CJC Open最新文献

{"title":"Using Implementation Science to Evaluate the Implementation of Patient-Reported Outcome Measures (PROMs) in a Clinical Heart Failure Care Setting","authors":"Sarah V.C. Lawrason MSc, PhD ,&nbsp;Heather Ross MSc, MD ,&nbsp;Michael McDonald MD ,&nbsp;Juan Duero Posada MD ,&nbsp;Samantha Engbers BAH ,&nbsp;Anne Simard MHSc","doi":"10.1016/j.cjco.2025.06.007","DOIUrl":"10.1016/j.cjco.2025.06.007","url":null,"abstract":"<div><h3>Background</h3><div>Patients with heart failure (HF) can experience poor quality of life, recurring hospitalizations, and progressive disease symptoms. Patient-reported outcome measures (PROMs) include patients’ voices in clinical care by assessing patient symptoms, function, and quality of life. In 2022, PROMs were implemented into the electronic health record system (Epic) at a large academic hospital in Toronto, Canada. The purpose of this study was to use implementation science frameworks to systematically evaluate the uptake and integration of PROMs into clinical HF care.</div></div><div><h3>Methods</h3><div>The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework guided this mixed-methods, 1-year quality-improvement project. Data sources included clinician use of PROMs, patient-level data on completed PROMs, and semistructured interviews with clinicians. The PROM was the Kansas City Cardiomyopathy Questionnaire-12, which captures 4 domains related to HF: symptom frequency, physical limitations, social limitations, and quality of life. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using behaviour-change frameworks and latent content analysis.</div></div><div><h3>Results</h3><div>Over the course of 1 year, more patients were assigned to PROMs, a higher proportion of patients completed PROMs, and approximately 60% of patients had high questionnaire scores. Clinicians experience barriers related to attention and decision processes, environmental context, and their professional role, in integrating PROMs into practice. Suggested resources include adding language licenses for PROM translations, reducing cognitive load for clinicians assigning and interpreting PROMs in Epic, and champions modelling PROMs in practice.</div></div><div><h3>Conclusions</h3><div>This study demonstrates the benefit of using implementation science frameworks to evaluate the implementation of PROMs in practice and provide actionable recommendations to health systems.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 8","pages":"Pages 1017-1026"},"PeriodicalIF":2.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858120","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":"Shaping Quality in Cardiovascular Magnetic Resonance: A Comparative Study of Segmentation Approaches by Trainees and Experts","authors":"Jan Gröschel MD ,&nbsp;Thomas Hadler PhD ,&nbsp;Leonhard Grassow ,&nbsp;Hadil Saad MD ,&nbsp;Darian Viezzer PhD ,&nbsp;Clemens Ammann MD ,&nbsp;Leonora Zange MD ,&nbsp;Florian von Knobelsdorff-Brenkenhoff MD ,&nbsp;Edyta Blaszczyk MD ,&nbsp;Jeanette Schulz-Menger MD","doi":"10.1016/j.cjco.2025.05.003","DOIUrl":"10.1016/j.cjco.2025.05.003","url":null,"abstract":"<div><h3>Background</h3><div>Cardiovascular magnetic resonance (CMR) is an established cardiovascular imaging (CVI) technique. Deficits in training limit the widespread use of CMR. This study analyzed the influence of CVI experience on segmentation, to define quality standards for teaching and supervision.</div></div><div><h3>Methods</h3><div>Four CMR experts determined left ventricular (LV) and right ventricular (RV) gold-standard contours in end-systole (ES) and end-diastole (ED), by consensus. After a brief teaching session, readers independently performed segmentations. Readers were classified as beginners (no previous experience in CVI), intermediates (previous experience in CVI, but not in CMR), or experts (extensive experience in CVI including CMR). Results were compared, and the cause of deviation was analyzed, using metrics such as the Dice similarity coefficient (DSC).</div></div><div><h3>Results</h3><div>A total of 46 readers (19 beginners, 21 intermediates, 6 experts) performed image analysis. Using the DSC, we found significant differences in endocardial LV ED contours (median [interquartile range]: beginners, 92.9% [91.9%-93.5%]); intermediates, 93.5% (93.0%-94.1%); experts, 93.9% (93.1%-94.3%); <em>P</em> = 0.043) and in myocardial contours (beginners, 79.0% (75.0%-80.9%); intermediates, 80.9% (78.0%-82.4%); experts, 85.0% (79.8%-86.5%); <em>p</em> = 0.001). Experts had higher DSC scores for the right ventricle (ES: beginners, 83.8% (81.3%-85.8%); intermediates, 81.7% (79.6%-85.6%); experts, 89.0% (86.6%-89.8%); <em>P</em> = 0.003; ED: beginners, 89.2% (88.1%-90.3%); intermediates, 88.6% (87.9%-89.2%); experts, 91.6% (89.8%-93.3%); <em>P</em> = 0.002). The disagreements were not traceable in absolute volume and function (<em>P</em> for all &gt; 0.2). Sources of disagreement were related mainly to handling of basal slices.</div></div><div><h3>Conclusions</h3><div>After a brief standardized teaching session, beginners and intermediates performed chamber quantification consistent with that of experts. Differences, especially in LV mass and RV segmentations, warrant continuous training, ideally accompanied by automatic methods for quality assurance.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 8","pages":"Pages 1120-1131"},"PeriodicalIF":2.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858189","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":"Incidental Aorto-Atrial Fistula Complicating a Watchman Implantation Procedure","authors":"Blair Warren DO ,&nbsp;Aakash Patel MD ,&nbsp;Farhat Khairallah MD ,&nbsp;Suman Pasupuleti MD ,&nbsp;Roshni Kotwani DO","doi":"10.1016/j.cjco.2025.04.075","DOIUrl":"10.1016/j.cjco.2025.04.075","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 8","pages":"Pages 1070-1072"},"PeriodicalIF":2.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858115","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":"Cardiovascular Prehabilitation in Patients Awaiting Heart Transplantation— Addressing Clinical Needs (the PREHAB HTx Study)","authors":"Jennifer L. Reed R. Kin, PhD ,&nbsp;Heather E. Tulloch PhD ,&nbsp;Heather Ross MD ,&nbsp;Tasuku Terada PhD ,&nbsp;Matheus Mistura MSc ,&nbsp;Isabela Roque Marçal MSc ,&nbsp;Paul Oh MD ,&nbsp;Sharon Chih MBBS, PhD","doi":"10.1016/j.cjco.2025.05.009","DOIUrl":"10.1016/j.cjco.2025.05.009","url":null,"abstract":"<div><h3>Background</h3><div>To compare the effects of a 12-week prehabilitation (PREHAB) program vs usual care (UC) on functional capacity in adults listed for heart transplantation. Secondary aims included comparing peak oxygen uptake (<span><math><mrow><mover><mi>V</mi><mo>˙</mo></mover></mrow></math></span>O₂peak), frailty, physical activity, mental health, cognitive function, quality of life (QoL), and dietary habits.</div></div><div><h3>Methods</h3><div>A multicentre randomized controlled trial was conducted. Participants were randomized to PREHAB or UC. The 12-week PREHAB program included twice weekly high-intensity interval training sessions on an upright cycle ergometer, a stress management course, and a nutrition workshop. The primary outcome was functional capacity (6-minute walk test distance) from baseline to 12 weeks of follow-up. Secondary outcomes included changes in <span><math><mrow><mover><mi>V</mi><mo>˙</mo></mover></mrow></math></span>O₂peak, frailty, physical activity, severity of anxiety, depression, and stress, cognitive function, QoL, and dietary habits.</div></div><div><h3>Results</h3><div>Trial recruitment began in October 2018 and closed, due to the COVID-19 pandemic, in October 2020. Of 84 patients screened, 17 were recruited (age: 44 ± 9 years, 71% male), and 4 were randomized (PREHAB = 2; UC = 2). Both patients completed PREHAB, and 1 patient completed UC. Reasons for dropout throughout the trial included the following: receiving a transplant; medication and device contraindications; commitment and travel constraints; and lack of interest. PREHAB showed potential for improvements in the 6-minute walk test distance (Baseline [B]: 343 ± 120; follow-up [FU]: 465 m), <span><math><mrow><mover><mi>V</mi><mo>˙</mo></mover></mrow></math></span>O₂peak (B: 14.9 ± 0.1; FU: 15.8 ± 0.4 mL/kg/min), and QoL measured using the Minnesota Living with Heart Failure Questionnaire (B: 41 ± 33; FU: 26 ± 1 points).</div></div><div><h3>Conclusions</h3><div>Recruitment for and completion of PREHAB for patients listed for heart transplantation proved challenging. Given wait-time limitations, future research should examine alternative PREHAB programming, offered sooner following listing, that addresses reported barriers to participation.</div></div><div><h3>Clinical Trial Registration</h3><div><span><span>NCT02957955</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 8","pages":"Pages 1110-1119"},"PeriodicalIF":2.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858188","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":"Characterization of Malnutrition in Atrial Functional Mitral Regurgitation","authors":"Tsukasa Murakami MD, PhD ,&nbsp;Nobuyuki Kagiyama MD, PhD ,&nbsp;Tomohiro Kaneko MD, PhD ,&nbsp;Kazuki Kagami MD, PhD ,&nbsp;Masashi Amano MD, PhD ,&nbsp;Taiji Okada MD, PhD ,&nbsp;Yukio Sato MD, PhD ,&nbsp;Yohei Ohno MD, PhD ,&nbsp;Kimi Sato MD, PhD ,&nbsp;Kojiro Morita MPH, PhD, RN, PHN ,&nbsp;Tomoko Machino-Ohtsuka MD, PhD ,&nbsp;Yukio Abe MD, PhD ,&nbsp;Hideki Ishii MD, PhD ,&nbsp;Masaru Obokata MD, PhD","doi":"10.1016/j.cjco.2025.05.007","DOIUrl":"10.1016/j.cjco.2025.05.007","url":null,"abstract":"<div><h3>Background</h3><div>In this study we sought to characterize the prevalence, clinical characteristics, and outcomes of malnutrition in patients with atrial functional mitral regurgitation (AFMR).</div></div><div><h3>Methods</h3><div>This multicentre, observational study included 802 patients diagnosed with AFMR. The <strong>G</strong>eriatric <strong>N</strong>utritional <strong>R</strong>isk <strong>I</strong>ndex (GNRI) was used as a nutritional risk metric. Patients were divided into 4 groups on the basis of the GNRI: normal (&gt; 98; n = 342), mild nutritional risk (92-98; n = 196), moderate risk (82 to &lt; 92; n = 166), and severe risk (&lt; 82; n = 98). The primary outcome was a composite of heart failure admission and all-cause death.</div></div><div><h3>Results</h3><div>At least mild nutrition risk (GNRI ≤ 98) was present in 57% of patients with AFMR. Patients with lower GNRI were older, had lower body mass index, hemoglobin levels, and renal function, and had a higher prevalence of New York Heart Association class III or IV, dementia, and impaired activities of daily living. During the median follow-up duration of 978 (interquartile range, 492-1141) days, 254 primary outcomes were observed. Increasing severity of malnutrition risk categories was associated with higher rates of the primary outcome. Multivariable analysis revealed that a continuous metric of GNRI was associated with the primary outcome after adjusting for multiple confounders (adjusted hazard ratio, 0.76 per 1 standard deviation increment; 95% confidence interval, 0.66-0.87; <em>P</em> &lt; 0.01). Follow-up GNRI values were available in 234 patients (29.2%). Patients with a decreased GNRI over time had higher rates of the composite outcome than those with preserved GNRI (adjusted hazard ratio, 3.83; 95% confidence interval, 1.97-7.43; <em>P</em> &lt; 0.01).</div></div><div><h3>Conclusions</h3><div>Patients with AFMR and malnutrition represent a vulnerable population with worse clinical outcomes.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 8","pages":"Pages 1038-1047"},"PeriodicalIF":2.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858165","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":"Efficacy and Safety of Transcatheter Mitral Valve Edge-to-Edge Repair with a MitraClip Device in Real-World Canadian Practice","authors":"Shamir R. Mehta MD, MSc ,&nbsp;Anita Asgar MD ,&nbsp;Robert Boone MD ,&nbsp;Josep Rodes-Cabau MD, PhD ,&nbsp;Eric A. Cohen MD ,&nbsp;Andrew Czarnecki MD ,&nbsp;Marino Labinaz MD ,&nbsp;Shahar Lavi MD ,&nbsp;Nicolo Piazza MD ,&nbsp;Kevin R. Bainey MD ,&nbsp;Akshay Bagai MD ,&nbsp;Jean-Michel Paradis MD ,&nbsp;J.D. Schwalm MD ,&nbsp;Douglas Wright MD ,&nbsp;Helen Nguyen BSc ,&nbsp;Tara McCready PhD ,&nbsp;Rajibul Mian PhD ,&nbsp;John Webb MD ,&nbsp;Neil Fam MD","doi":"10.1016/j.cjco.2025.05.008","DOIUrl":"10.1016/j.cjco.2025.05.008","url":null,"abstract":"<div><h3>Background</h3><div>Mitral transcatheter edge-to-edge repair (M-TEER) is a treatment option for patients with symptomatic mitral regurgitation (MR). The real-world experience with M-TEER in Canada has not been reported previously.</div></div><div><h3>Methods</h3><div>We conducted an observational study of 1191 patients from 11 Canadian centres undergoing M-TEER with a MitraClip device (Abbott, location). M-TEER databases from each centre were collected centrally and merged into a single Canada-wide database. The primary outcome was MR severity before M-TEER vs at up to 1 year after M-TEER. Secondary outcomes included hospitalizations for heart failure (HF) and New York Heart Association (NYHA) functional class.</div></div><div><h3>Results</h3><div>MR etiology was degenerative in 41%, and functional in 59%. The mean age was 76 years, and 36% were women. The proportion with MR ≥ 3+ was 97.3% before vs 11.0% at up to 1 year after M-TEER (absolute risk difference [ARD] 86.4%, <em>P</em> &lt; 0.001). Hospitalization for HF occurred in 50.7% before vs 10.3% at up to 1 year after M-TEER (ARD 40.4%, <em>P</em> &lt; 0.001), with similar benefit in patients with functional (ARD 44.8%, 95% confidence interval 39.5-50.1) and degenerative (ARD 34.8%, 95% confidence interval 29.0-40.6) MR. NYHA class III-IV HF was present in 82.8% before vs in 16.6% at up to 1 year after M-TEER (ARD 66.2%, <em>P</em> &lt; 0.001). Single-leaflet detachment (1.0%) and mitral valve surgery (2.2%) were infrequent. Mortality was 1.3% in-hospital, and 12.7% at 1 year.</div></div><div><h3>Conclusions</h3><div>In this first national registry of patients undergoing M-TEER in Canada, M-TEER resulted in a sustained reduction in MR and was associated with reduced HF hospitalizations and improvement in NYHA functional class, with a high degree of safety. This benefit was consistent in patients with functional and degenerative MR.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 8","pages":"Pages 1048-1054"},"PeriodicalIF":2.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858166","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":"Sex-Specific Disparities in the Female Vs Male Patient Population in Left Ventricular Assist Device Use","authors":"Stefanie Marek-Iannucci MD, PhD ,&nbsp;Estefania Oliveros MD ,&nbsp;Francesco Fedele MD ,&nbsp;Indranee N. Rajapreyar MD","doi":"10.1016/j.cjco.2025.04.017","DOIUrl":"10.1016/j.cjco.2025.04.017","url":null,"abstract":"<div><div>Women remain severely underrepresented in clinical trials, leading to a significant disparity in clinical care and outcome among male vs female patients with advanced heart failure (HF). Sex-specific disparities regarding the etiology of HF, time to diagnosis, severity of disease at time of index hospitalization, response to treatment, and treatment options, including use of temporary or durable mechanical circulatory support devices, may affect women unfavourably. Lack of knowledge regarding sex-specific complications has had an impact on the overall higher mortality level in women vs men. Increasing the awareness regarding this sex-specific imbalance is imperative. The inclusion of women in clinical mechanical circulatory support trials is critical, to improve female patient outcomes in stage D HF with reduced ejection fraction.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 8","pages":"Pages 1140-1147"},"PeriodicalIF":2.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858263","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":"Patterns of E-Cigarette Use Among Cardiac Inpatients at a Tertiary-Care Hospital: A Cross-Sectional Survey","authors":"Javad Heshmati BSc, MSc, PhD ,&nbsp;Emma Lynn Bates BA, MPH ,&nbsp;Spencer Shahen BSc, MSc ,&nbsp;Kathryn L. Walker MScPT ,&nbsp;Andrew Pipe CM, MD ,&nbsp;Kerri-Anne Mullen BSc, MSc, PhD ,&nbsp;Hassan Mir BSc, MD, MPH, MHI, FRCPC","doi":"10.1016/j.cjco.2025.02.004","DOIUrl":"10.1016/j.cjco.2025.02.004","url":null,"abstract":"<div><h3>Background</h3><div>E-cigarettes are promoted for smoking cessation due to their having lower toxicity than cigarettes, but they are often used recreationally and linked to cardiovascular, respiratory, and mental health risks. Clinicians must understand usage patterns and influencing factors to guide patients in reducing or quitting their use.</div></div><div><h3>Methods</h3><div>We surveyed consecutive cardiac inpatients admitted to the University of Ottawa Heart Institute between November 2019 and May 2020. Surveys were conducted in-person or via telephone. Descriptive statistics and logistic regression were used to examine factors associated with vaping status.</div></div><div><h3>Results</h3><div>During the evaluation, 1616 cardiac patients were admitted and discharged; 124 (7.7%) were ineligible, and 403 (24.9%) refused or were unreachable. A total of 1089 (73.0%) completed the survey. Among them, 10.3% had ever vaped, and 5.5% were current vapers. Of ever-users, 66.1% used vaping to quit smoking. Adjusted analysis showed that younger age, tobacco co-use, secondhand exposure at home, and lower education levels were significantly associated with e-cigarette use.</div></div><div><h3>Conclusions</h3><div>This evaluation found a low overall rate of e-cigarette use among cardiac inpatients. However, e-cigarette use was more common among younger patients, tobacco users, and those exposed to tobacco or e-cigarettes at home. These factors highlight the importance of advising patients to reduce their exposure to tobacco and e-cigarettes in their home and social environments, as doing so may improve their chances of quitting. Incorporating future prospective research in additional populations and settings would help support the generalizability of these results and assess their impact on clinical outcomes.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 8","pages":"Pages 1083-1092"},"PeriodicalIF":2.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858169","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":"Win Ratio in Biomedical Science: A Bibliometric Analysis","authors":"Zhenyu Li MSc ,&nbsp;Aliya Izumi HBSc ,&nbsp;Dominique Vervoort MD, MPH, CPH, MBA ,&nbsp;Anika Ranadive HBSc ,&nbsp;Subodh Verma MD ,&nbsp;Stephen E. Fremes MD, MSc","doi":"10.1016/j.cjco.2025.05.006","DOIUrl":"10.1016/j.cjco.2025.05.006","url":null,"abstract":"<div><h3>Background</h3><div>The win ratio (WR), introduced in 2012, has emerged as a method to analyze hierarchical composite outcomes by prioritizing clinically significant events, unlike traditional composite time-to-event analyses, which treat events equally. However, use of the WR in biomedical research beyond cardiovascular trials remains unexplored. The study aims to investigate trends in the use of the WR in biomedical research and determine the characteristics of these articles.</div></div><div><h3>Methods</h3><div>Biomedical articles indexed in Web of Science and PubMed were retrieved for 2012-2024. Data extraction included bibliometric information and content details. Statistical analyses utilized descriptive statistics, correlation, and linear regression to assess publication trends and the distribution of WR methodologies across disciplines.</div></div><div><h3>Results</h3><div>A total of 82 studies were analyzed. Publication counts using the WR have grown significantly since its introduction, with an annual compounded growth rate of 30.2%. Most articles were randomized controlled trials (n = 68; 82.9%). Of the 68 randomized controlled trials, 46 (67.6%) were in the field of cardiology. The unmatched WR was the predominant WR approach (n = 57; 69.5%). Mortality was the highest-ranked outcome in most studies (n = 55; 67.1%), and time-to-event variables were the most frequently used across all hierarchical outcome ranks (n = 173).</div></div><div><h3>Conclusions</h3><div>The WR has gained acceptance as a robust and clinically meaningful method for analyzing composite endpoints, particularly for cardiovascular trials. Although challenges remain, its adaptability and ability to prioritize clinically relevant outcomes make it a promising tool for future biomedical research across various disciplines.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 8","pages":"Pages 1097-1107"},"PeriodicalIF":2.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858186","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":"Association of Left Atrial Dysfunction with Pulmonary Hemodynamics and Cardiovascular Outcomes in Patients with Systemic Sclerosis","authors":"Kazutoshi Hirose MD ,&nbsp;Koki Nakanishi MD ,&nbsp;Masao Daimon MD ,&nbsp;Hikari Seki MD ,&nbsp;Yuriko Yoshida MD ,&nbsp;Megumi Hirokawa MD ,&nbsp;Tomoko Nakao MD ,&nbsp;Koichi Kimura MD ,&nbsp;Shun Minatsuki MD ,&nbsp;Masaru Hatano MD ,&nbsp;Hiroyuki Morita MD ,&nbsp;Marco R. Di Tullio MD ,&nbsp;Shunichi Homma MD ,&nbsp;Makoto Kurano MD ,&nbsp;Norihiko Takeda MD","doi":"10.1016/j.cjco.2025.02.006","DOIUrl":"10.1016/j.cjco.2025.02.006","url":null,"abstract":"<div><h3>Background</h3><div>Left atrial (LA) reservoir strain (LARS) is emerging as an early marker of cardiac remodelling, providing significant prognostic information. The present study investigated the prevalence of LA dysfunction and its association with pulmonary hemodynamics and cardiovascular (CV) outcomes in systemic sclerosis (SSc) patients.</div></div><div><h3>Methods</h3><div>We included 52 patients who had SSc without structural cardiac disease. All patients underwent 2-dimensional transthoracic echocardiography and right heart catheterization. LARS was assessed by using speckle-tracking analysis. The study outcome was a composite of heart failure or pulmonary hypertension (PH)–related hospitalization, lung transplantation, and CV death.</div></div><div><h3>Results</h3><div>Abnormal LARS (&lt; 24%) was present in 18 patients (34.6%). Despite the similar prevalence of PH between groups with abnormal vs normal LARS (<em>P</em> = 0.322), patients with LA dysfunction had significantly higher pulmonary vascular resistance (3.5 Wood Units [1.9-5.2] vs 2.0 Wood Units [1.3-2.9], <em>P</em> = 0.029) and reduced pulmonary artery compliance (2.4 [2.1-4.1] ml/mm Hg vs. 3.9 [2.5-5.0] ml/mm Hg, p=0.024) than those with normal LARS. During a median follow-up of 3.2 years, patients with LA dysfunction displayed worse event-free survival than their counterparts (log-rank <em>P</em> = 0.036). The combination of LA function and PH status provided better risk stratification for composite CV outcome, as the highest incidence of adverse outcome was observed in patients with LA dysfunction and PH (40.0%), followed by those with LA dysfunction or PH alone (13.6%), and finally those without LA dysfunction and PH (0%, <em>P</em> = 0.008).</div></div><div><h3>Conclusions</h3><div>LA dysfunction was related to unfavourable pulmonary artery remodelling and adverse outcomes in SSc patients without structural cardiac disease.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 8","pages":"Pages 1132-1139"},"PeriodicalIF":2.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858262","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}