Clinical Cardiology最新文献_第2页

Critique on “Evaluation of Sex-Based Differences in the Prescription of the Combination of Evidence-Based Medicine After the Occurrence of an Acute ST-Elevation Myocardial Infarction” 评《急性st段抬高型心肌梗死发生后循证医学结合处方的性别差异评价》

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2026-01-26 DOI: 10.1002/clc.70239

Maiza Naseer, Sameer Haider, Touqeer Rehman

<p>Evelo et al. published an article entitled “Evaluation of Sex-Based Differences in the Prescription of the Combination of Evidence-Based Medicine After the Occurrence of an Acute ST-Elevation Myocardial Infarction” which we read with interest [<span>1</span>]. The authors examined an important clinical question: Are women less likely than men to be discharged with the full combination of evidence-based medicine (cEBM) after STEMI? In a retrospective cohort of 1467 patients in a teaching hospital in the Netherlands, they demonstrated that women were significantly less likely to be prescribed cEBM, particularly ACEi/ARB and statins. However, sex was not an independent predictor following multivariable adjustment [<span>1</span>]. This work is particularly important, especially in the context of studying a sizable real-world cohort and establishing prescribing patterns in contemporary STEMI care. Sensitivity analyses for left ventricular ejection fraction and subgroup comparisons add further robustness to the work. More importantly, their study illustrates that even with guideline-directed therapy, women continue to experience elevated rates of stroke and mortality when compared to men, reinforcing existing sex differences in cardiovascular care. There are some other limitations, not explicitly recognized by the authors, that should be considered when applying their findings in practice.</p><p>First, the single-center design limits the generalizability of the findings. All patients were treated at a Dutch Teaching Hospital that offers a range of cardiology services, where the guideline treatment is often well followed. Prescribing patterns and patient characteristics will likely vary considerably in a community or rural hospital setting. As a result, the findings may not be generalizable to larger or more diverse populations [<span>2</span>]. Multicenter registries could help clarify if the finding that sex was not an independent predictor holds true across health care systems.</p><p>Second, medication prescriptions were measured only at the time of discharge, and there was no record of dose, intensity, or longitudinal adjustments. In the study, cEBM was defined operationally as a “recommendation” for prescription of all five drug classes on the day after the index discharge [<span>1</span>]. This binary definition totally ignores underdosing (e.g., low-intensity statins, subtarget ACEi/ARB), titration, or discontinuation at a later date. Previous studies have demonstrated that underdosing and discontinuation, which are more frequently observed among women, are related to worse outcomes [<span>3, 4</span>]. By ignoring these variables, there is a risk that sex differences in secondary prevention will be underestimated.</p><p>Third, this study did not assess physician and system factors. The analysis was limited to patient-level factors. However, cardiovascular care disparities are often a reflection of provider practice patterns, implicit bias, a

Evelo等人发表了一篇文章《急性st段抬高型心肌梗死发生后循证医学结合处方的性别差异评价》，我们饶有兴趣地阅读了[1]。作者研究了一个重要的临床问题：在STEMI后，女性是否比男性更不可能完全结合循证医学（cEBM）出院？在荷兰一家教学医院的1467名患者的回顾性队列研究中，他们证明了女性服用cEBM的可能性明显较低，尤其是ACEi/ARB和他汀类药物。然而，在多变量调整后，性别并不是一个独立的预测因子。这项工作尤其重要，特别是在研究一个相当大的现实世界队列和建立当代STEMI护理的处方模式的背景下。左心室射血分数的敏感性分析和亚组比较进一步增加了工作的稳健性。更重要的是，他们的研究表明，即使采用指导指导的治疗方法，与男性相比，女性的中风率和死亡率仍然较高，这加强了心血管护理中存在的性别差异。还有一些作者没有明确认识到的其他限制，在将他们的发现应用于实践时应该加以考虑。首先，单中心设计限制了研究结果的普遍性。所有患者都在荷兰教学医院接受治疗，该医院提供一系列心脏病学服务，指导治疗通常得到很好的遵循。在社区或农村医院设置中，处方模式和患者特征可能会有很大差异。因此，这些发现可能无法推广到更大或更多样化的人群中。多中心登记可以帮助澄清性别不是独立预测因素的发现是否适用于整个医疗保健系统。其次，仅在出院时测量药物处方，并且没有剂量，强度或纵向调整的记录。在本研究中，cEBM被操作性地定义为在指标出院[1]后的第二天对所有五类药物的处方进行“推荐”。这种二元定义完全忽略了剂量不足（例如，低强度他汀类药物、亚靶ACEi/ARB）、滴定或以后停药。先前的研究表明，在女性中更常见的剂量不足和停药与较差的预后有关[3,4]。如果忽视这些变量，二级预防中的性别差异就有被低估的风险。第三，本研究没有评估医生和系统因素。分析仅限于患者层面的因素。然而，心血管护理差异往往反映了提供者的实践模式、隐性偏见和制度因素，如出院计划和门诊随访[5,6]。如果不考虑这些因素，我们很难知道我们所看到的治疗差距是由于患者之间的合并症率还是由于医疗服务的结构性不平等。最后，不良结果的描述未考虑混杂因素。在这项观察性研究中，女性的6个月死亡率和中风率增加，但这些比较没有根据年龄、基线合并症或治疗强度进行调整。正如先前的分析所证明的那样，在对各种因素进行全面调整后，与性别有关的死亡率差距趋于缩小。因此，报告未经调整的不良结果可能夸大了性别本身的影响，而对护理过程的风险因素和变量可能更有影响。为了推进这一重要的研究议程，有必要提出以下建议：(a)扩展到多中心队列以促进推广，(b)考虑剂量和纵向依从性，(c)探索处方提供者和系统的特征，以及(d)承认不良后果的混杂因素。这些设计将更好地解决观察到的差异是生物学驱动的、患者相关的还是结构介质。综上所述，Evelo等人提供的证据表明，女性在STEMI后较少使用cEBM，而年龄、合并症和抗凝血剂的使用是最大的差异。鉴于与不良事件相关的风险增加，在多中心环境中，随着系统意识的提高，有必要开始确定系统，以解决stemi后二级预防中的不公平现象。作者没有得到这项工作的特别资助。作者没有什么可报告的。作者没有什么可报告的。作者声明无利益冲突。作者没有什么可报告的。

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引用次数: 0

Comment on Long-Term Outcomes of Catheter Ablation in Ventricular Tachycardia Electrical Storm 导管消融治疗室性心动过速电风暴的远期疗效评价。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2026-01-24 DOI: 10.1002/clc.70265

Sohana Memon, Gaaitri Lohano

<p>The research by Çöteli et al. [<span>1</span>], titled <i>“Long-Term Outcomes of Catheter Ablation in Ventricular Tachycardia Electrical Storm: A Retrospective Cohort Study,”</i> caught our interest. The authors deserve praise for their methodical evaluation of a high-risk patient population presenting with electrical storm and for providing a comprehensive description of their retrospective cohort study design, patient selection criteria, and procedural methods. Their detailed documentation of VT induction strategies, ICD therapy monitoring, catheter ablation techniques, and follow-up procedures offers valuable insight into real-world management. These methodological strengths reinforce the reliability of the reported findings regarding procedural success, VT recurrence, ICD interventions, and survival outcomes. Nevertheless, certain limitations related to risk stratification and outcome assessment may influence the interpretation and generalizability of the results.</p><p>First, in high-risk cardiac populations, procedural tolerance, mortality, and post-ablation outcomes are influenced not only by left ventricular ejection fraction and comorbidities but also by overall physiological reserve. Patients with similar LVEF profiles may differ substantially in frailty status, which has been shown to be an independent predictor of cardiovascular mortality. The absence of frailty assessment in the current study limits granular risk stratification and may complicate interpretation of long-term mortality and morbidity outcomes. Although frailty evaluation can be challenging in retrospective cohorts, incorporating validated frailty measures in future studies could enhance prognostic accuracy and clinical applicability [<span>2</span>].</p><p>Second, an important methodological consideration is the lack of a standardized ventricular tachycardia induction protocol during catheter ablation. While programmed ventricular stimulation and burst pacing were employed, details regarding pacing sites, number of extrastimuli, and stimulation parameters were not uniformly defined. Such variability may influence VT detection and the prognostic interpretation of post-ablation non-inducibility, even if it does not undermine procedural efficacy itself. Prior high-risk VT ablation studies have demonstrated that variability in stimulation methodology can affect the predictive value of inducibility for long-term clinical outcomes [<span>3</span>].</p><p>Finally, the influence of operator experience on procedural outcomes was not addressed. Given the prolonged study period and the complexity of VT ablation procedures, including combined endocardial and epicardial approaches, operator-related variability may have affected outcomes. Recent evidence demonstrates that higher procedural volume is associated with improved safety and efficacy in VT ablation: Bansal et al. (2025) showed that high-volume centers had significantly lower in-hospital mortality and major complications

Çöteli等人的研究，题为“室性心动过速电风暴中导管消融的长期结果：一项回顾性队列研究”引起了我们的兴趣。作者对出现电风暴的高危患者群体进行了系统的评估，并对他们的回顾性队列研究设计、患者选择标准和程序方法进行了全面的描述，值得称赞。他们详细记录了VT诱导策略、ICD治疗监测、导管消融技术和随访程序，为现实世界的管理提供了宝贵的见解。这些方法学上的优势加强了关于手术成功、室速复发、ICD干预和生存结果的报告结果的可靠性。然而，与风险分层和结果评估相关的某些局限性可能会影响结果的解释和推广。首先，在高危心脏人群中，手术耐受性、死亡率和消融后结果不仅受左室射血分数和合并症的影响，还受总体生理储备的影响。具有相似LVEF特征的患者在虚弱状态上可能存在很大差异，这已被证明是心血管死亡率的独立预测因子。目前研究中缺乏脆弱性评估，限制了细粒度的风险分层，并可能使长期死亡率和发病率结果的解释复杂化。尽管衰弱评估在回顾性队列中可能具有挑战性，但在未来的研究中纳入经过验证的衰弱测量可以提高预后准确性和临床适用性[10]。其次，一个重要的方法学考虑是在导管消融过程中缺乏标准化的室性心动过速诱导方案。虽然采用了程序性心室刺激和猝发起搏，但起搏部位、外刺激次数和刺激参数的细节并没有统一定义。这种变异性可能影响VT检测和消融后不可诱发性的预后解释，即使它本身不影响手术疗效。先前的高风险房室消融研究表明，刺激方法的可变性会影响诱导性对长期临床结果的预测价值。最后，操作人员经验对程序结果的影响没有得到解决。考虑到研究时间的延长和室速消融手术的复杂性，包括心内膜和心外膜联合入路，操作者相关的变异性可能会影响结果。最近的证据表明，更大的手术容量与更高的室速消融安全性和有效性相关：Bansal等人（2025）表明，与小容量中心相比，大容量中心的住院死亡率和主要并发症显著降低，这突出了操作人员和机构经验对手术结果的重要性[10]。再次，我们真诚地感谢作者对文献的宝贵贡献，以及他们在解决重要和具有挑战性的临床状况方面的努力。然而，作为研究人员，我们认为总是有改进的空间，任何必要的调整都应该做出，因为这将提高我们对整个研究的理解。作者没有得到这项工作的特别资助。伦理审批不适用于此类文章。作者声明无利益冲突。作者没有什么可报告的。

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引用次数: 0

Loop Diuretic Therapy in Severe Aortic Stenosis: Marker or Mediator of Adverse Outcomes? 重度主动脉瓣狭窄的循环利尿剂治疗：不良结局的标志还是中介？

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2026-01-23 DOI: 10.1002/clc.70264

Masaki Miyazawa, Teruhiko Imamura

<p>The association between loop diuretic therapy (LDT), congestion, heart failure severity, and post-procedural outcomes in patients with severe aortic stenosis (AS) undergoing aortic valve replacement (AVR) remains incompletely understood. In this well-conducted observational study, the authors demonstrated that pre-procedural LDT was associated with more advanced cardiac remodeling, greater systemic and pulmonary congestion, unfavorable invasive hemodynamics, and increased long-term mortality after AVR [<span>1</span>]. Several points merit further discussion.</p><p>Although the authors clearly demonstrated robust associations between LDT, congestion markers, and adverse outcomes [<span>1</span>], the causal relationship remains uncertain. It is unclear whether LDT merely reflects advanced disease severity or actively contributes to worse clinical outcomes. In other words, LDT may function as a marker rather than a mediator of poor prognosis. To better disentangle this relationship, it would be informative to compare outcomes among patients with comparable doses of loop diuretics but different congestion severity. For example, matching patients with similar doses of loop diuretics but differing pulmonary artery wedge pressure or radiographic congestion scores might help clarify whether congestion itself, rather than LDT, primarily drives prognosis.</p><p>A substantial proportion of patients receiving LDT still exhibited elevated filling pressures [<span>1</span>], suggesting suboptimal congestion control. If congestion is the principal determinant of poor outcomes [<span>2</span>], more aggressive or optimized decongestive strategies—rather than avoidance of LDT—might theoretically improve hemodynamics and prognosis. This perspective is particularly relevant given the paradoxical positive association between loop diuretic dose and filling pressures observed in the study [<span>1</span>].</p><p>Another hypothesis is that LDT is a major driver of worse clinical outcomes. Background-matched comparisons between patients receiving LDT and those not receiving LDT would further strengthen causal inference. Because LDT prescription was left entirely to the discretion of treating clinicians [<span>1</span>], confounding by indication is unavoidable (i.e., patients with more severe congestion tend to receive LDT). Although the authors appropriately acknowledge this limitation, advanced statistical approaches such as propensity score matching or inverse probability weighting could provide additional insights into whether LDT independently contributes to mortality risk beyond reflecting advanced cardiac damage.</p><p>If LDT is rather the major driver of worse clinical outcomes, the potential role of alternative or adjunctive therapies deserves consideration. If LDT is associated with renal dysfunction or neuro-hormonal activation, partial substitution with other agents—such as vasopressin V2 receptor antagonists or sodium–glucose cotransporter-2 inhibitors

对于重度主动脉瓣狭窄（AS）行主动脉瓣置换术（AVR）的患者，循环利尿剂治疗（LDT）、充血、心力衰竭严重程度和术后预后之间的关系尚不完全清楚。在这项进行良好的观察性研究中，作者证明手术前LDT与更晚期的心脏重构、更严重的全身和肺部充血、不利的侵入性血流动力学以及AVR[1]后长期死亡率增加有关。有几点值得进一步讨论。尽管作者清楚地证明了LDT、充血标记物和不良后果之间的密切联系，但因果关系仍不确定。目前尚不清楚LDT是否仅仅反映了疾病的严重程度，还是直接导致了更差的临床结果。换句话说，LDT可能作为不良预后的标志而不是中介。为了更好地理清这种关系，比较使用相同剂量利尿剂但不同充血严重程度的患者的结果将是有益的。例如，匹配使用相似剂量利尿剂但肺动脉楔压或x线片充血评分不同的患者，可能有助于澄清是充血本身，而不是LDT，主要驱动预后。相当一部分接受LDT治疗的患者仍然表现出较高的充血压力[1]，这表明充血控制不理想。如果充血是不良预后的主要决定因素，更积极或优化的去充血策略-而不是避免ldt -理论上可能改善血流动力学和预后。考虑到研究中观察到的利尿剂剂量和填充压力之间矛盾的正相关关系，这一观点尤其相关。另一种假设是，LDT是导致临床结果恶化的主要原因。在接受LDT和未接受LDT的患者之间进行背景匹配比较将进一步加强因果推理。由于LDT处方完全由治疗临床医生自行决定，因此不可避免地会出现适应症混淆（即充血更严重的患者倾向于接受LDT）。尽管作者适当地承认了这一局限性，但倾向评分匹配或逆概率加权等先进的统计方法可以提供额外的见解，以了解LDT是否独立地导致死亡风险，而不是反映晚期心脏损伤。如果LDT是不良临床结果的主要驱动因素，那么替代或辅助治疗的潜在作用值得考虑。如果LDT与肾功能障碍或神经激素激活有关，部分替代其他药物，如抗利尿激素V2受体拮抗剂或钠-葡萄糖共转运蛋白2抑制剂，可能在保持肾功能和潜在改善预后的同时有效地减少充血。有必要进行前瞻性研究，以探讨这些策略是否可以改变在AVR之前需要利尿剂治疗的严重AS患者的风险概况。作者没有得到这项工作的特别资助。作者没有什么可报告的。作者没有什么可报告的。作者声明无利益冲突。该手稿不包括任何原始数据。

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引用次数: 0

The Effect of Age on Improvement in Health-Related Quality of Life After Percutaneous Coronary Intervention 年龄对经皮冠状动脉介入治疗后健康相关生活质量改善的影响

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2026-01-20 DOI: 10.1002/clc.70260

Laura Lappalainen, Piia Lavikainen, Risto P. Roine, Harri Sintonen, Janne Martikainen, Anna-Maija Tolppanen, Juha Hartikainen

Introduction

Percutaneous coronary intervention (PCI) is the first-line therapy in patients scheduled for coronary revascularization, aiming to relieve symptoms of coronary artery disease (CAD) and improve health-related quality of life (HRQoL) and prognosis. Particularly, in older adults, symptom alleviation and HRQoL are emphasized. However, it is not known whether older patients benefit from PCI equally to their younger peers. We used disease-specific and generic instruments to evaluate the improvement in HRQoL after PCI, comparing changes in three age groups.

Methods

Altogether 300 patients undergoing PCI were divided into three age groups: ≥ 75 years (n = 89), 66–74 years (n = 117), and ≤ 65 years (n = 94). HRQoL was measured using the disease-specific Seattle Angina Questionnaire (SAQ-7) and the generic 15D instrument at baseline, one, and 12 months.

Results

Statistically and clinically significant improvements in the SAQ-7 and 15D scores were observed after one- and 12-month follow-up in all age groups. There were no differences in the 12-month improvements in the SAQ-7 and 15D scores between the groups. The 15D score started to decline after 1 month, particularly in the oldest group. The decline was associated with age-related rather than CAD-related 15D dimensions.

Conclusions

Our findings on comparable improvement in disease-specific and generic HRQoL after PCI in older and younger patients are encouraging, particularly considering that the aims of PCI in older adults are predominantly symptom alleviation and improvement of daily activities. In addition, to overcome age-related changes in HRQoL, a disease-specific instrument should be incorporated in the evaluation of PCI on HRQoL.

Clinical trial registration

5101114.

简介：经皮冠状动脉介入治疗（PCI）是冠脉重建术患者的一线治疗，旨在缓解冠状动脉疾病（CAD）的症状，改善健康相关生活质量（HRQoL）和预后。特别是在老年人中，强调症状缓解和HRQoL。然而，尚不清楚老年患者是否与年轻患者同样受益于PCI。我们使用疾病特异性和通用仪器来评估PCI术后HRQoL的改善，比较三个年龄组的变化。方法：300例行PCI的患者分为≥75岁（n = 89）、66 ~ 74岁（n = 117）和≤65岁（n = 94） 3组。HRQoL分别在基线、1个月和12个月采用疾病特异性西雅图心绞痛问卷（SAQ-7）和通用15D仪进行测量。结果：各年龄组在随访1个月和12个月后SAQ-7和15D评分均有统计学和临床意义的改善。在SAQ-7和15D评分的12个月改善方面，两组之间没有差异。1个月后，15D分数开始下降，尤其是在年龄最大的一组中。这种下降与年龄有关，而与cad相关的15D尺寸无关。结论：我们的研究结果显示，老年和年轻患者PCI后疾病特异性和一般HRQoL的可比改善是令人鼓舞的，特别是考虑到老年人PCI的目的主要是缓解症状和改善日常活动。此外，为了克服HRQoL与年龄相关的变化，应将疾病特异性仪器纳入PCI对HRQoL的评估。临床试验注册：5101114。

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引用次数: 0

States With Highest and Lowest Cardiovascular Disease-Related Mortality in the United States (1999−2019): Top and Bottom 3 美国心血管疾病相关死亡率最高和最低的州（1999-2019年）：前3和后3。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2026-01-16 DOI: 10.1002/clc.70256

Muhammad Umer Sohail, Ruqiat Masooma Batool, Muhammad Saad, Saad Ahmed Waqas, Asad Ali Ahmed Cheema, Abdul Mannan Khan Minhas

Background

Despite declines since the 1960s, cardiovascular diseases (CVDs) remain the leading cause of mortality in the United States. However, recent data indicate stabilization or increases in certain regions, highlighting persistent disparities. This study analyzes trends in states with the highest and lowest CVD-related age-adjusted mortality rates (AAMRs) from 1999 to 2019.

Methods

Using CDC WONDER, we conducted a retrospective analysis of CVD-related mortality in adults aged ≥ 25 years. AAMRs were calculated using ICD-10 codes I00-I99, and trends were assessed using Joinpoint regression for annual percent change (APC) and average annual percent change (AAPC).

Results

Between 1999 and 2019, national AAMR declined from 798.47 to 595.56 per 100 000 (AAPC: −1.5%, 95% CI: −1.8% to −1.2%). Mississippi had the highest AAMR (902.23) with the slowest decline, whereas Arizona had the lowest (530.40) with a steeper reduction. Males (702.15), non-Hispanic Black individuals (850.32), and nonmetropolitan populations (645.21) had persistently higher mortality. Urban-rural disparities widened over time.

Conclusion

State-level variations in CVD mortality reflect persistent socioeconomic, behavioral, and healthcare disparities. These findings highlight widening regional gaps and emphasize the need for stronger, state-specific public health strategies, improved access to preventive care, and targeted interventions for disproportionately affected groups. Strengthening surveillance systems, expanding evidence-based cardiovascular prevention programs, and addressing structural determinants of health will be essential to reduce the observed disparities and sustain long-term progress in CVD mortality reduction across the United States.

背景：尽管自20世纪60年代以来有所下降，但心血管疾病（cvd）仍然是美国死亡的主要原因。然而，最近的数据表明，某些区域的情况趋于稳定或有所增加，突出了持续存在的差距。本研究分析了1999年至2019年心血管疾病相关年龄调整死亡率（AAMRs）最高和最低州的趋势。方法：使用CDC WONDER对年龄≥25岁的成人心血管疾病相关死亡率进行回顾性分析。采用ICD-10代码I00-I99计算aamr，采用年变化百分比（APC）和平均年变化百分比（AAPC）的Joinpoint回归评估趋势。结果：1999年至2019年，全国AAMR从每10万人798.47下降到595.56 （AAPC: -1.5%, 95% CI: -1.8%至-1.2%）。密西西比州的AAMR最高（902.23），下降最慢，而亚利桑那州最低（530.40），下降幅度更大。男性（702.15）、非西班牙裔黑人（850.32）和非大都市人群（645.21）的死亡率持续较高。城乡差距随着时间的推移而扩大。结论：各州心血管疾病死亡率的差异反映了持续存在的社会经济、行为和医疗保健差异。这些调查结果突出了区域差距的扩大，并强调需要制定更强有力的、针对具体国家的公共卫生战略，改善获得预防保健的机会，并针对受严重影响的群体采取有针对性的干预措施。加强监测系统，扩大以证据为基础的心血管预防项目，解决健康的结构性决定因素，对于减少观察到的差距和维持美国心血管疾病死亡率降低的长期进展至关重要。

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引用次数: 0

Apical Sparing of Longitudinal Strain and Myocardial Fibrosis in Hypertensive Patients and Spontaneously Hypertensive Rats: Based on Speckle Tracking and Histological Analysis 高血压患者和自发性高血压大鼠纵向应变和心肌纤维化的根尖保留：基于斑点追踪和组织学分析。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2026-01-15 DOI: 10.1002/clc.70255

Chunyan Huang, Yongxin Wu, Meiyan Lin, Yupeng Chen, Shengnan Lin, Liyun Fu, Huimei Huang

Background

This study aimed to investigate regional myocardial strain and fibrosis distribution to analyze the apical sparing pattern and the relation with hypertrophy in hypertension.

Methods

This study included clinical and experimental animal investigations. Seventy-three hypertensive patients were divided into two groups: hypertension without left ventricular hypertrophy (HT-NLVH) and hypertension with LVH (HT-LVH). Six 16-week-old male spontaneously hypertensive rats (SHR) and six age-matched male Wistar-Kyoto (WKY) rats were included in this experiment. Echocardiographic measurements were obtained. Myocardial strain indexes, including global longitudinal strain (GLS), the basal, middle, and apical segmental LS (LS-bas, LS-mid, LS-ap), and the proportion of LS-ap/(LS-bas + LS-mid + LS-ap) (P-ap) were measured. The histological collagen volume fraction (CVF) and perivascular collagen area (PVCA) of basal and apical segments (CVF-bas, CVF-ap, PVCA-bas, PVCA-ap) were observed in all rats.

Results

Despite preserved systolic function (FS, LVEF), the HT-NLVH and HT-LVH groups exhibited diastolic impairment (elevated LAVI, E/e’) (all p < 0.05). LS-ap declined only in HT-LVH, while LS-mid and LS-bas worsened from HT-NLVH to HT-LVH, and the HT-LVH group exhibited a significantly elevated P-ap (all p < 0.05). P-ap was associated with LV remodeling indexes and E/e’ (all p < 0.05). Compared with WKY, LS-bas decreased in SHR (p < 0.05). The SHR group demonstrated significantly elevated PVCA-bas, PVCA-ap, and CVF-bas (p < 0.05), while the CVF-ap had no significant difference.

Conclusion

Myocardial dysfunction and fibrosis exhibited regional heterogeneity with predominant basal damage and apical sparing in hypertensive cardiac hypertrophy. This apical-sparing pattern correlated significantly with both diastolic dysfunction and hypertrophic progression, suggesting its potential as a clinically observable hallmark.

背景：本研究旨在通过研究高血压患者心肌局部应变和纤维化分布，分析心肌根尖保留模式及其与肥厚的关系。方法：采用临床和实验动物研究相结合的方法。73例高血压患者分为非左室肥厚型高血压（ht - nvh）和合并左室肥厚型高血压（HT-LVH）两组。实验选用16周龄雄性自发性高血压大鼠（SHR） 6只和同龄雄性Wistar-Kyoto大鼠（WKY） 6只。超声心动图测量。测量心肌应变指标，包括总纵应变（GLS），基底、中、尖段LS (LS-bas、LS-mid、LS-ap)，以及LS-ap/(LS-bas + LS-mid + LS-ap) （P-ap）的比例。观察各组大鼠基底节和根尖节（CVF-bas、CVF-ap、PVCA-bas、PVCA-ap）的组织学胶原体积分数（CVF）和血管周围胶原面积（PVCA）。结果：尽管收缩期功能（FS、LVEF）得以保留，但ht - nvlvh组和HT-LVH组均表现出舒张功能损害（LAVI、E/ E′升高）（均p）。结论：高血压性心脏肥厚患者心肌功能障碍和纤维化表现出区域异质性，以基底损害和根尖保留为主。这种根尖保留模式与舒张功能障碍和肥厚进展显著相关，表明其可能是临床可观察到的标志。

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引用次数: 0

Changes of Serum CTRP12 in Patients With Coronary Artery Disease After the Treatment of Percutaneous Coronary Intervention and Its Relationship With In-Stent Restenosis 冠状动脉疾病患者经皮冠状动脉介入治疗后血清CTRP12的变化及其与支架内再狭窄的关系

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2026-01-12 DOI: 10.1002/clc.70233

Botao Zhao, Yuchao Shen

Background

C1q/tumor necrosis factor-related protein 12 (CTRP12) plays a protective role in coronary artery disease (CAD) by reducing vascular inflammation. Whether CTRP12 could predict the occurrence of CAD and in-stent restenosis (ISR) occurrence after percutaneous coronary intervention (PCI) treatment remains unknown.

Methods

This retrospective cohort study included patients with CAD who underwent PCI and had serum samples collected at baseline, 24 h, and 72 h post-PCI. The Gensini score was used to assess the severity of coronary artery stenosis. Serum CTRP12 levels were measured using an ELISA kit. Follow-up evaluation of ISR was performed using coronary angiography.

Results

Serum CTRP12 levels were significantly lower in CAD patients than healthy controls (p < 0.001). A negative correlation was found between CTRP12 levels and both the Gensini score (r = −0.37, p < 0.001) and hs-CRP levels (r = −0.43, p < 0.001). Dynamic analysis revealed a significant reduction in CTRP12 levels 24 h post-PCI, with partial recovery observed at 72 h, although levels remained lower than baseline. Patients with ISR consistently demonstrated lower CTRP12 levels than those without ISR (NISR) at all time points. Receiver operating characteristic curve analysis indicated that CTRP12 levels at 24 h post-PCI exhibited the highest predictive accuracy for ISR occurrence.

Conclusion

Serum CTRP12 level may serve as a potential biomarker for diagnosing CAD and predicting ISR occurrence, with significant correlations to disease severity and dynamic changes after PCI.

背景：C1q/肿瘤坏死因子相关蛋白12 （CTRP12）通过减少血管炎症在冠状动脉疾病（CAD）中发挥保护作用。CTRP12能否预测冠心病的发生及经皮冠状动脉介入治疗（PCI）后支架内再狭窄（ISR）的发生尚不清楚。方法：这项回顾性队列研究纳入了接受PCI治疗的CAD患者，并在基线、24小时和PCI后72小时收集了血清样本。Gensini评分用于评价冠状动脉狭窄的严重程度。采用ELISA试剂盒检测血清CTRP12水平。采用冠状动脉造影对ISR进行随访评价。结果：冠心病患者血清CTRP12水平明显低于健康对照组(p)。结论：血清CTRP12水平可作为诊断CAD和预测ISR发生的潜在生物标志物，与病情严重程度及PCI术后动态变化有显著相关性。

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引用次数: 0

Is Ticagrelor-Related Dyspnea a Liability or a Biomarker of Response? 替格瑞洛相关呼吸困难是一种不良反应还是一种生物标志物？

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2026-01-11 DOI: 10.1002/clc.70258

Abdülmelik Birgün, Abdullah Sarıhan, Macit Kalçık

<p>Zhang et al. report a statistically robust association between the CYP3A5 rs776746 polymorphism and ticagrelor-related dyspnea in patients with acute coronary syndrome, proposing this variant as a candidate biomarker for individualized antiplatelet therapy [<span>1</span>]. While the genetic signal itself is convincing, the broader clinical interpretation of this finding warrants a more cautious and contextualized discussion.</p><p>A central issue is the implicit assumption that ticagrelor-related dyspnea represents an adverse effect that necessarily undermines treatment success. Accumulating evidence suggests that ticagrelor-induced dyspnea is frequently mild, transient, and poorly correlated with objective respiratory dysfunction, while ticagrelor continuation is often associated with superior ischemic protection [<span>2</span>]. Framing dyspnea primarily as a safety liability may therefore overemphasize tolerability at the expense of long-term cardiovascular benefit.</p><p>Relatedly, the manuscript risks conflating biological association with clinical actionability. Identification of a genotype linked to dyspnea does not automatically justify preemptive drug switching, particularly in the absence of evidence that genotype-guided de-escalation preserves ischemic efficacy. Prior pharmacogenetic experiences in antiplatelet therapy have shown that altering treatment based solely on surrogate markers may inadvertently increase thrombotic risk [<span>3</span>].</p><p>Another underexplored dimension is the competing mechanistic interpretation of dyspnea as a pharmacodynamic signature rather than a toxic effect. Ticagrelor-induced increases in adenosine signaling have been associated not only with dyspnea but also with cardioprotective and anti-inflammatory effects. From this perspective, dyspnea may identify patients with heightened biological responsiveness rather than impaired drug tolerance [<span>4</span>]. Genetic stratification that selectively removes such patients from ticagrelor therapy could paradoxically exclude those deriving the greatest benefit.</p><p>Finally, the proposal of routine CYP3A5 genotyping raises broader questions about feasibility and proportionality. Current guidelines emphasize simplicity, timeliness, and net clinical benefit in acute coronary syndrome management. Introducing genetic testing for a largely non-life-threatening symptom risks increasing complexity without clear outcome-level gains [<span>5</span>]. Precision medicine should refine decision-making, not fragment it.</p><p>In this context, the findings by Zhang et al. are best viewed as hypothesis-generating, highlighting the biological heterogeneity of ticagrelor response rather than defining an immediate clinical algorithm. Future studies should focus on whether dyspnea- or genotype-guided strategies meaningfully improve patient-centered outcomes while preserving ischemic protection.</p><p>The authors declare no conflicts of interest.</p><p>Data sharing i

Zhang等人报道了CYP3A5 rs776746多态性与急性冠状动脉综合征患者替格瑞洛相关呼吸困难之间的统计学显著相关性，提出该变异可作为个体化抗血小板治疗[1]的候选生物标志物。虽然基因信号本身是令人信服的，但对这一发现的更广泛的临床解释需要更加谨慎和背景化的讨论。一个核心问题是隐含的假设，即替格瑞洛相关的呼吸困难代表一种不利影响，必然会破坏治疗成功。越来越多的证据表明，替格瑞洛引起的呼吸困难通常是轻微的、短暂的，与客观呼吸功能障碍的相关性较差，而替格瑞洛的持续使用通常与较好的缺血保护作用相关。因此，将呼吸困难主要视为一种安全隐患可能会过分强调耐受性，而牺牲长期的心血管益处。与此相关，该论文存在混淆生物学关联与临床可操作性的风险。识别与呼吸困难相关的基因型并不能自动证明先发制人的药物转换是合理的，特别是在没有证据表明基因型引导的降压能保持缺血疗效的情况下。先前抗血小板治疗的药理学经验表明，仅根据替代标志物改变治疗可能会无意中增加血栓形成的风险。另一个未被充分探索的方面是呼吸困难作为药效学特征而不是毒性作用的竞争性机制解释。替格瑞洛诱导的腺苷信号增加不仅与呼吸困难有关，还与心脏保护和抗炎作用有关。从这个角度来看，呼吸困难可以识别出生物反应性增强的患者，而不是药物耐受性受损的患者。遗传分层选择性地将这些患者从替格瑞洛治疗中移除，可能会矛盾地排除那些获得最大益处的患者。最后，常规CYP3A5基因分型的提议提出了关于可行性和比例性的更广泛的问题。目前的指南强调急性冠脉综合征治疗的简单性、及时性和临床净效益。为一种基本上不会危及生命的症状引入基因检测，可能会增加复杂性，而没有明确的结果水平收益。精准医疗应该完善决策，而不是使决策支离破碎。在这种背景下，Zhang等人的发现最好被视为假设生成，强调替格瑞洛反应的生物学异质性，而不是定义一个直接的临床算法。未来的研究应该关注呼吸困难或基因型引导策略是否能在保持缺血保护的同时有效地改善以患者为中心的结果。作者声明无利益冲突。数据共享不适用于本文，因为在本研究中没有生成或分析数据集。

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引用次数: 0

Rationale and Design of the PASSIVATE-CAP Trial: The Preventive Intervention Value of Drug-Coated Balloons in Vulnerable Coronary Atherosclerotic Plaques PASSIVATE-CAP试验的基本原理和设计：药物包被球囊对易损冠状动脉粥样硬化斑块的预防干预价值。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2026-01-11 DOI: 10.1002/clc.70243

Zhongxiu Chen, Junyan Zhang, Minggang Zhou, Shichu Liang, Yong Chen, Chen Li, Hua Wang, Jiafu Wei, Baotao Huang, Mian Wang, Yong He, for the PASSIVATE-CAP trial investigator

Background

Patients with acute coronary syndrome (ACS) face a significantly increased risk of cardiovascular events due to vulnerable plaques. However, no clear evidence supports performing preventive percutaneous coronary intervention (PCI) for non-flow-limiting vulnerable plaques. To address this gap, the PASSIVATE-CAP study was designed to investigate the therapeutic potential of drug-coated balloon (DCB) for treating non-flow-limiting vulnerable plaques.

Methods

The PASSIVATE-CAP study is an investigator-initiated, prospective, randomized, multicenter, open-label superiority trial focusing on acute coronary syndrome (ACS) patients with non-flow-limiting vulnerable plaques in non-culprit vessels. In this study, eligible patients will be randomized at a 1:1 ratio into two groups: patients who received guideline-directed medical therapy (GDMT) and patients who received GDMT combined with a drug-coated balloon (DCB). The primary endpoint was the minimal lumen area of the target lesion 1 year after randomization. The secondary endpoints encompass a range of factors, including the proportion of patients with vulnerable plaques in the target vessel, fibrous cap thickness, lipid core arc of the target lesion, minimal lumen area of the target vessel, among others. The study has been registered on Clinicaltrials.gov (Identifier: NCT06416813).

Results: The PASSIVATE-CAP study enrolled its first patient on July 14, 2025, with projected enrollment completion by January 31, 2027. As of December 28, 2025, 6 patients have been enrolled. The anticipated study end date, marking the completion of the follow-up period, is January 31, 2028.

Conclusions

The PASSIVATE-CAP study represents the first prospective, randomized, multicenter, open-label trial designed to explore the therapeutic value of DCB for the treatment of vulnerable plaques within the ACS patient population.

背景：由于易损斑块，急性冠脉综合征（ACS）患者发生心血管事件的风险显著增加。然而，没有明确的证据支持对无血流限制的易损斑块进行预防性经皮冠状动脉介入治疗。为了解决这一差距，PASSIVATE-CAP研究旨在研究药物包被球囊（DCB）治疗非血流受限易损斑块的治疗潜力。方法：PASSIVATE-CAP研究是一项研究者发起的前瞻性、随机、多中心、开放标签的优势试验，重点研究急性冠脉综合征（ACS）患者在非罪魁祸首血管中存在非血流限制性易损斑块。在本研究中，符合条件的患者将按1:1的比例随机分为两组：接受指南导向药物治疗（GDMT）的患者和接受GDMT联合药物包被球囊（DCB）的患者。主要终点是随机分组后1年目标病变的最小管腔面积。次要终点包括一系列因素，包括目标血管中易损斑块患者的比例、纤维帽厚度、目标病变的脂质核心弧度、目标血管的最小管腔面积等。该研究已在Clinicaltrials.gov注册（标识符：NCT06416813）。PASSIVATE-CAP研究于2025年7月14日入组了第一位患者，预计入组时间为2027年1月31日。截至2025年12月28日，已有6例患者入组。预计研究结束日期为2028年1月31日，标志着随访期的完成。结论：PASSIVATE-CAP研究是首个前瞻性、随机、多中心、开放标签的试验，旨在探讨DCB治疗ACS患者易损斑块的治疗价值。

{"title":"Rationale and Design of the PASSIVATE-CAP Trial: The Preventive Intervention Value of Drug-Coated Balloons in Vulnerable Coronary Atherosclerotic Plaques","authors":"Zhongxiu Chen, Junyan Zhang, Minggang Zhou, Shichu Liang, Yong Chen, Chen Li, Hua Wang, Jiafu Wei, Baotao Huang, Mian Wang, Yong He, for the PASSIVATE-CAP trial investigator","doi":"10.1002/clc.70243","DOIUrl":"10.1002/clc.70243","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Patients with acute coronary syndrome (ACS) face a significantly increased risk of cardiovascular events due to vulnerable plaques. However, no clear evidence supports performing preventive percutaneous coronary intervention (PCI) for non-flow-limiting vulnerable plaques. To address this gap, the PASSIVATE-CAP study was designed to investigate the therapeutic potential of drug-coated balloon (DCB) for treating non-flow-limiting vulnerable plaques.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The PASSIVATE-CAP study is an investigator-initiated, prospective, randomized, multicenter, open-label superiority trial focusing on acute coronary syndrome (ACS) patients with non-flow-limiting vulnerable plaques in non-culprit vessels. In this study, eligible patients will be randomized at a 1:1 ratio into two groups: patients who received guideline-directed medical therapy (GDMT) and patients who received GDMT combined with a drug-coated balloon (DCB). The primary endpoint was the minimal lumen area of the target lesion 1 year after randomization. The secondary endpoints encompass a range of factors, including the proportion of patients with vulnerable plaques in the target vessel, fibrous cap thickness, lipid core arc of the target lesion, minimal lumen area of the target vessel, among others. The study has been registered on Clinicaltrials.gov (Identifier: NCT06416813).</p>\u0000 \u0000 <p><b>Results:</b> The PASSIVATE-CAP study enrolled its first patient on July 14, 2025, with projected enrollment completion by January 31, 2027. As of December 28, 2025, 6 patients have been enrolled. The anticipated study end date, marking the completion of the follow-up period, is January 31, 2028.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The PASSIVATE-CAP study represents the first prospective, randomized, multicenter, open-label trial designed to explore the therapeutic value of DCB for the treatment of vulnerable plaques within the ACS patient population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70243","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950935","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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Long-Term Outcomes and Follow-Up Management in Patients With Ventricular Tachycardia Electrical Storm After Catheter Ablation 导管消融后室性心动过速电风暴患者的长期预后和随访处理。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2026-01-09 DOI: 10.1002/clc.70259

Zhijie Song, Haizhen Guo

<p>We read with great interest the article by Çöteli et al. [<span>1</span>] reporting long-term outcomes of catheter ablation in patients with ventricular tachycardia-related electrical storm (VT-ES). The study confirms that catheter ablation is beneficial for managing ES, especially during the acute phase. Also, this high-risk group faces substantial long-term morbidity and mortality following the procedure. These data are valuable for guiding ES management, but several methodological limitations may undermine the reliability and generalizability of the findings and warrant further discussion.</p><p>First, the retrospective, single-center design and small sample size of 65 patients limit the generalizability of the findings. Notably, the wide, unstratified age range (18–85 years) introduces bias because age is a well-known risk factor for cardiovascular disease (CVD). Hence, most of the CVD studies use age stratification or restricted ranges to minimize this bias [<span>2, 3</span>], a safeguard that was absent here which constitutes a significant limitation.</p><p>Second, the authors identify left ventricular ejection fraction (LVEF) as the strongest predictor of post-ablation mortality. However, the mean LVEF in this cohort was 35.3 ± 13%. It characterizes a heterogeneous group with advanced systolic dysfunction and a correspondingly high sudden-death risk. This observation mainly mirrors the population's preexisting high-risk profile rather than an independent ablation effect. Because reduced LVEF itself is a well-established determinant of mortality [<span>1</span>], as a result, long-term outcomes may be confounded by ongoing disease progression, thereby limiting the clinical utility of the findings. Moreover, current guidelines use 40% LVEF as a critical prognostic threshold for heart failure [<span>4</span>]. In a recent report, patients with ischemic heart disease, VT, and LVEF > 30% derive more long-term benefit from early ablation than those with LVEF < 30% [<span>5</span>]. The impact of catheter ablation on long-term outcome could not be properly interpreted due to not performing any subgroup analysis for either of these LVEF thresholds, nor serial postoperative LVEF measurements.</p><p>In addition, competitive risks hinder subgroup analysis between ischemic and non-ischemic groups. Given an all-cause mortality rate of 40%, a number of patients died from end-stage heart failure before any recurrence of VT occurred, rendering the traditional Kaplan−Meier method inappropriate. Because it ignores competing risks and consequently misrepresents clinical reality, we recommend that Cumulative incidence functions and Gray's test are better suited to quantify the risks of recurrence and death, thereby enabling an accurate evaluation of ablation's antiarrhythmic efficacy.</p><p>To sum things up, methodological limitations warrant caution when interpreting the findings. Nevertheless, the study provides insightful evidence on the long-ter

我们饶有兴趣地阅读了Çöteli等人的文章，[1]报道了室性心动过速相关电风暴（VT-ES）患者导管消融的长期结果。研究证实，导管消融对ES的治疗是有益的，特别是在急性期。此外，这一高危人群在手术后面临大量的长期发病率和死亡率。这些数据对指导ES管理是有价值的，但一些方法上的限制可能会破坏研究结果的可靠性和普遍性，需要进一步讨论。首先，回顾性、单中心设计和65例患者的小样本量限制了研究结果的普遍性。值得注意的是，由于年龄是众所周知的心血管疾病（CVD）的危险因素，因此广泛且未分层的年龄范围（18-85岁）引入了偏倚。因此，大多数心血管疾病研究使用年龄分层或限制范围来减少这种偏差[2,3]，这是一种缺失的保障措施，构成了显著的局限性。其次，作者确定左室射血分数（LVEF）是消融后死亡率的最强预测因子。然而，该队列的平均LVEF为35.3±13%。它的特点是具有晚期收缩功能障碍和相应的高猝死风险的异质组。这一观察结果主要反映了人群先前存在的高风险特征，而不是独立的消融效应。由于LVEF降低本身是死亡率的一个确定的决定因素，因此，长期结果可能与持续的疾病进展相混淆，从而限制了研究结果的临床实用性。此外，目前的指南使用40% LVEF作为心力衰竭[4]的关键预后阈值。在最近的一份报告中，缺血性心脏病、房颤和LVEF <； 30%的患者比LVEF <； 30%的患者从早期消融术中获得更多的长期益处。由于没有对这些LVEF阈值进行任何亚组分析，也没有对术后LVEF进行系列测量，因此无法正确解释导管消融对长期结果的影响。此外，竞争风险阻碍了缺血组和非缺血组之间的亚组分析。考虑到40%的全因死亡率，许多患者在VT复发前死于终末期心力衰竭，这使得传统的Kaplan - Meier方法不合适。由于它忽略了相互竞争的风险，因此歪曲了临床现实，我们建议累积发生率函数和格雷试验更适合量化复发和死亡的风险，从而能够准确评估消融的抗心律失常疗效。总而言之，在解释研究结果时，方法上的局限性需要谨慎。尽管如此，该研究为ES患者导管消融后的长期预后提供了有见地的证据。这项研究的结果表明，未来的研究应优先考虑前瞻性、多中心队列研究，并进行精细的亚组分析，以制定个性化的随访策略。我们还建议建立一个多学科合作模式，在这种模式中，在预后评估和随访中考虑抗心律失常药物不良反应的药物警戒。作者声明无利益冲突。作者没有什么可报告的。

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引用次数: 0