Clinical Cardiology最新文献_第6页

Prevalence of Pulmonary Hypertension in Individuals With Heart Failure: A Systematic Review and Meta-Analysis 心力衰竭患者肺动脉高压患病率：系统回顾和荟萃分析

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2025-08-29 DOI: 10.1002/clc.70197

Maaedah Khan, Rhea Suribhatla, Jak Spencer, Nadia Daniel, Alex Pitcher, Christiana Kartsonaki

Aims

Heart failure (HF) is a leading cause of hospitalizations worldwide. HF can lead to pulmonary hypertension (PH) and co-occurrence of HF and PH is associated with a poor prognosis. This systematic review and meta-analysis aim to estimate the prevalence of PH in patients with HF.

Methods

We searched MEDLINE and EMBASE for studies reporting the prevalence of PH amongst HF patients. A meta-analysis of PH prevalence, including subgroup analyses, was conducted using a random-effects model. Subgroup analyses and meta-regressions by comorbidities and patient characteristics were done. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Tool.

Results

Fifty-four papers with 259 665 HF patients were included, of which 46 004 also had PH. The overall PH prevalence estimate in individuals with HF is 46.6% (95% CI: 39.6%–53.7%). Prevalence varied by diagnostic method, with studies using right heart catheterization reporting the highest estimates (62.5%; 52.0%–72.0%), hospital recorded data the lowest (18.4%; 14.4%–23.3%), and echocardiography 45.7% (37.1%–54.6%). Prevalence was higher in HF with preserved (47.2%; 34.8%–60.0%) than reduced ejection fraction (35.7%; 22.6%–51.3%). Prospective studies show higher estimates (60.1%; 50.7%–68.8%) than retrospective studies (37.3%; 29.5%–45.9%).

Conclusions

This is the first systematic review and meta-analysis investigating the prevalence of PH in HF patients and shows that the prevalence of PH in this patient population is strikingly high. There is notable variability in estimates reported by different studies, largely attributed to differences in the diagnostic method of PH. Future studies with robust, standardized methodologies are needed to estimate prevalence more accurately.

目的心力衰竭（HF）是世界范围内住院治疗的主要原因。心衰可导致肺动脉高压（PH），同时出现心衰和PH与预后不良相关。本系统综述和荟萃分析旨在估计心衰患者中PH的患病率。方法：我们检索MEDLINE和EMBASE中关于HF患者中PH患病率的研究。采用随机效应模型对PH患病率进行meta分析，包括亚组分析。根据合并症和患者特征进行亚组分析和meta回归。使用乔安娜布里格斯研究所关键评估工具评估研究质量。结果纳入54篇论文，共259 665例HF患者，其中46 004例同时患有PH。HF患者的总体PH患病率估计为46.6% （95% CI: 39.6%-53.7%）。不同诊断方法的患病率不同，使用右心导管的研究报告的患病率最高（62.5%;52.0%-72.0%），医院记录的数据最低（18.4%;14.4%-23.3%），超声心动图的患病率为45.7%（37.1%-54.6%）。保留心力衰竭的患病率（47.2%;34.8% ~ 60.0%）高于射血分数降低的患病率（35.7%;22.6% ~ 51.3%）。前瞻性研究的估计值（60.1%;50.7%-68.8%）高于回顾性研究（37.3%;29.5%-45.9%）。这是第一个系统回顾和荟萃分析，调查了HF患者中PH的患病率，并表明该患者人群中PH的患病率非常高。不同研究报告的估计值存在显著差异，这主要归因于ph诊断方法的差异。未来需要采用可靠的标准化方法进行研究，以更准确地估计患病率。

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引用次数: 0

Atrial Fibrillation and Obstructive Sleep Apnea: Do Mortality Trends Reflect Disease Burden or Diagnostic Gaps? 心房颤动和阻塞性睡眠呼吸暂停：死亡率趋势反映疾病负担还是诊断差距？

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2025-08-28 DOI: 10.1002/clc.70200

Naoya Kataoka, Teruhiko Imamura

The authors demonstrated a striking and consistent rise in atrial fibrillation (AF)–related mortality involving obstructive sleep apnea (OSA), particularly among elderly, female, rural, and minority populations [1]. This important analysis highlights the growing public health burden of AF–OSA overlap. However, several issues merit further clarification and discussion.

The authors report a steep increase in AF-related mortality involving OSA over the past two decades [1]. However, as AF prevalence and mortality have also generally increased in the U.S. population [2], it is unclear whether the observed trend is specific to patients with comorbid OSA or merely reflects overall AF epidemiology. A comparative analysis of mortality trends in AF patients without OSA would be helpful to determine the additive risk associated with OSA.

During the study period (1999–2020), catheter ablation became increasingly adopted for rhythm control in AF [3]. Recent studies suggest that AF ablation is associated with improved long-term outcomes, particularly in younger male patients [4]. Yet, despite these advances, AF-related mortality in patients with OSA continued to rise. How do the authors interpret this apparent contradiction? Were these procedures less commonly used or less effective in the OSA subgroup?

The study identifies AF (ICD-10 I48.x) as the “underlying” cause of death and OSA (G47.33) as a “contributing” condition [1]. However, the clinical circumstances in which AF is recorded as the primary cause of death—distinct from its role as a comorbidity in stroke, heart failure, or sudden death—are not well defined. It would be informative to clarify how “AF-related mortality” was operationalized in this study and whether misclassification or variation in coding practices may have influenced the observed trends.

The authors correctly point out the rising burden of AF-related mortality in the presence of OSA [1]. Yet over the same period, mortality from stroke and heart failure—two major downstream complications of AF—has generally declined, partly due to improvements in anticoagulation and HF management [5]. This discrepancy raises the question of whether the increase in AF-related deaths reflects actual clinical deterioration or improved documentation of AF on death certificates.

While the use of CDC WONDER provides valuable national-level insights [1], the reliance on death certificate data introduces several limitations. OSA is often underdiagnosed, particularly among women, minorities, and older adults—groups in whom mortality increases were most pronounced. Additionally, data on OSA severity, AF subtype, comorbidities (e.g., heart failure, chronic kidney disease), and continuous positive airway pressure adherence were not available. These unmeasured variables may have played an important role in shaping th

作者证明了心房颤动（AF）相关的死亡率显著且持续上升，包括阻塞性睡眠呼吸暂停（OSA），特别是在老年人、女性、农村和少数民族人群中。这一重要分析凸显了AF-OSA重叠造成的日益加重的公共卫生负担。然而，有几个问题值得进一步澄清和讨论。作者报告说，在过去的20年里，与呼吸暂停相关的死亡率急剧上升。然而，由于房颤的患病率和死亡率在美国人群中也普遍增加，目前尚不清楚观察到的趋势是针对合并OSA的患者，还是仅仅反映了房颤的总体流行病学。对无OSA的房颤患者的死亡率趋势进行比较分析将有助于确定与OSA相关的附加风险。在研究期间（1999-2020），导管消融越来越多地被用于房颤心律控制。最近的研究表明，房颤消融与长期预后的改善有关，特别是在年轻男性患者中。然而，尽管取得了这些进展，阻塞性睡眠呼吸暂停患者与房颤相关的死亡率仍在继续上升。作者如何解释这个明显的矛盾？这些治疗方法在OSA亚组中是否较少使用或效果较差？该研究确定了AF （icd - 10i48）。x)为死亡的“潜在”原因，而呼吸暂停（G47.33）为“促成”病况[1]。然而，将房颤记录为主要死亡原因的临床情况——不同于其作为卒中、心力衰竭或猝死的合并症的作用——并没有很好的定义。澄清“af相关死亡率”在本研究中是如何操作的，以及错误分类或编码实践的变化是否可能影响观察到的趋势，将是有益的。作者正确地指出，在存在阻塞性睡眠呼吸暂停的情况下，af相关死亡率的负担正在上升。然而，在同一时期，中风和心力衰竭（af的两大下游并发症）的死亡率普遍下降，部分原因是抗凝和心衰管理的改善。这一差异提出了一个问题，即AF相关死亡人数的增加是反映了实际的临床恶化，还是反映了死亡证明上AF记录的改善。虽然CDC WONDER的使用提供了有价值的国家级见解，但对死亡证明数据的依赖带来了一些限制。阻塞性睡眠呼吸暂停经常被误诊，特别是在妇女、少数民族和老年人群体中，他们的死亡率增加最为明显。此外，没有关于OSA严重程度、房颤亚型、合并症（如心力衰竭、慢性肾脏疾病）和持续气道正压依从性的数据。这些无法测量的变量可能在形成观察到的趋势方面发挥了重要作用。作者声明无利益冲突。

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引用次数: 0

Comments on the Observational Study on Statin Intensity Following CABG 冠状动脉搭桥后他汀类药物强度观察研究评论

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2025-08-28 DOI: 10.1002/clc.70198

Murat Abdulhamit Ercişli, Ahmet Süsenbük

We read with interest the article titled “Effect of Statin Intensity on Cardiovascular Outcomes and Survival Following Coronary Artery Bypass Grafting” recently published in Clinical Cardiology [1]. The study addresses a crucial area concerning optimal lipid management in patients undergoing Coronary Artery Bypass Grafting (CABG), particularly the impact of statin intensity on long-term cardiovascular outcomes.

While we commend the authors for conducting this relevant and timely observational study, we would like to raise several points for clarification and discussion, which might significantly impact the interpretation of the results:

First, we note considerable discrepancies in patient numbers between the comparison groups: No-statin (156 patients), low/moderate-intensity statin (1301 patients), and high-intensity statin (397 patients). Although the authors acknowledged this statistical concern due to the observational study design, such imbalanced group sizes may inherently introduce bias and confounding, limiting the reliability and generalizability of the conclusions.

Second, the authors mentioned that older patients and women were less likely to receive statins or were prescribed lower-intensity statins. This finding raises concerns regarding potential selection bias or disparities in clinical practice. It would be helpful for the authors to elaborate further on possible reasons for these discrepancies and their potential influence on clinical outcomes.

Third, the study did not adequately track patient compliance or continued usage of statins over the follow-up period, which is pivotal to understanding the true impact of the medication. Given that statin adherence significantly influences clinical outcomes, this limitation might have considerably affected the study's conclusions.

Additionally, the authors defined Major Adverse Cardiovascular Events (MACE) broadly to include acute coronary syndrome (ACS), cerebrovascular accident (CVA), and cardiovascular mortality. However, the study did not consider graft occlusion rates directly, which could significantly affect revascularization rates and subsequent MACE. Including graft occlusion data might have provided additional critical insights into statin efficacy.

Lastly, the timing of lipid measurements, which were taken variably between 1 and 3 months postoperatively, could introduce measurement bias. This variability in follow-up LDL measurements might limit the robustness of the conclusions drawn about the efficacy of lipid management.

Despite these concerns, the findings strongly suggest potential long-term benefits associated with high-intensity statin therapy in reducing cardiovascular risks post-CABG, especially evident beyond 2 years. This underscores the importance of robust randomized controlled trials to conclusively establish the most effective lipid-lowering strategies in post-CABG patients.

We appreciate the authors'

我们饶有兴趣地阅读了最近发表在《临床心脏病学b[1]》上的一篇题为“他汀类药物强度对冠状动脉搭桥术后心血管结局和生存的影响”的文章。该研究解决了冠状动脉旁路移植术（CABG）患者最佳脂质管理的关键领域，特别是他汀类药物强度对长期心血管预后的影响。虽然我们赞扬作者进行了这项相关且及时的观察性研究，但我们想提出几点澄清和讨论，这可能会对结果的解释产生重大影响：首先，我们注意到对照组之间患者数量的显著差异：无他汀类药物（156例），低/中等强度他汀类药物（1301例）和高强度他汀类药物（397例）。尽管作者承认由于观察性研究设计，这种不平衡的群体规模可能固有地引入偏倚和混淆，限制了结论的可靠性和可推广性。其次，作者提到，老年患者和女性接受他汀类药物治疗或服用低强度他汀类药物的可能性较小。这一发现引起了人们对临床实践中潜在的选择偏差或差异的关注。这将有助于作者进一步阐述这些差异的可能原因及其对临床结果的潜在影响。第三，该研究没有充分跟踪患者的依从性或在随访期间继续使用他汀类药物，这对了解药物的真正影响至关重要。考虑到他汀类药物的依从性显著影响临床结果，这一限制可能在很大程度上影响了研究的结论。此外，作者将主要心血管不良事件（MACE）广义地定义为包括急性冠状动脉综合征（ACS）、脑血管意外（CVA）和心血管死亡。然而，该研究没有直接考虑移植物闭塞率，这可能会显著影响血运重建率和随后的MACE。包括移植物闭塞数据可能为他汀类药物的疗效提供了额外的关键见解。最后，脂质测量的时间在术后1至3个月不等，可能会导致测量偏差。这种随访LDL测量的可变性可能会限制脂质管理有效性结论的稳健性。尽管存在这些担忧，但研究结果强烈表明，高强度他汀类药物治疗在降低冠脉搭桥后心血管风险方面具有潜在的长期益处，特别是在2年以上。这强调了可靠的随机对照试验对于最终确定cabg后患者最有效的降脂策略的重要性。我们感谢作者在强调这一关键问题上所做的努力，并期待进一步的研究解决这些关注的领域。

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引用次数: 0

Addressing Underrepresented Factors in Cardiovascular Mortality Trends Among Chronic Kidney Disease Patients: A Call for Comprehensive Intervention Strategies 解决慢性肾病患者心血管死亡趋势中代表性不足的因素：呼吁采取综合干预策略

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2025-08-27 DOI: 10.1002/clc.70199

Shaher Yar, Zahin Shahriar, Sumaiya Ahmed, Muhammad Shehzad Asif

<p>I read with great interest the comprehensive retrospective analysis by Ahmad et al. examining cardiovascular mortality trends in chronic kidney disease (CKD) patients from 1999 to 2020 [<span>1</span>]. While the authors excellently document demographic disparities and temporal patterns in cardiovascular mortality, their work highlights several critical gaps that warrant further discussion, particularly regarding the underutilization of evidence-based interventions and the impact of emerging therapeutic paradigms on cardiovascular outcomes in CKD patients.</p><p>The study period (1999−2020) captures a transformative era in CKD management, yet the authors do not adequately address how the introduction of novel therapies may explain certain mortality trends. The 2024 KDIGO guidelines now emphasize SGLT2 inhibitors as cornerstone therapy, showing remarkable cardiovascular benefits in CKD populations [<span>2</span>]. Recent meta-analyses demonstrate that SGLT2 inhibitors reduce major adverse cardiovascular events by 9%−14% in CKD patients, with particularly strong effects on heart failure hospitalization and cardiovascular death [<span>3</span>].</p><p>Similarly, the emergence of non-steroidal mineralocorticoid receptor antagonists (MRAs) like finerenone has revolutionized CKD-cardiovascular care. The pooled FIDELITY analysis demonstrated a 14% reduction in cardiovascular death, myocardial infarction, stroke, and heart failure hospitalization, with a 23% reduction in CKD progression [<span>4</span>]. These therapeutic advances, introduced toward the end of the study period, likely contributed to the stabilization of mortality rates observed by Ahmad et al.</p><p>The significant racial and geographic disparities documented by the authors reflect deeper healthcare access issues that extend beyond demographic risk factors. Research demonstrates that up to 98% of people with kidney failure in low-income regions cannot access kidney replacement therapy, compared to 30% in high-income countries [<span>5</span>]. Within the United States, these disparities manifest as differential access to nephrology care, with rural and minority populations experiencing delays in specialist referral and reduced access to evidence-based therapies [<span>6</span>].</p><p>The authors' observation that non-metropolitan areas exhibited higher age-adjusted mortality rates (8.6 vs. 8.1 per 100 000) underscores the critical role of healthcare infrastructure in cardiovascular outcomes. Studies show that less than one-third of community healthcare settings in resource-limited areas can access essential diagnostics for CKD monitoring, further contributing to delayed intervention and poor outcomes [<span>5</span>].</p><p>The study period concludes in 2020, capturing the early COVID-19 pandemic impact. Recent evidence demonstrates that COVID-19 significantly amplifies cardiovascular risk in CKD patients, with a twofold increased risk of cardiovascular death within 30 days and a 64

我饶有兴趣地阅读了Ahmad等人对1999年至2020年慢性肾脏疾病（CKD）患者心血管死亡率趋势的全面回顾性分析[10]。虽然作者出色地记录了心血管死亡率的人口差异和时间模式，但他们的工作强调了几个值得进一步讨论的关键差距，特别是关于循证干预措施的利用不足和新兴治疗范式对CKD患者心血管结局的影响。研究期间（1999 - 2020年）捕获了CKD管理的变革时代，但作者没有充分说明新疗法的引入如何解释某些死亡率趋势。2024年KDIGO指南现在强调SGLT2抑制剂作为基础治疗，在CKD人群中显示出显着的心血管益处。最近的荟萃分析表明，SGLT2抑制剂可使CKD患者的主要不良心血管事件减少9% - 14%，对心力衰竭住院和心血管死亡的影响尤其明显。类似地，非甾体矿物皮质激素受体拮抗剂（MRAs）的出现，如芬烯酮，已经彻底改变了ckd心血管护理。合并FIDELITY分析显示，心血管死亡、心肌梗死、中风和心力衰竭住院率降低14%，CKD进展率降低23%。这些治疗方面的进步，在研究结束时被引入，可能有助于艾哈迈德等人观察到的死亡率的稳定。作者记录的显著的种族和地理差异反映了超越人口危险因素的更深层次的医疗保健获取问题。研究表明，低收入地区高达98%的肾衰竭患者无法获得肾脏替代治疗，而高收入国家的这一比例为30%。在美国，这些差异表现为获得肾病护理的机会不同，农村和少数民族人口在专家转诊方面出现延误，获得循证治疗的机会减少[10]。作者观察到，非大都市地区表现出更高的年龄调整死亡率（每10万人8.6比8.1），这强调了医疗基础设施在心血管结局中的关键作用。研究表明，在资源有限的地区，只有不到三分之一的社区医疗机构能够获得CKD监测的基本诊断，这进一步导致了干预延迟和预后不良。研究期将于2020年结束，涵盖COVID-19大流行的早期影响。最近的证据表明，COVID-19显著增加了CKD患者的心血管风险，与非CKD患者相比，30天内心血管死亡风险增加了两倍，总体风险增加了64%。这种大流行的影响可能影响了2020年观察到的死亡率趋势，是分析中未解决的一个重要混杂因素。Ahmad等人观察到的稳定的死亡率趋势与一般人群中心血管死亡率的下降形成鲜明对比，表明CKD患者并没有从心血管护理的进步中同等受益。这种差异强调了几个紧迫的优先事项：首先，需要实施科学研究来优化循证治疗的提供。研究表明，SGLT2抑制剂、MRAs和RAAS抑制剂联合治疗可以提供额外的心血管保护，但摄取仍然不是最佳的。其次，作者确定的针对高危人群的有针对性的干预措施至关重要。非西班牙裔黑人或非洲裔美国患者的死亡率明显较高（15.37 / 10万），这需要适应文化的心血管风险降低计划和改善专科护理的可及性。第三，医疗保健系统必须解决CKD患者心血管结局的地理和种族差异造成的基础设施差距。Ahmad等人对CKD患者心血管疾病死亡率趋势提供了有价值的流行病学见解。然而，他们记录的稳定死亡率，与一般人群的改善相比，强调了迫切需要全面的干预策略，以解决治疗利用不足、医疗保健获取障碍和系统实施循证护理的问题。只有通过这种多方面的方法，我们才有希望改善数百万患有慢性肾病的美国人的心血管预后。Shaher Yar构思、撰写并修改了手稿。Zahin Shahriar博士对手稿进行了验证、编辑和编辑。Sumaiya Ahmed博士审阅了手稿。Muhammad Shehzad Asif博士监督了这项研究。作者声明无利益冲突。

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引用次数: 0

Correction to “Physician and Patient Preferences for Oral Anticoagulation Therapy Decision Making in Atrial Fibrillation: Results From a National Best–Worst Scaling Survey in Türkiye” 对“房颤患者和医生对口服抗凝治疗决策的偏好：来自<s:1> rkiye全国最佳最差量表调查的结果”的修正

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2025-08-21 DOI: 10.1002/clc.70193

Pref-Af Study Group

K. Kılıckesmez, D. Aras, M. Degertekin, et al., “Physician and Patient Preferences for Oral Anticoagulation Therapy Decision Making in Atrial Fibrillation: Results From a National Best–Worst Scaling Survey in Türkiye,” Clinical Cardiology 47 (2024): e70038. https://doi.org/10.1002/clc.70038

In the published version of this article, the Pref-Af Study Group was missing in the author by-line. The correct author list should be:

K. Kılıckesmez, D. Aras, M. Degertekin, N. Ozer, B. Hacibedel, K. Helvacioglu, U. Koc, B. Ozdengulsun, E. Dundar Ahi, Pref-Af Study Group, and O. Ergene

Additionally, the Acknowledgments section has been updated as follows:

Medical writing and editorial support was provided by Ferda Kiziltas at remedium Consulting Group. The Pref-Af study group contributed to this study during the data collection and the names of the contributors as follows: Betul Balaban Kocas, Firdevs Aysenur Ekizler, Ayse Colak, Ahmet Anil Baskurt, Erdal Durmus, and Ugur Nadir Karakulak.

We apologize for this error.

K. Kılıckesmez， D. Aras， M. Degertekin，等，“心房颤动患者对口服抗凝治疗决策的偏好：来自全国最佳-最差量表调查的结果”，临床心脏病学47 (2024):e700 - 38。https://doi.org/10.1002/clc.70038In在这篇文章的发布版本中，作者署名中缺少了pre - af研究小组。正确的作者名单应该是：Kılıckesmez， D. Aras， M. Degertekin， N. Ozer， B. Hacibedel， K. Helvacioglu， U. Koc， B. ozdengursun， E. Dundar Ahi， Pref-Af研究小组和O. ergene此外，致谢部分更新如下：医学写作和编辑支持由remedium咨询集团的Ferda Kiziltas提供。Pref-Af研究组在数据收集过程中为本研究做出了贡献，贡献者的名字如下：Betul Balaban Kocas， Firdevs Aysenur Ekizler, Ayse Colak, Ahmet Anil Baskurt， Erdal Durmus和Ugur Nadir Karakulak。我们为这个错误道歉。

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引用次数: 0

Mortality Trends Associated With Acute Myocardial Infarction and Psychoactive Substance Use in Older Adults: A US Nationwide Analysis (1999–2020) 老年人急性心肌梗死和精神活性物质使用相关的死亡率趋势：美国全国范围的分析（1999-2020）

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2025-08-11 DOI: 10.1002/clc.70191

Muhammad Hamza Shuja, Ramish Hannat, Ahmad Shahid, Komail Khalid Meer, Ayesha Mubbashir, Maliha Edhi, Irfan Ullah, Ahmad Alareed, Nitish Behary Paray, Raheel Ahmed, Bernardo Cortese, Michael E. Hall

Background

Acute myocardial infarction (AMI) remains a leading cause of mortality in the USA, particularly among individuals aged 65 and older. There is limited research about the association between psychoactive substance use and cardiovascular death due to AMI. This study aims to analyze trends in AMI-related mortality among older adults (aged ≥ 65) associated with psychoactive substance use in the USA from 1999 to 2020, with a focus on demographic and geographic variations.

Methods

We conducted a descriptive analysis using death certificates from the CDC's WONDER database. Data were extracted for age, sex, race/ethnicity, urban–rural status, and geographic region. Crude mortality rates and AAMR were calculated, and temporal trends were assessed using Joinpoint regression.

Results

Between 1999 and 2020, there were 231 359 AMI-related deaths among older adults with substance use disorders. Men (39.2) had a markedly higher mortality rate than women (15.0). Mortality rates increased across all age groups, with the most pronounced rise in those aged 85 and older (33.9). Metropolitan areas (22.3) experienced lower mortality rates than nonmetropolitan areas (37.9). The Midwest (32.3) consistently recorded the highest mortality rates, followed by the Northeast (25.0), South (24.5), and West (18.7).

Conclusion

The study reveals notable temporal trends in AMI mortality among older adults with psychoactive substance use, highlighting significant demographic and regional disparities. These findings underscore the need for targeted interventions to address this growing public health issue.

在美国，急性心肌梗死（AMI）仍然是导致死亡的主要原因，尤其是在65岁及以上的人群中。关于精神活性物质使用与AMI所致心血管死亡之间关系的研究有限。本研究旨在分析1999年至2020年美国老年人（≥65岁）与精神活性物质使用相关的ami相关死亡率趋势，重点关注人口统计学和地理差异。方法采用CDC WONDER数据库中的死亡证明进行描述性分析。提取年龄、性别、种族/民族、城乡状况和地理区域的数据。计算粗死亡率和AAMR，并使用连接点回归评估时间趋势。结果1999年至2020年期间，老年物质使用障碍患者中有231 359例ami相关死亡。男性（39.2）的死亡率明显高于女性（15.0）。所有年龄组的死亡率都有所上升，其中85岁及以上年龄组的死亡率上升最为明显（33.9%）。大都市地区（22.3）的死亡率低于非大都市地区（37.9）。死亡率最高的地区依次是中西部（32.3人）、东北部（25.0人）、南部（24.5人）、西部（18.7人）。结论该研究揭示了使用精神活性物质的老年人AMI死亡率的显著时间趋势，突出了显著的人口和地区差异。这些发现强调需要有针对性的干预措施来解决这一日益严重的公共卫生问题。

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引用次数: 0

Can Sodium-Glucose Co-Transporter-2 Inhibitors Improve Sleep Quality, Anxiety, and Quality of Life in Patients With Heart Failure? 钠-葡萄糖共转运蛋白-2抑制剂能改善心力衰竭患者的睡眠质量、焦虑和生活质量吗？

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2025-08-05 DOI: 10.1002/clc.70190

Ilke Erbay, Naile Eris Gudul, Ahmet Furkan Suner, Pelin Aladag, Umit Karacar, Ahmet Avci

Background

Sodium-glucose co-transporter-2 (SGLT2) inhibitors improve cardiovascular outcomes in heart failure (HF), but their effect on sleep quality (SQ) and patient-centered outcomes remains unclear.

Objective

This study aims to evaluate the impact of SGLT2 inhibitor use on SQ, anxiety, and quality of life in patients with HF.

Methods

This longitudinal observational study included 95 HF patients grouped by SGLT2 inhibitor use. A total of 79 patients (SGLT2 inhibitor group: 33; non-SGLT2 inhibitor group: 46) completed a 6-month follow-up. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), anxiety with the Beck Anxiety Inventory (BAI), and quality of life with the Short Form-36 (SF-36). Subgroup analyses were conducted based on left ventricular ejection fraction (LVEF), and logistic regression was used to identify predictors of PSQI improvement.

Results

At baseline, PSQI scores were slightly better in the SGLT2 inhibitor group (p = 0.036), while BAI and SF-36 scores were similar. At follow-up, the SGLT2 inhibitor group showed significant improvements in PSQI (p < 0.001) and BAI (p = 0.002), whereas no significant changes were observed in the non-SGLT2 inhibitor group for either PSQI (p = 0.698) or BAI (p = 0.373). PSQI improvement was observed in SGLT2 users regardless of LVEF. In multivariate analysis, SGLT2 inhibitor use was an independent predictor of PSQI improvement (adjusted OR: 4.255; p = 0.010).

Conclusion

SGLT2 inhibitor use was associated with improved SQ and reduced anxiety in patients with HF, suggesting symptom-related benefits beyond cardiovascular effects.

钠-葡萄糖共转运蛋白-2 （SGLT2）抑制剂可改善心力衰竭（HF）患者的心血管结局，但其对睡眠质量（SQ）和以患者为中心的结局的影响尚不清楚。目的本研究旨在评估使用SGLT2抑制剂对心衰患者SQ、焦虑和生活质量的影响。方法对95例HF患者进行纵向观察研究，按SGLT2抑制剂使用情况分组。79例患者(SGLT2抑制剂组33例；非sglt2抑制剂组：46例)完成了6个月的随访。使用匹兹堡睡眠质量指数（PSQI）评估睡眠质量，使用贝克焦虑量表（BAI）评估焦虑，使用SF-36评估生活质量。根据左室射血分数（LVEF）进行亚组分析，并采用logistic回归确定PSQI改善的预测因素。结果在基线时，SGLT2抑制剂组PSQI评分略好（p = 0.036），而BAI和SF-36评分相似。在随访中，SGLT2抑制剂组PSQI （p < 0.001）和BAI （p = 0.002）均有显著改善，而非SGLT2抑制剂组PSQI （p = 0.698）和BAI （p = 0.373）均无显著变化。无论LVEF如何，SGLT2患者PSQI均有改善。在多变量分析中，SGLT2抑制剂的使用是PSQI改善的独立预测因子(调整OR: 4.255；p = 0.010)。结论：使用SGLT2抑制剂与心衰患者SQ改善和焦虑减少相关，提示症状相关的益处超出心血管效应。

{"title":"Can Sodium-Glucose Co-Transporter-2 Inhibitors Improve Sleep Quality, Anxiety, and Quality of Life in Patients With Heart Failure?","authors":"Ilke Erbay, Naile Eris Gudul, Ahmet Furkan Suner, Pelin Aladag, Umit Karacar, Ahmet Avci","doi":"10.1002/clc.70190","DOIUrl":"https://doi.org/10.1002/clc.70190","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Sodium-glucose co-transporter-2 (SGLT2) inhibitors improve cardiovascular outcomes in heart failure (HF), but their effect on sleep quality (SQ) and patient-centered outcomes remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aims to evaluate the impact of SGLT2 inhibitor use on SQ, anxiety, and quality of life in patients with HF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This longitudinal observational study included 95 HF patients grouped by SGLT2 inhibitor use. A total of 79 patients (SGLT2 inhibitor group: 33; non-SGLT2 inhibitor group: 46) completed a 6-month follow-up. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), anxiety with the Beck Anxiety Inventory (BAI), and quality of life with the Short Form-36 (SF-36). Subgroup analyses were conducted based on left ventricular ejection fraction (LVEF), and logistic regression was used to identify predictors of PSQI improvement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At baseline, PSQI scores were slightly better in the SGLT2 inhibitor group (<i>p</i> = 0.036), while BAI and SF-36 scores were similar. At follow-up, the SGLT2 inhibitor group showed significant improvements in PSQI (<i>p</i> < 0.001) and BAI (<i>p</i> = 0.002), whereas no significant changes were observed in the non-SGLT2 inhibitor group for either PSQI (<i>p</i> = 0.698) or BAI (<i>p</i> = 0.373). PSQI improvement was observed in SGLT2 users regardless of LVEF. In multivariate analysis, SGLT2 inhibitor use was an independent predictor of PSQI improvement (adjusted OR: 4.255; <i>p</i> = 0.010).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>SGLT2 inhibitor use was associated with improved SQ and reduced anxiety in patients with HF, suggesting symptom-related benefits beyond cardiovascular effects.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 8","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70190","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144773999","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

Evaluation of the Presence of Native Valvular Disease in Patients With Atrial Fibrillation Using the EHRA (Evaluated Heartvalves, Rheumatic, or Artificial) Classification 使用EHRA（评估心瓣膜、风湿性或人工）分类评估心房颤动患者存在先天性瓣膜疾病

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2025-07-31 DOI: 10.1002/clc.70172

Antonio Escolar Conesa, María Asunción Esteve-Pastor, Vanessa Roldán, Eva Soler Espejo, José Miguel Rivera-Caravaca, Pablo Gil Pérez, Eduardo González Lozano, José María Arribas Leal, Sergio Cánovas López, Daniel Saura Espín, María José Oliva Sandoval, Eduardo Pinar Bermúdez, Juan García De Lara, Gregory Y. H. Lip, Francisco Marín

Background

Atrial fibrillation (AF) in association with native valvular heart disease (VHD) is very common and both entities perpetuate each other due to volume and pressure overload. In 2017, the new EHRA classification (Evaluated Heartvalves, Rheumatic or Artificial) was proposed: EHRA 1 (mechanical prostheses or moderate/severe mitral stenosis), EHRA 2 (native valvular involvement or biological prosthesis) and EHRA 3 (without valve disease). The objective was to analyze the clinical characteristics as well as adverse events in the follow-up of AF patients under oral anticoagulation classified according EHRA classification.

Methods

A multicenter retrospective observational descriptive study was designed and collected clinical, analytical, echocardiographic characteristics as well as adverse events in the follow-up of patients with AF who start oral anticoagulation.

Results

1.399 patients were included (mean age 75.3 ± 9.9 years; 659 (47.1%) male), of whom, 63% were classified as EHRA 2. After a median follow-up of 910 (IQR 730−1018) days, native EHRA 2 patients had higher event rates/patient-year as well as a higher total rate of adverse events such as cardiovascular mortality (5.5% vs. 1.1% event/patient-year; 8.7% vs. 1.1% p < 0.001) and major adverse cardiovascular events (MACE) (8.9% vs. 3.4% event/patient-year; 14.2% vs. 3.1% p < 0.001), compared with EHRA 3 patients. Multivariate logistic regression analysis showed that native EHRA 2 group was independently associated with all major adverse events.

Conclusion

In anticoagulated AF patients, those with native valve involvement (EHRA 2) have a worse prognosis than patients without valve involvement (EHRA 3). The presence of native valvular disease is shown as an independent risk factor for all-cause mortality, major bleeding, cardiovascular mortality, ACS, heart failure, and MACE.

背景房颤（AF）与先天性瓣膜性心脏病（VHD）相关是非常常见的，由于容量和压力过载，这两种疾病相互延续。2017年，提出了新的EHRA分类（评估心脏瓣膜，风湿性或人工）：EHRA 1（机械假体或中度/重度二尖瓣狭窄），EHRA 2（天然瓣膜受累或生物假体）和EHRA 3（无瓣膜疾病）。目的分析按EHRA分级口服抗凝治疗的房颤患者的临床特点及随访不良事件。方法设计多中心回顾性观察性描述性研究，收集房颤患者口服抗凝治疗后的临床、分析、超声心动图特征及随访不良事件。结果纳入患者1.399例(平均年龄75.3±9.9岁；659例（男性47.1%），其中63%为EHRA 2级。中位随访910 （IQR 730 - 1018）天后，原生EHRA 2患者的事件发生率/患者-年更高，心血管死亡率等不良事件的总发生率也更高(5.5% vs 1.1%事件/患者-年；8.7% vs. 1.1% p < 0.001)和主要不良心血管事件（MACE） (8.9% vs. 3.4%事件/患者-年；14.2%对3.1% p < 0.001)，与EHRA 3型患者相比。多因素logistic回归分析显示，原生EHRA 2组与所有主要不良事件独立相关。结论在抗凝房颤患者中，先天性瓣膜受累（EHRA 2）患者预后较无瓣膜受累（EHRA 3）患者差。原生瓣膜疾病的存在是全因死亡率、大出血、心血管死亡率、ACS、心力衰竭和MACE的独立危险因素。

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引用次数: 0

Trends in Cardiovascular Mortality in Patients With Chronic Kidney Disease From 1999 to 2020: A Retrospective Study in the United States 1999年至2020年慢性肾脏疾病患者心血管死亡率趋势：美国回顾性研究

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2025-07-31 DOI: 10.1002/clc.70174

Eeman Ahmad, Shoaib Ahmad, Azka Naeem, Shahzaib Ahmed, Maryam Shehzad, Umar Akram, Hamza Ashraf, Obaid Ur Rehman, Irfan Ullah, Raheel Ahmed, Chadi Alraies, Gregg C. Fonarow

Background

Chronic kidney disease (CKD) may be associated with fatal cardiovascular diseases (CVDs). We aim to identify CVD-related mortality trends in patients with CKD in the US, examining the variation by sex, race, and region, and compare them to CVD-related mortality trends in general.

Methods

The CDC-WONDER database was used to obtain age-adjusted mortality rates (AAMRs) per 100,000 population. Annual percent change (APC) and average APC (AAPC) in these rates were calculated using Joinpoint regression and comparisons were done using pairwise comparison.

Results

From 1999 to 2020, a total of 605,384 CVD-related deaths were observed in patients with CKD. The AAMR was almost double in males (11.0) than females (6.3). NH (Non-Hispanic) Blacks or African Americans displayed the highest overall AAMR while NH Asians or Pacific Islanders displayed the lowest. AAMRs also varied substantially by region (Midwest: 8.8; West: 8.6; South: 8.0; Northeast: 7.3). States with the highest AAMR was the District of Columbia. Nonmetropolitan regions exhibited a slightly higher AAMR (8.6) than metropolitan regions (8.1). The AAPC for CVD-related deaths in patients with CKD differed significantly from that of the general population for the entire cohort, across both sexes, as well as among NH Whites, NH Black or African Americans, and Hispanics or Latinos. Regional differences were also observed in the Midwest, Northeast, and West.

Conclusion

Significant differences in CVD-related deaths in patients with CKD were observed. These high-risk groups should be the point of focus for targeted interventions to reduce CVD-related mortality in CKD patients.

背景：慢性肾脏疾病（CKD）可能与致命性心血管疾病（cvd）相关。我们的目标是确定美国CKD患者与cvd相关的死亡率趋势，检查性别、种族和地区的差异，并将其与一般的cvd相关死亡率趋势进行比较。方法采用CDC-WONDER数据库获取每10万人的年龄调整死亡率（AAMRs）。使用Joinpoint回归计算这些比率的年变化百分比（APC）和平均APC (AAPC)，并使用两两比较进行比较。结果1999年至2020年，CKD患者共发生605384例cvd相关死亡。男性的AAMR（11.0）几乎是女性（6.3）的两倍。NH（非西班牙裔）黑人或非裔美国人的总体AAMR最高，而NH亚洲人或太平洋岛民的AAMR最低。aamr也因地区而异(中西部：8.8；西方:8.6;南:8.0;东北:7.3)。AAMR最高的州是哥伦比亚特区。非都市圈的AAMR（8.6）略高于都市圈（8.1）。CKD患者cvd相关死亡的AAPC与整个队列的一般人群有显著差异，无论性别，以及NH白人、NH黑人或非裔美国人、西班牙裔或拉丁裔美国人。中西部、东北部和西部也存在地区差异。结论CKD患者cvd相关死亡有显著性差异。这些高危人群应该成为有针对性的干预措施的重点，以降低CKD患者与cvd相关的死亡率。

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引用次数: 0

Long-Term Effectiveness of a Stent-Less Strategy With Drug Coated Balloon in Coronary Artery Disease: 3-Year Follow-Up of a Prospective All-Comers Observational Study 冠状动脉疾病药物包覆球囊无支架策略的长期有效性：一项前瞻性全患者观察性研究的3年随访

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2025-07-31 DOI: 10.1002/clc.70189

Ludovic Meunier, Simon Eccleshall, Ronan Bakdi, Matthieu Godin, Géraud Souteyrand, Benoît Mottin, Yann Valy, Christian Benoit, Vincent Lordet, Virginie Laurençon, Antoine Milhem, Matthias Waliszewski, Caroline Allix-Béguec

Introduction

Drug-eluting stent (DES) angioplasty is the gold standard treatment for coronary lesions. Drug-coated balloon (DCB) is an option for in-stent restenosis, and has also shown promise for small-calibre coronary artery disease. We evaluated the 3-year effectiveness of a decision algorithm for percutaneous coronary intervention (PCI) that favoured a stent-less strategy (SLS) in primary angioplasty.

Methods

All patients who underwent angioplasty during 1 year were included in a prospective observational study. Patients eligible for SLS first underwent scoring balloon followed by DCB angioplasty or DES in case of mandatory bailout. Patients not eligible for SLS were unstable patients who underwent conventional drug-eluting stenting. The metal index, stent burden, was calculated by stent length divided by the total lesion length. A 36-month follow-up recorded target lesion revascularization (TLR).

Results

Patients eligible for SLS represented 85% (n = 840) of patients who underwent PCI. TLR was required in 2.6% and 6% of patients in the DCB-only and bailout-DES groups, respectively. Median metal index was 0.25 (IQR: 0.5) in patients with TLR. There was a difference between TLR–free survival distributions in the DCB-only and bailout-DES groups (p = 0.016).

Conclusions

The SLS based on a combination of scoring balloon and DCB was effective at 3 years with a low rate of TLR. This rate was higher in patients with stent burden.

Trial Registration: This study was registered with clinicaltrials. gov (NCT03893396, first posted on March 28, 2019).

药物洗脱支架（DES）血管成形术是治疗冠状动脉病变的金标准。药物包被球囊（DCB）是支架内再狭窄的一种选择，也显示出对小口径冠状动脉疾病的希望。我们评估了经皮冠状动脉介入治疗（PCI）的决策算法的3年有效性，该算法在初级血管成形术中支持无支架策略（SLS）。方法所有1年内行血管成形术的患者纳入前瞻性观察研究。符合SLS条件的患者首先进行评分球囊，然后进行DCB血管成形术或在强制救助情况下进行DES。不适合SLS的患者是接受常规药物洗脱支架植入术的不稳定患者。用支架长度除以病变总长度计算金属指数，即支架负荷。36个月的随访记录了靶病变血运重建术（TLR）。结果符合SLS的患者占行PCI患者的85% （n = 840）。仅dcb组和救助- des组分别有2.6%和6%的患者需要TLR。TLR患者的中位金属指数为0.25 （IQR: 0.5）。dcb组和救出- des组无tlr生存分布存在差异（p = 0.016）。结论基于评分球囊和DCB联合的SLS在3年内有效，TLR率低。这一比例在支架负担患者中更高。试验注册：本研究已注册为临床试验。（NCT03893396，首次发布于2019年3月28日）。

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