CJC Open最新文献

{"title":"Cardiac Papillary Fibroelastoma and Cerebrovascular Events: A Systematic Review","authors":"","doi":"10.1016/j.cjco.2024.07.008","DOIUrl":"10.1016/j.cjco.2024.07.008","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac papillary fibroelastomas (CPFs) are benign endocardial tumours with embolic potential. This article is a systematic review to identify the clinical profile, diagnosis, tumour characteristics, and treatment modalities in patients with CPF presenting with stroke or transient ischemic attack (TIA).</div></div><div><h3>Methods</h3><div>This systematic review was conducted using the PubMed and Embase databases, including case reports and/or series and observational studies (for a search period of up until April 2022). A descriptive summary of case reports and/or series, and a narrative summary of observational studies, were completed.</div></div><div><h3>Results</h3><div>A total of 161 cases were identified from 133 case reports and 11 case series. The mean age of patients was 54.8 years, and 46.6% were male. TIA and stroke were reported in 32.3% and 67.8%, respectively. The most common stroke territory was multiple brain sites (36.6%). The mean tumour size was 11.8 mm. Most of the tumours were left-sided (98.7%). The mitral valve was the most involved valve (38.9%), with the anterior leaflet being the commonest site (61.3%). A total of 91.4% of tumours were independently mobile; 10.6% of tumours missed by transthoracic echocardiography were identified on transesophageal echocardiography. Antiplatelet and anticoagulation treatment were used in 87.9% and 12.1% of cases, respectively. Simple excision, valve repair, and valve replacement were performed in 66.7%, 16.7%, and 16.7%, respectively. The logistic regression model revealed that age was the only significant predictor; an increase in the log-odds of recurrent cerebrovascular events occurred with increasing age.</div></div><div><h3>Conclusions</h3><div>CPFs are a differential diagnosis of cryptogenic stroke, especially if the initial workup for stroke is negative. Transesophageal echocardiography serves as a better imaging tool, compared to transthoracic echocardiography, in identifying CPF. Although the consensus for CPF management remains controversial, surgical excision is the primary approach for left-sided CPF presenting as stroke or TIA.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141844258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the Safety of Early Repatriation for Stable ST-Segment Elevation Myocardial Infarction Patients After Primary Percutaneous Coronary Intervention","authors":"","doi":"10.1016/j.cjco.2024.07.010","DOIUrl":"10.1016/j.cjco.2024.07.010","url":null,"abstract":"<div><h3>Background</h3><div>Repatriation of ST-segment elevation myocardial infarction (STEMI) patients after primary percutaneous coronary intervention (PPCI) is common in regional health care programs. We examined the short- and long-term safety of early repatriation after PPCI in stable STEMI patients.</div></div><div><h3>Methods</h3><div>Consecutive stable STEMI patients undergoing PPCI between 2016 to 2018 in the Fraser Health Authority were included. Outcomes were compared between early and nonrepatriated cohorts. Co-primary outcomes were a composite of death, myocardial infarction, congestive heart failure, and stroke at 30 days and 1 year. Logistic regression analyses were performed to determine association between early repatriation and outcomes, and to assess impact of transfer to cardiologist- vs internist-based care centres.</div></div><div><h3>Results</h3><div>A total of 788 patients were included, with 62% being repatriated early. Primary composite and individual outcomes rates were similar between both cohorts. Early repatriation was not an independent predictor of 30-day (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.50-1.72; <em>P</em> = 0.82) or 1-year (OR 1.05, 95% CI 0.67-1.65; <em>P</em> = 0.8) primary outcome, or of 30-day (OR 1.35, 95% CI 0.41-4.47, <em>P</em> = 0.63) or 1-year (OR 1.03, 95% CI 0.44-2.40; <em>P</em> = 0.95) mortality. Among early repatriated patients, transfer to cardiologist- vs internist-based care centres was not an independent factor for 30-day (OR 1.07, 95% CI 0.45-2.54; <em>P</em> = 0.87) or 1-year (OR 1.17, 95% 0.55-2.50, <em>P</em> = 0.69) primary outcome.</div></div><div><h3>Conclusions</h3><div>Early repatriation of stable STEMI patients after PPCI appears to be safe based on short- and long-term outcomes, and transfer to internist- vs cardiology-based centres did not affect outcomes. After PPCI, early repatriation allows for redistribution of stable STEMI patients to lower-acuity settings across regional hospitals.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141853068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary Sinus Reducer Improves Myocardial Perfusion in a Patient With Angina, Hypertrophic Cardiomyopathy, and Coronary Microvascular Disease","authors":"","doi":"10.1016/j.cjco.2024.07.011","DOIUrl":"10.1016/j.cjco.2024.07.011","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141853925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal Trends in the Management Practices of Clinically Important Perioperative Atrial Fibrillation After Noncardiac Surgery","authors":"","doi":"10.1016/j.cjco.2024.08.003","DOIUrl":"10.1016/j.cjco.2024.08.003","url":null,"abstract":"<div><h3>Background</h3><div>Clinically important perioperative atrial fibrillation (POAF) is a common cardiac complication after noncardiac surgery. Little is known about how patients with POAF are managed acutely and whether practices have changed over time.</div></div><div><h3>Methods</h3><div>We conducted an observational substudy of patients who had POAF, were at elevated cardiovascular risk, and were enrolled in the PeriOperative Ischemic Evaluation (POISE)-1, 2 and 3 trials between 2002 and 2021. POAF was defined as new, clinically important atrial fibrillation occurring within 30 days after surgery. We assessed the use of rhythm-control and anticoagulation treatment in response to POAF, at hospital discharge and at 30 days after surgery. We assessed for temporal trends using multivariable logistic regression.</div></div><div><h3>Results</h3><div>Of the 27,896 patients included, 545 (1.9%) developed clinically important POAF. Patients received rhythm-control treatment in 48.6% of cases. The level of use of rhythm-control treatment increased over the course of the trials (POISE-1 vs POISE-2 vs POISE-3; 40.9% vs 49.5% vs 59.1%). A later randomization date was associated independently with use of rhythm-control treatment (odds ratio, 1.05 per year; 95% confidence interval, 1.01-1.09). Anticoagulation treatment was prescribed in 21% of POAF cases. The level of anticoagulation treatement use was higher in POISE-3, compared to that in the 2 previous trials (POISE-1 vs POISE-2 vs POISE-3—16.4% vs 16.5% vs 33.6%). A later randomization date was associated independently with use of anticoagulation treatment (odds ratio, 1.06 per year; 95% confidence interval, 1.02-1.11).</div></div><div><h3>Conclusions</h3><div>Despite the absence of randomized controlled trials, the level of use of rhythm-control and anticoagulation treatment for POAF is rising. High-quality trials are needed urgently to determine whether these interventions are safe and effective in this population.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex Differences in Outcomes of Adults with Repaired Coarctation of Aorta and Concomitant Aortic Valve Disease","authors":"","doi":"10.1016/j.cjco.2024.08.006","DOIUrl":"10.1016/j.cjco.2024.08.006","url":null,"abstract":"<div><h3>Background</h3><div>Aortic valve disease is common in adults with coarctation of aorta. However, no systematic comparative analyses have been performed of the clinical course of aortic valve disease for male vs female patients in this population. The purpose of this study was to compare cardiac remodelling, onset of symptoms, and incidence of aortic valve replacement (AVR) for male vs female patients.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted of adults with repaired coarctation of aorta and ≥ moderate aortic stenosis and/or aortic regurgitation. Cardiac remodelling (left ventricular [LV], left atrial, right ventricular [RV], and right atrial structure and function) and symptomatic and/or functional class were determined at the baseline encounter. Development of new-onset symptoms and the incidence of AVR were ascertained for the period from baseline to last encounter.</div></div><div><h3>Results</h3><div>We identified 214 patients (121 male [57%], 93 female [43%]). Although both groups had a similar aortic valve gradient, aortic valve area indexed to body surface area, aortic regurgitation severity, and functional status at baseline, female patients had more LV concentric hypertrophy and remodelling, left atrial hypertension and dysfunction, elevated RV systolic pressure, and RV systolic dysfunction. Of 151 patients without symptoms at baseline,102 (72%) developed symptoms. Female sex was independently associated with new-onset symptoms (adjusted hazard ratio 1.14, [95% confidence interval 1.05-1.23]). Of 214 patients, 191 (89%) underwent AVR. Female sex was not associated with AVR upon multivariable analysis. However, LV concentric hypertrophy and remodelling (both of which were more common in female patients) were associated with new-onset symptoms and AVR.</div></div><div><h3>Conclusions</h3><div>Female patients, compared to male patients, had more-advanced cardiac remodelling, and more-rapid onset of symptoms, but a similar risk of AVR.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One Size Does Not Fit All: An Exploration of Compression Garment Use in Patients With Postural Orthostatic Tachycardia Syndrome","authors":"","doi":"10.1016/j.cjco.2024.07.013","DOIUrl":"10.1016/j.cjco.2024.07.013","url":null,"abstract":"<div><h3>Background</h3><div>Postural orthostatic tachycardia syndrome (POTS) is a chronic form of orthostatic intolerance that primarily affects female patients. Despite the severity of POTS, there are no approved medications for use in patients with this disorder. Compression garments are a commonly prescribed nonpharmacological treatment, but little is known about the patient experience with compression. In this study we aimed to evaluate the patient experience with compression garments using a structured survey and semistructured telephone interviews.</div></div><div><h3>Methods</h3><div>A focused survey was designed as a component of a larger clinical trial on compression garment use in patients diagnosed with POTS. Building on the survey, semistructured telephone interviews were conducted with POTS patients. Recorded interviews were transcribed and coded in a thematic analysis using a descriptive-interpretive approach.</div></div><div><h3>Results</h3><div>A total of 27 participants completed the survey, and 20 participants completed the telephone interview. Patient experiences with compression were variable, with some participants experiencing significant benefits, and others reporting minimal to no benefits. Six themes that influenced garment use were identified: the potential benefit of the garment to improve symptoms, specific activities patients will be undertaking, environmental conditions, garment attributes, psychological and cognitive aspects, and financial considerations.</div></div><div><h3>Conclusions</h3><div>Participants engage in a daily cost-benefit analysis when making decisions to use a compression garment. Clinicians should be aware of the benefits of and factors that limit use of compression garments as a treatment for POTS.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of the Comparison of Outcomes and Access to Care for Heart Failure (COACH) Trial","authors":"","doi":"10.1016/j.cjco.2024.07.012","DOIUrl":"10.1016/j.cjco.2024.07.012","url":null,"abstract":"<div><h3>Background</h3><div>The Comparison of Outcomes and Access to Care for Heart Failure (COACH) trial demonstrated that use of a point-of-care risk assessment tool and a rapid ambulatory transitional heart failure clinic led to significant reductions in death and cardiovascular hospitalisation among patients with acute heart failure. We report a process evaluation of COACH intervention and strategy implementation.</div></div><div><h3>Methods</h3><div>We conducted longitudinal interviews with staff to assess barriers and facilitators to COACH implementation. Factors were coded according to the Theoretical Domains Framework (TDF) and the Consolidated Framework for Implementation Research (CFIR). Intervention mapping was conducted to identify theory-rooted strategies to address barriers and influence facilitators toward implementation. We used interviews, document reviews, and check-in calls with implementation teams to describe uptake of these strategies and their impact on implementation success over time.</div></div><div><h3>Results</h3><div>A total of 29 interviews were conducted across 10 sites. We identified 10 factors that affected COACH implementation, which corresponded to 6 TDF and 5 CFIR domains. Some barriers were resolved within the study period, but others persisted over time. Seven implementation strategies were recommended to sites. Participants identified ample preparation time, site-specific personnel support, structural and social characteristics conducive to the intervention needs, and implementation experience as factors that facilitated implementation success.</div></div><div><h3>Conclusions</h3><div>We supported implementation of the COACH intervention in 10 acute care hospital sites and describe the factors impacting implementation. We recommend a rapid implementation assessment to sites wishing to implement COACH, and suggest strategies that can be used to mitigate barriers and aid facilitators to improve implementation success.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fibromuscular Dysplasia: A Focused Review for the Cardiologist","authors":"","doi":"10.1016/j.cjco.2024.07.014","DOIUrl":"10.1016/j.cjco.2024.07.014","url":null,"abstract":"<div><div>Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndromes. Fibromuscular dysplasia (FMD) is an idiopathic, nonatherosclerotic, and noninflammatory arterial disease that affects small- to medium-sized arteries that can result in multifocal aneurysms, stenosis, tortuosity, and dissections. Extracoronary FMD has been identified in approximately 70% of SCAD patients and it is recommended that all SCAD patients undergo screening for FMD once in their lifetime using computed tomography angiography from head to pelvis. This focused review for cardiologists outlines current approaches to diagnosis and management of patients with FMD.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Arrests Due to Medically Refractory Coronary Vasospasm in the Acute Cardiac Care Unit","authors":"","doi":"10.1016/j.cjco.2024.08.010","DOIUrl":"10.1016/j.cjco.2024.08.010","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paced QRS Interval Duration and Pacing-Induced Cardiomyopathy - Time to Display","authors":"","doi":"10.1016/j.cjco.2024.08.002","DOIUrl":"10.1016/j.cjco.2024.08.002","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}