CLINICAL CARDIOLOGY 为发表原创临床研究以及心血管医学和心血管外科诊断和治疗问题的简要评论提供了一个完全黄金开放访问论坛。该杂志包括临床调查、评论、独立社论和评论以及奖金仅限在线内容。该杂志还出版增刊、专家小组讨论、赞助的临床评论、试验设计以及质量和结果。

Clinical Cardiology is a fully gold open access forum dedicated to publishing original clinical research and brief reviews on issues related to cardiovascular medicine and cardiovascular surgery diagnosis and treatment. The journal includes clinical investigations, reviews, independent editorials, and bonus online-only content. It also publishes supplements, expert panel discussions, sponsored clinical reviews, trial designs, and studies on quality and outcomes.

《Clinical Cardiology》是一个完全开放获取的论坛，专注于发表原创的临床研究以及心血管医学和心血管外科的诊断与治疗问题。该杂志涵盖临床调查、评论、独立社论和奖金仅限在线内容。此外，杂志还出版增刊、专家小组讨论、赞助的临床评论、试验设计以及质量与结果相关的研究。

Clinical Cardiology

Abstract One metabolic equivalent (MET) is defined as the amount of oxygen consumed while sitting at rest and is equal to 3.5 ml O 2 per kg body weight x min. The MET concept represents a simple, practical, and easily understood procedure for expressing the energy cost of physical activities as a multiple of the resting metabolic rate. The energy cost of an activity can be determined by dividing the relative oxygen cost of the activity (ml O 2 /kg/min)x by 3.5. This article summarizes and presents energy expenditure values for numerous household and recreational activities in both METS and watts units. Also, the intensity levels (in METS) for selected exercise protocols are compared stage by stage. In spite of its limitations, the MET concept provides a convenient method to describe the functional capacity or exercise tolerance of an individual as determined from progressive exercise testing and to define a repertoire of physical activities in which a person may participate safely, without exceeding a prescribed intensity level.

M. Jetté

K. Sidney

G. Blümchen

Metabolic equivalents (METS) in exercise testing, exercise prescription, and evaluation of functional capacity

代谢当量（METS）在运动测试、运动处方和功能能力评估中的应用

Plaque healing may serve a vital function in the natural progression of atherosclerotic disease. This study sought to investigate predictors and morphological characteristics of healed plaque (HP) among angina pectoris (AP) patients.
Patients who presented with AP and received preintervention optical coherence tomography (OCT) imaging were consecutively selected for this single‐center retrospective observational study. Patient's demographic and clinical information was collected from the hospital's electronic medical records. Coronary angiograms and OCT images were compared via offline software.
A total of 390 patients were chosen as the final study population. HP was identified in 186 patients (47.7%) and was relatively less in cases of unstable angina pectoris (UAP) than in stable angina pectoris (SAP) (89/233 [38.2%] vs. 97/157[61.8%]). The HP group had greater prevalence rates of previous myocardial infarction and SAP and higher levels of triglycerides and uremia (median, 1.67 vs. 1.31 mmol/L [p= .01] and 364.22 ± 91.80 vs. 341.53 ± 77.64 µmol/L [p= .01], respectively). Using multivariate analysis, SAP and long lesion length were shown to be stand‐alone indicators of HP. HP presented with more severe stenosis as well as a longer lesion length and had more vulnerable and more complex features. In HP lesions, UAP patients had more plaque ruptures and thrombosis, whereas SAP patients had lower uric acid levels and more multiple HPs(≥3 HPs).
Clinical presentation of SAP and long lesion length were strong predictors for HP in patients with AP. Patients with HP presented with more severe stenosis, longer lesion lengths, greater inflammation, and vulnerability.

Hongying Yao

Qianyun Guo

Yujing Cheng

Tianyu Zhu

Qian Ma

Yujie Zhou

Predictors and morphological properties of culprit healed plaques in patients with angina pectoris

心绞痛患者罪犯愈合斑块的预测因素及形态学特征

Obesity is an important risk factor for heart failure (HF).
Visceral adiposity index (VAI) is a simple metric for assessing obesity; however, the association between VAI and risk for HF has not been studied.
A cross‐sectional study involving 28 764 participants ≥18 years of age from the National Health and Nutrition Examination Survey (NHANES), 2009–2018, in the United States was performed. VAI was calculated using body mass index (BMI), waist circumference (WC), triglycerides (TG), and high‐density lipoprotein cholesterol. VAI was analyzed as a continuous and categorical variable to examine its association with HF. Subgroup analysis was also performed.
The highest VAI (fourth quartile [Q4]) was found among males, BMI, systolic and diastolic blood pressure, WC, hypertension, diabetes, liver disease, coronary heart disease, smoking, total cholesterol, and TG. More participants in Q4 took β‐receptor blockers, angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers/angiotensin receptor‐neprilysin inhibitor, calcium channel blockers, and antidiabetic and antihyperlipidemic medications. Participants with HF exhibited greater VAI. A per‐unit increase in VAI resulted in a 4% increased risk for HF (odds ratio [OR] 1.04 [95% confidence interval (CI) 1.02–1.05]). After multivariable adjustment, compared with the lowest quartile, the OR for Q3 was 1.55 (95% CI 1.24–1.94). Subgroup analysis revealed no significant interactions between VAI and specific subgroups.
VAI was independently associated with the risk for HF. As a noninvasive index of visceral adiposity, VAI could be used for a “one shot” assessment of HF risk and may serve as a novel marker.

Xinyu Zhang

Yijun Sun

Ying Li

Chengwei Wang

Yi Wang

Mei Dong

Jie Xiao

Zongwei Lin

Huixia Lu

Xiaoping Ji

Association between visceral adiposity index and heart failure: A cross‐sectional study

内脏脂肪指数与心力衰竭的关联：一项横断面研究

The progression of carotid intima-media thickness (cIMT) and plaques are associated with cardiovascular health, especially for high-risk population of cardiovascular disease (CVD).Risk factors for atherosclerosis may vary by sex. This study aimed to investigate the sex-specific risk factors of cIMT and plaque progression.We selected subjects who were identified as high-risk population of CVD, and collected their carotid ultrasound data and baseline characteristics. Linear regression and logistic regression analyses were used to identify risk factors for cIMT and plaque progression. Sex-specific risk factors were identified respectively.A total of 7908 participants were included. The mean age was 57.75 ± 9.45 years and 61.51% were female. During mean follow-up of 1.92 ± 0.89 years, the median annual cIMT change rate was -7.25 μm/year. Seven hundred and fifteen subjects free from plaques at baseline developed plaque. Age, smoking, hypertension, and diabetes were common risk factors for carotid atherosclerosis progression in all participants. Smoking and alcohol drinking were significantly associated with increased cIMT change in women, while hypertension and antihypertensive medication were significant in men. Increased total cholesterol and diabetes were significantly associated with new plaque presence in women, while smoking, increased triglyceride, and dyslipidemia were significant in men (p ˂ .05 for all cases). The association of baseline cIMT and smoking with annual cIMT change rate and increased total cholesterol with new plaque presence were significantly differentiated between both sexes (p for interaction ˂ .05).The risk factors for cIMT and plaque progression differed by sex.

Qi Cheng

Dan Zhou

Jiabin Wang

Zhiqiang Nie

Xiaoxuan Feng

Yuqing Huang

Qiaomin Liang

Yingqing Feng

Sex‐specific risk factors of carotid atherosclerosis progression in a high‐risk population of cardiovascular disease

心血管疾病高危人群中颈动脉粥样硬化进展的性别特异性危险因素

Typical signs of heart failure (HF), like increased cardiothoracic ratio (CTR) and pleural effusion, can be seen on X-ray. Artificial Intelligence (AI) can help in the early and quicker diagnosis of HF.The study's goal was to demonstrate that the AI interpretation of chest X-rays can assist the clinician in diagnosing HF.Patients older than 45 years were included in the study. The study analyzed 10 100 deidentified outpatient chest X-rays by AI algorithm. The AI-generated report was later verified by an independent radiologist. Patients with CTR > 0.5 and pleural effusion were marked as potential HF. Flagged patients underwent confirmatory tests, and those labeled as negative also underwent further investigations to rule out HF.Out of 10 100, the AI algorithm detected 183 (1.8%) patients with increased CTR and pleural effusion on chest X-rays. One hundred and six out of 183 underwent diagnostic tests. Eighty-two (77%) out of 106 were diagnosed with HF according to current guidelines. From the remaining 9917 patients, 106 patients were randomly selected. Nine (8%) out of them were diagnosed with HF. The positive predictive value of AI for diagnosing HF is 77%, and the negative predictive value is 91%. More than half (54.9%) of newly diagnosed patients had HF with preserved ejection fraction.HF is a risky condition with nonspecific symptoms that are difficult to diagnose, especially in the early stages. Using AI assistance for X-ray interpretation can be helpful for early diagnosis of HF especially HF with preserved ejection fraction.

Ahmet Celik

Ali Orcun Surmeli

Mustafa Demir

Kaan Esen

Ahmet Camsari

The diagnostic value of chest X‐ray scanning by the help of Artificial Intelligence in Heart Failure (ART‐IN‐HF)

人工智能辅助胸部X线扫描在心力衰竭诊断中的价值（ART-IN-HF）

ABSTRACT Background Concomitant right ventricular (RV) failure and tricuspid regurgitation (TR) are common comorbidities in patients undergoing mitral valve transcatheter edge‐to‐edge repair (M‐TEER) and are associated with worse prognosis. Improvement of TR after M‐TEER occurs frequently, however determinants of this course are poorly understood. This study aimed to analyze serum biomarkers that are differentially regulated in patients with TR and to identify biomarkers predictive of the course of TR after M‐TEER. Methods and Results Biomarker expression was analyzed in 242 prospectively included patients undergoing M‐TEER. Patients with moderate‐to‐severe TR had significant comorbidities (median EuroSCORE II 5.2 in patients with severe TR, 4.9 in moderate TR, 3.2 in no/mild TR; p = 0.002) and a large number of biomarkers was upregulated including IGFBP‐2 (1.4‐fold in severe TR compared to no/mild TR, p = 0.005). Echocardiographic follow‐up 3 months after M‐TEER was carried out in 99 patients. RV reverse remodeling (RVRR) as defined by improvement of concomitant TR by at least one grade and/or RV diameter downsizing of at least 10% compared to baseline was seen in 50 patients (50.5%). IGFBP‐2 (Odds Ratio 2.078) and presence of chronic pulmonary disease (Odds Ratio 15.341) proved independent predictors of non‐development of RVRR within 3 months after M‐TEER. Conclusions In patients undergoing M‐TEER with concomitant moderate or severe TR, numerous cardiometabolic biomarkers including IGFBP‐2 are upregulated. Higher levels of IGFBP‐2 at baseline are independently associated with persistent TR and/or RV dilation after M‐TEER.

Matthias Gröger

Dominik Felbel

Michael Paukovitsch

Leonhard Moritz Schneider

Sinisa Markovic

Wolfgang Rottbauer

Mirjam Keßler

Insulin‐Like Growth Factor Binding Protein 2 Predicts Right Ventricular Reverse Remodeling and Improvement of Concomitant Tricuspid Regurgitation After Transcatheter Edge‐to‐Edge Mitral Valve Repair

胰岛素样生长因子结合蛋白2预测经导管缘对缘二尖瓣修复术后右心室逆向重构及伴随三尖瓣反流改善

ABSTRACT Objectives To perform a bibliometric analysis of publications of arrhythmogenic right ventricular cardiomyopathy (ARVC) from 1981 to 2023 to summarize the current publications and explore frontiers on this topic. Methods We integrated the scientific publications on ARVC in the Web of Science (WOS) Core Collection database from January 1981 to September 2023, using the retrieval strategy of medical subject headings combined with keywords. We focused on articles and reviews that were published in English. Relevant information such as the journal and publisher, the title, authors, organizations, abstract, keywords, published date, and number of citations, were collected. Bibliometric analysis was performed and visualized by the R software and Microsoft Excel. Results The results revealed a total of 4792 records related to ARVC from the WOS database, and 2992 original articles or reviews which were selected for bibliometric analysis. There were 79 countries and regions, 3724 research institutions, and 12 157 scholars who have published in this topic. The number of scientific publications of ARVC increased year‐by‐year, with an annual growth rate of 12.12%. We also investigated the top 10 contributing countries, organizations with affiliations, most influential researchers, highest‐cited articles, and highest‐frequency keywords. In addition, the most active areas of research on ARVC included that of fatal complications, molecular pathological mechanisms, diagnosis, therapy, and prognosis respectively according to the keywords trend analysis. Conclusions Our study reports the publication landscape of ARVC during the past four decades based on bibliometric analysis. This study provides a deeper understanding of the published literature on ARVC.

Leitong Mo

Ching‐Hui Sia

Weiqin Lin

Xifeng Zheng

Kaiyi Peng

Describing and Mapping the Research Trend of Scientific Publications on Arrhythmogenic Right Ventricular Cardiomyopathy Across Four Decades: A Bibliometric Analysis

描述和绘制心律失常性右室心肌病科学出版物研究趋势的跨四十年文献计量分析

ABSTRACT Aim A recent European Heart Rhythm Association (EHRA) practical guide provides guidance on the use of novel digital devices for heart rhythm analysis using either electrocardiogram (ECG) or photoplethysmography (PPG) technology for the diagnosis of atrial fibrillation (AF). This survey assesses physicians' preferences to use digital devices in patients with possible AF and their impact on clinical decision‐making. Methods and Results Participants of the DAS‐CAM III initiated and distributed an online survey assessing physician preferences in using digital devices for the management of AF in different clinical scenarios. A total of 505 physicians (median age: 38 [IQR 33–46] years) from 30 countries completed the survey. A third of respondents were electrophysiologists, the others were cardiologists, cardiology residents, or general practitioners. Electrophysiologists were more likely to have experience with both ECG‐based (92% vs. 68%, p &lt; 0.001) and PPG‐based (60% vs. 34%, p &lt; 0.001) digital devices. The initial diagnostic approach to each scenario (symptomatic low‐risk, symptomatic high‐risk, or asymptomatic high‐risk patient) was heterogeneous. Electrophysiologists preferred intermittent single‐lead ECG monitoring to traditional Holter ECGs to screen for AF. Both electrophysiologists and non‐electrophysiologists would rarely use PPG‐based devices to diagnose and screen for AF (8.2%–9.8%). Electrophysiologists and non‐electrophysiologists use ECG‐based technology to confirm PPG‐documented tracings suggestive of AF. Conclusion While PPG‐based digital devices are rarely used for diagnosis and screening for AF, intermittent ECG‐based digital devices are beginning to be implemented in clinical practice. More education on the potential of novel digital devices is required to achieve diagnostic pathways as suggested by the EHRA practical guide.

Martin Manninger

David Zweiker

Tatevik Hovakimyan

Paweł T. Matusik

Sergio Conti

Pierre Ollitrault

Aapo Aro

Bart A. Mulder

Wolfgang Dichtl

Christian‐Hendrik Heeger

Rachel ter Bekke

Enes Elvin Gul

Bob Weijs

Ann‐Kathrin Rahm

Angeliki Darma

Banu Evranos

Avi Sabbag

Kgomotso Moroka

Vassil Traykov

Jacob Moesgaard Larsen

Gisella Rita Amoroso

Stijn Evens

William F. McIntyre

Dominik Linz

Physician Preferences in Using Novel Digital Devices for the Management of Atrial Fibrillation—A DAS‐CAM III Survey

医生在心房颤动管理中使用新型数字设备的偏好——DAS-CAM III调查

ABSTRACT Background The optimal duration of dual antiplatelet therapy (DAPT) for patients with coronary multi‐vessel disease (MVD) who have received drug‐eluting stents (DES) remains unclear. Hypothesis and Methods The Dual Antiplatelet Therapy in Patients with Coronary Multi‐Vessel Disease (DAPT‐MVD) study is a multicenter, open‐label, randomized controlled trial designed to assess the efficacy and safety of extended DAPT in MVD patients 12 months following DES implantation. We plan to enroll 8250 patients across approximately 100 sites in China. Participants will be randomized in a 1:1 ratio to receive either extended DAPT (75 mg clopidogrel plus 75–150 mg aspirin daily) or monotherapy (75–150 mg aspirin daily) beyond 12 months post‐DES implantation. The follow‐up period will last at least 12 months, with all potential endpoints adjudicated by a blinded Clinical Events Committee. The primary endpoint is major adverse cardiovascular and cerebrovascular events (MACCE), including cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. Results As of April 2024, a total of 8250 participants have been enrolled in the study. The mean age of the enrolled patients was 60.5 ± 8.8years, with 5753 (69.7%) being men. Conclusions The DAPT‐MVD study is the first large‐scale trial to evaluate the efficacy and safety of prolonged DAPT with clopidogrel plus aspirin beyond 12 months after DES implantation in MVD patients. The trial will provide novel insights into the optimal duration of DAPT for MVD patients (ClinicalTrials. gov ID: NCT04624854. Registered on 10/27/2020).

Jinwei Tian

Zhuozhong Wang

Yan Wang

Fan Wang

Yini Wang

Peng Zhao

Xinyu Hou

Xiang Peng

Maoyi Tian

Duolao Wang

Bo Yu

Rationale and Design of Dual Antiplatelet Therapy in Patients with Coronary Multi‐Vessel Disease (DAPT‐MVD): A Multicenter, Randomized, Controlled Trial

冠状多支病变患者双联抗血小板治疗的原理与设计（DAPT-MVD）：一项多中心、随机、对照试验

ABSTRACT Background Since 2010, all non‐VA hospitals performing cardiac surgeries and percutaneous interventions in Washington State have participated in the Cardiac Care Outcomes Assessment Program (COAP), a data‐driven, physician‐led collaborative quality improvement (QI) collaborative. Prior literature has demonstrated QI programs such as COAP can avert avoidable utilization such as hospital readmissions. However, it is unknown whether such improvements translate into economic benefits. Hypothesis This study compared downstream healthcare costs between patients undergoing cardiac interventions for coronary artery disease (CAD) at hospitals that were and were not participating in COAP. Methods Post hoc analysis of Medicare administrative and claims data examined 2.5 million randomly selected deidentified beneficiaries receiving a percutaneous coronary intervention or coronary artery bypass grafting between 2013 and 2020. Total costs were defined as all reimbursements paid by Medicare for up to 5 years following cardiac intervention. Because all non‐VA hospitals in Washington State participated in COAP, we compared respective groups of patients receiving intervention in Washington State with all non‐Washington states, adjusting for patient demographics and comorbidity. To model costs, we applied a multipart estimator, which distinguishes the impact of QI program participation due to survival and utilization while accounting for censoring. Results Total 5‐year downstream costs were $3861 lower (95% confidence interval [CI] = $1794 to $5741) among patients receiving cardiac intervention at COAP‐exposed hospitals. Lower costs were largely driven by lower utilization during calendar quarters where death was not observed. Conclusions Participation in this state‐wide cardiac quality improvement program was associated with economic benefits in patients receiving intervention for CAD.

Edwin S. Wong

Joshua Nelson

Richard Whitten

Charles Maynard

Jeannie Collins‐Brandon

Kristin Sitcov

Ravi S. Hira

Association Between State‐Wide Cardiac Quality Improvement Program and Costs Following Intervention for Coronary Artery Disease

州级心脏质量改进计划与冠状动脉疾病干预后成本之间的关联

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Clinical Cardiology

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Metabolic equivalents (METS) in exercise testing, exercise prescription, and evaluation of functional capacity

Predictors and morphological properties of culprit healed plaques in patients with angina pectoris

Association between visceral adiposity index and heart failure: A cross‐sectional study

Sex‐specific risk factors of carotid atherosclerosis progression in a high‐risk population of cardiovascular disease

The diagnostic value of chest X‐ray scanning by the help of Artificial Intelligence in Heart Failure (ART‐IN‐HF)

Insulin‐Like Growth Factor Binding Protein 2 Predicts Right Ventricular Reverse Remodeling and Improvement of Concomitant Tricuspid Regurgitation After Transcatheter Edge‐to‐Edge Mitral Valve Repair

Describing and Mapping the Research Trend of Scientific Publications on Arrhythmogenic Right Ventricular Cardiomyopathy Across Four Decades: A Bibliometric Analysis

Physician Preferences in Using Novel Digital Devices for the Management of Atrial Fibrillation—A DAS‐CAM III Survey

Rationale and Design of Dual Antiplatelet Therapy in Patients with Coronary Multi‐Vessel Disease (DAPT‐MVD): A Multicenter, Randomized, Controlled Trial

Association Between State‐Wide Cardiac Quality Improvement Program and Costs Following Intervention for Coronary Artery Disease