CJC Open最新文献

{"title":"Takotsubo Cardiomyopathy After Oxaliplatin Chemotherapy Exposure: A Case Report","authors":"","doi":"10.1016/j.cjco.2024.07.005","DOIUrl":"10.1016/j.cjco.2024.07.005","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141691589","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":"Intracardiac Echocardiography-Guided Transseptal Puncture Invisible by Transesophageal Echocardiography After Secundum Atrial Septal Defect Closure","authors":"","doi":"10.1016/j.cjco.2024.07.002","DOIUrl":"10.1016/j.cjco.2024.07.002","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141701059","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":"Competency-Based Cardiology Training: A Simple Approach to Improve Supervisor Completion of Entrustable Professional Activities","authors":"","doi":"10.1016/j.cjco.2024.07.007","DOIUrl":"10.1016/j.cjco.2024.07.007","url":null,"abstract":"<div><h3>Background</h3><div>Adult cardiology residency programs formally transitioned to Competency by Design (CBD) in July 2021. CBD was designed to establish clear learning expectations and increase opportunities for coaching; however, cited challenges include inconsistent participation by staff, and variable timelines for receiving feedback. This project was designed to implement a simple intervention to improve expiry rates and completion timelines of entrustable professional activities (EPAs).</div></div><div><h3>Methods</h3><div>EPAs triggered by cardiology residents at Dalhousie University between July 1, 2020 and February 28, 2023 were reviewed. The intervention consisted of performance reviews, including a grand rounds presentation, along with a personalized data set distributed to each staff supervisor, with individual statistics compared to group averages. Outcomes include EPAs completed per resident-months, time to completion, and percentage of expired EPAs.</div></div><div><h3>Results</h3><div>At 12 months postintervention, the percentage of expired EPAs decreased from 35.0% to 21.5% (odds ratio 0.51, CI 0.33–0.79; <em>P</em> = 0.03), and the time to completion decreased from 7.3 ± 5.99 days to 5.0 ± 5.78 days (difference –2.31, CI –3.55 to –1.07; <em>P</em> &lt; 0.001). The number of EPAs completed per resident-months increased from 3.10 to 4.29 (rate difference 1.18; CI 0.64–1.72; <em>P</em> &lt; 0.001), and the percentage of EPAs completed within the target time of 48 hours increased from 54.4% to 71.5% (OR 2.11, CI 1.27–3.50; <em>P</em> = 0.004).</div></div><div><h3>Conclusions</h3><div>Performance reviews in the form of a group presentation, along with the distribution of personalized data sets to supervisors, positively impacted EPA expiry rates, completion timelines, and completion rates, which helped facilitate the transition to CBD.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141843601","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":"Assessment of Coagulation Factors in Patients with Severe Rheumatic Mitral Stenosis in Sinus Rhythm with Left Atrial Appendage Inactivity","authors":"","doi":"10.1016/j.cjco.2024.07.004","DOIUrl":"10.1016/j.cjco.2024.07.004","url":null,"abstract":"<div><h3>Background</h3><div>Patients with severe mitral stenosis (MS) in normal sinus rhythm (NSR), presenting with left atrial appendage (LAA) inactivity and associated left atrial spontaneous echo contrast (LASEC) are prone to left atrium (LA) or LAA thrombus formation. But unlike for atrial fibrillation, oral anticoagulants are not commonly prescribed for this patient subset. This study aimed to compare the levels of procoagulants and fibrinogen in both local (LA) and systemic contexts between patients with severe MS in NSR vs those in healthy control subjects.</div></div><div><h3>Methods</h3><div>The study involved 35 patients with severe MS in NSR with LAA inactivity and LASEC who were eligible for balloon mitral valvuloplasty vs 35 healthy controls. All patients underwent transthoracic and transesophageal echocardiography to assess MS severity, LAA activity, and LASEC grade, and had blood samples analyzed for procoagulant levels.</div></div><div><h3>Results</h3><div>Results showed comparable baseline characteristics between groups, with most patients in the New York Heart Association II or III functional classes, and with varying LASEC grades. Patients exhibited significantly higher levels of prothrombin fragment 1 + 2 [patient vs control, 9017 pg/mL (6228.0-10,963.5) vs 1790 pg/mL (842.3-2712), <em>P</em> &lt; 0.0001], thrombin-antithrombin III [patient vs control, 39 ng/mL (5.45-74.85) vs 2.80 ng/mL (1.6-6.5), <em>P</em> &lt; 0.0001], plasminogen activator inhibitor-1 (patients vs controls, 26.09 ± 8.18 ng/mL vs 8.05 ± 3.53 ng/mL, <em>P</em> &lt; 0.0001), and fibrinogen (3.48 ± 0.89 g/L vs 3.01 ± 0.53 g/L, <em>P</em> = 0.029) in the LA of patients, compared to those in control subjects. Systemic procoagulant levels also were elevated in patients, but D-dimer levels were similar between the 2 groups.</div></div><div><h3>Conclusions</h3><div>The findings suggest a hypercoagulable state in patients, similar to that in patients with atrial fibrillation. The study advocates for consideration of use of oral anticoagulants in these patients until LA and LAA function improves, to mitigate thrombus formation.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141852191","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":"The Potential for Heart Donation After Death Determination by Circulatory Criteria in the Province of Québec","authors":"","doi":"10.1016/j.cjco.2024.05.004","DOIUrl":"10.1016/j.cjco.2024.05.004","url":null,"abstract":"<div><h3>Background</h3><p>Heart donation (HD) by those with death determination by circulatory criteria (DDCC) has been proposed as a method to increase the heart donor pool in response to the growing need for heart transplantation (HT). However, the potential level of HD after DDCC in the province of Québec has not yet been reported. This study aims to assess the suitability for HD among donors with DDCC, and to estimate its impact on HT activity.</p></div><div><h3>Methods</h3><p>Donation records by those with DDCC in the province of Québec, from January 2016 to December 2020, were retrospectively reviewed for donor and predonation characteristics. Predetermined exclusion criteria were used to evaluate eligibility for HD.</p></div><div><h3>Results</h3><p>Of the 122 patients with DDCC who were included, 42 (34%) were identified as potentially-eligible heart donors. The median age of potentially-eligible donors was 52 years; 60% were female; and the most prevalent causes leading to organ donation in this group were medical aid in dying (26%), traumatic brain injury (26%), and anoxia (24%). A 19% increase (42 of 225) in potential HT activity was estimated using strict criteria. In only one case did functional warm ischemia time exceed the 30-minute limit.</p></div><div><h3>Conclusions</h3><p>Using those with DDCC as a new source of heart donors can significantly increase the volume of heart donation in the province of Québec. Implementing an HD program for those with DDCC in Québec may reduce waiting time and increase the number of heart recipients.</p></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589790X24002142/pdfft?md5=87bac081bee735d5a8b8075151b1711b&pid=1-s2.0-S2589790X24002142-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141048009","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":"Outcome of Percutaneous and Surgical Management for Tricuspid Infective Endocarditis: Insights From a National Study","authors":"","doi":"10.1016/j.cjco.2024.05.010","DOIUrl":"10.1016/j.cjco.2024.05.010","url":null,"abstract":"<div><h3>Background</h3><p>The prevalence of infective endocarditis (IE) and its associated mortality rates remain high, despite medical advances. In recent years, treatment options for IE have expanded, but they are yet to be widely utilized. The current study aimed to compare in-hospital outcomes of high-risk tricuspid valve (TV) IE patients, by treatment strategy.</p></div><div><h3>Methods</h3><p>Patients from the National Inpatient Sample 2017-2019 database who had TV IE were grouped by therapy type—percutaneous aspiration, surgical, or conservative management. Patients were considered to be at high risk if they underwent mechanical intervention or if they had right ventricle failure or septic emboli.</p></div><div><h3>Results</h3><p>The analyzed cohort consisted of 28,495 patients—1.7% were treated with percutaneous aspiration, 13.5% with surgery, and 84.6% conservatively. Patients treated with percutaneous aspiration had the highest prevalence of septic shock and acute respiratory failure (<em>P</em> &lt; 0.001). The overall in-hospital mortality rate was 7%. Patients treated conservatively had higher in-hospital mortality rates (7.5%) compared to those of the surgical group (4.4%) and the percutaneous aspiration group (4.1%; <em>P</em> &lt; 0.001). In a multivariate analysis, conservative management was associated with an increased risk of in-hospital mortality (odds ratio 2.853, 95% confidence interval 1.748-4.659, <em>P</em> &lt; 0.001), and no significant difference was found between the aspiration and surgical groups (<em>P</em> = 0.346). Benefits were pronounced in younger patients and those with septic shock or respiratory failure. Patients in the aspiration group had the highest rate of home discharge with self-care, of the various patient dispositions (<em>P</em> &lt; 0.001).</p></div><div><h3>Conclusions</h3><p>Among high-risk patients with TV IE, an invasive approach is associated with a significantly lower in-hospital mortality rate than is a conservative approach, particularly in younger and unstable patients.</p></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589790X24002221/pdfft?md5=598d103dd222901d6751d4d41ef9b540&pid=1-s2.0-S2589790X24002221-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142162566","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":"Acute Coronary Syndrome in a 40-Year-Old Man with Triglyceride Deposit Cardiomyovasculopathy: A Case Report","authors":"","doi":"10.1016/j.cjco.2024.06.004","DOIUrl":"10.1016/j.cjco.2024.06.004","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589790X24002543/pdfft?md5=86c0df3bf5f13ca425f05e6da1ec89ed&pid=1-s2.0-S2589790X24002543-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142162645","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":"Long-term Monitoring to Detect Risk of Sudden Cardiac Death in Inherited Arrhythmia Patients","authors":"","doi":"10.1016/j.cjco.2024.05.007","DOIUrl":"10.1016/j.cjco.2024.05.007","url":null,"abstract":"<div><h3>Background</h3><p>Risk stratification in inherited arrhythmia syndromes is challenging. Implantable cardioverter defibrillators (ICDs) are effective in the prevention of sudden cardiac death but are associated with significant complications. We aimed to determine the value of long-term implantable loop recorder (ILR) monitoring to determine risk factors for arrhythmias in inherited arrhythmia patients.</p></div><div><h3>Methods</h3><p>We conducted a prospective multicentre study between 2015 and 2020 recruiting inherited arrhythmia probands and family members at intermediate arrhythmic risk, with no class 1 indication for ICD implantation. The primary endpoint was the detection by ILR of nonsustained ventricular tachycardia over ≥ 10 consecutive beats. Secondary endpoints included ICD insertion during follow-up, all-cause mortality, and ILR complication rates.</p></div><div><h3>Results</h3><p>A total of 45 individuals (30 female participants) were enrolled in the study. The most common diagnoses were long-QT syndrome (28%), Brugada syndrome (26%), and arrhythmogenic cardiomyopathy (11%). Following ILR insertion (mean follow-up 633 days; range, 387-969), cardiac symptoms occurred in 19 of 45 patients (42%), 5 of whom had nonsustained ventricular tachycardias (11%), which were symptomatic in 3 individuals. This situation led to ICD implantation based on ILR in 5 of 45 patients (11%). Fifty percent of symptomatic events occurred in ARVC patients. The median time from ILR insertion to ICD implantation was 152 days (interquartile range (25th, 75th percentiles) 55 of 209). No patient experienced sudden cardiac death.</p></div><div><h3>Conclusions</h3><p>ILRs enable the detection of high-risk arrhythmic features and facilitate selection of ICD candidates in inherited arrhythmia patients with borderline indications.</p></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589790X24002178/pdfft?md5=c82271f86991dd2c2dbcf8399f970b24&pid=1-s2.0-S2589790X24002178-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141139218","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, Patient Awareness, Treatment, and Control of Hypertension in Canadian Adults With Common Comorbidities","authors":"","doi":"10.1016/j.cjco.2024.05.012","DOIUrl":"10.1016/j.cjco.2024.05.012","url":null,"abstract":"<div><h3>Background</h3><p>Whether certain medical conditions are associated with blood pressure (BP) treatment and control is unclear.</p></div><div><h3>Methods</h3><p>Using the Canadian Health Measures Survey (2007-2019), BP was assessed according to the presence of selected comorbidities, including prior heart attack or stroke, dyslipidemia, chronic kidney disease, diabetes mellitus, obstructive sleep apnea, and overweight or obesity.</p></div><div><h3>Results</h3><p>A total of 5,841,453 people, representing 23.0% (95% confidence interval [CI] 21.7%-24.2%) of Canadian adults, were hypertensive. The adjusted odds ratio (aOR) of having hypertension treated and controlled was higher in people with the following conditions, as compared to people without these conditions: a prior heart attack or stroke (aOR 3.15; 95% CI 2.31-4.31); dyslipidemia (aOR 2.51; 95% CI 1.96-3.21); obstructive sleep apnea (aOR 1.95; 95% CI 1.19-3.21); overweight or obesity (aOR 1.51; 95% CI 1.18-1.94); chronic kidney disease (aOR 1.49; 95% CI 1.13-1.95); and diabetes (aOR 1.44; 95% CI 1.12-1.86). Individuals without any of these comorbidities were less likely to have BP that is treated and controlled (aOR 0.34; 95% CI 0.25-0.48). Moreover, the prevalence of BP treatment and control was low among many people without prior heart attack or stroke, even those with a moderate (aOR 0.25; 95% CI 0.17-0.37) or high (aOR 0.10; 95% CI 0.06-0.16) Framingham risk.</p></div><div><h3>Conclusions</h3><p>Large differences in levels of BP control exist across comorbidity profiles, and the greatest gaps are seen in individuals without recognized comorbidities, even those who have a moderate-to-high Framingham risk. Efforts to optimize BP control and narrow care gaps, especially in individuals without recognized comorbidities, are necessary to reduce the burden of cardiovascular disease and premature death in Canada.</p></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589790X24002245/pdfft?md5=411839c062bc84c37a80300dfaa9cec9&pid=1-s2.0-S2589790X24002245-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142162568","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":"Time to Calm the Fick Down? A Systematic Review and Meta-Analysis of Thermodilution Compared to Direct Fick in Tricuspid Regurgitation","authors":"","doi":"10.1016/j.cjco.2024.05.008","DOIUrl":"10.1016/j.cjco.2024.05.008","url":null,"abstract":"<div><h3>Background</h3><p>Many clinicians consider thermodilution (TD) as a means to measure cardiac output (CO) to be unreliable in patients with tricuspid regurgitation (TR). No systematic appraisals of this clinical issue have been conducted. We hypothesized that the level of inaccuracy of using TD in patients with TR, compared to the direct Fick (DF) method, to determine CO, is overstated.</p></div><div><h3>Methods</h3><p>We performed a systematic search of 6 major literature databases for the period from 1946 to July 2023. Studies were included if they included CO measurements determined with both TD and the DF method in patients with vs without TR. Meta-analysis of the correlation between the measurements determined by TD vs the DF method was performed, stratified by the presence of TR.</p></div><div><h3>Results</h3><p>A total of 1064 studies were identified, of which 8 met the inclusion criteria. Four of the studies were included in the pooled analysis. The presence of TR did not affect the correlation between CO measurements determined by TD vs the DF method (moderate-to-severe TR: <em>r</em> = 0.90, 95% confidence interval 0.76, 0.96; mild or no TR, <em>r</em> = 0.86, 95% confidence interval 0.71, 0.93). Many studies had high levels of heterogeneity and risk of bias.</p></div><div><h3>Conclusions</h3><p>The accuracy of CO measurements made using TD, compared to the gold-standard DF method, may not be meaningfully affected by the presence of moderate-to-severe TR. Given the high levels of heterogeneity and risk of bias of the included studies, these findings should be replicated in a modern cohort.</p></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589790X24002191/pdfft?md5=6f931b75f8dde0578b1551625196e48d&pid=1-s2.0-S2589790X24002191-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141134974","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}