Heart rate variability (HRV) and plasma neuropeptide Y (NPY) were evaluated at respective time points.
Results
The mean age of participants was 31.9 ± 7.2 years (61.4% female). LL-TS significantly attenuated the increase in heart rate from supine to a 10-min stand, as well as the average and maximum heart rates after 1 month of treatment. LL-TS also significantly reduced NPY levels. In addition, LL-TS significantly increased the high frequency (HF), but decreased the low frequency (LF) and LF/HF ratio during the postural test (all p < 0.01). These effects persisted during the 1-year follow-up.
Conclusion
LL-TS may be a promising therapeutic approach for attenuating autonomic imbalance in patients with POTS following COVID-19 infection.
{"title":"Tragus Nerve Stimulation Attenuates Postural Orthostatic Tachycardia Syndrome in Post COVID-19 Infection","authors":"Zhuo Wang, Tongjian Zhu, Xuping Li, Xin Lai, Mingxian Chen","doi":"10.1002/clc.70110","DOIUrl":"https://doi.org/10.1002/clc.70110","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Postural orthostatic tachycardia syndrome (POTS) is characterized by symptoms of orthostatic intolerance and is frequently observed in post-COVID conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We conducted controlled, prospective, and randomized clinical trials to explore the potential therapeutic benefits of low-level tragus stimulation (LL-TS) in patients with POTS following COVID-19 infection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study enrolled 57 participants with confirmed post-acute COVID-19 who had been diagnosed with POTS. The ear clip was attached to the right tragus of the patients for stimulation (20 Hz with a 1-ms duration) or sham stimulation. They were divided into two groups: the sham LL-TS group (sham stimulation, <i>n</i> = 26) and the LL-TS group (stimulation for 1 month, <i>n</i> = 31). LL-TS was performed 1 h twice daily for 1 month. Postural tachycardia was evaluated at baseline, 1-month visit, and 1-year visit. Heart rate variability (HRV) and plasma neuropeptide Y (NPY) were evaluated at respective time points.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean age of participants was 31.9 ± 7.2 years (61.4% female). LL-TS significantly attenuated the increase in heart rate from supine to a 10-min stand, as well as the average and maximum heart rates after 1 month of treatment. LL-TS also significantly reduced NPY levels. In addition, LL-TS significantly increased the high frequency (HF), but decreased the low frequency (LF) and LF/HF ratio during the postural test (all <i>p</i> < 0.01). These effects persisted during the 1-year follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>LL-TS may be a promising therapeutic approach for attenuating autonomic imbalance in patients with POTS following COVID-19 infection.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70110","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143513657","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}
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