Clinical Cardiology最新文献_第3页

Association of Ticagrelor Metabolic SNPs With Adverse Drug Reactions in Patients With Acute Coronary Syndrome 替格瑞洛代谢snp与急性冠脉综合征患者药物不良反应的关系

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2025-12-11 DOI: 10.1002/clc.70232

Yanming Zhang, Gaoxiu Yu, Cong Wang, Jingwen Song, Junmei Liu, Feng Chen

Background

Dual antiplatelet therapy with aspirin and a P2Y₁₂ inhibitor is standard for patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention. While ticagrelor offers superior efficacy in reducing ischemic events compared to clopidogrel, its use is limited by a higher incidence of dyspnea, an adverse reaction whose underlying predictors remain incompletely understood. Genetic variations in CYP3A4/5, the principal enzymes responsible for ticagrelor metabolism, may influence interindividual susceptibility to this side effect.

Methods

In a prospective cohort of 385 ACS patients on ticagrelor, we genotyped CYP3A4 rs2242480 and CYP3A5 rs776746. Outcomes (dyspnea per CTCAE v5.0, bleeding per BARC criteria) were assessed over 1 year. Associations were analyzed using logistic regression and GMDR modeling.

Results

The CYP3A5 rs776746 genotype strongly predicted dyspnea risk. Compared to the CC genotype, CT and TT genotypes were associated with a 55% and 91% reduced risk, respectively. Carriers of the combined CT/TT genotypes had a 63% lower risk. CC genotype carriers (poor metabolizers) exhibited a 2.3-fold higher dyspnea incidence. No significant associations were found for CYP3A4 rs2242480 or for bleeding outcomes.

Conclusion

The CYP3A5 rs776746 CC genotype is a significant genetic biomarker for ticagrelor-induced dyspnea. Pre-emptive genotyping could enable personalized antiplatelet therapy, such as alternative P2Y₁₂ inhibitors for high-risk CC carriers, to improve patient safety.

背景阿司匹林和P2Y₁₂抑制剂的双重抗血小板治疗是急性冠状动脉综合征（ACS）患者接受经皮冠状动脉介入治疗的标准。虽然与氯吡格雷相比，替格瑞洛在减少缺血性事件方面具有优越的疗效，但其使用受到呼吸困难发生率较高的限制，呼吸困难是一种不良反应，其潜在的预测因素仍不完全清楚。负责替格瑞洛代谢的主要酶CYP3A4/5的遗传变异可能影响个体间对该副作用的易感性。方法在385例使用替格瑞洛的ACS患者的前瞻性队列中，我们对CYP3A4 rs2242480和CYP3A5 rs776746进行基因分型。结果（CTCAE v5.0标准呼吸困难，BARC标准出血）在1年内进行评估。使用逻辑回归和GMDR模型分析关联。结果CYP3A5 rs776746基因型可预测呼吸困难风险。与CC基因型相比，CT和TT基因型分别降低了55%和91%的风险。CT/TT联合基因型携带者的风险降低63%。CC基因型携带者（代谢不良者）的呼吸困难发生率高出2.3倍。CYP3A4 rs2242480或出血结局未发现显著相关性。结论CYP3A5 rs776746 CC基因型是替格瑞洛诱发呼吸困难的重要遗传生物标志物。先发制人的基因分型可以实现个性化的抗血小板治疗，例如针对高危CC携带者的替代P2Y₁2抑制剂，以提高患者的安全性。

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引用次数: 0

Concerns and Considerations Regarding the Study on Epicardial Fat Thickness as a Marker for Coronary Artery Disease in Diabetic Patients 糖尿病患者心外膜脂肪厚度作为冠状动脉病变标志物研究的关注与思考

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2025-12-06 DOI: 10.1002/clc.70205

Hakan Tibilli, Sezer Markirt

We read with great interest the article titled “Epicardial Fat Thickness as a Marker of Coronary Artery Disease in Diabetics: A Single Center Study” [1]. The authors highlight significant findings regarding epicardial fat thickness (EFT) as an effective marker of coronary artery disease (CAD) severity in diabetic patients. However, several methodological and analytical aspects warrant further clarification and discussion.

Firstly, the exclusion criteria used in the study notably omit consideration of chronic kidney disease (CKD), frequently comorbid with diabetes mellitus and potentially impactful on both CAD prevalence and EFT [2]. Additionally, the retrospective design of this study raises critical questions regarding the practicality and reliability of assessing CAD presence and severity in a substantial patient cohort (n = 2340). The authors describe employing invasive and noninvasive tests retrospectively based on clinical indications, but the specifics of these indications and the process for systematically retrieving and validating past clinical data remain unclear. This approach might introduce substantial bias related to clinician-dependent test selection.

Moreover, despite collecting detailed lipid profiles, the study did not address statin therapy usage, an essential consideration given its widespread use and known influence on CAD progression and potentially EFT itself. Future investigations would benefit from clarifying the role of statins or other pharmacotherapies that may influence EFT and CAD outcomes.

In summary, while this study provides insightful findings that underscore EFT's potential as a noninvasive cardiovascular marker, addressing these methodological and analytical concerns would considerably enhance the study's robustness and clinical applicability.

Sincerely,

Data sharing is not applicable for this article.

我们怀着极大的兴趣阅读了题为“心外膜脂肪厚度作为糖尿病患者冠状动脉疾病的标志：一项单中心研究”的文章。作者强调了关于心外膜脂肪厚度（EFT）作为糖尿病患者冠状动脉疾病（CAD）严重程度的有效标志的重要发现。然而，有几个方法和分析方面需要进一步澄清和讨论。首先，研究中使用的排除标准明显忽略了慢性肾脏疾病（CKD）的考虑，慢性肾脏疾病经常与糖尿病合并症，并可能影响CAD患病率和EFT bb0。此外，本研究的回顾性设计提出了在大量患者队列（n = 2340）中评估CAD存在和严重程度的实用性和可靠性的关键问题。作者描述了基于临床适应症回顾性地采用侵入性和非侵入性检查，但这些适应症的具体情况以及系统地检索和验证过去临床数据的过程仍不清楚。这种方法可能会引入与临床依赖试验选择相关的实质性偏差。此外，尽管收集了详细的脂质谱，但该研究并未涉及他汀类药物的使用，考虑到他汀类药物的广泛使用以及已知对CAD进展和潜在EFT本身的影响，这是一个必要的考虑因素。未来的研究将受益于澄清他汀类药物或其他药物治疗可能影响EFT和CAD结果的作用。总之，虽然本研究提供了深刻的发现，强调了EFT作为无创心血管标志物的潜力，但解决这些方法学和分析问题将大大提高研究的稳健性和临床适用性。真诚地说，数据共享不适用于本文。

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引用次数: 0

Exploring the Link: Marijuana Use Patterns and Their Impact on Coronary Heart Disease Risk 探索联系：大麻使用模式及其对冠心病风险的影响。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2025-12-05 DOI: 10.1002/clc.70223

Tianwen Wei, Shitong Shen, Tiankai Shan, Tangjiang Wan, Yucheng Liang, Zhihao Lin, Yuxiao Sun, Yafei Li, Qi Zhang

Background

As marijuana use increases globally, understanding its cardiovascular impact is crucial. This study investigates the relationship between marijuana use patterns and coronary heart disease (CHD) risk.

Methods

Using 2023 Behavioral Risk Factor Surveillance System data, we conducted cross-sectional analysis examining marijuana consumption methods (smoking, vaping, eating, dabbing) and CHD risk. Multivariable logistic regression assessed associations while controlling for demographic variables and established cardiovascular risk factors.

Results

Significant associations emerged between various marijuana consumption methods and increased CHD risk. Individuals engaging in both smoking and vaping showed significantly higher CHD risk. Combined consumption methods, particularly smoking and eating, further compounded risk among those with pre-existing cardiovascular risk factors. Traditional risk factors including hypertension, diabetes, and obesity remained critical CHD predictors.

Conclusion

This study reveals complex relationships between marijuana use patterns and CHD risk, emphasizing the need for comprehensive public health strategies addressing cardiovascular implications of marijuana consumption. As usage rises, particularly among younger populations, healthcare providers and policymakers must educate individuals about potential cardiovascular risks associated with different consumption methods. Further research is needed to elucidate mechanisms and inform future guidelines for CHD risk reduction.

背景：随着全球大麻使用量的增加，了解其对心血管的影响至关重要。本研究调查了大麻使用模式与冠心病（CHD）风险之间的关系。方法：利用2023年行为危险因素监测系统数据，对大麻消费方式（吸烟、雾化、食用、轻吸）与冠心病风险进行横断面分析。在控制人口统计变量和确定的心血管危险因素的同时，多变量逻辑回归评估了相关性。结果：不同的大麻消费方式与冠心病风险增加之间存在显著关联。同时吸烟和吸电子烟的人患冠心病的风险明显更高。综合消费方式，特别是吸烟和饮食，进一步加剧了那些已经存在心血管风险因素的人的风险。传统的危险因素包括高血压、糖尿病和肥胖仍然是冠心病的重要预测因素。结论：本研究揭示了大麻使用模式与冠心病风险之间的复杂关系，强调需要制定全面的公共卫生策略来解决大麻消费对心血管的影响。随着使用量的增加，特别是在年轻人群中，医疗保健提供者和政策制定者必须教育个人不同的消费方式相关的潜在心血管风险。需要进一步的研究来阐明其机制，并为未来降低冠心病风险的指导方针提供信息。

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引用次数: 0

Underestimation of Stent Efficacy: Untreated Artery Events Distort Coronary Intervention Outcomes 低估支架疗效：未经治疗的动脉事件扭曲了冠状动脉介入治疗的结果。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2025-12-05 DOI: 10.1002/clc.70229

Mauricio Rigodanzo Mocha, Whady Hueb, Paulo Cury Rezende, Matheus de Oliveira Laterza Ribeiro, Thiago Luis Scudeler, Eduardo Gomes Lima, José Antonio Franchini Ramires, Roberto Kalil Filho

Background

Evaluation of percutaneous coronary intervention (PCI) effectiveness typically focuses on overall coronary events, often overlooking the specific location of these events within the coronary vasculature. This study aimed to evaluate the incidence of coronary events in patients treated with PCI and to investigate the correlation between these events, the location of the event within the treated site, and the type of stent used.

Methods

This study determined the proportion of coronary events occurring after percutaneous coronary intervention (PCI) and investigated the association between these events and the location of the previous treatment site. A retrospective cohort analysis was conducted on patients with stable coronary artery disease (CAD) who underwent PCI using either conventional or drug-eluting stents. Data was obtained from the MASS Clinical Research Unit database. The location of the coronary event was determined by angiography.

Results

Five hundred and sixty two patients were included, with 232 (41.3%) experiencing coronary events. 55.8% of the events occurred at the treated site, while the remaining 44.2% were unrelated to the treated site. Of the events related to the treated site, 54.1% occurred in the conventional stent group and 61.1% in the drug-eluting stent group. No statistically significant association was found between the event in the treated site and the type of stent used (p = 0.363).

Conclusions

A significant proportion of coronary events occurred in untreated sites. Our results suggest that isolated evaluation of the treated site may provide a more accurate estimate of the effectiveness of stents.

背景：经皮冠状动脉介入治疗（PCI）有效性的评估通常侧重于整体冠状动脉事件，往往忽略了这些事件在冠状动脉血管中的特定位置。本研究旨在评估接受PCI治疗的患者冠状动脉事件的发生率，并探讨这些事件、事件在治疗部位的位置以及所使用的支架类型之间的相关性。方法：本研究测定经皮冠状动脉介入治疗（PCI）后发生冠状动脉事件的比例，并探讨这些事件与先前治疗部位的关系。回顾性队列分析对使用常规或药物洗脱支架行PCI治疗的稳定型冠心病（CAD）患者进行。数据来自MASS临床研究单位数据库。冠状动脉事件的位置由血管造影确定。结果：纳入562例患者，其中232例（41.3%）发生冠状动脉事件。55.8%的事件发生在治疗部位，其余44.2%与治疗部位无关。与治疗部位相关的事件中，54.1%发生在常规支架组，61.1%发生在药物洗脱支架组。治疗部位的事件与使用的支架类型之间没有统计学意义的关联（p = 0.363）。结论：相当比例的冠状动脉事件发生在未经治疗的部位。我们的研究结果表明，单独评估治疗部位可以更准确地估计支架的有效性。

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引用次数: 0

Two-Dimensional Speckle Tracking Echocardiography and Real-Time Three-Dimensional Echocardiography in Marathon Runners: A Study of Left Atrium 二维斑点跟踪超声心动图和实时三维超声心动图在马拉松运动员：左心房的研究。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2025-12-02 DOI: 10.1002/clc.70230

Pan Yang, Zhixiang Ge, Liping Wang, Haiyan Ke, Min Xu

Objective

To assess left atrial (LA) structure and function in marathon runners using two-dimensional speckle tracking echocardiography (2D-STE) and real-time three-dimensional echocardiography (RT-3DE).

Methods

This study enrolled 50 healthy volunteers (control group) and 132 marathon runners, and collected their general information. 2D-STE and RT-3DE were performed to obtain LA structural and functional parameters and left ventricular mass index (LVMI). According to the LVMI criteria for diagnosing left ventricular hypertrophy (LVH), all marathon runners were divided into an LVMI normal group and an LVH group. A comparative analysis was performed among the three groups. Multivariate logistic regression was used to analyze the association, and curve fitting was used to show the change trends.

Results

Compared with the control group, LA total ejection fraction (LATEF) and LA passive ejection fraction (LAPEF) were higher in the LVMI normal group (p < 0.05). Compared with the control group and the LVMI normal group, LA maximal volume index (LAVImax), LA presystolic volume index (LAVIpre), and LA stiffness index (LASI) were higher in the LVH group, whereas LA reservoir strain (LASr), LA conduit strain (LAScd), and LA contraction strain (LASct) were lower (p < 0.05). Multivariate logistic regression analysis showed that LAVImax, LAScd, and LASct were significantly associated with LVH in marathon runners. Curve fitting showed that LAVImax increased with the increase of LVMI, whereas LAScd and LASct decreased.

Conclusion

2D-STE and RT-3DE can effectively assess LA structure and function in marathon runners. Marathon runners with normal LVMI exhibit normal LA structure and function, and even some functional enhancement, while those with LVH exhibit increased LA volume and decreased LA strain function.

目的：应用二维散斑跟踪超声心动图（2D-STE）和实时三维超声心动图（RT-3DE）评价马拉松运动员左心房（LA）结构和功能。方法：选取50名健康志愿者（对照组）和132名马拉松运动员，收集其一般信息。采用2D-STE和RT-3DE测定左室结构、功能参数和左室质量指数（LVMI）。根据LVMI诊断左心室肥厚（LVH）的标准，将所有马拉松运动员分为LVMI正常组和LVH组。对三组患者进行比较分析。采用多元逻辑回归分析相关性，曲线拟合显示变化趋势。结果：与对照组相比，LVMI正常组LA总射血分数（LATEF）和LA被动射血分数（LAPEF）均较高(p)。结论：2D-STE和RT-3DE可有效评估马拉松运动员LA结构和功能。LVMI正常的马拉松运动员的LA结构和功能正常，甚至有一定的功能增强，而LVH运动员的LA体积增加，LA应变功能下降。

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引用次数: 0

How to Assess the Impact of Catheter Ablation for Atrial Fibrillation in Patients With Heart Failure With Preserved Ejection Fraction 如何评估导管消融对保留射血分数的心力衰竭患者房颤的影响。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2025-12-02 DOI: 10.1002/clc.70231

Naoya Kataoka, Teruhiko Imamura

The prognostic impact of catheter ablation in patients with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) remains controversial. Using a nationwide database, the authors demonstrated that catheter ablation was associated with cardiovascular and cerebral benefits, as well as a reduction in all-cause mortality, in patients with AF and HFpEF [1]. Several concerns arise from these findings.

The authors assessed all-cause mortality in the HFpEF cohort, although the prescription rates of guideline-directed medical therapy—including sodium–glucose cotransporter-2 inhibitors—were extremely low [1]. This may limit the interpretation of mortality reduction attributable to catheter ablation itself.

The major causes of death in HFpEF are generally noncardiac [2]. The mechanism by which catheter ablation would reduce all-cause mortality in this population therefore remains unclear. Catheter ablation helps prevent thrombus formation and stroke, and may reduce worsening heart failure by preserving atrial contraction. However, it is unlikely to directly decrease noncardiac events, which represent a substantial proportion of deaths in HFpEF.

The authors excluded patients who underwent valve replacement [1]. Yet, one of the most advanced clinical scenarios of HFpEF with AF involves significant valvular disease—particularly mitral regurgitation—that requires intervention [3]. Including such patients would improve the generalizability of the findings to a more representative HFpEF population. Moreover, individuals with severe valvular disease often have markedly remodeled atria and are seldom considered for catheter ablation.

Another important issue not evaluated in this study is bleeding related to anticoagulant therapy [1]. Patients with HFpEF may be at higher risk of bleeding complications than those with reduced ejection fraction [4]. In this regard, we strongly recommend considering left atrial appendage closure at the time of catheter ablation to mitigate anticoagulant-related bleeding risk, if applicable.

The authors have nothing to report.

The authors declare no conflicts of interest.

The authors have nothing to report.

导管消融对保留射血分数（HFpEF）的心房颤动（AF）和心力衰竭患者的预后影响仍有争议。通过使用一个全国性的数据库，作者证明导管消融与心房颤动和HFpEF患者的心血管和大脑益处以及全因死亡率的降低有关。这些发现引起了一些关注。作者评估了HFpEF队列的全因死亡率，尽管指南指导的药物治疗（包括钠-葡萄糖共转运蛋白-2抑制剂）的处方率极低。这可能限制了对导管消融本身导致的死亡率降低的解释。HFpEF的主要死亡原因通常是非心源性血卒中。因此，导管消融降低该人群全因死亡率的机制尚不清楚。导管消融有助于预防血栓形成和中风，并可能通过保持心房收缩来减少恶化的心力衰竭。然而，它不太可能直接减少非心脏事件，而非心脏事件占HFpEF死亡的很大比例。作者排除了接受瓣膜置换术的患者。然而，HFpEF合并房颤的最晚期临床情况之一涉及明显的瓣膜疾病，特别是二尖瓣反流，这需要干预。包括这些患者将提高研究结果的普遍性，使其更具有代表性的HFpEF人群。此外，患有严重瓣膜疾病的个体通常有明显的心房重塑，很少考虑导管消融。本研究未评估的另一个重要问题是与抗凝治疗相关的出血。与射血分数降低的患者相比，HFpEF患者出血并发症的风险可能更高。在这方面，我们强烈建议在导管消融时考虑左心耳关闭，以减轻抗凝相关出血的风险，如果适用的话。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

Leave Nothing Behind in Coronary Intervention: Time to Move From Promise to Proof 在冠状动脉介入治疗中不留下任何东西：从承诺到证明的时间。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2025-12-02 DOI: 10.1002/clc.70228

Hasnain Wajeeh Saqib, Talha Khan, Rehman Bashir, Tazeem Hayat, Areesha Ishfaq Ahmed, Ayesha Tariq

<p>We read with great interest the recent article by Meunier et al. [<span>1</span>] reporting the 3-year follow-up of a prospective all-comers observational study evaluating a stentless percutaneous coronary intervention (PCI) strategy with drug-coated balloons (DCB). The authors are to be commended for providing one of the most comprehensive long-term datasets on this approach. Their findings, particularly the low rate of target lesion revascularization (TLR) in the DCB-only cohort (2.6%) compared with the bailout drug-eluting stent (DES) group (6%), underscore the feasibility of a “leave nothing behind” strategy in contemporary practice.</p><p>The rationale for DCB angioplasty rests on avoiding the long-term complications of permanent metallic scaffolds, including in-stent restenosis, neoatherosclerosis, and late thrombosis [<span>2</span>]. The durability of outcomes over 3 years in an unselected population provides important reassurance for interventional cardiologists considering wider adoption of a DCB-first approach.</p><p>However, the absence of randomization precludes firm causal inference. The differences in TLR-free survival (<i>p</i> = 0.016) may reflect lesion complexity or operator selection bias rather than an actual treatment effect. Randomized controlled trials directly comparing stentless PCI with current-generation DES are required to establish durability, safety, and generalizability [<span>3, 4</span>]. Such studies should also examine endpoints beyond TLR, including myocardial infarction, late thrombosis, and patient-reported outcomes.</p><p>Notably, the introduction of the “metal index” serves as a quantitative marker of stent burden. The observation that higher indices were associated with worse outcomes highlights their potential as a prognostic tool. Future research should validate the metal index in diverse cohorts and determine whether it can guide clinical decision-making, particularly when hybrid strategies necessitate bailout stenting.</p><p>Patient and lesion selection also remain critical considerations. While small-vessel disease, bifurcations, and high-bleeding-risk subsets have been the traditional focus of DCB angioplasty [<span>5</span>], the favorable long-term outcomes reported here suggest that the potential scope of patients who may benefit could be broader. Rigorous comparative studies, including registry-based analyses, will be essential to delineate these populations more precisely.</p><p>In summary, Meunier et al. provide compelling evidence that reinforces the biological and clinical appeal of a stentless PCI strategy, advancing the dialogue on the “leave nothing behind” paradigm. At the same time, their work should be viewed as a call to action: large-scale randomized trials are urgently needed to validate these observational insights, to explore the clinical utility of the metal index, and to define the optimal patient subsets for DCB-first strategies.</p><p><b>Hasnain Wajeeh Saqib:</b> writing –

我们饶有兴趣地阅读了Meunier等人最近发表的一篇文章，该文章报道了一项为期3年的前瞻性观察性研究，该研究评估了使用药物包被球囊（DCB）的无支架经皮冠状动脉介入治疗（PCI）策略。作者为这种方法提供了最全面的长期数据集之一，值得赞扬。他们的研究结果，特别是与药物洗脱支架（DES）组（6%）相比，dcb组的靶病变血运重建率（TLR）较低（2.6%），强调了“不留下任何东西”策略在当代实践中的可行性。DCB血管成形术的基本原理在于避免永久性金属支架的长期并发症，包括支架内再狭窄、新动脉粥样硬化和晚期血栓形成。在未选择的人群中超过3年的结果耐久性为介入性心脏病专家考虑更广泛地采用DCB-first方法提供了重要的保证。然而，缺乏随机化排除了可靠的因果推理。无tlr生存的差异（p = 0.016）可能反映了病变的复杂性或操作者的选择偏差，而不是实际的治疗效果。需要随机对照试验直接比较无支架PCI与当前代DES，以确定耐久性、安全性和普遍性[3,4]。此类研究还应检查TLR以外的终点，包括心肌梗死、晚期血栓形成和患者报告的结局。值得注意的是，引入“金属指数”作为支架负荷的定量指标。观察到较高的指数与较差的结果相关，突出了它们作为预后工具的潜力。未来的研究应该在不同的队列中验证金属指数，并确定它是否可以指导临床决策，特别是当混合策略需要置入术时。患者和病变的选择也仍然是关键的考虑因素。虽然小血管疾病、分叉和高出血风险亚群一直是DCB血管成形术的传统焦点，但本文报道的良好的长期结果表明，受益的潜在患者范围可能更广。严格的比较研究，包括基于登记的分析，将是更准确地描绘这些人口的必要条件。总之，Meunier等人提供了令人信服的证据，加强了无支架PCI策略的生物学和临床吸引力，推进了关于“不留下任何东西”范式的对话。同时，他们的工作应该被视为行动的号召：迫切需要大规模的随机试验来验证这些观察性的见解，探索金属指数的临床应用，并确定dcb优先策略的最佳患者亚群。Hasnain Wajeeh Saqib：写作-原稿。Talha Khan：写作——原稿。拉赫曼·巴希尔：写作——原稿。Tazeem Hayat：写作——原稿。阿蕾莎·伊什法克·艾哈迈德：写作——原稿。Ayesha Tariq：写作——原稿。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

Impact of Insomnia on Myocardial Infarction Risk and Coronary Plaque Vulnerability: Insights From Mendelian Randomization and OCT Imaging 失眠对心肌梗死风险和冠状动脉斑块易损性的影响：来自孟德尔随机化和OCT成像的见解。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2025-12-02 DOI: 10.1002/clc.70226

Yang Gao, Qingbo Shi, Zhuocheng Shi, Zhiwen Zhang, Haosen Yu, Mingxing Lv, Tong Zhang, Donghui Chen, Yu shuo Gu, Quan Guo, Muwei Li, Cao Ma

Background

Insomnia is a prevalent sleep disorder increasingly recognized as a risk factor for cardiovascular diseases (CVDs). However, its causal relationship with myocardial infarction (MI) and its impact on coronary plaque vulnerability remain poorly understood.

Methods

We performed Mendelian randomization (MR) analysis using genome-wide association study (GWAS) summary data for insomnia (n = 462,341) and MI (n = 484,598) in populations of European descent. Additionally, 340 patients with coronary artery disease (CAD) underwent coronary angiography and optical coherence tomography (OCT) imaging. Insomnia was assessed by the Insomnia Severity Index (ISI), and OCT was used to evaluate plaque features including thin-cap fibroatheroma (TCFA), fibrous cap thickness, lipid arc, macrophage infiltration, and plaque rupture.

Results

MR analysis showed a potential causal effect of genetically predicted insomnia on MI risk (OR = 1.015; 95% CI: 1.004–1.027; p = 0.007), with no evidence of pleiotropy or heterogeneity. Clinically patients with insomnia (ISI ≥ 8) had higher rates of hypertension (54.3% vs. 39.6%) and MI (32.4% vs. 21.7%), elevated CRP levels, and exhibited greater plaque vulnerability on OCT, including increased incidence of TCFA (29.5% vs. 17.0%), thinner fibrous caps, larger lipid arcs, and more frequent macrophage infiltration and plaque rupture. Logistic regression identified both insomnia (OR = 1.806; p = 0.037) and CRP (OR = 1.384; p = 0.034) as independent predictors of TCFA.

Conclusions

This study provides genetic and clinical evidence that insomnia contributes to MI risk and coronary plaque vulnerability, underscoring the importance of addressing sleep disturbances in CAD management.

背景：失眠是一种普遍的睡眠障碍，越来越被认为是心血管疾病（cvd）的危险因素。然而，其与心肌梗死（MI）的因果关系及其对冠状动脉斑块易损性的影响仍知之甚少。方法：我们使用全基因组关联研究（GWAS）汇总数据对欧洲血统人群的失眠（n = 462,341）和心肌梗死（n = 484,598）进行孟德尔随机化（MR）分析。此外，340例冠心病（CAD）患者接受了冠状动脉造影和光学相干断层扫描（OCT）成像。通过失眠严重指数（ISI）评估失眠，并用OCT评估斑块特征，包括薄帽纤维粥样瘤（TCFA）、纤维帽厚度、脂质弧、巨噬细胞浸润和斑块破裂。结果：磁共振分析显示基因预测失眠对心肌梗死风险的潜在因果影响（OR = 1.015; 95% CI: 1.004-1.027; p = 0.007），无多效性或异质性证据。临床失眠患者（ISI≥8）高血压（54.3% vs. 39.6%）和心肌梗死（32.4% vs. 21.7%）的发生率较高，CRP水平升高，在OCT上表现出更大的斑块易损性，包括TCFA发生率增加（29.5% vs. 17.0%），纤维帽更薄，脂质弧更大，巨噬细胞浸润和斑块破裂更频繁。Logistic回归发现失眠（OR = 1.806; p = 0.037）和CRP （OR = 1.384; p = 0.034）是TCFA的独立预测因子。结论：本研究提供了遗传学和临床证据，表明失眠有助于心肌梗死风险和冠状动脉斑块易感性，强调了解决睡眠障碍在冠心病管理中的重要性。

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引用次数: 0

Loop Diuretic Therapy in Severe Aortic Stenosis: Marker of Organ Congestion, Unfavorable Hemodynamics, and Increased Post-Valve Replacement Mortality 重度主动脉瓣狭窄的环状利尿剂治疗：器官充血、不利的血流动力学和瓣膜置换术后死亡率增加的标志

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2025-11-29 DOI: 10.1002/clc.70225

Micha T. Maeder, Alexander Breuss, Sharon Appert, Simon Wildermuth, Philipp K. Haager, Johannes Rigger, Joannis Chronis, Martin O. Schmiady, Hans Rickli, Lukas Weber

Background

Loop diuretic therapy (LDT) is associated with increased mortality in heart failure. Severe aortic stenosis (AS) patients are at risk for heart failure and frequently on LDT. We assessed cardiac structure and function, organ congestion, filling pressures, and long-term outcomes of severe AS patients on LDT undergoing aortic valve replacement (AVR).

Methods

Consecutive patients with severe AS with [n = 157; median (interquartile range) daily torasemide dose: 10 (5–15) mg] or without (n = 346) LDT undergoing a detailed assessment of congestion (B-type natriuretic peptide, liver enzymes, systematic chest X-ray analysis) and cardiac catheterization before AVR with a post-AVR follow-up of several years were studied.

Results

Despite similar AS severity (indexed aortic valve area 0.41 ± 0.12 vs. 0.43 ± 0.12 cm²/m²) patients with LDT had more advanced biventricular remodeling and dysfunction, higher B-type natriuretic peptide [446 (245–991) vs. 150 (62–317) ng/L; p < 0.001], higher liver enzymes, higher chest x-ray congestion score [2 (1–4.5) vs. 1 (0–2) score points; p < 0.001], and higher mean right atrial pressure (8 ± 4 vs. 6 ± 3 mmHg) and mean pulmonary artery wedge pressure (21 ± 8 vs. 14 ± 6 mmHg; p < 0.001 for both) than those without. After a median post-AVR follow-up of 15 months functional capacity was worse, and estimated systolic pulmonary pressure was higher (37 ± 11 vs. 32 ± 8 mmHg; p < 0.001), and after a median follow-up of 44 months mortality was higher [hazard ratio 2.01 (95% confidence interval 1.17–3.77); p = 0.01] in LDT compared to non-LDT patients.

Conclusions

LDT identifies AS patients with more advanced cardiac remodeling, more severe congestion, unfavorable hemodynamics, impaired post-AVR status, and increased post-AVR long-term mortality.

背景：循环利尿剂治疗（LDT）与心力衰竭死亡率增加有关。严重主动脉瓣狭窄（AS）患者有心力衰竭的危险，经常发生LDT。我们评估了严重AS患者接受主动脉瓣置换术（AVR）的心脏结构和功能、器官充血、充盈压力和长期预后。方法连续收治重症AS患者[n = 157；研究中位（四分位数范围）每日托拉塞米剂量：10 (5-15)mg]或无（n = 346） LDT在AVR前进行详细的充血评估（b型利钠肽、肝酶、系统胸部x线分析）和心导管插管，并在AVR后随访数年。结果尽管AS严重程度相似（主动脉瓣面积指数0.41±0.12比0.43±0.12 cm2/m2），但LDT患者双室重构和功能障碍更严重，b型利钠肽更高[446（245-991）比150 (62-317)ng/L；P < 0.001]，较高的肝酶，较高的胸片充血评分[2（1 - 4.5）比1（0-2）分；p < 0.001]，平均右心房压（8±4比6±3 mmHg）和平均肺动脉楔压（21±8比14±6 mmHg； p < 0.001）均高于未服用药物的患者。avr术后中位随访15个月后，功能能力更差，估计收缩压更高（37±11比32±8 mmHg； p < 0.001），中位随访44个月后死亡率更高[风险比2.01(95%可信区间1.17-3.77)；p = 0.01]与非LDT患者相比。结论LDT识别AS患者有更晚期的心脏重构，更严重的充血，不利的血流动力学，avr后状态受损，avr后长期死亡率增加。

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引用次数: 0

Nuanced Considerations in Immediate Versus Staged Multivessel PCI: Implications for Clinical Practice and Guideline Development 即时与分期多血管PCI的细微差别：对临床实践和指南制定的影响

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2025-11-26 DOI: 10.1002/clc.70224

Hassan E Muhammad, Samia Nawaz

<p>The recent systematic review and meta-analysis by Yasmin et al. addressing immediate versus staged revascularization of non-culprit arteries in patients with acute coronary syndrome (ACS) and multivessel disease offers timely and clinically relevant insights [<span>1</span>]. While their work advances the field, several important considerations remain under explored and warrant further attention.</p><p>Procedural complexity is an underappreciated determinant of outcomes. Immediate multivessel intervention often entails longer procedural duration, higher fluoroscopy exposure, and greater operator workload factors rarely captured in randomized trials. These elements are directly linked to complication rates and periprocedural safety. Contemporary evidence demonstrates that operator experience and intravascular imaging improve long-term outcomes in complex PCI, underscoring the importance of workload and expertise as modifiers of risk [<span>2</span>].</p><p>Renal outcomes also deserve greater emphasis. Although the authors note the potential for contrast-induced nephropathy, their analysis does not account for cumulative contrast burden or the possibility of renal recovery between staged procedures. Observational studies have established that contrast volume is a strong predictor of acute kidney injury and adverse prognosis, particularly in patients with impaired baseline renal function [<span>3, 4</span>]. Pooled analyses that omit this dimension may underestimate renal risk associated with either strategy.</p><p>Economic and resource implications are highly relevant but absent from the analysis. Differences in hospital length of stay, catheterization laboratory occupancy, and downstream costs carry meaningful consequences for patients and health systems. Prior studies indicate that staged PCI is associated with higher cumulative costs compared with one-time complete revascularization [<span>5</span>]. These considerations are particularly salient for resource-limited settings where system efficiency influences real-world adoption.</p><p>Physiologic lesion assessment is another key omission. The landmark FAME trial demonstrated that fractional flow reserve (FFR)-guided PCI reduces unnecessary stenting and improves outcomes [<span>6</span>]. Current European guidelines endorse physiology-guided revascularization whenever feasible [<span>7</span>]. Staged procedures allow for reassessment with FFR or instantaneous wave-free ratio following stabilization, which may enhance the appropriateness of intervention and reduce overtreatment.</p><p>Finally, operator and institutional expertise are well-recognized determinants of PCI outcomes. Large registries confirm that both operator volume and the use of intravascular imaging independently improve results [<span>2</span>]. Failure to stratify outcomes by these variables limits generalizability across diverse practice environments.</p><p>In conclusion, while the work by Yasmin et al. contributes signific

Yasmin等人最近对急性冠状动脉综合征（ACS）和多血管疾病患者的非罪魁动脉立即与分期血运重建进行了系统回顾和荟萃分析，提供了及时和临床相关的见解。虽然他们的工作推动了这一领域的发展，但仍有几个重要的问题有待探讨，值得进一步关注。程序复杂性是一种被低估的结果决定因素。即时多血管介入通常需要更长的手术时间，更高的透视暴露，以及更大的操作员工作量因素，这些在随机试验中很少被捕获。这些因素与并发症发生率和围手术期安全性直接相关。当代证据表明，操作人员的经验和血管内成像改善了复杂PCI的长期结果，强调了工作量和专业知识作为风险调节因素的重要性。肾脏预后也值得重视。尽管作者注意到造影剂肾病的可能性，但他们的分析并没有考虑到造影剂累积负担或分期手术之间肾脏恢复的可能性。观察性研究已经证实，造影剂体积是急性肾损伤和不良预后的一个强有力的预测因子，特别是在基线肾功能受损的患者中[3,4]。忽略这一维度的综合分析可能低估了两种策略相关的肾脏风险。经济和资源影响是高度相关的，但在分析中却没有提及。住院时间、导尿实验室占用和下游成本的差异对患者和卫生系统产生了重大影响。先前的研究表明，与一次性完全血运重建术相比，分期PCI的累积费用更高。这些考虑对于资源有限的环境尤其突出，因为系统效率会影响实际应用。生理性病变评估是另一个重要的遗漏。具有里程碑意义的FAME试验表明，分数血流储备（FFR）引导的PCI减少了不必要的支架置入，改善了预后。目前的欧洲指南支持在可行的情况下进行生理引导的血运重建术。分阶段手术允许在稳定后用FFR或瞬时无波比重新评估，这可以提高干预的适当性并减少过度治疗。最后，操作人员和机构的专业知识是PCI结果的公认决定因素。大型注册表证实，操作者体积和血管内成像的使用都独立改善了结果[2]。未能通过这些变量对结果进行分层限制了在不同实践环境中的通用性。综上所述，Yasmin等人的研究对立即行多支血管PCI与分期行多支血管PCI的争论做出了重大贡献，但未来的分析将受益于整合手术复杂性、肾脏终点、经济因素、生理性病变重新评估和操作人员的专业知识。前瞻性研究应该(a)量化手术持续时间、辐射和操作人员工作量；(b)系统地评估累积造影剂暴露和恢复；(c)稳定后结合病变特异性生理评估；(d)评估卫生系统和经济成果；(e)根据经营者和机构经验对结果进行分层。这些努力将加强证据基础，完善指南建议，并确保血运重建术在整个医疗系统中保持安全、有效和适应性。chatgpt - 40 （OpenAI）仅用于语法和语言改进。所有内容均由作者按照TITAN 2025指南编写和验证。作者声明无利益冲突。数据共享不适用于本文，因为在当前研究期间没有生成或分析数据集。

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引用次数: 0