Canadian Journal of Cardiology最新文献

{"title":"Early Potentially Irreversible Cardiac Damage in Fabry Disease Precedes Gb3 Inclusion Body Formation.","authors":"Chung-Lin Lee, Pei-Sin Chen, Yu-Ying Lu, Yu-Ting Chiang, Ching-Tzu Yen, Chun-Ying Huang, Yen-Fu Cheng, Hsiang-Yu Lin, Yun-Ru Chen, Dau-Ming Niu","doi":"10.1016/j.cjca.2025.03.001","DOIUrl":"https://doi.org/10.1016/j.cjca.2025.03.001","url":null,"abstract":"<p><strong>Background: </strong>Fabry disease (FD) is a lysosomal storage disorder impacting multiple organs, including the heart. We investigated whether early-stage globotriaosylceramide (Gb3) accumulation, occurring before the formation of inclusion bodies, could cause significant stress and potentially irreversible damages of the cardiac tissue in FD patients.</p><p><strong>Methods: </strong>Immunofluorescent (IF) staining and Western blotting were performed on fibroblasts from FD IVS4 patients and myocardial biopsies from G3Stg/GLAko mice as well as three IVS4 patients (aged 44, 37, and 41 years). Notably, all biopsies showed detectable Gb3 accumulation under IF but lacked the typical pathology of FD (Gb3 inclusion bodies). Staining targeted nuclear factor-κB (NF-κB), interleukin-18 (IL-18), phospho-p42/44 mitogen-activated protein kinase (MAPK), and inducible nitric oxide synthase (iNOS) as markers of inflammation and oxidative stress. Additionally, alpha-smooth muscle actin (α-SMA) IF staining was conducted to identify myofibroblasts.</p><p><strong>Results: </strong>Fibroblasts from FD patients, along with cardiac tissues from both G3Stg/GLAko mice and FD patients, exhibited significant accumulation of inflammatory markers such as NF-κB IL-18 and phospho-p42/44 MAPK, as well as the oxidative stress marker iNOS. Despite the absence of typical FD pathology, the presence of fibrogenesis was confirmed in myocardial biopsies from these patients through strong positive staining of α-SMA.</p><p><strong>Conclusions: </strong>Significant cellular stress and potential irreversible damage may occur before the onset of typical pathological changes in the cardiac tissues of FD. Our findings raise an intriguing question: should ERT be initiated much earlier than currently recommended? However, this hypothesis requires validation through rigorous randomized controlled trials (RCTs) to draw definitive conclusions.</p>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the Hemodynamic Basis of Angiotensin Receptor Neprilysin Inhibitor Intolerance: Reason for Frustration or New Motivation?","authors":"Micha T Maeder","doi":"10.1016/j.cjca.2025.03.005","DOIUrl":"https://doi.org/10.1016/j.cjca.2025.03.005","url":null,"abstract":"","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frailty as a potential modifier in the triad of cardiovascular disease, physical activity, and sedentary behaviour.","authors":"Kuo-Chin Hung, Chia-Ter Chao","doi":"10.1016/j.cjca.2025.03.004","DOIUrl":"https://doi.org/10.1016/j.cjca.2025.03.004","url":null,"abstract":"","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potent P2Y12 inhibitors versus clopidogrel in cancer patients undergoing percutaneous coronary intervention.","authors":"Mauro Gitto, Samantha Sartori, Birgit Vogel, Pier Pasquale Leone, Kenneth Smith, Benjamin Bay, Prakash Krishnan, Joseph Sweeny, Angelo Oliva, Pedro Moreno, Sean Gilhooley, Francesca Maria Di Muro, Parasuram Melarcode Krishnamoorthy, Annapoorna Kini, George Dangas, Roxana Mehran, Samin Sharma","doi":"10.1016/j.cjca.2025.02.035","DOIUrl":"https://doi.org/10.1016/j.cjca.2025.02.035","url":null,"abstract":"<p><strong>Background: </strong>Patients with cancer undergoing percutaneous coronary intervention (PCI) experience higher risk of both ischemic and bleeding events. The aim of this study is to assess ischemic and bleeding risks after PCI in cancer patients treated with potent P2Y12 inhibitors (P2Y12i; prasugrel and ticagrelor), compared to clopidogrel.</p><p><strong>Methods: </strong>Consecutive cancer patients undergoing PCI at a tertiary centre between 2012 and 2022 and discharged on P2Y12i were included. Propensity score covariate adjustment was used to account for baseline differences between patients treated with potent P2Y12i and clopidogrel. Key clinical endpoints included major adverse cardiac and cerebrovascular events (MACCE - composite of death, myocardial infarction or stroke) and major bleeding.</p><p><strong>Results: </strong>Of the 1,702 included patients, 373 (21.9%) were treated with potent P2Y12i and 1,329 (78.1%) with clopidogrel. Factors associated with potent P2Y12i use were acute coronary syndrome presentation and lesion length, while clopidogrel use was associated with active cancer status, thrombocytopenia, older age and femoral access. MACCE at one year occurred in 3.5% of patients treated with potent P2Y12i vs. 6.8% of those receiving clopidogrel (log-rank p=0.035; adj. HR: 0.53, 95% CI: 0.26-1.10), while no differences in bleeding risk were detected (5.5% vs. 7.0%, adj. HR: 0.92, 95% CI: 0.53 - 1.60). The reduction in MACCE was significant in patients with remission but not active cancer (p-interaction = 0.011).</p><p><strong>Conclusions: </strong>Among cancer patients undergoing PCI, potent P2Y12i were associated with similar bleeding risk and lower incidence of ischemic events compared to clopidogrel, however with no significant difference after propensity score adjustment.</p>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-dependent pathophysiology and therapeutic considerations in right heart disease.","authors":"Sue Gu, Benjamin J Kopecky, Brisa Peña, Ronald J Vagnozzi, Tim Lahm","doi":"10.1016/j.cjca.2025.02.034","DOIUrl":"https://doi.org/10.1016/j.cjca.2025.02.034","url":null,"abstract":"<p><strong>Clinical significance: </strong>Right ventricular (RV) adaptation to the increased afterload in the setting of pulmonary hypertension (PH) and other cardiac and pulmonary vascular conditions is a major determinant of survival. While the RV remains understudied and less well understood than the left ventricle, recent advances have been made in understanding the function and biology of the RV in health and in disease, particularly in PH.</p><p><strong>Sexual dimorphisms in rv adaptation: </strong>RV adaptation in PH exhibits significant sexual dimorphisms in pathophysiology, adaptation, and outcomes. Despite a higher incidence of PH, women consistently demonstrate better RV adaptation and survival rates in the setting of increased RV afterload compared to men. Sexual dimorphisms extend to therapy responsiveness, with women benefiting more from certain pulmonary vasodilators and exhibiting superior RV recovery. This review discusses the current literature on sexual dimorphisms in RV structure, function and molecular pathways in health and disease as well as in RV-specific clinical manifestations, treatments, and outcomes in PH. Sex steroid-mediated effects as well as emerging studies on sex steroid-independent effects will be reviewed. In general, sex steroids such as 17β-estradiol and dehydroepiandrosterone exert RV-protective effects. In contrast, testosterone negatively impacts RV structure and function. Emerging evidence highlights the influence of non-hormonal genetic determinants, such as BMPR1A and DMRT2 loci, which are associated with better RV function in women.</p><p><strong>Implications for therapy: </strong>A better understanding of the interplay between sex hormones, genetic factors, and RV biology is crucial for advancing and developing RV-directed therapies for patients of either sex.</p>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using QRS-V_His Interval-based Algorithm to Optimize the Outflow Tract Premature Ventricular Complexes Ablation Process.","authors":"Linlin Wang, Lei Wang, Hailei Liu, Nan Wu, Kuan Cheng, Yunlong Wang, Yuegang Wang, Fangyi Xiao, Ruhong Jiang, Xuefeng Zhu, Jingcheng Chen, Jinfeng Wang, Rongbin Yu, Weizhu Ju, Minglong Chen","doi":"10.1016/j.cjca.2025.02.032","DOIUrl":"https://doi.org/10.1016/j.cjca.2025.02.032","url":null,"abstract":"<p><strong>Background: </strong>The choice between left-sided and right-sided ablation for outflow tract premature ventricular complexes (OT-PVCs) during procedures remains a topic of ongoing discussion. This study aims to elucidate the value of QRS-V_His interval in distinguishing between left and right origins in LBBB-type OT-PVCs, thereby optimizing the ablation process.</p><p><strong>Methods: </strong>The QRS-V_His interval was measured in consecutive patients with LBBB-type OT-PVCs. The performance of this interval was compared to traditional ECG algorithms and prospectively validated in a cohort from 8 centers. Based on the interval, we developed an algorithm to assess its efficacy in optimizing the ablation process.</p><p><strong>Results: </strong>A total of 166 patients were enrolled in the development cohort, and 53 patients in the validation cohort. The QRS-V_His interval demonstrated greater accuracy than ECG algorithms among 153 patients with typical endocardial origins (AUC = 0.962). At a cutoff of 30 ms, the QRS-V_His interval showed a sensitivity of 71.8% and a specificity of 98.2% for identifying left-sided locations. A flowchart was developed based on the QRS-V_His interval, indicating that a QRS-V_His value of less than 30 ms necessitated left-sided ablation with a 94% likelihood, leading to an 88% success rate. Conversely, when the QRS-V_His value was 30 ms or greater, the likelihood of requiring left-sided ablation dropped to only 16%. The accuracy of the flowchart was validated in the independent cohort.</p><p><strong>Conclusions: </strong>The QRS-V_His interval is superior for distinguishing between LVOT and RVOT origins in LBBB-type OT-PVCs and has proven valuable in optimizing the intra-procedural process.</p>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of a standardized approach to repeat paroxysmal atrial fibrillation ablation: insights into the value of extrapulmonary vein targets.","authors":"Nikesh Pandey, Brianna Murray, Mehrdad Golian, Andres Klein, Simon Hansom, Mouhannad M Sadek, Willy Weng, Calum J Redpath, Pablo B Nery, Girish M Nair, David Birnie, F Daniel Ramirez","doi":"10.1016/j.cjca.2025.02.033","DOIUrl":"https://doi.org/10.1016/j.cjca.2025.02.033","url":null,"abstract":"<p><strong>Background: </strong>The optimal approach to repeat catheter ablation for recurrent paroxysmal atrial fibrillation (PAF) is unknown.</p><p><strong>Methods: </strong>Consecutive patients undergoing repeat PAF ablation were studied. A six-step approach was used in all cases: re-isolation of reconnected pulmonary veins (PVs), ablation of left atrial low voltage areas (LVAs), targeted ablation of clinical or inducible atrial flutter/tachycardia, non-PV trigger ablation, ablation of inducible supraventricular tachycardia, and additional empiric ablation based on operator judgment. The primary study outcome was atrial arrhythmia-free survival at 1-year.</p><p><strong>Results: </strong>113 patients were included (age 63.7±8.6 years, 28.3% female). In this cohort, 73.5% had PV reconnection(s); 31.9% had LVAs; 10.6% had identifiable non-PV triggers; 5.3% had inducible atrioventricular nodal reentrant tachycardia; 31.9% underwent atrial flutter/tachycardia ablation; and 12.4% had additional empiric ablation performed. Arrhythmia-free survival at 1-year was 53.1%. Patients with arrhythmia recurrence were more likely to be older, female, have hypertension, have durably isolated PVs, and to have undergone LVA ablation. In multivariable analysis, female sex and LVA ablation remained predictive of arrhythmia recurrence. Among patients with durably isolated PVs, only female sex was (negatively) associated with procedural success.</p><p><strong>Conclusions: </strong>A comprehensive protocol for repeat PAF ablation resulted in arrhythmia-free survival at 1-year in 53% of patients. Durably isolated PVs were observed in 26.5%. None of the ablation protocol's steps was suggested to independently improve procedural success. Further research to determine the optimal ablation strategy in patients undergoing repeat ablation for PAF is needed, a growing proportion of whom are expected to have durably isolated PVs.</p>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are the Cardiovascular Benefits and Potential Risks of Physical Activity and Exercise Dependent on Race, Ethnicity, or Sex?","authors":"Daniel T. Tardo BAppSc(Ex&SpSc)(Hons), MBBS(Hons), MMed, FRACP ,&nbsp;Michael Papadakis MBBS, MD(Res), FRCP, FESC","doi":"10.1016/j.cjca.2024.11.013","DOIUrl":"10.1016/j.cjca.2024.11.013","url":null,"abstract":"<div><div>Physical activity (PA) is established as a cornerstone of cardiovascular health, however, disparities in participation exist across sociocultural groups, which in turn affect cardiovascular outcomes. Evidence suggests that although the positive cardiovascular effects of exercise are consistent across populations, notable differences in the magnitude of these benefits exist for racial and ethnic minorities and the female sex. Women derive greater protection from PA compared with men, with reduced rates of sudden cardiac death. In this review we examine the complex interplay of race and/or ethnicity and sex on the cardiovascular benefits associated with PA and exercise, cardiovascular adaptations to exercise, risks of sudden cardiac death, and “excessive” volume of exercise. Understanding these factors is crucial for developing targeted interventions to promote cardiovascular health and offset disparities.</div></div>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 3","pages":"Pages 456-469"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Surviving to Thriving: A Roadmap for Reinventing Cardiac Rehabilitation in Pediatric Congenital Heart Disease","authors":"Katherine Hansen MD","doi":"10.1016/j.cjca.2024.11.020","DOIUrl":"10.1016/j.cjca.2024.11.020","url":null,"abstract":"<div><div>Exercise is an essential component of the cardiac care of children with congenital heart disease (CHD), and safe and effective exercise counselling by the medical team is important early in life to develop positive physical activity and exercise habits. Without it, children are at risk for sedentariness and related comorbidities in childhood and adulthood. Pediatric cardiologists can guide patients to a cycle of positive fitness through exercise counselling, promotion, prescription, and/or supervised exercise training similar to adult cardiac rehabilitation (ACR). ACR has improved exercise capacity, mortality, and quality of life in adults with acquired heart disease. Similar outcomes have been shown in exercise training for adult and pediatric CHD. Exercise training specific to pediatric CHD is not widely available but is expanding in response to growing need and increasing demand. Although ACR provides a framework for structured exercise training, approaches to pediatric exercise training must be individualized and innovated upon to be successful for children. I propose that the ACR model must be reinvented for children with CHD by integrating 6 missing pieces. First, the underlying goal should be to optimize fitness, not rehabilitate to a previous state of health. Second and third are training mental skills and motor skills. Fourth, play-based exercise training is needed to foster a positive relationship with exercise. Fifth, family-focused exercise interventions can address root causes of sedentariness. Finally, building communities in which positive fitness is a priority will be essential to long-term sustainability.</div></div>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 3","pages":"Pages 375-385"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Many Roads Toward Sports Cardiology—How to Become A Sports Cardiologist and the Importance of Specialised Training","authors":"Ryan Quinn MD ,&nbsp;David Dorian MD","doi":"10.1016/j.cjca.2024.11.026","DOIUrl":"10.1016/j.cjca.2024.11.026","url":null,"abstract":"","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 3","pages":"Pages 542-544"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}