Clinical Cardiology最新文献_第6页

Long-Term Outcomes of Catheter Ablation in Ventricular Tachycardia Electrical Storm: A Retrospective Cohort Study 室性心动过速电风暴患者导管消融的远期疗效：一项回顾性队列研究。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2025-11-15 DOI: 10.1002/clc.70221

Cem Çöteli, Samuray Zekeriyayev, Can Sezer, Hikmet Yorgun, Kudret Aytemir

Background and Objective

Electrical storm is a life-threatening condition commonly observed in patients with structural heart disease. While catheter ablation has emerged as an effective treatment for electrical storm, the long-term outcomes are still unknown. This study aims to evaluate the long-term outcomes of catheter ablation in patients with electrical storm, focusing on mortality, ventricular tachycardia (VT) recurrence, and hospitalization rates.

Methods

We conducted a retrospective cohort study at a single center, enrolling 65 patients admitted with electrical storm. All patients underwent catheter ablation The primary outcome was VT-related ICD therapies, while the secondary outcomes included all caused mortality, VT-related ICD therapies, repeat ablation, hospitalization, and stroke.

Results

The cohort was predominantly male (86.15%) with ischemic cardiomyopathy (56.92%) and a mean left ventricular ejection fraction (LVEF) of 35.3% ± 13%. All procedures were completed without any fatalities and without significant complications in 93.85% of cases. During follow-up, 22 patients (33.85%) received ICD therapies for VT. The median estimated survival time for the VT-free survival was 43 months. The 12-month mortality rate was 26.15%. Over the median follow-up of 23 months, 40% of patients died, and 72% experienced a composite endpoint of death, VT recurrence, or hospitalization. Multivariate analysis identified reduced LVEF as the strongest predictor of mortality during follow-up.

Conclusion

VT ablation is a safe and effective therapeutic option for managing electrical storm, providing high acute procedural success and allowing most patients to be discharged. However, this high-risk population remains at significant risk for long-term morbidity and mortality.

背景与目的：电风暴是一种危及生命的疾病，常见于结构性心脏病患者。虽然导管消融已成为治疗电风暴的有效方法，但其长期疗效尚不清楚。本研究旨在评估电风暴患者导管消融的长期预后，重点关注死亡率、室性心动过速（VT）复发和住院率。方法：我们在单个中心进行了回顾性队列研究，纳入了65例入院的电风暴患者。所有患者均行导管消融术，主要结局是与vt相关的ICD治疗，次要结局包括所有原因的死亡率、与vt相关的ICD治疗、重复消融术、住院和卒中。结果：该队列以男性为主（86.15%），伴有缺血性心肌病（56.92%），平均左室射血分数（LVEF）为35.3%±13%。93.85%的病例完成所有手术，无死亡和明显并发症。在随访期间，22例（33.85%）患者接受了ICD治疗VT。无VT生存期的中位估计生存时间为43个月。12个月死亡率为26.15%。在中位随访23个月期间，40%的患者死亡，72%的患者出现死亡、室速复发或住院的复合终点。多变量分析确定LVEF降低是随访期间死亡率的最强预测因子。结论：VT消融是一种安全有效的治疗电风暴的方法，具有较高的急性手术成功率，并使大多数患者出院。然而，这一高危人群长期发病和死亡的风险仍然很大。

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引用次数: 0

Radiofrequency Ablation for Focal Atrial Tachycardia Originating From the Fossa Ovalis: Experiences and Outcomes 射频消融治疗起源于卵圆窝的局灶性房性心动过速：经验和结果。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2025-11-12 DOI: 10.1002/clc.70219

Mingxian Chen, Xuping Li, Zhuo Wang, Jiantong Zhu, Min Zhong, Qiming Liu, Shenghua Zhou

Background

This study aimed to investigate the electrocardiographic characteristics, electrophysiological features, and outcomes of radiofrequency ablation in patients with focal atrial tachycardia (FAT) originating from the fossa ovalis (FO).

Methods

We retrospectively analyzed 67 patients with FAT originating from the FO and classified into two groups: the Unilateral Ablation Group (n = 36) and the Bilateral Ablation Group (n = 31). Patients in the Unilateral Ablation Group underwent ablation on the earliest single side, whereas patients in the Bilateral Ablation Group underwent ablation on both the right and left earliest sides. Ablation targets were guided by fluoroscopy, three-dimensional mapping, and intracardiac ultrasound. All patients were followed up for more than 1 year.

Results

Out of 1914 patients with atrial tachycardia, 3.5% had FAT originating from the FO. Fifty-four patients were located at the superior area of the FO with positive P waves in inferior leads, while 13 patients were located at the inferior area of the FO with negative P waves in inferior leads. The recurrence rate of FAT was 16.6% in the Unilateral Ablation Group, but no recurrence occurred in the Bilateral Ablation Group during regular follow-up (p = 0.026). Among the six patients with recurrence, five underwent left-sided ablation and one underwent right-sided ablation. All recurrent cases were then ablated by a bilateral strategy. Follow-up showed no further recurrence.

Conclusions

Bi-atrial mapping is necessary for ablation of FAT arising from the FO. Bilateral ablation for FO AT appears to be more reasonable.

背景：本研究旨在探讨起源于卵窝（FO）的局灶性房性心动过速（FAT）患者的心电图特征、电生理特征和射频消融的结果。方法：回顾性分析67例FO源性FAT患者，分为单侧消融组（n = 36）和双侧消融组（n = 31）。单侧消融组患者最早在单侧进行消融，双侧消融组患者最早在左右两侧进行消融。消融目标由透视、三维定位和心内超声引导。所有患者均随访1年以上。结果：在1914例房性心动过速患者中，3.5%的FAT起源于心房前房。54例位于下导联P波正的FO上区，13例位于下导联P波负的FO下区。单侧消融组FAT复发率为16.6%，双侧消融组常规随访无复发（p = 0.026）。在6例复发患者中，5例行左侧消融，1例行右侧消融。所有复发病例均采用双侧消融策略。随访未见复发。结论：双房标测对于消融前房区脂肪是必要的。双侧消融术治疗前叶性鼻窦炎似乎更为合理。

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引用次数: 0

A Novel Clinical Score Integrating Low-Voltage Zones and Biomarkers Predicts Atrial Fibrillation Recurrence Post-Ablation 结合低压区和生物标志物的新型临床评分预测消融后房颤复发。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2025-11-12 DOI: 10.1002/clc.70218

Ying Han, Jingzhe Liu, Xiaobo Liu, Hanyue Zheng, Juan Wang, Juan Zhang

Purpose

Despite technological advances, predicting atrial fibrillation (AF) recurrence after catheter ablation remains a clinical challenge. We developed a novel multi-parametric model integrating electrophysiological substrate characteristics, structural remodeling, and inflammatory/metabolic biomarkers to improve risk stratification.

Methods

This retrospective study analyzed 279 consecutive patients undergoing first-time AF ablation (June 2022 to January 2024) with 12-month follow-up. Using a 7:3 training-validation split, we identified independent predictors through multivariate logistic regression.

Results

Four key parameters emerged as powerful predictors: low-voltage zone extent (LVZ), high-sensitivity C-reactive protein (hs-CRP), red cell distribution width (RDW), and left atrial diameter (LAD). The composite model showed exceptional discrimination (AUC, in the training set and 0.84 in the validation set), significantly outperforming both individual parameters (LAD AUC 0.77, LVZ 0.75) and the APPLE score (AUC: 0.73, p < 0.001). The model stratified patients into five distinct risk categories (recurrence risk < 5% to > 70%) with strong clinical utility.

Conclusion

This is the first East Asian study to integrate voltage mapping with hematological-inflammatory biomarkers, providing a cost-effective and precise tool for post-ablation management. The model's performance and generalizability support its adoption in precision medicine pathways, particularly for guiding substrate modification in high-risk patients.

目的：尽管技术进步，但预测导管消融后房颤（AF）复发仍然是一个临床挑战。我们开发了一种新的多参数模型，整合了电生理底物特征、结构重塑和炎症/代谢生物标志物，以改善风险分层。方法：本回顾性研究分析了279例首次房颤消融患者（2022年6月至2024年1月），随访12个月。使用7:3的训练-验证分割，我们通过多变量逻辑回归确定了独立的预测因子。结果：低压区范围（LVZ）、高敏c反应蛋白（hs-CRP）、红细胞分布宽度（RDW）和左房内径（LAD）四个关键参数被认为是有效的预测指标。该复合模型在训练集和验证集中表现出显著的区分性（AUC为0.84），显著优于单项参数（LAD AUC为0.77，LVZ为0.75）和APPLE评分（AUC为0.73，p为70%），具有较强的临床实用性。结论：这是东亚第一个将电压测绘与血液学炎症生物标志物相结合的研究，为消融后管理提供了一种经济有效的精确工具。该模型的性能和通用性支持其在精确医学途径中的采用，特别是在指导高危患者的底物修饰方面。

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引用次数: 0

Evaluating the Impact of Catheter Ablation on Cardiovascular and Cerebral Outcomes in Atrial Fibrillation With Heart Failure and Preserved Ejection Fraction 评估导管消融对心房颤动合并心力衰竭和保留射血分数患者心血管和大脑预后的影响

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2025-11-07 DOI: 10.1002/clc.70220

Wei-Chieh Lee, Wan-Hsuan Hsu, Chih-Cheng Lai, Wei-Ting Chang, Chia-Te Liao, Jhih-Yuan Shih, Zhih-Cherng Chen, Hsiu-Yu Fang, Mien-Cheng Chen

Background

Evidence supporting catheter ablation (CA) for atrial fibrillation (AF) in heart failure with preserved ejection fraction (HFpEF) is limited. This study evaluated the impact of CA on clinical outcomes in patients with AF and HFpEF using a global clinical database.

Methods

The TriNetX research network identified patients aged ≥ 18 years with AF and HFpEF (February 2014 to June 2024). Patients were categorized by whether they underwent CA for AF. Primary outcomes included all-cause mortality, heart failure (HF) with acute exacerbation, and ischemic stroke. Secondary outcomes included progression to mildly reduced or reduced ejection fraction (EF) during follow-up.

Results

Patients receiving CA showed lower incidences of all-cause mortality, HF exacerbation, and ischemic stroke. There was a trend of less patients with progression to reduced EF in patients with CA. The reduction in mortality was consistent across all subgroups, while stroke reduction was more significant in females, those with better EF, without chronic kidney disease (CKD) or diabetes mellitus (DM), with hypertension (HTN), and with paroxysmal AF. The benefits in reducing HF exacerbation were particularly notable in females, those with better EF, without CKD, and with HTN.

Conclusions

In patients with AF and HFpEF, CA provided cardiovascular and cerebral benefits and might reduce the risk of progression to HFrEF over 5 years of follow-up. Additionally, CA was associated with a reduction in all-cause mortality in patients with AF and HFpEF.

背景：支持导管消融（CA）治疗心力衰竭患者房颤（AF）并保留射血分数（HFpEF）的证据有限。本研究使用全球临床数据库评估了CA对房颤和HFpEF患者临床结局的影响。方法TriNetX研究网络选取年龄≥18岁的房颤和HFpEF患者（2014年2月至2024年6月）。患者根据是否因房颤而接受CA进行分类。主要结局包括全因死亡率、心力衰竭伴急性加重和缺血性卒中。次要结局包括随访期间射血分数（EF）轻度降低或降低。结果CA组患者全因死亡率、心衰加重、缺血性脑卒中发生率均较低。在CA患者中，进展为EF降低的患者人数较少。死亡率的降低在所有亚组中都是一致的，而卒中的减少在女性、EF较好、无慢性肾病（CKD）或糖尿病（DM）、高血压（HTN）和阵发性房颤中更为显著。减少HF加重的益处在女性、EF较好、无CKD的患者中尤为显著。和HTN。在房颤和HFpEF患者中，CA提供了心血管和大脑方面的益处，并可能在5年的随访中降低进展为HFrEF的风险。此外，CA与房颤和HFpEF患者全因死亡率的降低有关。

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引用次数: 0

Mapping Gastroesophageal Reflux Disease and Coronary Artery Disease: A Comprehensive Analysis of Multivariable Mendelian Randomization and Shared Genetic Etiology 绘制胃食管反流病和冠状动脉疾病：多变量孟德尔随机化和共享遗传病因的综合分析。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2025-10-21 DOI: 10.1002/clc.70213

Yiying Zhen, Xiang Yuan, Min Ruan, Huan Lu, Dakai Liang, Dehua Huang, Fengyang Deng, Haozhang Huang, Jiaman Ou

Aims

We employed a robust genetic approach to provide a better understanding of whether Gastroesophageal reflux disease (GERD) contributes to coronary artery disease (CAD) risk from a genetic perspective.

Methods

Multivariable Mendelian Randomization (MVMR) was applied to explore causal links between GERD and CAD using genetic instruments derived from genome-wide association studies (GWAS). The MVMR models were adjusted for key metabolic confounders, including low-density lipoprotein cholesterol (LDL-C), body mass index (BMI), systolic blood pressure (SBP), and glycated hemoglobin (HbA1c). Genetic correlations were estimated using linkage disequilibrium score regression. Cross-trait meta-analyses, Heritability Estimation from Summary Statistics (ρ-HESS) and colocalization analyses were performed to identify pleiotropic genes and shared genetic loci, elucidating the genetic relationship between GERD and CAD.

Results

Genetically predicted GERD was found to be causally linked with CAD (rg = 0.38, P = 2.37E-52), independent of metabolic risk factors, including LDL-C, BMI, SBP, and HbA1c (odds ratio: 1.24, 95% CI: 1.02–1.52, p < 0.05). Cross-trait meta-analyses identified eight novel pleiotropic single nucleotide polymorphisms, four of which were independent of metabolic confounders, including rs11764337 in MAD1L1, rs2240326 in RBM5, rs9615905 in FAM19A5, and rs9837341 in BSN. ρ-HESS and colocalization analysis further revealed shared genetic loci for GERD and CAD, specifically rs4643373 in IGF2BP1 (located in chr17: 45876022-47517400 and posterior probability for H4 > 0.75).

Conclusions

GERD is identified as an independent risk factor for CAD. The discovery of shared genetic loci provides novel insights into the genetic mechanisms underlying GERD and CAD, with IGF2BP1 emerging as a potential therapeutic target for intervention.

目的：我们采用了一种强大的遗传学方法，从遗传学角度更好地了解胃食管反流病（GERD）是否会导致冠状动脉疾病（CAD）的风险。方法：采用多变量孟德尔随机化（MVMR）方法，利用来自全基因组关联研究（GWAS）的遗传工具探索GERD和CAD之间的因果关系。对MVMR模型进行了关键代谢混杂因素调整，包括低密度脂蛋白胆固醇（LDL-C）、体重指数（BMI）、收缩压（SBP）和糖化血红蛋白（HbA1c）。利用连锁不平衡评分回归估计遗传相关性。通过交叉性状荟萃分析、遗传力估计（ρ-HESS）和共定位分析，鉴定多效性基因和共享基因位点，阐明GERD与CAD的遗传关系。结果：基因预测的GERD与CAD有因果关系（rg = 0.38, P = 2.37E-52），独立于代谢危险因素，包括LDL-C、BMI、收缩压和HbA1c（优势比：1.24,95% CI: 1.02-1.52, P 0.75）。结论：胃食管反流是冠心病的独立危险因素。共享基因位点的发现为研究GERD和CAD的遗传机制提供了新的见解，IGF2BP1成为干预的潜在治疗靶点。

{"title":"Mapping Gastroesophageal Reflux Disease and Coronary Artery Disease: A Comprehensive Analysis of Multivariable Mendelian Randomization and Shared Genetic Etiology","authors":"Yiying Zhen, Xiang Yuan, Min Ruan, Huan Lu, Dakai Liang, Dehua Huang, Fengyang Deng, Haozhang Huang, Jiaman Ou","doi":"10.1002/clc.70213","DOIUrl":"10.1002/clc.70213","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>We employed a robust genetic approach to provide a better understanding of whether Gastroesophageal reflux disease (GERD) contributes to coronary artery disease (CAD) risk from a genetic perspective.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Multivariable Mendelian Randomization (MVMR) was applied to explore causal links between GERD and CAD using genetic instruments derived from genome-wide association studies (GWAS). The MVMR models were adjusted for key metabolic confounders, including low-density lipoprotein cholesterol (LDL-C), body mass index (BMI), systolic blood pressure (SBP), and glycated hemoglobin (HbA1c). Genetic correlations were estimated using linkage disequilibrium score regression. Cross-trait meta-analyses, Heritability Estimation from Summary Statistics (ρ-HESS) and colocalization analyses were performed to identify pleiotropic genes and shared genetic loci, elucidating the genetic relationship between GERD and CAD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Genetically predicted GERD was found to be causally linked with CAD (rg = 0.38, <i>P</i> = 2.37E-52), independent of metabolic risk factors, including LDL-C, BMI, SBP, and HbA1c (odds ratio: 1.24, 95% CI: 1.02–1.52, <i>p</i> < 0.05). Cross-trait meta-analyses identified eight novel pleiotropic single nucleotide polymorphisms, four of which were independent of metabolic confounders, including rs11764337 in MAD1L1, rs2240326 in RBM5, rs9615905 in FAM19A5, and rs9837341 in BSN. ρ-HESS and colocalization analysis further revealed shared genetic loci for GERD and CAD, specifically rs4643373 in IGF2BP1 (located in chr17: 45876022-47517400 and posterior probability for H4 > 0.75).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>GERD is identified as an independent risk factor for CAD. The discovery of shared genetic loci provides novel insights into the genetic mechanisms underlying GERD and CAD, with IGF2BP1 emerging as a potential therapeutic target for intervention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 10","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12538509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145336468","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}

引用次数: 0

Management of Antithrombotic Therapy in Patients With Coexisting Atrial Fibrillation and Coronary Artery Disease Who Underwent Percutaneous Coronary Intervention Within the Last Year 去年经皮冠状动脉介入治疗并发心房颤动和冠状动脉疾病患者的抗血栓治疗管理

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2025-10-16 DOI: 10.1002/clc.70196

Sebastian König, Sven Hohenstein, Johannes Leiner, Anne Nitsche, Alexander Staudt, Frank Steinborn, Christian Bietau, Henning T. Baberg, Michael Niehaus, Jürgen Tebbenjohanns, Melchior Seyfarth, Markus W. Ferrari, Marc M. Vorpahl, Ralf Kuhlen, Kerstin Bode, Andreas Bollmann

Background

Coronary artery disease (CAD) is a common comorbidity in patients with atrial fibrillation (AF), and optimal antithrombotic medication improves clinical outcomes in this high-risk population. The aim of our study was to describe antithrombotic drug regimens in different patient cohorts.

Methods

We investigated data from the prospective Helios Heart registry (H2) and the Heart Center Leipzig routine clinical database (HZL). We included inpatient cases with AF and CAD (hospitalized from March 2021 to July 2024 [H2] or January 2017 to December 2021 [HZL]), who underwent percutaneous coronary intervention (PCI) within the last 12 months. Information on clinical characteristics, coronary interventions, and medication prescribed was obtained from electronic case report forms and/or administrative data based on ICD-10, OPS, and ATC codes.

Results

We included 3481 (HZL), and 205 (H2) index cases with comparable baseline characteristics. Overall, 92.5% (HZL) and 87.6% (H2) of patients were on any anticoagulation, and 93.0% (HZL) and 80.2% (H2) were prescribed ≥ 1 antiplatelet agent. There were relevant differences in antithrombotic therapy when stratifying for PCI timing. Factors associated with higher (older age) or lower (comorbidity burden, antiplatelet treatment, prior left atrial appendage occlusion) prescription rates of OAC were identified. OAC therapy without adjunctive antiplatelet therapy was associated with an increased rate of rehospitalization for major adverse cardiovascular events at 12 months (HZL).

Conclusion

We presented current data on antithrombotic drug utilization in patients with AF and CAD and found comorbidity burden, concomitant antiplatelet treatment and other factors to be associated with lower anticoagulant prescription rates.

背景：冠状动脉疾病（CAD）是房颤（AF）患者的常见合并症，最佳抗血栓药物可改善这一高危人群的临床结果。我们研究的目的是描述不同患者群体的抗血栓药物治疗方案。方法：研究来自Helios心脏注册表（H2）和莱比锡心脏中心常规临床数据库（HZL）的数据。我们纳入了在过去12个月内接受过经皮冠状动脉介入治疗（PCI）的房颤合并CAD住院病例（2021年3月至2024年7月[H2]或2017年1月至2021年12月[HZL]）。临床特征、冠状动脉介入治疗和处方药物信息来自电子病例报告表格和/或基于ICD-10、OPS和ATC代码的管理数据。结果：我们纳入了3481例（HZL）和205例（H2）具有可比基线特征的指标病例。总体而言，92.5% （HZL）和87.6% （H2）的患者使用抗凝药物，93.0% （HZL）和80.2% （H2）的患者使用≥1种抗血小板药物。在PCI时间分层时，抗血栓治疗存在相关差异。确定与OAC处方率较高（年龄较大）或较低（合并症负担、抗血小板治疗、既往左心耳闭塞）相关的因素。无辅助抗血小板治疗的OAC治疗与12个月时主要不良心血管事件再住院率增加相关（HZL）。结论：我们提供了房颤和冠心病患者抗血栓药物使用的最新数据，发现合并症负担、伴随抗血小板治疗和其他因素与较低的抗凝处方率相关。

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引用次数: 0

Prognostic Value of Platelet to Lymphocyte Ratio for Myocardial Infarction: A Systematic Review and Meta-Analysis 血小板/淋巴细胞比值对心肌梗死的预后价值：一项系统综述和荟萃分析。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2025-10-14 DOI: 10.1002/clc.70215

Hengxu Yu, Shitao Li, Yutong Wu, Xiangpeng Ren

Background

Correlations between platelet-to-lymphocyte ratio (PLR) and prognosis in patients with acute myocardial infarction (AMI) are reported in more studies, though there is no evidence-based data.

Methods

Databases (PubMed, Embase, Web of Science, and Cochrane Library) were searched from their inception to April 19, 2024, to retrieve articles discussing associations between PLR and clinical outcomes in AMI patients. The primary outcomes, comprising mortality and major adverse cardiovascular events (MACE), were assessed with odds ratios (OR) and their 95% confidence intervals (CI). Sensitivity analyses and subgroup analyses were utilized to probe the results' robustness and potential heterogeneity sources. Analysis was carried out utilizing the software of Review Manager 5.4 & STATA 15.0.

Results

This article selected 18 cohort studies, covering 16,545 AMI patients. The meta-analysis found that elevated PLR was significantly linked with mortality in AMI patients (OR = 1.06; 95% CI: 1.04–1.08, p < 0.00001). Additionally, PLR was highly linked with MACE risks in AMI patients (OR = 1.495; 95% CI: 1.24–1.80, p < 0.0001). Further subgroup analyses discovered a significant correlation between PLR and mortality in prospective studies (OR = 1.07; 95% CI: 1.05–1.09), studies with a sample size ≥ 500 (OR = 1.06; 95% CI: 1.04–1.08), patients under 70 years of age (OR = 1.07; 95% CI: 1.05–1.09), studies from European regions (OR = 1.08; 95% CI: 1.06–1.10), patients with ST-elevation myocardial infarction (OR = 1.09; 95% CI: 1.07–1.11), and those with a PLR cutoff value < 140 (OR = 1.07; 95% CI: 1.05–1.09) (p < 0.05). For MACE, similar subgroup analyses also proved an obvious correlation between PLR and MACE in the aforementioned subgroups (p < 0.05).

Conclusion

PLR values are linked with mortality and MACE in AMI patients. PLR serves as an effective prognostic biomarker for AMI patients, providing precious opinions for sensible therapeutic decisions in AMI treatments.

背景：急性心肌梗死（AMI）患者的血小板与淋巴细胞比率（PLR）与预后之间的相关性被更多的研究报道，尽管没有基于证据的数据。方法：检索数据库（PubMed、Embase、Web of Science和Cochrane Library），检索从数据库建立到2024年4月19日讨论AMI患者PLR与临床结局之间关系的文章。主要结局包括死亡率和主要不良心血管事件（MACE），采用优势比（OR）及其95%置信区间（CI）进行评估。采用敏感性分析和亚组分析来探讨结果的稳健性和潜在异质性来源。利用Review Manager 5.4和STATA 15.0软件进行分析。结果：本文选择了18项队列研究，涵盖了16545例AMI患者。荟萃分析发现，AMI患者PLR升高与死亡率显著相关（OR = 1.06; 95% CI: 1.04-1.08, p）。结论：AMI患者PLR值与死亡率和MACE相关。PLR作为AMI患者有效的预后生物标志物，为AMI治疗的合理治疗决策提供宝贵意见。

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引用次数: 0

Computed Tomography-Verified Pacing Location of Micra Leadless Pacemakers and Characteristics of Paced Electrocardiograms in Bradycardia Patients 计算机断层扫描验证Micra无铅起搏器起搏位置和心动过缓患者起搏心电图特征

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2025-10-07 DOI: 10.1002/clc.70209

Jianghua Zhang, Xianhui Zhou, Yanmei Lu, Yaodong Li, Qiang Xing, Zukela Tuerhong, Xu Yang, Jiasuoer Xiaokereti, Yankai Guo, Xiaohong Zhou, Samantha Kohnle, Siyuan Zou, Baopeng Tang

Introduction

The leadless pacemakers are implanted routinely under fluoroscopic image, yet the pacing sites and corresponding paced electrocardiography (ECG) remain unclear. This study was to determine the computed tomography (CT)-verified location of the leadless Micra pacemakers (Micra) and ECG characteristics.

Methods

Twenty consecutive patients who met the pacemaker indications for bradycardia and underwent fluoroscopy assisted Micra implantation were enrolled. All subjects underwent a postoperative CT scan to determine the precise location of the Micra pacing tip. Paced 12-lead ECG characteristics were analysed and correlated with the Micra tip location.

Results

In the nine partitions of fluoroscopic RAO images, 14 (70%) of 20 patients had the Micra tip in zone 5, 5 (25%) in zone 6 and 1 in zone 2. Reconstructed CT 3-D cardiac images found Micra tips mostly clustered near the anterior insertion between the RV septum and free wall with 12 cases at the insertion-septal side and 8 at the free-wall side. ECG morphological analysis found that the peak deflection index in ECG lead V1 was 0.409 ± 0.058 for Micra tips at the insertion-septal side and 0.527 ± 0.062 in the free-wall side (p < 0.001 between two sides) and R wave amplitude in lead V6 appeared larger for Micra tips in the free-wall group compared to Micra tips in the insertion-septal group, while there was no difference in QRS duration between two sides.

Conclusion

In routine Micra implantation, the pacing sites were often located in the anterior insertion region.

无导线起搏器在透视下常规植入，但起搏部位和相应的起搏心电图（ECG）仍不清楚。本研究旨在确定计算机断层扫描（CT）验证的无导线Micra起搏器（Micra）的位置和心电图特征。方法连续20例符合起搏器适应症的心动过缓患者行透视辅助Micra植入。所有受试者术后都进行了CT扫描，以确定Micra起搏尖端的精确位置。分析有节奏的12导联心电图特征，并将其与Micra尖端位置相关联。结果20例患者中有14例（70%）Micra尖端位于5区，5例（25%）位于6区，1例位于2区。重建CT三维心脏图像发现，Micra尖端多聚集在右心室间隔与游离壁之间的前止点附近，其中12例位于插入-间隔侧，8例位于游离壁侧。心电形态学分析发现，插入-间隔侧Micra尖端V1导联的峰值偏转指数为0.409±0.058，自由壁侧为0.527±0.062（两边p <； 0.001），自由壁组Micra尖端V6导联的R波幅度大于插入-间隔组Micra尖端，而两侧QRS持续时间无差异。结论在常规Micra植入中，起搏部位多位于前植入区。

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引用次数: 0

Impact of Empagliflozin Versus Dapagliflozin on Left Ventricular Remodeling in Heart Failure Patients: A 1-Year Comparative Study 恩格列净与达格列净对心力衰竭患者左心室重构的影响：一项为期1年的比较研究

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2025-09-18 DOI: 10.1002/clc.70192

Mahmoud Balata, Marc Ulrich Becher, Marwa Hassan, Mohamed Rady, Shady Rashed, Usama Alkomi, Marian Christoph, Karim Ibrahim, Akram Youssef

Background

Sodium-glucose cotransporter-2 inhibitors (SGLT2is) reduce cardiovascular mortality and heart failure (HF)-related hospitalizations in HF patients. However, the mechanisms underlying these benefits remain unclear, and it is uncertain whether empagliflozin and dapagliflozin have differential effects on cardiac structure and function.

Aim

This study aims to compare the effects of these two SGLT2is on left ventricular echocardiographic parameters in HF patients over 1 year.

Methods

This retrospective study included 558 consecutive HF patients newly prescribed either dapagliflozin or empagliflozin. Key echocardiographic parameters, such as peak E-wave velocity, E/e' ratio, left atrial volume index (LAVI), LV end-diastolic and end-systolic volumes (LV-EDVI, LV-ESVI), LV mass index (LV-MI), relative wall thickness (RWT), LV sphericity index (LV-SI), and ejection fraction (LVEF), were measured at baseline and after 1 year.

Results

At 1-year, significant reductions were observed only in the empagliflozin group for peak E-wave velocity (mean difference = −12.76 cm/s, 95% CI: −16.26 to −9.27, p < 0.001), E/e' ratio (mean difference = −3.04, 95% CI: −4.17 to −1.91, p < 0.001), and LV sphericity index (LV-SI; mean difference = −0.01, 95% CI: −0.02 to −0.0005, p = 0.040). Both SGLT2is significantly improved E-wave deceleration time, LAVI, LV-EDVI, LV-ESVI, LV-MI, and LVEF. Neither medication produced significant changes in RWT, and no significant differences were noted between groups regarding HF hospitalizations or all-cause mortality.

Conclusion

Empagliflozin demonstrated more pronounced effects on LV remodeling markers, including peak E-wave velocity, E/e' ratio, and LV-SI, compared to dapagliflozin. These findings suggest potential efficacy differences between SGLT2is, highlighting the need for future randomized comparative studies.

背景：钠-葡萄糖共转运蛋白-2抑制剂（SGLT2is）可降低心衰患者心血管死亡率和心衰相关住院率。然而，这些益处的机制尚不清楚，也不确定恩格列净和达格列净是否对心脏结构和功能有不同的影响。目的：本研究旨在比较这两种SGLT2is对1年以上HF患者左室超声心动图参数的影响。方法：回顾性研究纳入558例连续新开达格列净或恩格列净的HF患者。在基线和1年后分别测量超声心动图关键参数，如峰值E波速度、E/ E比值、左房容积指数（LAVI）、左室舒张末期和收缩末期容积（LV- edvi、LV- esvi）、左室质量指数（LV- mi）、相对壁厚（RWT）、左室球形指数（LV- si）和射血分数（LVEF）。结果：1年后，只有恩帕格列净组的E波峰速度显著降低（平均差值= -12.76 cm/s, 95% CI: -16.26至-9.27,p）。结论：与达格列净相比，恩帕格列净对左室重构标志物的影响更明显，包括E波峰速度、E/ E’比和LV- si。这些发现提示了SGLT2is之间潜在的疗效差异，强调了未来随机比较研究的必要性。

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引用次数: 0

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 急性st段抬高型心肌梗死发生后循证医学联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 : 2025-09-15 DOI: 10.1002/clc.70195

A. Evelo, E. Leegwater, W. J. R. Rietdijk, T. D. Warning, C. E. Schotborgh, L. E. Visser

Aim

To evaluate sex-based differences in the prescription of the combination of evidence-based medicine (cEBM) at discharge after an acute ST-elevation myocardial infarction (STEMI). Secondly, we analysed risk factors for the absence of cEBM after discharge, and examined sex differences in adverse events.

Methods

This retrospective cohort study compared women to men who were admitted with an acute STEMI at Haga Teaching Hospital between January 2017 and June 2023. The primary outcome was cEBM, defined as an active prescription of the combination of acetylsalicylic acid, P2Y₁₂-inhibitor, ACEi/ARB, beta-blocker, and statin/ezetimibe on the day after discharge.

Results

Among 1467 patients (27% women), women were older than men (74 years vs. 65 years, p < 0.001). cEBM was less often prescribed to women than men (66.0% vs. 72.8%, p = 0.013), primarily due to ACEi/ARB (82.1% vs. 87.7%, p = 0.007) and statins (90.2% vs. 95.2%, p = 0.001). In a multivariable logistic regression analysis, female sex was not associated with the absence of cEBM (Odds Ratio (OR) = 1.01, 95% confidence interval [95% CI]: 0.73–1.39). Other confounders such as increasing age, decreasing haemoglobin, and oral anticoagulants were correlated with the absence of cEBM.

Conclusions

A smaller proportion of women were prescribed cEBM post-STEMI compared to men. However, this difference disappeared when controlled for other confounders. Also, women remained to have a higher chance for a stroke or death at 6 months post-discharge. These findings highlight the need for further research into sex disparities and their underlying confounders in the field of evidence-based medicine after an acute STEMI.

目的评价急性st段抬高型心肌梗死（STEMI）出院时循证医学联合用药（cEBM）处方的性别差异。其次，我们分析了出院后缺乏cEBM的危险因素，并检查了不良事件的性别差异。方法：本回顾性队列研究比较了2017年1月至2023年6月期间在Haga教学医院因急性STEMI入院的女性和男性。主要终点是cEBM，定义为出院后第一天乙酰水杨酸、p2y12抑制剂、ACEi/ARB、受体阻滞剂和他汀类药物/依折替米贝联合使用的有效处方。结果1467例患者（27%为女性）中，女性年龄大于男性（74岁比65岁，p < 0.001）。女性使用cEBM的频率低于男性（66.0% vs. 72.8%, p = 0.013），主要是由于ACEi/ARB （82.1% vs. 87.7%, p = 0.007）和他汀类药物（90.2% vs. 95.2%, p = 0.001）。在多变量logistic回归分析中，女性与缺乏cEBM无关（优势比(OR) = 1.01, 95%可信区间[95% CI]: 0.73-1.39）。其他混杂因素如年龄增长、血红蛋白下降和口服抗凝剂与cEBM的缺失相关。结论：与男性相比，女性在stemi后服用cEBM的比例较小。然而，当控制其他混杂因素时，这种差异就消失了。此外，女性在出院后6个月中风或死亡的几率仍然较高。这些发现强调了在急性STEMI后的循证医学领域对性别差异及其潜在混杂因素进行进一步研究的必要性。

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引用次数: 0