CJC Open最新文献

{"title":"Cerebral Hemodynamics Are Related to Cortical Brain Morphology in Heart Failure with Reduced Ejection Fraction Independent of Reduced Cardiac Output","authors":"Cameron J. Morse MSc ,&nbsp;Adam M.S. Luchkanych MSc ,&nbsp;Natasha G. Boyes PhD ,&nbsp;Allen A. Champagne MD, PhD ,&nbsp;Michael D. Nelson PhD ,&nbsp;Geoffrey Karjala MD ,&nbsp;Alexander Zhai MD ,&nbsp;Haissam Haddad MD ,&nbsp;Darcy D. Marciniuk MD ,&nbsp;Michael E. Kelly PhD ,&nbsp;Corey R. Tomczak PhD ,&nbsp;T. Dylan Olver PhD","doi":"10.1016/j.cjco.2025.12.011","DOIUrl":"10.1016/j.cjco.2025.12.011","url":null,"abstract":"<div><div>This study aimed to investigate whether reduced cerebral blood flow is associated with cortical brain remodelling in patients with heart failure with reduced ejection fraction (HFrEF). Further, to assess whether these changes occur independently of decreased cardiac output and correlate with alternative markers of HFrEF severity. The findings suggest that brain remodelling in HFrEF can occur independently of reduced cardiac output, highlighting the importance of other pathophysiological factors. A nuanced understanding of these mechanisms could inform improved diagnostic and therapeutic strategies targeting cardiocerebral interactions.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 4","pages":"Pages 396-399"},"PeriodicalIF":2.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147636584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"McGill Approach to Evaluate Jugular Venous Pressures: A 2-Case Series","authors":"Motahareh Vameghestahbanati MD, PhD ,&nbsp;Thao Huynh MD, PhD","doi":"10.1016/j.cjco.2025.12.001","DOIUrl":"10.1016/j.cjco.2025.12.001","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 4","pages":"Pages 408-410"},"PeriodicalIF":2.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147636586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Venous Thoracic Outlet Syndrome Secondary to First–Second Rib Synostosis: A Rare Cause of Upper-Extremity Deep Vein Thrombosis","authors":"Paisit Kosum MD, MSc ,&nbsp;Rachata Tangkulboriboon MD ,&nbsp;Thitinan Chulroek MD ,&nbsp;Napisa Bunnag MD ,&nbsp;Krissana Panarong MD, MSc ,&nbsp;Noppacharn Uaprasert MD, MSc ,&nbsp;Nonthikorn Theerasuwipakorn MD, MSc","doi":"10.1016/j.cjco.2025.12.005","DOIUrl":"10.1016/j.cjco.2025.12.005","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 4","pages":"Pages 478-480"},"PeriodicalIF":2.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147636664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Transcatheter Aortic Valve Implantation Efficiency and Outcomes in the Canadian Healthcare Environment","authors":"Nitish Bhatt MD,&nbsp;Rodrigo Bagur MD, PhD,&nbsp;Karama Bayamin MD,&nbsp;Pantelis Diamantouros MD,&nbsp;Patrick J. Teefy MD,&nbsp;Matthew Valdis MD,&nbsp;Gloria Chaumont MN, NP,&nbsp;Raffael Zamper MD,&nbsp;Michael W.A. Chu MD, MEd,&nbsp;OPTICS (Optimizing Patient Trajectories to Improve Cardiovascular Outcomes and Science) investigators","doi":"10.1016/j.cjco.2025.11.014","DOIUrl":"10.1016/j.cjco.2025.11.014","url":null,"abstract":"<div><h3>Background</h3><div>With increased demand for transcatheter aortic valve implantation (TAVI), comprehensive strategies are required to improve procedural efficiency and increase case loads at Canadian TAVI programs.</div></div><div><h3>Methods</h3><div>Time-efficiency measures were implemented at the preprocedure, anesthesia, procedural, and postprocedural stages at our centre between 2019 to 2024, using a 1-day-per-week strategy in a hybrid operating room. We analyzed trends in case volumes and procedural times during the study period. Patients were stratified based on whether their procedure was performed on days with a high (HCV) vs a low case volume (LCV), and differences in early clinical outcomes were analyzed. Effects of specific efficiency measures on procedural times were also analyzed.</div></div><div><h3>Results</h3><div>A total of 1019 patients were analyzed. We noted significant increases in TAVI volumes (+0.51 cases per year, <em>P</em> &lt; 0.0001) and a decrease in total operating room time (–10.2 minutes per year, <em>P</em> &lt; 0.0001) during the study period. The time savings were driven most strongly by decreases in anesthesia and procedure times. No significant differences occurred between the HCV vs LCV groups in terms of in-hospital mortality (0.7% vs 1.8%, <em>P</em> = 0.20), stroke and/or transient ischemic attack (2.4% vs 2.3%, <em>P</em> = 0.25), new pacemaker (9.0% vs 10.1%, <em>P</em> = 0.64), moderate-severe paravalvular leak (2.9% vs 5.2%, <em>P</em> = 0.25), but increased bleeding occurred in the LCV group (3.0% vs 6.4%, <em>P</em> = 0.028). Multivariable linear regression showed that use of conscious sedation, left ventricular pacing, and hybrid closure strategies significantly reduced total TAVI times.</div></div><div><h3>Conclusions</h3><div>Our comprehensive, innovative time-efficiency strategies have improved TAVI efficiency significantly while preserving good outcomes and not requiring significant additional resources.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 4","pages":"Pages 420-429"},"PeriodicalIF":2.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147636662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guideline-Directed Medical Therapy in Patients After Implantation of Implantable Cardioverter Defibrillators to Improve Outcomes","authors":"Ratika Parkash MD, MSc ,&nbsp;Doug Hayami MD ,&nbsp;Andrew Caddell MD ,&nbsp;Ashar Pirzada MD, MSc ,&nbsp;Suzanne Greeley RN, BScN ,&nbsp;Kim Anderson MD, MSc","doi":"10.1016/j.cjco.2025.12.006","DOIUrl":"10.1016/j.cjco.2025.12.006","url":null,"abstract":"<div><h3>Background</h3><div>Despite its well established benefits, guideline-directed medical therapy (GDMT) is often underutilized following cardiac implantable electronic device (CIED) implantation. We sought to determine the rate of use of GDMT and whether a specialized intervention could improve GDMT and heart failure (HF) outcomes in a CIED clinic.</div></div><div><h3>Methods</h3><div>This prospective quasi-experimental observational cohort study was performed from July 2020 to April 2022. Patients were included if they had a CIED with a left ventricular ejection fraction (LVEF) ≤ 35%. The intervention consisted of a 12-month program in a specialized heart function clinic and device optimization. Controls were patients who were eligible but did not participate in the intervention. The outcome measures were improvement in GDMT use, N-terminal pro-B type natriuretic peptide level (NTproBNP), New York Heart Association class, LVEF, and HF-related emergency department visits and/or hospitalizations.</div></div><div><h3>Results</h3><div>After screening of 942 patients, 220 were identified as having an LVEF ≤ 35%, of which 58% were not on GDMT (intervention n = 29; control n = 99). In the intervention group, 54% of patients reached 4 classes of GDMT, compared to 2.1% of the control group (<em>P</em> &lt; 0.001). HF-related emergency department visits and/or hospitalization were significantly reduced in the intervention group (3.4% vs 14.1%, <em>P</em> = 0.018). NT-proBNP level was reduced by 25%, and LVEF increased by 6.5% in the intervention group. No difference in mortality was noted.</div></div><div><h3>Conclusions</h3><div>This study demonstrates that a specialized HF intervention, designed to optimize GDMT in patients with CIEDs, was associated with an improved NTproBNP level and fewer HF-related emergency department visits and/or hospitalizations, highlighting an important addressable gap in the management of CIED patients.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 4","pages":"Pages 371-378"},"PeriodicalIF":2.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147636665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pericardial Fluid–Derived Small Extracellular Vesicles from Patients with Coronary Disease Alter the Lipidome of Human Coronary Artery Endothelium","authors":"Ali Fatehi Hassanabad MD, PhD ,&nbsp;Megan B. Meechem BSc ,&nbsp;Yi Li Chen ,&nbsp;Anna N. Zarzycki MD ,&nbsp;Mortaza Fatehi Hassanabad MD, MSc ,&nbsp;Adriana Zardini Buzatto PhD ,&nbsp;Paul W.M. Fedak MD, PhD ,&nbsp;Vaibhav B. Patel PhD","doi":"10.1016/j.cjco.2025.12.010","DOIUrl":"10.1016/j.cjco.2025.12.010","url":null,"abstract":"<div><h3>Background</h3><div>To date, we have lacked an understanding of how factors in the pericardial fluid (PF) of patients with coronary artery disease (CAD) can influence the lipidome of coronary artery endothelium. This study explores the impact of PF-derived extracellular vesicles (EVs) on the lipidome of human coronary artery endothelial cells (HCAECs) in patients with CAD.</div></div><div><h3>Methods</h3><div>In this observational study, PF was collected from patients with CAD (n = 3) and without CAD (n = 3). PF-derived small EVs were isolated and characterized using microfluidic resistive pulse sensing. HCAECs were exposed to these EVs, and untargeted liquid chromatography-mass spectrometry was subsequently used to determine the lipidome of the HCAECs. In silico analysis was used to evaluate changes in lipid species and classes.</div></div><div><h3>Results</h3><div>A total of 1043 lipid species were identified in untreated HCAECs and HCAECs treated with PF-derived small EVs. The predominant lipid types were glycerophospholipids, glycerolipids, and sphingolipids. Quantification of individual lipid classes showed HCAECs treated with PF EVs showed reduced summed intensities of lysophosphatidylglycerols and diacylglycerophosphoinositols compared to untreated controls. Treatment with PF EVs derived from Non-CAD patients led to an increase in sphingoid bases, whereas this effect was not observed with CAD-derived PF EVs. Both Non-CAD and CAD PF EV treatments resulted in elevated prenol lipids compared to controls.</div></div><div><h3>Conclusions</h3><div>We identify that small EVs isolated from the PF of patients with CAD alter the lipid profile and metabolism of human coronary artery endothelium. Future studies should determine whether such changes can contribute to the pathophysiology of ischemic heart disease.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 4","pages":"Pages 481-492"},"PeriodicalIF":2.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147636663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in the Heart Sounds Between Discharge and Initial Follow-Up and Subsequent Cardiac Events in Patients with Acute Decompensated Heart Failure","authors":"Jun Shitara MD, PhD ,&nbsp;Nobutaka Murata MPharm ,&nbsp;Shoichiro Yatsu MD, PhD ,&nbsp;Azusa Murata MD, PhD ,&nbsp;Hiroki Matsumoto MD, PhD ,&nbsp;Takao Kato MD, PhD ,&nbsp;Shoko Suda MD, PhD ,&nbsp;Ryo Naito MD, PhD ,&nbsp;Masaru Hiki MD, PhD ,&nbsp;Hiroyuki Daida MD ,&nbsp;Takatoshi Kasai MD, PhD","doi":"10.1016/j.cjco.2025.12.008","DOIUrl":"10.1016/j.cjco.2025.12.008","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac acoustic biomarkers (CABs) measured by acoustic cardiography support the diagnosis or monitoring of worsening heart failure (HF). Our previous observational study suggested that temporal changes in CABs in patients with acute decompensated HF may reflect changes in cardiac function during hospitalization and between discharge and the first follow-up visit. This study aimed to assess whether changes in CABs between discharge and the first follow-up visit in such patients are associated with cardiac events over a 1-year follow-up period.</div></div><div><h3>Methods</h3><div>This study was a follow-up to our previous observational study. CABs assessed at discharge and the first clinic visit following discharge were examined. The incidence of cardiac events, defined as the composite of death and rehospitalization due to worsening HF following the first clinic visit, was investigated.</div></div><div><h3>Results</h3><div>Among 60 patients enrolled in our previous study, 47 who had CAB data at discharge and their first clinic visit were monitored for 1 year. During a median follow-up period of 351 days, 17 of these 47 patients experienced cardiac events, including 4 deaths and 13 rehospitalizations. The cumulative event-free survival rate was significantly poorer in patients whose change in third heart sound (ΔS3) strength was ≥ 0.1 than in those whose ΔS3 strength was &lt; 0.1. Multivariate Cox regression models indicated that the ΔS3 strength increase was significantly associated with increased risk of cardiac events.</div></div><div><h3>Conclusions</h3><div>An increase in S3 as assessed using the CAB device between discharge and the first clinic visit may be a predictor of subsequent cardiac events in patients initially hospitalized for acute decompensated HF.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 4","pages":"Pages 400-407"},"PeriodicalIF":2.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147636585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Author Corrections to “Smoking, Colchicine, and Postoperative Outcomes in Thoracic Surgery: Post Hoc Analysis of the COP-AF Randomized Controlled Trial","authors":"Sandra Ofori MBBS, PhD ,&nbsp;Michael K. Wang MD ,&nbsp;Ekaterine Popova MD, PhD ,&nbsp;William F. McIntyre MD, PhD ,&nbsp;Matthew Chan MBBS, PhD ,&nbsp;Daniel I. Sessler MD ,&nbsp;Veronesi Giulia MD ,&nbsp;Mark Warwas MD ,&nbsp;Kumar Balasubramanian MSc ,&nbsp;Vikas Tandon MD ,&nbsp;Christain Finley MD, MPH ,&nbsp;Gonzalez Tallada Anna MD ,&nbsp;Juan Cata MD ,&nbsp;Sadeesh Srinathan MD ,&nbsp;Cara Reimer MD ,&nbsp;Sean McLean MD, FRCPC ,&nbsp;Juan Carlos Trujillo MD, PhD ,&nbsp;Edith Fleischmann MD ,&nbsp;Luca Voltolini MD ,&nbsp;Patricia Cruz MD ,&nbsp;David Conen MD, MPH","doi":"10.1016/j.cjco.2026.01.001","DOIUrl":"10.1016/j.cjco.2026.01.001","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 4","pages":"Pages 438-439"},"PeriodicalIF":2.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147636513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality Benefit of Microaxial Flow Pump Use in Infarct-Related Cardiogenic Shock: a Bayesian Reanalysis of the DanGer Shock Trial","authors":"Marco Tomasino MD ,&nbsp;Garazi Urio-Garmendia MSc ,&nbsp;Eduard Ródenas-Alesina MD ,&nbsp;Aitor Uribarri MD, PhD ,&nbsp;Ignacio Ferreira-González MD, PhD","doi":"10.1016/j.cjco.2025.11.017","DOIUrl":"10.1016/j.cjco.2025.11.017","url":null,"abstract":"<div><h3>Background</h3><div>The Danish-German Cardiogenic Shock (DanGer Shock) trial was the first randomized study to suggest a survival benefit of microaxial flow pump use in patients with ST-elevation myocardial infarction complicated by cardiogenic shock. The frequentist analysis reported borderline significance, leaving uncertainty regarding the robustness and magnitude of benefit. Bayesian methods offer a complementary framework by quantifying the probability of clinically meaningful treatment effects.</div></div><div><h3>Methods</h3><div>We conducted a Bayesian reanalysis of the DanGer Shock trial using aggregate, published 180-day mortality data. Priors reflecting a spectrum of clinical beliefs (from strongly skeptical to strongly enthusiastic) were employed. Posterior probabilities of benefit were estimated for relative risk (RR) thresholds &lt; 1, &lt; 0.90, &lt; 0.80, and &lt; 0.70, and for absolute risk reduction (ARR) thresholds ≥ 2%, ≥ 4%, ≥ 6%, ≥ 8%, ≥ 10%, and ≥ 18%, assuming a baseline 180-day mortality risk of 58.5%.</div></div><div><h3>Results</h3><div>With a minimally informative prior, the median posterior RR was 0.78 (95% credible interval, 0.64-0.95). The posterior probability of any mortality benefit (RR &lt; 1) was 99%, whereas the probability of a large effect (RR &lt; 0.70) was 15%. The posterior median ARR was 12.8% (95% credible interval, 3.0%-21.6%), with a 98% probability of ARR ≥ 2%, but only 17% probability of ARR ≥ 18%. Across all priors, the probability of RR &lt; 1 ranged from 98% to 100%.</div></div><div><h3>Conclusions</h3><div>This Bayesian reanalysis of the DanGer Shock trial supports a high probability that microaxial flow pump use reduces mortality in ST-elevation myocardial infarction complicated by cardiogenic shock, although large treatment effects appear unlikely. These findings complement the original trial and provide a more intuitive probabilistic interpretation for clinicians.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 4","pages":"Pages 448-456"},"PeriodicalIF":2.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147636578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Intravascular Imaging to Guide Percutaneous Coronary Interventions: Experience from a Single, High-Volume Canadian Centre","authors":"Mehdi Madanchi MD ,&nbsp;Natalia Pinilla-Echeverri MD, PhD ,&nbsp;Shamir R. Mehta MD, MSc ,&nbsp;Jon-David Schwalm MD, Msc ,&nbsp;Nicholas Valettas MD, MASc ,&nbsp;James L. Velianou MD ,&nbsp;Micheal B. Tsang MD, MSc ,&nbsp;Madhu K. Natarajan MD, MSc ,&nbsp;Sanjit S. Jolly MD, Msc ,&nbsp;Tej Sheth MD ,&nbsp;Matthew Sibbald MD, PhD","doi":"10.1016/j.cjco.2025.11.020","DOIUrl":"10.1016/j.cjco.2025.11.020","url":null,"abstract":"<div><h3>Background</h3><div>Intravascular imaging (IVI) improves outcomes in complex percutaneous coronary intervention (PCI) and is recommended by the latest guidelines. However, data about its real-world application remain limited.</div></div><div><h3>Methods</h3><div>We conducted a retrospective audit of 300 consecutive PCI cases. Lesions were classified as complex if they involved &gt; 1 of the following characteristics: bifurcation, severe calcifications, chronic total occlusion, long lesions, ostial location, and involvement of the left main artery. IVI use was analyzed by lesion subtype and individual operator.</div></div><div><h3>Results</h3><div>Of 300 consecutive PCI cases, 146 (49%) were classified as complex PCI. IVI was used in 53% of complex PCIs and 23% of noncomplex PCIs. Among patients undergoing complex PCI, IVI was most frequently performed in chronic total occlusions (86%) and left main disease (76%), but its use remained below 50% for bifurcations, severe calcified lesions, and long lesions. IVI-guided PCI was associated with higher contrast use (215 ± 78 vs 179 ± 65 mL, <em>P</em> = 0.003) and longer procedural duration (72 ± 32 vs 51 ± 22 minutes, <em>P</em> &lt; 0.001) and varied widely across operators, ranging from 0%-79% in the overall population (<em>P</em> &lt; 0.001) to 0%-90% in complex lesions (<em>P</em> = 0.004). Notably, IVI adoption declined with increasing operator age (odds ratio, 0.88 per +1 year; 95% confidence interval 0.78-0.98), whereas it increased with lesion complexity (odds ratio 2.34 per additional complexity feature; 95% confidence interval 1 1.62-3.39).</div></div><div><h3>Conclusions</h3><div>Despite current evidence and guideline recommendations, IVI use showed notable variation across operators. Standardizing IVI utilization through education, protocols, and system-level support are essential to promoting guideline-concordant practice.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 4","pages":"Pages 469-477"},"PeriodicalIF":2.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147636581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}