CJC Open最新文献

{"title":"Time for Change: Strengthening Early Detection and Intervention Strategies to Improve Cardiovascular Health in Canada","authors":"Andriy Katyukha MD,&nbsp;Kendra Pelland MSc,&nbsp;Santabhanu Chakrabarti MD,&nbsp;David Messika-Zeitoun MD, PhD,&nbsp;Stephanie Poon MD, MSc,&nbsp;Anne Simard MHSc,&nbsp;Harindra C. Wijeysundera MD, PhD,&nbsp;Seema Nagpal PhD","doi":"10.1016/j.cjco.2026.05.002","DOIUrl":"10.1016/j.cjco.2026.05.002","url":null,"abstract":"<div><div>Cardiovascular disease remains a significant cause of morbidity and mortality in Canada, and early detection and intervention programs have the potential to improve outcomes for patients. This review aims to outline the importance of early detection and intervention for various cardiac diseases, outline barriers that exist to early detection in Canada, identify the system-level benefits to improving early detection and intervention, and ultimately help policymakers and other stakeholders identify new opportunities for intervention. Various data show that early detection and intervention in coronary artery disease, arrhythmias, valvular heart disease, and heart failure are feasible and are associated with better outcomes for patients. Recognizing the unique barriers that exist in Canada, we must work toward creating innovative solutions aimed at helping patients access care. Several innovative collaborative models of care and programs have been piloted around the world, allowing us to learn from different jurisdictions and begin work locally to help improve early detection of cardiovascular diseases in Canada. Canadian stakeholders including health leaders, policymakers, and other health advocates must continue to work with physician leaders to create robust, comprehensive, and cost-effective early detection and intervention programs to improve cardiac care nationally.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 10","pages":"Pages 1483-1494"},"PeriodicalIF":2.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149096061","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":"Preprocedural Q-wave Depth Does Not Predict Mortality After Primary Coronary Intervention for ST-elevation Myocardial Infarction","authors":"Kristian Arak MBChB,&nbsp;Kaushika Rautray MBBS,&nbsp;Sulaiman Tomy MBChB,&nbsp;Rosemary Siby MBBS,&nbsp;Mhd Alaa Aldin Al Haffar MD,&nbsp;Salman Sahibzada MBBS,&nbsp;Julian P. Gunn MD,&nbsp;Hazel A. Haley MBChB, MD","doi":"10.1016/j.cjco.2026.06.004","DOIUrl":"10.1016/j.cjco.2026.06.004","url":null,"abstract":"<div><h3>Background</h3><div>Pathologic Q waves on the admission electrocardiogram (ECG) have historically been markers of myocardial necrosis and adverse outcomes after ST-elevation myocardial infarction (STEMI). Although quantitative markers such as Q-wave width may add prognostic value, they can be difficult to apply clinically. We hypothesised that maximal and average pre–percutaneous coronary intervention (PCI) Q-wave depth could predict short- and medium-term mortality.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study of consecutive STEMI patients undergoing primary PCI (N = 625). Pre-PCI ECGs were analysed using European Society of Cardiology/American Heart Association definitions to identify pathologic Q waves. Maximal and average Q-wave depth (mm) and infarct territory were recorded. Posterior patterns, bundle branch block confounding interpretation, and Q waves outside the culprit territory were excluded. Outcomes were all-cause mortality at 3 and 12 months.</div></div><div><h3>Results</h3><div>Of the 625 patients studied, 203 with pathologic Q waves in the infarct territory had complete depth measurements for analysis. Twelve-month mortality was 7.4% (15 of 203). Neither maximal nor average Q-wave depth was associated with mortality at 3 or 12 months in any infarct territory. Pain-to-balloon time demonstrated a weak positive correlation with maximal (Spearman rho = 0.204, <em>P</em> = 0.004) and average (rho = 0.152, <em>P</em> = 0.033) Q-wave depth.</div></div><div><h3>Conclusions</h3><div>In this small, observational cohort of STEMI patients undergoing primary PCI, preprocedural Q-wave depth was not associated with all-cause mortality at 3 or 12 months. These findings do not support Q-wave depth as a standalone pre-PCI prognostic marker; larger studies and alternative ECG measures may be more informative. Q-wave depth was weakly associated with total ischemic time, warranting further evaluation in larger multicentre cohorts.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 10","pages":"Pages 1423-1430"},"PeriodicalIF":2.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149095971","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":"Frailty and Bleeding Events in Heart Failure: Insights from the JROADHF-NEXT","authors":"Taisuke Nakade MD,&nbsp;Yudai Fujimoto MD,&nbsp;Tomomi Ide MD, PhD,&nbsp;Keisuke Kida MD, PhD,&nbsp;Shouji Matsushima MD, PhD,&nbsp;Hidetaka Kaku MD, PhD,&nbsp;Nobuyuki Enzan MD, PhD,&nbsp;Masataka Ikeda MD, PhD,&nbsp;Takeshi Kitai MD, PhD,&nbsp;Tatsunori Taniguchi MD, PhD,&nbsp;Takahiro Okumura MD, PhD,&nbsp;Takeshi Tohyama MD, PhD,&nbsp;Hiroyuki Tsutsui MD, PhD,&nbsp;Yuya Matsue MD, PhD","doi":"10.1016/j.cjco.2026.06.006","DOIUrl":"10.1016/j.cjco.2026.06.006","url":null,"abstract":"<div><h3>Background</h3><div>Frail patients are considered to be at higher risk of bleeding than non-frail patients; however, the association between frailty and bleeding risk in patients with heart failure (HF) remains unclear. Therefore, this study aims to evaluate the prevalence of bleeding events, examine the relationship between frailty severity and bleeding risk, and assess the association between bleeding events and subsequent mortality in patients with HF receiving antiplatelet or anticoagulant therapy.</div></div><div><h3>Methods</h3><div>This post hoc analysis used data from the Japanese Registry of Acute Decompensated Heart Failure–Next, a prospective, multicentre, nationwide registry. Frailty was evaluated using the Clinical Frailty Scale (CFS). Bleeding events were defined as major or clinically relevant non-major bleeding, based on the International Society on Thrombosis and Haemostasis Bleeding Scale.</div></div><div><h3>Results</h3><div>Among 4016 patients, 3029 (75.4%) were discharged on antiplatelet or anticoagulant medication. After excluding 89 with missing CFS data, 2940 patients were analyzed (mean age: 75 ± 12 years; 64.0% male). Patients were grouped by CFS scores: 1-3 (n = 1033); 4-5 (n = 1364); and 6-9 (n = 543). At 2 years, 149 (5.0%) experienced bleeding. Higher CFS scores were associated with increased bleeding risk (CFS score 4-5: hazard ratio [HR]: 1.53, 95% confidence interval [CI]: 1.00-2.34; CFS score 6-9: HR: 1.75; 95% CI: 1.04-2.93). In addition, bleeding events were associated with a higher risk of mortality (HR: 2.80; 95% CI: 1.88-4.17, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Frailty is associated with bleeding risk in patients with HF receiving antithrombotic therapy. Bleeding events were associated with a higher risk of subsequent death.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 10","pages":"Pages 1288-1297"},"PeriodicalIF":2.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149096065","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":"Prevalence, Health Care Burden, and Longitudinal Outcomes of Chronic Obstructive Pulmonary Disease Among People With Heart Failure","authors":"Tauben Averbuch MD,&nbsp;Brandon Zagorski MS,&nbsp;Joan Carles Trullàs MD, PhD,&nbsp;Lehana Thabane PhD,&nbsp;Harriette G.C. Van Spall MD, MPH","doi":"10.1016/j.cjco.2026.06.020","DOIUrl":"10.1016/j.cjco.2026.06.020","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are common comorbidities. We aimed to assess health care resource use and outcomes associated with COPD in patients hospitalized for HF.</div></div><div><h3>Methods</h3><div>This was an exploratory cohort analysis of patients hospitalized for HF and enrolled in the Patient-Centered Care Transitions in HF cluster-randomized trial. The primary outcome was all-cause mortality. Secondary outcomes included all-cause and HF hospitalization, health care resource use, and direct health care costs. Survival was evaluated using Cox proportional hazards models adjusted for baseline variables.</div></div><div><h3>Results</h3><div>Among 4441 patients discharged alive, 1136 (25.6%) had COPD at baseline. All-cause mortality was higher at 5 years among patients with vs without COPD (75.2% vs 60.9%, adjusted hazard ratio 1.29, 95% confidence interval 1.19-1.40). Patients with COPD had more frequent all-cause rehospitalizations (mean [standard deviation] 3.4 [6.6] vs 2.7 [8.6] per patient, <em>P</em> = 0.01), but no significant difference in HF rehospitalizations (0.9 [2.3] vs 0.9 [4.5] per patient, <em>P</em> = 0.74). Patients with COPD had more annual physician visits, multidisciplinary clinic visits, and supportive care (all <em>P</em> &lt; 0.01), as well as greater annual direct health care costs in Canadian dollars (at 5 years: $91,888 [$109,319] vs $76,823 [$116,218]) than those without COPD, primarily driven by rehospitalizations.</div></div><div><h3>Conclusions</h3><div>Among patients discharged alive after hospitalization for HF, COPD is common and is associated with higher all-cause mortality and all-cause rehospitalizations, greater health care use, and higher direct health care costs. Interventions to reduce the health care burden in HF should include broad approaches that address important comorbidities.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 10","pages":"Pages 1472-1482"},"PeriodicalIF":2.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149095590","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":"Optical Coherence Tomography Findings Following Intravascular Lithotripsy in Calcified Coronary Artery Disease: A Systematic Review and Meta-Analysis","authors":"Giacomo Maria Cioffi MD,&nbsp;Stéphane Cook MD,&nbsp;Mario Togni MD,&nbsp;Julius Jonas Jelisejevas MD,&nbsp;Pascal Meier MD,&nbsp;Peter Wenaweser MD,&nbsp;Dorian Garin MD,&nbsp;Mehdi Madanchi MD,&nbsp;Natalia Pinilla-Echeverri MD,&nbsp;Karim M. Al-Azizi MD,&nbsp;Grigorios Tsigkas MD, PhD,&nbsp;Nicolas Amabile MD, PhD,&nbsp;Ioannis Skalidis MD, PhD","doi":"10.1016/j.cjco.2026.06.016","DOIUrl":"10.1016/j.cjco.2026.06.016","url":null,"abstract":"<div><h3>Background</h3><div>Intravascular lithotripsy (IVL) has emerged as a novel technology for modifying calcified coronary lesions, whereas optical coherence tomography (OCT) enables high-resolution assessment of calcium modification and procedural outcomes. However, the mechanistic and procedural effects of IVL assessed by OCT across studies remain incompletely characterized.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis was conducted according to PRISMA guidelines and registered in PROSPERO (CRD420261332946). PubMed/MEDLINE, Cochrane Library, and Epistemonikos were searched from inception through February 2026. Randomized controlled trials and observational studies with extractable quantitative OCT outcomes were included. The primary endpoint was OCT-detected calcium fracture. Secondary endpoints included multiple calcium fractures, minimum stent area (MSA), stent expansion, acute lumen gain, procedural success, and in-hospital major adverse cardiovascular events (MACEs). Random-effects meta-analyses were performed to estimate pooled proportions or mean values with 95% confidence intervals (CIs).</div></div><div><h3>Results</h3><div>Thirty studies encompassing a total of 3030 patients were included. OCT-detected calcium fracture occurred in 68% (95% CI 56%-79%) of lesions, whereas multiple fractures were observed in 34% (95% CI 26%-41%). IVL-treated lesions achieved favorable procedural metrics, including a pooled final MSA of 6.45 (95% CI 6.07-6.82) mm², stent expansion of 85.9% (95% CI 82.3%-89.5%), and acute lumen gain of 3.50 (95% CI 3.14-3.87) mm². Procedural success was high (95%, 95% CI 93%-98%) with low in-hospital MACEs (2%, 95% CI 1%-3%). Substantial heterogeneity was observed across endpoints.</div></div><div><h3>Conclusions</h3><div>Coronary IVL assessed by OCT is frequently associated with calcium fracture and favorable procedural outcomes with high procedural success and low early adverse events.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 10","pages":"Pages 1399-1418"},"PeriodicalIF":2.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149095973","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":"Antiplatelet Therapy Strategies in Patients with High Bleeding Risk Treated with Complex Percutaneous Coronary Intervention: A Descriptive Study","authors":"Éloi Ravet-Claret PharmD, MSc,&nbsp;Susan Chen PharmD, MSc,&nbsp;Adèle Goulet PharmD, MSc,&nbsp;Dan Tcaciuc PharmD, MSc,&nbsp;Jamey Scraire PharmD,&nbsp;Léa Turgeon-Mallette PharmD, MSc,&nbsp;Marie Lordkipanidzé BPharm, PhD,&nbsp;Marie-France Gauthier PharmD, ACPR, BCCP,&nbsp;Julien Quang Le Van BPharm, MSc, BCCP","doi":"10.1016/j.cjco.2026.06.009","DOIUrl":"10.1016/j.cjco.2026.06.009","url":null,"abstract":"<div><h3>Background</h3><div>Following acute coronary syndrome (ACS) treated by percutaneous coronary intervention (PCI), guideline-directed dual antiplatelet therapy (DAPT) typically consists of 12 months of aspirin plus a P2Y₁₂ inhibitor. Recent trials support antiplatelet de-escalation strategies in patients at high bleeding risk (HBR), whereas patients undergoing complex PCI are at increased thrombotic risk and may benefit from extended DAPT. The overlap between these groups with high bleeding risk and high thrombotic risk in contemporary practice is not well characterized.</div></div><div><h3>Methods</h3><div>Patients undergoing PCI for ACS were randomly sampled from those hospitalized at the Montreal Heart Institute between May 1, 2024 and April 30, 2025. Data were extracted from electronic health records. HBR was assessed using the <strong>Pre</strong>dicting Bleeding <strong>C</strong>omplications in Patients Undergoing Stent <strong>I</strong>mplantation and <strong>S</strong>ubsequ<strong>e</strong>nt Dual Antiplatelet Therapy-<strong>H</strong>igh <strong>B</strong>leeding <strong>R</strong>isk (PRECISE-HBR) score, and complex PCI was assessed using guideline-based criteria. The primary objective was to estimate the proportion of patients meeting both criteria; secondary objectives described discharge antiplatelet strategies across risk groups.</div></div><div><h3>Results</h3><div>Of the 309 participants sampled, 35% were identified as being at HBR, 43% underwent complex PCI, and 17.5% (95% confidence interval, 13.3%-21.7%) met both HBR and complex PCI criteria. De-escalation strategies were infrequently prescribed across risk groups, even among patients at HBR without complex PCI. Among those not receiving long-term anticoagulation, only 4.2% received a de-escalation strategy.</div></div><div><h3>Conclusions</h3><div>Nearly 1 in 6 patients undergoing PCI for ACS met both HBR and complex PCI criteria. In this setting, clinicians appeared to favour standard-duration clopidogrel-based DAPT rather than de-escalation approaches. These findings underscore the need for practical guidance to support individualized antiplatelet decision-making in patients with competing bleeding and ischemic risks.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 10","pages":"Pages 1389-1398"},"PeriodicalIF":2.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149095974","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":"Atorvastatin Prevents Early Lipotoxic Remodelling in Right Ventricular Pacing–Induced Cardiomyopathy","authors":"Yu-Sheng Lin MD, PhD,&nbsp;Wan-Chun Ho MSc,&nbsp;Meng-Hung Lin PhD,&nbsp;Ting-Yu Kuo MS,&nbsp;Chang-Min Chung MD,&nbsp;Pei-Chun Yen MSc,&nbsp;Yung-Lung Chen MD,&nbsp;Huang-Chung Chen MD,&nbsp;Mien-Cheng Chen MD,&nbsp;Tzu-Hsien Tsai MD,&nbsp;Wei-Chieh Lee MD, PhD, FEHRA","doi":"10.1016/j.cjco.2026.06.018","DOIUrl":"10.1016/j.cjco.2026.06.018","url":null,"abstract":"<div><h3>Background</h3><div>Right ventricular (RV) pacing can induce metabolic and structural alterations in left ventricular (LV) myocardium, including lipid accumulation, glycogen depletion, and increased endoplasmic reticulum (ER) stress. This study evaluated protective effects of atorvastatin on RV pacing–induced metabolic dysfunction.</div></div><div><h3>Methods</h3><div>Fifteen male Lanyu miniature pigs were randomized into sham control (n = 5), RV pacing (n = 5), and RV pacing with atorvastatin treatment (n = 5) groups. RV pacing was achieved via ventricular lead implantation at the RV outflow tract, followed by complete atrioventricular block, with ventricular pacing maintained for at least 80 beats/min in dual-chamber, dual-sensing, dual-response, rate-responsive mode to provide atrial-synchronous ventricular pacing while allowing atrial sensing or pacing. The RV pacing with atorvastatin treatment group received atorvastatin (40 mg/d) starting 2 weeks before surgery until euthanasia at 6 months. Metabolic, histologic, and molecular parameters were assessed in LV myocardial tissue.</div></div><div><h3>Results</h3><div>Compared with sham controls, RV pacing significantly increased myocardial lipid accumulation, with higher triglyceride (2.43 ± 0.17 vs 1.74 ± 0.14 μg/mg, <em>P</em> &lt; 0.01) and diacylglycerol (2902 ± 567.7 vs 977.5 ± 182.5 μg/mg, <em>P</em> &lt; 0.01) levels, and significantly reduced glycogen content (0.09 ± 0.03 vs 0.21 ± 0.03 μg/mg, <em>P</em> &lt; 0.05). ER stress markers binding immunoglobulin protein and cleaved caspase-9 were markedly increased in the RV pacing group (<em>P</em> &lt; 0.0001). Atorvastatin significantly reduced lipid accumulation (triglycerides: 1.83 ± 0.08 μg/mg; <em>P</em> &lt; 0.05), ER stress, and apoptosis, but did not significantly restore glycogen levels.</div></div><div><h3>Conclusions</h3><div>RV pacing induces lipid accumulation, glycogen loss, and increased ER stress in the LV myocardium. Atorvastatin partially mitigated these effects by normalizing fatty acid metabolism and reducing ER stress and apoptosis, suggesting a potential role in attenuating early/subclinical RV pacing–induced metabolic remodelling.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 10","pages":"Pages 1298-1309"},"PeriodicalIF":2.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149096068","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":"A Novel Technique Using Flash 2.0 Catheter for Percutaneous Aspiration of Native Tricuspid Valve Endocarditis Caused by a Hemodialysis Venous Catheter","authors":"Kelsey Stanford MPH,&nbsp;Ashar Pirzada MD, FRCPC,&nbsp;Frederic Paulin MD, FRCPC,&nbsp;Janet Ngu MD, FRCSC,&nbsp;Scott Harris MD, FRCPC,&nbsp;Tiffany Furneaux MSc,&nbsp;Mohammad Almutawa MD, FRCPC","doi":"10.1016/j.cjco.2026.07.001","DOIUrl":"10.1016/j.cjco.2026.07.001","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 10","pages":"Pages 1468-1471"},"PeriodicalIF":2.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149096077","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":"Natural Language Processing for Risk Stratification of Emergency Department Patients with Chest Pain","authors":"Reza Valimoradi MSc, MBA,&nbsp;George Cao MD,&nbsp;Allen Ding BSc,&nbsp;Cristian Toarta MD, MSc, FRCPC,&nbsp;Seung Ho Lee MD,&nbsp;David Le Nguyen MD,&nbsp;Alexandra Wudwud MD, MSc, FRCPC,&nbsp;Preeti Gupta MBBS,&nbsp;Phuong Anh (Iris) Nguyen BSc,&nbsp;Bahareh Ghaedi MSc,&nbsp;Jonathan Yu-Meng Li PhD, MASc,&nbsp;Venkatesh Thiruganasambandamoorthy MBBS, MSc, CCFP-EM","doi":"10.1016/j.cjco.2026.06.002","DOIUrl":"10.1016/j.cjco.2026.06.002","url":null,"abstract":"<div><h3>Background</h3><div>Natural language processing can transform unstructured clinical data into actionable insights that optimize workflows, improve patient outcomes, and reduce bias. We created a machine learning model that predicted suspicion of acute coronary syndrome (ACS) based on physician notes and assessed its capability to predict major adverse cardiovascular events (MACE) when implemented within the HEART (history, electrocardiogram, age, risk factors, troponin) score.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed adults presenting with chest pain to The Ottawa Hospital emergency departments (EDs). GPT-4 produced and extracted 11 binary symptom features from physician-documented history of present illness. An extreme gradient boosting (XGBoost) classifier was trained on these features to predict ED disposition, a surrogate marker of physician suspicion of ACS (pACS). The resulting natural language processing–derived ACS suspicion score (nACS) replaced the history component of HEART (nHEART) and was compared with the disposition-based composite (pHEART).</div></div><div><h3>Results</h3><div>Of 1011 patients (48.5% female; mean age, 55.7 years), 69 (6.8%) experienced MACE within 6 weeks. nHEART achieved sensitivity of 97.1% and specificity of 53.8%; pHEART achieved sensitivity and specificity of 95.7% and 69.1%, respectively. pACS and troponin were the strongest multivariable predictors. GPT-4o extraction showed Fleiss’ kappa &gt; 0.8 across runs and Cohen’s kappa &gt; 0.6 vs extraction by research assistants.</div></div><div><h3>Conclusions</h3><div>Large language models can extract structured symptom features from ED notes, and an XGBoost model trained on these features can reproduce a coarse measure of physician suspicion of ACS. Clinical deployment will require further model training and testing against a prospectively documented measure of physician ACS suspicion.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 10","pages":"Pages 1458-1467"},"PeriodicalIF":2.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149096078","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":"Machine Learning for Predicting Mortality Following Transcatheter Aortic Valve Replacement: A Scoping Review of Current Literature","authors":"Adham H. Elsherbini BHSc,&nbsp;Ibrahim Ahmed Cherif BHSc,&nbsp;Alisha Ahmed BHSc,&nbsp;Ali Haider BHSc,&nbsp;Ahmad Alaraki MBBS,&nbsp;Mohamed R. Gemae MD, BSc,&nbsp;Farzan Ansari MD, BSc,&nbsp;Ahmed A. Harby MSc,&nbsp;Vipin Chaudhary PhD,&nbsp;Yasir Abu-Omar MD, PhD,&nbsp;Mohammad El-Diasty MD, PhD","doi":"10.1016/j.cjco.2026.06.007","DOIUrl":"10.1016/j.cjco.2026.06.007","url":null,"abstract":"<div><div>This scoping review aims to consolidate the current evidence on the use of machine learning (ML) algorithms to predict mortality following transcatheter aortic valve replacement (TAVR) procedures. This review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Electronic databases, including Medline, Embase, Cochrane, and <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>, were searched for studies assessing the use of ML models for the prediction of mortality in patients undergoing TAVR. A total of 1076 citations were screened, of which 21 studies underwent full-text review. Ultimately, 11 studies comprising 101,030 patients were included for data extraction. Study sample sizes ranged from 178 to 54,739 patients, with reported mortality intervals ranging from 30 days to 5 years after surgery. The parameters that were included in these ML models included demographic and clinical variables, electrocardiographic findings, laboratory results, computed tomography scans, and the type and size of the selected TAVR device. A total of 13 ML models were assessed across the included studies. Random Forest appeared to be the highest performing ML model in predicting 30-day and 1-year survival following TAVR, with reported area under the receiver operating characteristic (AUROC) scores ranging from 0.66 to 0.97. In addition, the gradient-boosted machine seemed to outperform the CoreValve and TAVI2-SCORE in predicting 1-year survival. ML models may allow for accurate prediction of mortality following TAVR and may offer advantages over traditional clinical risk scores. However, limited datasets and variability in algorithm metric scores remain the main limitations to the implementation of these models in clinical practice.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 10","pages":"Pages 1375-1385"},"PeriodicalIF":2.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149095977","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}