Wiley: Clinical Cardiology: Table of Contents

IVUS‐Guided Versus Angiography‐Guided PCI for Unprotected Left Main Coronary Artery Disease: A Systematic Review, Meta‐Analysis, and GRADE Assessment of Randomized Trials

Wed, 10 Jun 2026 04:32:14 -0700

graphical abstract for IVUS-guided versus angiography-guided pci for unprotected left main coronary artery disease.

ABSTRACT

Background

Intravascular ultrasound (IVUS) has been increasingly used as an adjunctive tool for complex percutaneous interventions (PCIs); however, comparative randomized evidence with conventional angiography in unprotected left main coronary artery (ULMCA) disease remains scarce and fragmented. Therefore, this systematic review and meta-analysis aimed to assess and synthesize evidence regarding its use in ULMCA disease.

Methods

We performed a systematic literature search across PubMed, Scopus, Web of Science, and Cochrane until April 2026 to identify relevant RCTs comparing IVUS-guided PCI with conventional angiography-guided PCI in ULMCA disease. Risk of bias of studies was assessed using the Cochrane RoB-2 tool. A random-effects model meta-analysis was performed in R, with an exploratory univariate meta-regression of covariates.

Results

Four randomized trials involving 2278 patients with ULMCA disease were included. Compared with angiography-guided PCI, IVUS guidance was associated with numerically lower risks of all-cause death, cardiac death, target lesion revascularization, and target vessel revascularization, while myocardial infarction and stent thrombosis were similar between groups.

Conclusion

In patients undergoing PCI for ULMCA disease, IVUS guidance was associated with numerically favorable but statistically nonsignificant reductions in mortality and repeat revascularization, without clear differences in myocardial infarction or stent thrombosis. Although randomized evidence is still lacking to determine clinical superiority, these results justify powered future trials to determine whether the effects of IVUS guidance vary according to prior myocardial infarction status and left ventricular ejection fraction.

CDK7 as a Potential Exploratory Biomarker for Distinguishing Acute Myocardial Infarction Subtypes via DDR Pathways: Evidence From a Bangladeshi Cohort

Wed, 10 Jun 2026 04:31:32 -0700

Differential expression of DNA damage response genes was evaluated in Bangladeshi AMI patients. CDK7 showed significantly higher expression in NSTEMI compared to STEMI, while ATM, OGG1, and NBN showed no subtype-specific differences, highlighting potential transcriptional heterogeneity between AMI subtypes.

ABSTRACT

Introduction

Acute myocardial infarction (AMI) is a major cause of cardiovascular death, with STEMI and NSTEMI as distinct subtypes. Current diagnostic tools often lack the sensitivity and timeliness to rapidly distinguish these subtypes at early clinical presentation. The DNA damage response (DDR), activated by ischemia and oxidative stress during AMI, represents a promising pathway for identifying novel biomarkers. Despite evidence of its role in myocardial infarction, little is known about DDR gene expression in South Asian populations, particularly in Bangladesh. This study evaluated the expression of four DDR genes; ATM, CDK7, OGG1, and NBN and their potential for distinguishing between STEMI and NSTEMI.

Methods

A total of 70 AMI patients and 60 healthy controls from the Bangladeshi population were recruited. RNA was extracted from blood samples, and gene expression was quantified using qRT-PCR. Statistical analyses included Mann–Whitney U tests for group differences, linear regression analysis and Spearman's correlation analysis for gene co-expression.

Results

CDK7 expression was significantly higher in NSTEMI compared to STEMI patients (p < 0.05). However, ATM, OGG1, and NBN did not differ significantly between the subtypes. Co-expression analysis revealed strong positive correlations among all four genes, with the strongest between ATM and CDK7 (r = 0.76, p < 0.001).

Conclusion

This is the first study in the Bangladeshi population to demonstrate distinct DDR gene expression patterns across AMI subtypes, with CDK7 showing subtype-specific differential expression between STEMI and NSTEMI. Although the observed discrimination was modest and requires further validation, these findings provide important exploratory insights into ischemia-associated transcriptional regulation in an underrepresented population.

Reconsidering the Clinical Utility of a Body Shape Index for Abdominal Aortic Calcification in Hypertension: From Association to Clinical Applicability

Dengfeng Zhang, Xiaoling Shang — Mon, 08 Jun 2026 00:00:00 -0700

Clinical Cardiology, Volume 49, Issue 6, June 2026.

Admission Shock Index in Acute Aortic Dissection: A Triage Trigger or a Restated Vital Sign?

Shaher Yar, Youmna Imtiaz, Haniyah Attiq, Ishvah Shashwat Nag — Sat, 06 Jun 2026 00:00:00 -0700

Clinical Cardiology, Volume 49, Issue 6, June 2026.

Correction to “Prognostic Value of HALP Score in Rheumatic Mitral Stenosis: A Long‐Term Follow‐up Study”

Fri, 05 Jun 2026 00:00:00 -0700

Clinical Cardiology, Volume 49, Issue 6, June 2026.

“Diagnostic Performance of Artificial Intelligence in Evaluating Tricuspid Regurgitation: A Systematic Review and Meta‐Analysis”

Pooya Eini, Homa Serpoush, Mohammad Rezayee, Milan Kassulke — Fri, 05 Jun 2026 00:00:00 -0700

Artificial intelligence demonstrates strong diagnostic accuracy for detecting tricuspid regurgitation, particularly with echocardiography-based models. Despite promising performance, substantial heterogeneity and limited external validation highlight the need for prospective, multicenter studies before routine clinical implementation.

ABSTRACT

Background

Tricuspid regurgitation (TR) is a common valvular heart disease affecting 0.55%–1.6% of adults, rising to 5%–8% in those over 75 years, often secondary to left-sided pathology or pulmonary hypertension. Moderate-to-severe TR independently predicts mortality and heart failure hospitalization, yet underdiagnosis persists due to echocardiography's operator dependence and variability. Artificial intelligence (AI), including machine learning (ML) and deep learning (DL), promises automated detection to enhance sensitivity and reproducibility. This systematic review and meta-analysis synthesizes evidence on AI's diagnostic performance for TR using echocardiographic or alternative modalities.

Methods

Following PRISMA guidelines, we searched PubMed, Embase, Scopus, Web of Science, and EBSCO from inception to August 2025, without language restrictions. Eligibility used PICOS: adults with TR evaluation; AI/ML index tests; clinician-interpreted echocardiography reference; outcomes, including AUROC, sensitivity, and specificity. Data extraction and quality assessment by two reviewers; random-effects meta-analysis for pooled estimates; heterogeneity via I²; certainty per GRADE.

Results

Eight studies were included. Pooled AUROC was 0.89 (95% CI 0.86–0.92) for TR detection. Echocardiography-based models showed sensitivity 0.87 (95% CI 0.81–0.90), specificity 0.88 (95% CI 0.73–0.95), AUROC 0.92 (95% CI 0.89–0.94); ECG-based models had AUROC 0.805. Substantial heterogeneity (I² > 90%) arose from modalities and reference standards; GRADE certainty moderate due to retrospective designs and limited external validation.

Conclusions

AI demonstrates promising diagnostic accuracy for TR, potentially standardizing early detection and triage. However, heterogeneity and methodological gaps necessitate larger prospective, multicenter studies with standardized reporting (e.g., TRIPOD-AI) to confirm clinical utility.

Generalizability of Low‐Voltage Zone‐Based Risk Scores After Atrial Fibrillation Ablation

Tue, 02 Jun 2026 00:00:00 -0700

Clinical Cardiology, Volume 49, Issue 6, June 2026.

Evaluation of Polygenic Scores and CT Imaging in Risk Factor Modification in Patients With Diabetes: Rationale and Design of the VOLTAIRE Study

Mon, 01 Jun 2026 00:00:00 -0700

Three-arm randomized trial assessing whether computed tomography coronary angiography or polygenic risk score disclosure, combined with nurse-led counseling, improves cardiovascular risk factor modification in people with type 2 diabetes.

ABSTRACT

Background

The contemporary management of type 2 diabetes (T2D) involves a multifaceted model of care integrating intensive management of lipids, blood pressure, and glucose, along with lifestyle modifications. Despite these efforts, cardiovascular disease (CVD) remains a leading cause of morbidity and mortality among patients with T2D, largely due to suboptimal adherence to preventive strategies. The VOLTAIRE trial aims to assess the impact of providing personalized cardiovascular risk information derived from computed tomography coronary angiography (CTCA) and a polygenic risk score (PRS) on cardiovascular risk factor modification.

Objectives

VOLTAIRE evaluates whether integrating CTCA and PRS into risk counseling enhances adherence to lifestyle and pharmacological interventions, ultimately improving cardiovascular outcomes among patients with T2D.

Methods

VOLTAIRE is a prospective three-arm, parallel-group, randomized controlled trial enrolling participants aged 40 years or older with T2D and no established atherosclerotic CVD. Participants are randomized 1:1:1 to receive: (1) risk factor counseling plus CTCA result, (2) risk factor counseling plus PRS result, or (3) standard risk factor counseling (control). Nurse-led motivational interviewing is used for risk counseling. The primary outcome is change in non-calcified plaque volume measured by serial CTCA at 12 months. Secondary outcomes include low-density lipoprotein cholesterol levels, adherence to medication, patient engagement, CVD knowledge improvements, and psychological outcomes over 12 months. Enrollment began in August 2023.

Discussion

VOLTAIRE seeks to determine if coupling nurse-led risk factor counseling with personalized CTCA or PRS information improves cardiovascular outcomes, adherence, and participant engagement in T2D management.

Symptom Denial and Cultural Constraints: A Qualitative Exploration of Pre‐Hospital Delay Determinants in Myocardial Infarction Patients in China

Yunjie Tang, Danqing Hu, Jing Han — Sat, 30 May 2026 00:00:00 -0700

This study reveals that heart attack patients often dangerously delay emergency care due to unrecognized symptoms, passive endurance, and traditional cultural constraints, like fearing to burden families. Crucially, family involvement acts as a double-edged sword, either accelerating or further delaying life-saving treatment.

ABSTRACT

Objective

To explore the pre-hospital delay experiences of myocardial infarction patients in China from a patient-centered perspective.

Background

Pre-hospital delay remains a globally prevalent issue, influenced by subjective and context-dependent factors that are not easily captured through quantitative methods. Traditional metrics may oversimplify the psychological processes involved and fail to account for individual variability and contextual influences.

Design

A descriptive qualitative study.

Methods

Semi-structured interviews were conducted with MI patients at a tertiary hospital in Qingdao between November 18 and 30, 2024. Participants were selected through purposeful sampling. Thematic analysis was performed using MAXQDA software to code and analyze the qualitative data. The study followed the COREQ checklist.

Findings

We interviewed 16 patients and conducted four core themes: (1) limited disease awareness, (2) inappropriate symptom response strategies, (3) constraints of traditional cultural beliefs and (4) family influence on decision-making, along with 12 subthemes.

Conclusion

Patients' pre-hospital delays frequently stem from cognitive limitations in symptom recognition coupled with maladaptive coping strategies contributes to treatment postponement. Notably, familial decision-making intervention demonstrates potential in mitigating such delays. And traditional Chinese culture exerts a profound influence on pre-hospital delays among elderly MI patients.

Implications for Patients

Patients' experiences of pre-hospital delay in myocardial infarction reveal its key determinants. Healthcare providers should develop targeted interventions tailored to patients' cognition, culture, and family situations to enhance intervention effectiveness.

Patient or Public Contribution

Patients and family members contributed to the data collected.

Issue Information

Thu, 28 May 2026 03:35:24 -0700

Clinical Cardiology, Volume 49, Issue 6, June 2026.

The Linear Association Between A Body Shape Index and Abdominal Aortic Calcification in Individuals With Hypertension

Xinyi Qiu, Zhenwei Wang — Thu, 28 May 2026 00:00:00 -0700

Higher A Body Shape Index (ABSI) was independently associated with increased abdominal aortic calcification (AAC) risk in hypertensive individuals and showed a linear positive relationship with AAC risk. ABSI may serve as a supplementary risk indicator, although its discriminative ability was limited.

ABSTRACT

Objective

This study aimed to evaluate the association between A Body Shape Index (ABSI) and abdominal aortic calcification (AAC) in individuals with hypertension.

Methods

This cross-sectional analysis utilized data from 1486 participants in the National Health and Nutrition Examination Survey (NHANES). The relationship between ABSI and AAC was evaluated through logistic regression, subgroup analyses, receiver operating characteristic (ROC) curve assessment, and restricted cubic spline (RCS) modeling.

Results

Multivariable logistic regression revealed that each standard deviation increase in ABSI corresponded to a 16.2% elevated AAC risk (OR = 1.162, 95% CI: 1.025–1.318, p = 0.019). Compared with the lowest quartile (Q1), individuals in Q3 and Q4 had significantly higher risks of AAC, with ORs of 1.554 (95% CI: 1.096–2.204, p = 0.013) and 1.503 (95% CI: 1.047–2.157, p = 0.027), respectively. Subgroup analyses revealed a robust association between ABSI and AAC that was consistently observed across strata. ROC curve analysis revealed that ABSI provided moderate discriminative ability for AAC detection in the overall cohort (AUC = 0.625, 95% CI: 0.596–0.654, p < 0.001), males (AUC = 0.632, 95% CI: 0.589–0.675, p < 0.001), and females (AUC = 0.627, 95% CI: 0.588–0.666, p < 0.001). RCS analysis, in both unadjusted and multivariable-adjusted models, RCS analysis confirmed a dose-dependent positive relationship between ABSI and AAC risk (P for nonlinearity > 0.05).

Conclusion

Higher ABSI levels show a significant, independent association with increased AAC risk in hypertensive patients, suggesting potential clinical value as a indicator for early vascular calcification detection in this population.

Concerns Regarding the Design, Methodology, and Potential Biases in the Türkiye Heart Failure (TURK‐HF) Registry

Çağrı Zorlu — Thu, 28 May 2026 00:00:00 -0700

Clinical Cardiology, Volume 49, Issue 6, June 2026.

Clarifying the Scope of Native EHRA Type 2 Valvular Disease and Event Reporting in Anticoagulated Patients With Atrial Fibrillation

Jiaqi Chen, Mangmang Xu — Thu, 28 May 2026 00:00:00 -0700

Clinical Cardiology, Volume 49, Issue 6, June 2026.

Hand Dysfunction After Intervention via Distal Versus Conventional Transradial Access: A Meta‐Analysis of Randomized Trials

Fareena Ishtiaq — Thu, 28 May 2026 00:00:00 -0700

Clinical Cardiology, Volume 49, Issue 6, June 2026.