CJC Open最新文献

{"title":"Multimodal Imaging Evaluation and Follow-up of a Congenital Left Ventricular Aneurysm","authors":"Matteo Brusamolino MD , Ruper Oliveró MD , Victor González MD , Jose F. Rodriguez-Palomares MD, PhD , Gianluca Pontone MD, PhD","doi":"10.1016/j.cjco.2025.06.002","DOIUrl":"10.1016/j.cjco.2025.06.002","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 9","pages":"Pages 1214-1217"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061780","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":"Utility of Transesophageal Echocardiography and Isoproterenol Provocation in Detecting Latent Obstruction in Hypertrophic Cardiomyopathy","authors":"Kutaiba Nazif DO ,&nbsp;Aakash Bavishi MD, MSCI ,&nbsp;Matthew W. Martinez MD","doi":"10.1016/j.cjco.2025.06.015","DOIUrl":"10.1016/j.cjco.2025.06.015","url":null,"abstract":"<div><div>Transthoracic echocardiography imaging has traditionally been used to screen for left ventricular outflow tract (LVOT) obstruction in hypertrophic cardiomyopathy. However, there may be limitations in the ability to diagnose LVOT obstruction using transthoracic echocardiography (TTE). We present 6 symptomatic hypertrophic cardiomyopathy patients without significant LVOT obstruction on TTE imaging who underwent transesophageal echocardiography (TEE) with isoproterenol provocation. Four of the 6 patients developed significant obstruction. Three patients underwent septal myectomy and 1 chose cardiac myosin inhibitor therapy, with significant improvement in their symptoms. Our findings suggest that provocation with isoproterenol during TEE can provide a sensitive assessment for latent systolic anterior motion.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 9","pages":"Pages 1201-1203"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061759","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":"Variation in Availability of Continuous Ambulatory Electrocardiographic Monitors Across Canadian Provinces","authors":"Amr Saleh BSc ,&nbsp;Jason G. Andrade MD ,&nbsp;Patrick Bergin MD ,&nbsp;Derek S. Chew MD MSc ,&nbsp;Larry Sterns MD ,&nbsp;Christian Steinberg MD ,&nbsp;Mehdrad Golian MD ,&nbsp;Evan Lockwood MD ,&nbsp;Min-Shien Chen MD ,&nbsp;Stephen Duffett MD ,&nbsp;Jeff S. Healey MD MSc ,&nbsp;Ratika Parkash MD ,&nbsp;Lena Rivard MD ,&nbsp;Colette M. Seifer MD ,&nbsp;Satish Toal MD ,&nbsp;William F. McIntyre MD, PhD","doi":"10.1016/j.cjco.2025.06.005","DOIUrl":"10.1016/j.cjco.2025.06.005","url":null,"abstract":"<div><h3>Background</h3><div>Continuous ambulatory electrocardiographic (ECG) monitors are essential for diagnosing cardiac arrhythmias. In Canada, individual provinces dictate access to and reimbursement for these services. This study examines variations in access to continuous ambulatory ECG monitoring in Canada.</div></div><div><h3>Methods</h3><div>We reviewed publicly available provincial schedules of benefits, to identify the durations of continuous ambulatory ECG monitoring reimbursed across Canadian provinces. We abstracted data on the duration, modality, and reimbursement criteria for monitoring services. Additionally, at least one specialist from each province provided information on the types of monitors available, their accessibility, and further information on local reimbursement processes.</div></div><div><h3>Results</h3><div>We found significant variability in continuous ambulatory ECG monitoring coverage across provinces. Shorter monitoring durations (24 and 48 hours) are available in all provinces, but coverage for longer durations varies. Only patients in Ontario, Nova Scotia, and Saskatchewan can access publicly funded, 14-day, continuous, ambulatory ECG monitors. Ambulatory ECG monitoring is available from hospitals in all provinces. Direct-to-patient device delivery is available in all but 4 provinces (Alberta, Saskatchewan, Manitoba, and Nova Scotia). Testing by private entities is available in 5 provinces (British Columbia, Alberta, Saskatchewan, Ontario, and Quebec).</div></div><div><h3>Conclusions</h3><div>The availability of continuous, ambulatory, ECG monitoring across Canadian provinces has considerable variability. Measures are needed to ensure equitable access to ambulatory ECG monitoring services nationwide. Creating national monitoring guidelines could set goals for provinces to work toward, enhancing access for all Canadians and reinforcing values of the Canada Health Act.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 9","pages":"Pages 1157-1161"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145060785","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":"Circulating Angiopoietin-Like Protein 3 Level and Plaque Calcification: An Optical Coherence Tomography Imaging Analysis","authors":"Yu Kataoka MD, PhD ,&nbsp;Kota Murai MD ,&nbsp;Stephen J. Nicholls MBBS, PhD ,&nbsp;Yoshiyuki Tomishima MD ,&nbsp;Takamasa Iwai MD ,&nbsp;Kenichiro Sawada MD ,&nbsp;Hideo Matama MD ,&nbsp;Satoshi Honda MD, PhD ,&nbsp;Kensuke Takagi MD, PhD ,&nbsp;Masashi Fujino MD, PhD ,&nbsp;Shuichi Yoneda MD, PhD ,&nbsp;Kazuhiro Nakao MD, PhD ,&nbsp;Fumiyuki Otsuka MD, PhD ,&nbsp;Yasuhide Asaumi MD, PhD ,&nbsp;Teruo Noguchi MD, PhD","doi":"10.1016/j.cjco.2025.06.006","DOIUrl":"10.1016/j.cjco.2025.06.006","url":null,"abstract":"<div><h3>Background</h3><div>Angiopoietin-like protein 3 (ANGPTL3) regulates lipoprotein metabolism, and its genetic deficiency reduces the risk of atherosclerotic cardiovascular disease. However, the association between ANGPTL3 expression and atherosclerotic plaque formation remains unclear.</div></div><div><h3>Methods</h3><div>We analyzed 58 patients with coronary artery disease (89 non-culprit lesions) who underwent optical coherence tomography (OCT)-guided percutaneous coronary intervention. ANGPTL3 levels were measured by an enzymatic method (Immuno-Biological Laboratories, Gunma, Japan). Clinical demographics and OCT-derived plaque features were compared among patients stratified according to tertiles of ANGPTL3 levels.</div></div><div><h3>Results</h3><div>The ANGPTL3 level was 356.2 ± 158.9 ng/mL (statin = 98.2%; low-density lipoprotein cholesterol = 74.5 ± 21.7 mg/dL). Patients in tertile 3 of ANGPTL3 level were older (<em>P</em> = 0.025) and had a lower estimated glomerular filtration rate (eGFR; <em>P</em> = 0.010). On OCT imaging, the lipid arc (<em>P</em> = 0.139), fibrous cap thickness (<em>P</em> = 0.826), and other plaque microstructures did not significantly differ among the 3 groups, whereas increased ANGPTL3 levels were associated with a larger calcification arc (<em>P</em> &lt; 0.001) and a longer calcification length (<em>P</em> &lt; 0.001). Multivariate analysis demonstrated that ANGPTL3 (β-coefficient = 0.143, 95% confidence interval [CI] = 0.07–0.21, <em>P</em> &lt; 0.001) and eGFR (β-coefficient = −1.380, 95% CI = −2.53-0.22, <em>P</em> = 0.019) are independent factors affecting the maximum calcification arc. ANGPTL3 (β-coefficient = 0.013, 95% CI = 0.010-0.016, <em>P</em> &lt; 0.001) levels remained independently associated with calcification length. Receiver operating characteristic curve analyses revealed that ANGPTL3 ≥ 410.9 ng/mL (area under the curve = 0.815, 95% CI = 0.718–0.913, <em>P</em> &lt; 0.001) and eGFR ≤ 65.2 mL/min per 1.73 m² (area under the curve = 0.759, 95% CI = 0.645–0.873, <em>P</em> &lt; 0.001) are the best cutoff values for predicting OCT-derived greater calcification (calcification arc &gt; 87.7° + calcification length &gt; 5.6 mm). The proportion of patients with greater calcification increased with the number of these features (<em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>ANGPTL3 expression was associated with plaque calcification in patients with coronary artery disease. Further studies are required to confirm ANGPTL3 as a therapeutic target for modulating calcification.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 9","pages":"Pages 1204-1213"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061761","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":"Postsurgical Temporary Epicardial Pacing: Electrophysiological Implications of Contemporary Pacing Lead Designs","authors":"Intisar Ahmed MBBS, FCPS ,&nbsp;Chloe Netlefold MBBS, FRACP ,&nbsp;Robert D. Anderson MBBS, PhD,&nbsp;Stephane Masse MASc,&nbsp;Melanie R. Burg MD, MSc,&nbsp;Tirone E. David MD, FRCSC,&nbsp;Jane Heggie MD, FRCP,&nbsp;Maral Ouzounian MD, PhD,&nbsp;Kumaraswamy Nanthakumar MD, FRCPC","doi":"10.1016/j.cjco.2025.06.003","DOIUrl":"10.1016/j.cjco.2025.06.003","url":null,"abstract":"<div><h3>Background</h3><div>Despite advancements in postoperative temporary epicardial pacing leads, sensing malfunction can still happen. Oversensing presents as inappropriate inhibition of pacing (a major concern for pacemaker-dependent patients), whereas undersensing may lead to an extremely rare complication of ventricular fibrillation from R on T. The single-lead and dual-lead configurations have key structural differences related to the size of the bipole electrodes and the spacing between them. We assessed how this affects the sensing function.</div></div><div><h3>Methods</h3><div>Five porcine studies were conducted using open chest and Langendorff models. We used 2 pacing wire configurations and compared the sensed electrograms. We compared a newer single-lead configuration (small, closely spaced electrodes) with a dual-lead (large, widely spaced) configuration. The primary outcome was the amplitude of the R wave. Secondary outcomes were the relative size of the T wave and the effect of sampling frequency and low-pass filtering.</div></div><div><h3>Results</h3><div>The sensed QRS was significantly larger in the widely spaced, larger electrodes when compared with closely spaced, smaller electrodes across all sampling frequencies and filter settings (6.9-29.7 mV vs 1.7-8.6 mV, <em>P</em> &lt; 0.001). The average amplitude of the T wave was closer to the average QRS amplitude with the newer configuration across all settings. The mean T wave to R wave difference ranged from 3.0 to 3.7 mV for the single lead and 1.0 to 21.5 mV for the dual lead configuration. Large, widely spaced electrodes resulted in much larger sensed QRS signals and a safer programming window for sensitivity.</div></div><div><h3>Conclusions</h3><div>The smaller, closely spaced electrodes detect a relatively small QRS and a larger T wave, leading to a narrower safety window and an increased risk of sensing malfunction (Central Illustration). To avert catastrophic consequences, the electrophysiologic implications of new temporary pacing wires must be considered during postoperative care.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 9","pages":"Pages 1162-1169"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145060786","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":"The Effect of an Incentive Billing Code on Heart Failure Management in Primary Care: A Population-Based Study","authors":"Shijie Zhou MD ,&nbsp;Douglas S. Lee MD, PhD ,&nbsp;Francis Nguyen MPH ,&nbsp;Harsukh Benipal MD, MSc ,&nbsp;Richard Perez PhD ,&nbsp;Peter C. Austin PhD ,&nbsp;Husam Abdel-Qadir MD, PhD ,&nbsp;Jacob A. Udell MD, MPH ,&nbsp;Catherine Demers MD, MSc","doi":"10.1016/j.cjco.2025.05.002","DOIUrl":"10.1016/j.cjco.2025.05.002","url":null,"abstract":"<div><h3>Background</h3><div>To support family physicians (FPs) in managing patients with heart failure (HF), the Ministry of Health in Ontario, Canada implemented the Q050A billing code in 2008, a pay-for-performance incentive for guideline-based HF care. We studied whether the incentive was associated with any change in the prescription of HF medications.</div></div><div><h3>Methods</h3><div>We identified all patients with HF in Ontario aged ≥ 66 years who were managed by FPs claiming the Q050A incentive between 2008 and 2021. We determined the proportion of patients who were prescribed renin-angiotensin system inhibitors (RASis), beta-blockers (BBs), mineralocorticoid receptor antagonists (MRAs), and diuretics 3 months before and after the Q050A billing code was used in claims for these patients. As applicable, we classified the agents by whether they are guideline-directed as recommended by the Canadian Cardiovascular Society.</div></div><div><h3>Results</h3><div>We included 39,425 HF patients in the study. The median age was 80 years (interquartile range, 73-85); 49% were female. Compared to the pre-Q050A period, prescriptions increased after the incentive was implemented, from 45.2% to 45.8% for RASis, 51.9% to 54.4% for BBs, 9.2% to 11.7% for MRAs, and 63.2% to 65.7% for diuretics (<em>P</em> &lt; 0.05). The proportion of those who were not on any HF medications decreased from 27.5% to 24.9% (<em>P</em> &lt; 0.001). Those with newly diagnosed HF and prompt follow-up with FPs experienced the largest—but a clinically modest—increase in HF medications.</div></div><div><h3>Conclusions</h3><div>The Q050A incentive led to a minimal increase in the prescription of HF medications; disease-modifying agents are underutilized.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 8","pages":"Pages 1007-1013"},"PeriodicalIF":2.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858117","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":"Uptake of novel evidence-based therapies in patients with type 2 diabetes after a cardiovascular event: insights from CANHEART","authors":"Wade Thompson PharmD, PhD ,&nbsp;Brendan Wong MD ,&nbsp;Atul Sivaswamy MSc ,&nbsp;Laura Ferreira-Legere MScN ,&nbsp;Douglas S. Lee MD, PhD ,&nbsp;Husam Abdel-Qadir MD, PhD ,&nbsp;Dennis T. Ko MD, MSc ,&nbsp;Alanna Weisman MD, PhD ,&nbsp;Sheldon Tobe MD, MSc ,&nbsp;Cynthia A. Jackevicius PharmD, MSc ,&nbsp;Shaun G. Goodman MD, MSc ,&nbsp;Michael E. Farkouh MD ,&nbsp;Jacob A. Udell MD, MPH","doi":"10.1016/j.cjco.2025.02.008","DOIUrl":"10.1016/j.cjco.2025.02.008","url":null,"abstract":"<div><h3>Background</h3><div>A cardiovascular (CV) hospitalization is a seminal opportunity to implement guideline-directed medical therapy (GDMT). Sodium-glucose transporter 2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP1RAs) can improve outcomes among those with type 2 diabetes mellitus (T2DM) and CV disease.</div></div><div><h3>Methods</h3><div>We conducted a population-based cohort study among patients aged ≥ 66 years with T2DM in Ontario hospitalized for a CV event (myocardial infarction, heart failure, peripheral arterial disease, ischemic stroke) from June 2015 to March 2022, who were followed until March 2023. We examined use of GDMT before vs after the index event, including use of SGLT2is, GLP1RAs, statins, and others medications.</div></div><div><h3>Results</h3><div>We identified 75,869 people aged ≥ 66 years with T2DM (median age 78 years; 43% female). The proportion receiving SGLT2is was 9% before index hospitalization and 29% during the follow-up period. GLP1RA was used for 1% before vs 9% after, compared with 65% before and 86% after for statins. Use of novel GDMT increased across the follow-up period. The incidence of SGLT2i use 1-year posthospitalization was 4% in 2016 vs 39% in 2021; for GLP1RA use, the incidence was 0% in 2016 vs 11% in 2021.</div></div><div><h3>Conclusions</h3><div>A rise in the use of novel GDMT suggests increasing adoption of therapies to optimize secondary prevention in patients with T2DM and CV disease after index CV events.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 8","pages":"Pages 1055-1061"},"PeriodicalIF":2.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858113","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 “Using implementation science to evaluate the implementation of patient-reported outcome measures (PROMs) in a clinical heart failure care setting [CJC Open. (2024) 1-10]”","authors":"","doi":"10.1016/j.cjco.2025.06.008","DOIUrl":"10.1016/j.cjco.2025.06.008","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 8","pages":"Page 1016"},"PeriodicalIF":2.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858119","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":"Benefits of Expert Online Consultations for the Detection of Pulmonary Embolism and Timely Treatment: Enhancing Telemedicine Technology–A Case Report","authors":"Masaki Takenaka MD, PhD ,&nbsp;Satoshi Yanagisawa MD, PhD ,&nbsp;Yukihiko Yoshida MD, PhD ,&nbsp;Yasuya Inden MD, PhD ,&nbsp;Toyoaki Murohara MD, PhD","doi":"10.1016/j.cjco.2025.05.014","DOIUrl":"10.1016/j.cjco.2025.05.014","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 8","pages":"Pages 1093-1096"},"PeriodicalIF":2.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858170","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":"Managing Acute Coronary Syndromes in Older Adults: Challenges and Registry Insights","authors":"Artur Dziewierz MD, PhD,&nbsp;Natalia Kulicka MD,&nbsp;Barbara Zdzierak MD, PhD,&nbsp;Zbigniew Siudak MD, PhD","doi":"10.1016/j.cjco.2025.05.013","DOIUrl":"10.1016/j.cjco.2025.05.013","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 8","pages":"Pages 1108-1109"},"PeriodicalIF":2.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858187","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}