Background:Atrial fibrillation (AF) clinical trials are essential for informing evidence-based care, yet many trials are discontinued or remain unpublished. This contributes to research inefficiency and reduced transparency. This study evaluated characteristics associated with discontinuation and non-publication of AF clinical trials registered on ClinicalTrials.gov. Methods:We performed a retrospective analysis of interventional AF trials registered between 1999 and 2025 on ClinicalTrials.gov. Trials were categorized as completed or discontinued, and as published or unpublished. Trial characteristics were extracted, and multivariable logistic regression was used to identify predictors of discontinuation and non-publication. Results:Among 538 AF trials, 423 trials (78.6 percent) were completed and 115 trials (21.4 percent) were discontinued. Only 153 trials (36.2 percent) were published. The estimated median time from primary completion to publication was 18.0 months (95% confidence interval, 14.0-21.0 months). Trials enrolling 100 participants or more had significantly lower odds of both discontinuation and non-publication. Multicenter trials showed higher odds of discontinuation but lower odds of non-publication. The other characteristics studied were not significant predictors. Conclusions:A substantial proportion of AF trials are discontinued or remain unpublished, revealing ongoing gaps in research transparency. Larger sample sizes support higher completion and publication rates, while a multicenter design increases discontinuation risk but improves dissemination. These findings underscore the need for strategies that strengthen trial feasibility and reporting practices.
Objective To quantitatively measure gender-specific anatomical structures of the right atrial appendage (RAA) and right atrium (RA) in atrial fibrillation (AF) patients, and explore their clinical significance for post-radiofrequency ablation (RFA) recurrence using 256-slice spiral Computed Tomography (CT). Method This study included 321 AF patients (184 males and 137 females) undergoing RFA for the first time. All patients underwent a 256-slice spiral CT examination before surgery. The volume of the RA, RAA, and left atrium (LA); RAA height; short diameter, long diameter, area, and circumference of RAA base; RA anteroposterior diameter, tricuspid annulus diameter, crista terminalis, and cavo-tricuspid isthmus (CTI) were measured, and clinical data were collected. Results After body surface area normalization, the RA volume and RA anteroposterior diameter in female patients with AF showed more significant structural remodeling than those in male patients. Both male and female patients with recurrent AF showed larger RAA and RA structural parameters. In females, short diameter of RAA base, crista terminalis thickness and persistent AF were independent recurrence predictors post-RFA, while short diameter of RAA base and AF duration were independent predictors in males (all P < 0.05). ROC analysis showed that short diameter of RAA base served as the strongest predictor of AF recurrence in both genders. The optimal cutoff values were 26.95 mm for females (sensitivity = 0.696, specificity = 0.824, AUC = 0.811, P = 0.000) and 25.55 mm for males (sensitivity = 0.700, specificity = 0.746, AUC = 0.786, P = 0.000). Conclusion The short diameter of the RAA base had the highest predictive value for postoperative recurrence in both male and female patients.
Background:Cardio-ankle vascular index (CAVI) is an important indicator to evaluate arteriosclerosis. This study was to explore the changes and related factors of CAVI in the elderly population, providing a certain basis for the prevention and control of cardiovascular and cerebrovascular diseases. Methods:1117 subjects (M/F 488/629) were divided into three groups according to age: group 1: subjects with age 60-69 years; group 2: subjects with age 70-79 years; group 3: subjects with age≧80 years. CAVI value was recorded by using the VaseraVS-1000 vascular screening system. Results:There were significant differences about body mass index (BMI), CAVI, systolic blood pressure (SBP), diastolic blood pressure(DBP), pulse pressure, creatinine, fasting plasma glucose (FPG), total cholesterol, high-density lipoprotein cholesterol (HDL-C) and uric acid between these three groups. CAVI value was increasing year by year, with the increasing incidence of hypertension, coronary artery disease and stroke. General Linear Model analysis showed that age, incidence of diabetes mellitus, BMI, DBP and HDL-C were independent associating factors of CAVI in elderly subjects (β = 0.048, p < 0.001; β = 0.349, p = 0.012; β = -0.060, p = 0.001; β = 0.023, p = 0.001; β = -0.530, p = 0.020; respectively). Conclusions:CAVI was increasing with ageing. The influencing factors of CAVI varied among different age groups. Subjects aged 60-69 were needed to pay close attention to blood pressure and subjects aged 70-79 were needed to focus on diabetes meillitus, providing a theoretical basis for intervening in different targets in different age groups, to reduce or delay the progression of arteriosclerosis.
Background:Coronary microvascular dysfunction (CMD) is increasingly recognized as a key contributor to angina and non-obstructive coronary arteries (ANOCA) and adverse cardiovascular outcomes. Despite its clinical importance, the molecular basis of CMD remains to be fully elucidated. CMD is known to be associated with systemic microvascular endothelial dysfunction. Methods:We examined serum levels of molecules crucial for endothelium-dependent vasodilation, especially nitric oxide (NO)- mediated responses and endothelium-dependent hyperpolarizing responses. These included caveolin-1 (Cav1), endothelial NO synthase (eNOS), and Cu,Zn-superoxide dismutase (Cu,Zn-SOD) in patients with ANOCA enrolled in the nationwide registry by the Japanese Association of CMD. Results:This multicenter study included 295 ANOCA patients (M/F 134/161, mean age 63.7 ± 13.9 years). All patients underwent coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) measurements for CMD diagnosis. Serum Cav1, eNOS, and Cu,Zn-SOD levels were quantified by enzyme-linked immunosorbent assay. CMD was identified in 43% of patients who showed significantly lower Cu,Zn-SOD levels than non-CMD patients (P = 0.001). In patients with abnormal IMR, Cu,Zn-SOD was particularly reduced, while those with both abnormal CFR and IMR had reduced Cav1. In contrast, eNOS levels did not differ significantly between groups. Multivariable logistic regression analysis revealed that Cu,Zn-SOD levels below the cut-off value (97.2 ng/ml) independently predicted CMD [odds ratio (95% confidence interval) 2.71 (1.56-4.74), P < 0.001]. Conclusions:Reduced Cu,Zn-SOD levels are associated with CMD, suggesting enhanced systemic oxidative stress. This reduction may impair the endothelium-derived hyperpolarizing factor pathway, thereby contributing to CMD pathophysiology.
Background:The prognostic role of endothelin-1 (ET-1) in patients with obstructive hypertrophic cardiomyopathy (oHCM) who underwent septal myectomy remains unclear. We aimed to assess its prognostic importance in patients undergoing septal myectomy. Methods:We recruited 1207 oHCM patients for this analysis. The participants were divided into three groups according to the tertile of big ET-1. Cox regression analyses were conducted to assess the prognostic value of big ET-1 on all-cause death and cardiovascular death. Results:The mean age of the participants was 49.9 ± 12.0 years, 713 (59%) study patients were male. female (adjusted coefficient 0.106, 95% CI: 0.053-0.158) and left atrial dimension (adjusted coefficient 0.005, 95%CI: 0.001-0.009) were significantly associated with big ET-1 levels. During mean 3.8 years follow-up, 35 patients died including 27 cardiovascular deaths. Multivariate Cox regression analyses showed that patients with highest tertile had the highest incidence of all-cause mortalities (adjusted HR = 3.483, 95% CI: 1.365-8.887, P = 0.009) and cardiovascular mortalities (adjusted HR = 8.328, 95%CI: 1.883-36.828, P = 0.005), compared to the referenced patients with lowest tertile. When Big ET-1 was evaluated as a continuous variable, data showed that the big ET-1 was correlated with higher risks of all-cause deaths (adjusted HR = 1.588, 95%CI: 1.148-2.196, P = 0.005) and cardiovascular deaths (adjusted HR = 1.757, 95%CI: 1.250-2.470, P = 0.001). Furthermore, interactions were detected in the subgroups of gender, and maximum wall thickness. Conclusion:Our study revealed that high level of plasma big ET-1 could predict worse clinical outcomes for oHCM patients undergoing myectomy.
