Canadian Journal of Cardiology最新文献

{"title":"Adipose Tissue Stromal Cells: Rheostats for Adipose Tissue Function and Metabolic Disease Risk.","authors":"Taylor B Scheidl, Jessica L Wager, Jennifer A Thompson","doi":"10.1016/j.cjca.2025.02.025","DOIUrl":"10.1016/j.cjca.2025.02.025","url":null,"abstract":"<p><p>The transition from metabolically healthy obesity to the development of obesity-associated metabolic syndrome and cardiovascular disease is thought to be triggered by a loss in the functional integrity of adipose tissue. Although mature adipocytes are the primary functional units that carry out lipid partitioning in adipose tissue for the promotion of whole-body energy balance, they are supported by a heterogenous collection of nonadipocytes in the stroma. Research over the past couple of decades has expanded perspectives on the homeostatic and pathological roles of the nonadipocyte compartment. Adipose progenitors originate in the embryonic period and drive the developmental adipogenesis that establishes the set point of adiposity. A population of adipocyte progenitors reside in adult depots and serve an important homeostatic role as a reservoir to support adipocyte turnover. Adipocyte hypertrophy in obesity increases the rate of adipocyte death and the ability of progenitors to support this high rate of adipocyte turnover is important for the preservation of the lipid-buffering function of adipose tissue. Some evidence exists to suggest that impaired adipogenesis or a decline in progenitors capable of differentiation is a key event in the development of adipose dysfunction. The efficiency of macrophages to clear the debris and toxic lipids released from dead adipocytes lies at the fulcrum between preservation of adipose function and the progression toward chronic inflammation. Although macrophages in collaboration with other immune cells propagate the inflammation that underlies adipose dysfunction, there is now a greater appreciation for the diverse and unique roles of immune cells within adipose tissue.</p>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476421","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":"Revascularization Recommendations for Patients with Multivessel Coronary Artery Disease: Reestablished at Last.","authors":"Marc Ruel, Michael E Farkouh, Michelle Graham, Rosemary F Kelly, Maral Ouzounian, Paul Poirier, Louise Y Sun, Anne E Williams, Faisal G Bakaeen","doi":"10.1016/j.cjca.2025.02.022","DOIUrl":"10.1016/j.cjca.2025.02.022","url":null,"abstract":"","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466445","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":"Beyond Text: The Impact of Clinical Context on GPT-4's 12-Lead Electrocardiogram Interpretation Accuracy.","authors":"Ivan Zeljkovic, Andrej Novak, Ante Lisicic, Ana Jordan, Ana Serman, Ivana Jurin, Nikola Pavlovic, Sime Manola","doi":"10.1016/j.cjca.2025.01.036","DOIUrl":"10.1016/j.cjca.2025.01.036","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) and large language models (LLMs), such as OpenAI's GPT-4, are increasingly being explored for medical applications. Recently, GPT-4 gained image processing capabilities, enabling it to handle tasks such as image captioning, visual question answering, and potentially interpreting medical data. Despite promising potential in diagnostics, the effectiveness of GPT-4 in interpreting complex 12-lead electrocardiograms (ECGs) remains to be assessed.</p><p><strong>Methods: </strong>This study utilized GPT-4 to interpret 150 12-lead ECGs from the Cardiology Research Dubrava (CaRD) registry, spanning a wide range of cardiac pathologies. The ECGs were classified into 4 categories for analysis: arrhythmias, conduction system abnormalities, acute coronary syndrome, and other. Two experiments were conducted: one where GPT-4 interpreted ECGs without clinical context, and another with added clinical scenarios. A panel of experienced cardiologists evaluated the accuracy of GPT-4's interpretations.</p><p><strong>Results: </strong>In this cross-sectional observational study, GPT-4 demonstrated a correct interpretation rate of 19% without clinical context and a significantly improved rate of 45% with context (P < 0.001). The addition of clinical scenarios significantly enhanced interpretative accuracy, particularly in the acute coronary syndrome category (10% vs 70%; P < 0.0.01). The \"other\" category showed no impact (51% vs 59%; P = 0.640), and trends toward significance were observed in the arrhythmias (9.7% vs 32%; P = 0.059) and conduction system abnormalities (4.8% vs 19%; P = 0.088) categories when given clinical context.</p><p><strong>Conclusions: </strong>Although GPT-4 shows potential in aiding 12-lead ECG interpretation, its effectiveness varies significantly with clinical context. The study suggests that GPT-4 alone in its current form may not provide accurate 12-lead ECG interpretation.</p>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457016","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":"Machine Learning vs Traditional Approaches to Predict All-Cause Mortality for Acute Coronary Syndrome: A Systematic Review and Meta-analysis.","authors":"Aashray K Gupta, Cecil Mustafiz, Daud Mutahar, Ammar Zaka, Razeen Parvez, Naim Mridha, Brandon Stretton, Joshua G Kovoor, Stephen Bacchi, Fabio Ramponi, Justin C Y Chan, Sarah Zaman, Clara Chow, Pramesh Kovoor, Jayme S Bennetts, Guy J Maddern","doi":"10.1016/j.cjca.2025.01.037","DOIUrl":"10.1016/j.cjca.2025.01.037","url":null,"abstract":"<p><strong>Background: </strong>Acute coronary syndrome (ACS) remains one of the leading causes of death globally. Accurate and reliable mortality risk prediction of ACS patients is essential for developing targeted treatment strategies and improve prognostication. Traditional models for risk stratification such as the GRACE and TIMI risk scores offer moderate discriminative value, and do not incorporate contemporary predictors of ACS prognosis. Machine learning (ML) models have emerged as an alternate method that may offer improved risk assessment. This review compares ML models with traditional risk scores for predicting all-cause mortality in patients with ACS.</p><p><strong>Methods: </strong>PubMed, Embase, Web of Science, Cochrane, CINAHL, Scopus, and IEEE XPlore databases were searched through October 30, 2024, as well as Google Scholar and manual screening of reference lists from included studies and the grey literature for studies comparing ML models with traditional statistical methods for event prediction of ACS patients. The primary outcome was comparative discrimination measured by C-statistics with 95% confidence intervals (CIs) in estimating risk of all-cause mortality.</p><p><strong>Results: </strong>Twelve studies were included (250,510 patients). The summary C-statistic of best-performing ML models across all end points was 0.88 (95% CI 0.86-0.91), compared with 0.82 (95% CI 0.80-0.85) for traditional methods. The difference in C-statistic between ML models and traditional methods was 0.06 (P < 0.0007). Five studies undertook external validation. The PROBAST tool demonstrated high risk of bias for all studies. Common sources of bias included reporting bias and selection bias. Best-performing ML models demonstrated superior discrimination of all-cause mortality for ACS patients compared with traditional risk scores.</p><p><strong>Conclusions: </strong>Despite outperforming well established prognostic tools such as the GRACE and TIMI scores, current clinical applications of ML approaches remain uncertain, particularly in view of the need for greater model validation.</p>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143456933","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":"Clinical Role of Epicardial Adipose Tissue.","authors":"Paolo Raggi, Arthur E Stillman","doi":"10.1016/j.cjca.2025.02.021","DOIUrl":"10.1016/j.cjca.2025.02.021","url":null,"abstract":"<p><p>Although the epidemic of atherosclerosis has slowed down in industrialized nations, it has increased in speed and severity in developing countries. The worldwide expanding incidence and prevalence of obesity, insulin resistance, and diabetes mellitus may be among the most important drivers of this trend, and the role of visceral adipose tissue as a promoter of atherosclerosis has come under intense scrutiny. Epicardial adipose tissue (EAT) is embryologically similar to the visceral fat in the intraperitoneal space. Both adipose compartments are capable of secreting numerous pro-atherosclerotic cytokines and have been shown to promote inflammation in patients with dysmetabolic syndromes and in patients with established coronary artery disease. The adverse cardiovascular effects of EAT extend to influencing the development of atrial fibrillation and heart failure, mostly with preserved ejection fraction, through a combination of inflammatory, pro-fibrotic, and pro-arrhythmogenic pathways. In this work we provide an overview of the current understanding of the role of EAT in the development of several cardiovascular conditions as well as some of the therapeutic advances in the field.</p>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143456928","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":"New Insights Into Genetic Right Ventricular Cardiomyopathies.","authors":"Marta Garcia-Montero, Yehia Fanous, Andrew D Krahn, Brianna Davies, Julia Cadrin-Tourigny, Jason D Roberts","doi":"10.1016/j.cjca.2025.02.020","DOIUrl":"10.1016/j.cjca.2025.02.020","url":null,"abstract":"<p><p>Inherited right ventricular disease in the form of arrhythmogenic right ventricular cardiomyopathy (ARVC) was first described 40 years ago. The ARVC-causing genes have progressively been identified from the year 2000, accompanied by a robust journey of deep phenotyping. The explosion of genotype and phenotype data coupled with a collaborative spirit in the ARVC community has led to an immense advance in our understanding of the various faces of this disease, with a recent focus on gene-specific phenotypes and risk assessment and mitigation. The modern cardiogenetic team has a wealth of information that informs the biology of the disease, its phenotypic expression, and the processes of care to detect the presence and progression of disease. Gene-specific considerations will raise the bar in precision medicine applied to diagnosis, natural history, and potentially curative interventions with targeted small molecules and gene therapy. This is an exciting time for the ARVC collaborative community to usher in a new era in changing the course of ARVC for patients and their families.</p>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432471","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":"Mechanisms and Prognosis of Intolerance to Angiotensin Receptor-Neprilysin Inhibitors in Advanced Heart Failure: Insights From Vasodilator Challenge.","authors":"Giulio Cacioli, Guglielmo Gallone, Alessandro Verde, Michele Ciabatti, Stefano Pidello, Valentina Colombo, Ludovica De Fazio, Vanessa Peano, Giacomo Angeli, Federica De Donno, Pier Paolo Bocchino, Luciana D'Angelo, Piero Gentile, Fabrizio D'Ascenzo, Paola Lilla Della Monica, Vito Piazza, Federico Conrotto, Gabriella Masciocco, Claudia Raineri, Fabio Sbaraglia, Giampaolo Luzi, Andrea Garascia, Federico Ranocchi, Ryan J Tedford, Gaetano Maria De Ferrari","doi":"10.1016/j.cjca.2025.02.019","DOIUrl":"10.1016/j.cjca.2025.02.019","url":null,"abstract":"<p><strong>Background: </strong>Angiotensin receptor-neprilysin inhibitor (ARNI) intolerance is common in patients with advanced heart failure (AdHF) and may be associated with worse prognosis. During right heart catheterization (RHC), afterload reduction induced by vasodilator challenge may reproduce the hemodynamic effects of ARNI. Through sodium nitroprusside (NTP) infusion, we characterized the hemodynamic mechanisms of ARNI intolerance and explored its prognostic relevance in AdHF.</p><p><strong>Methods: </strong>We performed a retrospective, multicenter study evaluating AdHF patients undergoing RHC with NTP infusion. Hemodynamic ARNI intolerance was defined as symptomatic hypotension requiring ARNI cessation. We collected clinical, echocardiographic, and hemodynamic parameters at baseline and after vasodilator challenge and evaluated their association with ARNI intolerance and a composite clinical outcome of 1-year all-cause death, urgent heart transplantation, or LVAD implantation.</p><p><strong>Results: </strong>Of the 116 consecutive patients, hemodynamic ARNI intolerance was seen in 26 (22.4%). Baseline hemodynamics were not associated with ARNI intolerance. After NTP infusion, a smaller increase in stroke volume index (ΔSVi; adjusted odds ratio [adj-OR] per mL increase: 0.89, 95% confidence interval [CI] 0.81-0.99, P = 0.031) and higher pulmonary elastance (post-NTP arterial elastance; adj-OR per mm Hg per mL increase: 6.49, 95% confidence interval [CI] 1.04-40.46, P = 0.045) were independently associated with hemodynamic ARNI intolerance. Patients with ARNI intolerance were more likely to experience the primary outcome (Kaplan-Meier estimates: 73.0% vs 36.2%, P = 0.021). Higher baseline right atrial pressure/pulmonary artery wedge pressure (hazard ratio [HR] 8.57, 95% CI 2.23-32.89, P = 0.002) and lower post-NTP SVi (HR 0.95, 95% CI 0.92-0.99, P = 0.015) were independent predictors of adverse events.</p><p><strong>Conclusions: </strong>Among AdHF patients, ARNI intolerance is common and associated with worse outcomes. NTP infusion unveils exhausted hemodynamic reserve as its underlying mechanism and prognostic determinant.</p>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432344","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":"Pulmonary Ridge Coverage: a Two-edged Sword in Left Atrial Appendage Closure With LAmbre.","authors":"Jiaxu Shen, Yanyan Chen, Liangguo Wang, Shengjie Wu, Hao Zhou, Zhouqing Huang, Yihe Chen, Xiangxiang Shi, Xiao Chen, Xinlei Wu, Jincheng Xing, Zixuan Wang, Fangyi Xiao","doi":"10.1016/j.cjca.2025.02.018","DOIUrl":"10.1016/j.cjca.2025.02.018","url":null,"abstract":"<p><strong>Background: </strong>The LAmbre occluder, available in 2 versions, allows for selective coverage of the pulmonary ridge (PR) during left atrial appendage closure (LAAC). In this study we evaluated the effects of PR coverage on imaging and clinical outcomes in patients undergoing LAAC.</p><p><strong>Methods: </strong>Imaging data and clinical events were retrospectively analyzed for patients with nonvalvular atrial fibrillation who successfully underwent LAAC using the LAmbre device at the First Affiliated Hospital of Wenzhou Medical University between October 2018 and May 2022. The primary composite endpoint was thromboembolic (TE) events and device-related thrombus (DRT).</p><p><strong>Results: </strong>In total, 259 patients were evaluated using transesophageal echocardiography (TEE) at median intervals of 52 days (short term) and 385 days (long term). Patients were divided into a PR-covered group (n = 109) and a PR-uncovered group (n = 150). PR-uncovered patients showed a trend toward higher DRT incidence (8 of 150 vs 1 of 109, P = 0.056, log-rank test). The primary composite endpoint of TE events and DRT was significantly lower in the PR-covered group (14.0% vs 6.4%, P = 0.046, log-rank test). Any peridevice leak (PDL) was more frequent in the PR-covered group during both short-term (45.9% vs 28.7%, P = 0.004) and long-term (49.5% vs 25.3%, P < 0.001) follow-up, but no differences were observed for significant PDLs (> 3 mm). PR coverage was identified as an independent predictor of any long-term PDL (odds ratio 3.19, 95% confidence interval 1.64-6.18, P < 0.001).</p><p><strong>Conclusions: </strong>PR coverage during LAAC with the LAmbre device was associated with a reduced risk of the primary composite endpoint of TE events and DRT, albeit with an increased incidence of nonsignificant PDL (≤ 3 mm).</p>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425136","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":"Long-Term Outcomes of Fontan Patients With an Extracardiac Conduit: A Systematic Review and Meta-Analysis.","authors":"Marienell Talla, Nathan Best, Abhinay Challa, Sruthy Balakumar, Sergio Lopez-Tejero, Ella Huszti, Eric Horlick, Rafael Alonso-Gonzalez, Lusine Abrahamyan","doi":"10.1016/j.cjca.2025.02.017","DOIUrl":"10.1016/j.cjca.2025.02.017","url":null,"abstract":"<p><strong>Background: </strong>Although Fontan palliation improves survival, it poses a large burden of lifelong morbidity. In extracardiac Fontan (ECF) patients, for example, conduit stenosis developing over time has been associated with Fontan failure and other adverse outcomes. This systematic review, for the first time, synthesized existing data on various long-term outcomes of ECF patients, including change in conduit and associated outcomes.</p><p><strong>Methods: </strong>We searched the Medline, Embase, and Cochrane indexes from inception to 2023 and included studies reporting separate results for ECF patients with a follow-up time of at least 3 years. Full-text studies were assessed for risk of bias. We summarised information on the study, patient characteristics, and outcomes narratively and with the use of descriptive tables. Meta-analysis was performed to calculate pooled incidence rates of adverse events.</p><p><strong>Results: </strong>We included 61 full-text studies, with most studies published after 2009 (77.0%) and using a retrospective cohort design (76.2%). The pooled incidence rates per 100 person-years were for arrhythmia 1.8 (95% confidence interval [CI] 1.3-2.6), thrombotic events 0.2 (95% CI 0.1-0.4), protein-losing enteropathy 0.7 (95% CI 0.5-1.0), conduit obstruction 0.7 (95% CI 0.3-1.5), reoperation 1.9 (95% CI 1.1-3.4), and late death 0.3 (95% CI 0.2-0.5). The ranges of hemodynamic and exercise parameters and findings from studies reporting changes in conduit size and liver disease were reported.</p><p><strong>Conclusions: </strong>Although many studies have largely focused on long-term survival, several other adverse outcomes require further research to develop consensus-based definitions and approaches for evaluations, especially as the ECF population ages. (PROSPERO: CRD42024533080).</p>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425060","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":"Integrative Omics Approaches in Cardiovascular Disease Research: Current Trends and Future Directions.","authors":"Shekoofeh Saboktakin Rizi, Aleksandra Stamenkovic, Amir Ravandi","doi":"10.1016/j.cjca.2025.02.016","DOIUrl":"10.1016/j.cjca.2025.02.016","url":null,"abstract":"","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425059","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}