Canadian Journal of Cardiology最新文献

{"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":"10.1016/j.cjca.2025.02.034","url":null,"abstract":"<p><p>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. Although 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. 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 with men. Sexual dimorphisms extend to therapy responsiveness, with women benefiting more from certain pulmonary vasodilators and exhibiting superior RV recovery. In this review we discuss 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 are 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 nonhormonal genetic determinants, such as BMPR1A and DMRT2 loci, which are associated with better RV function in women. 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 the QRS-V_His Interval-based Algorithm to Optimize the Ablation Process of Outflow Tract Premature Ventricular Complexes.","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":"10.1016/j.cjca.2025.02.032","url":null,"abstract":"<p><strong>Background: </strong>The choice between left- and right-sided ablation for outflow tract premature ventricular complexes (OT-PVCs) during procedures remains a topic of ongoing discussion. In this study we aim to elucidate the value of the QRS-V_His interval in distinguishing between left and right origins in left bundle branch block (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 with traditional electrocardiographic (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 (area under the curve = 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 < 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, 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 left and right ventricular outflow tract origins in LBBB-type OT-PVCs and has proven valuable in optimizing the intraprocedural 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":"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. The following 6-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 empirical ablation based on operator judgement. The primary study outcome was atrial arrhythmia-free survival at 1 year.</p><p><strong>Results: </strong>One hundred thirteen patients were included in the study (mean age 63.7 ± 8.6 years, 28.3% women). 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 re-entrant tachycardia, 31.9% underwent atrial flutter/tachycardia ablation, and 12.4% had additional empirical 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% of cases. 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}

{"title":"Your Heart Can’t See What Sneakers You Are Wearing: Exercise Training Load in Endurance Athletes Is Inadequately Quantified in Sports Cardiology","authors":"Christophe Dausin MSc ,&nbsp;Rafael Machado Tironi MD ,&nbsp;Véronique Cornelissen PhD ,&nbsp;Peter Hespel PhD ,&nbsp;Rik Willems MD, PhD ,&nbsp;Mark Haykowsky PhD ,&nbsp;André La Gerche MBBS, PhD ,&nbsp;Guido Claessen MD, PhD ,&nbsp;Stephen Foulkes PhD","doi":"10.1016/j.cjca.2024.12.009","DOIUrl":"10.1016/j.cjca.2024.12.009","url":null,"abstract":"<div><h3>Background</h3><div>Training load may be an important factor underlying the (patho-)physiologic cardiovascular adaptations from endurance exercise. Yet, quantifying training load remains challenging due to the complexity of its components (Frequency, Intensity, Time, and Type [FITT]). In this systematic review we evaluate how training load has been quantified in sports cardiology studies and provide recommendations for how this can be improved.</div></div><div><h3>Methods</h3><div>A comprehensive search was conducted across PubMed and EMBASE up to October 2024. Studies involving \"sports cardiology,\" \"training load,\" and \"endurance sport\" were included. Data extraction included study characteristics, training load assessment methods, cardiovascular outcomes, and athlete profiles.</div></div><div><h3>Results</h3><div>A total of 62 studies with 1,060,700 participants were included in our review. The majority of studies (59.7%) focused on exercise-induced cardiac remodelling, with other topics being cardiac arrhythmias (12.9%), cardiac autonomic adaptation (3.2%), exercise dose-response (6.5%), and coronary heart disease (17.7%). Training load was primarily quantified by questionnaires (58.1%), whereas heart rate monitoring, a more objective measure, was used in only 1.6% of the studies. All studies reported exercise type, but only 19.4% measured all FITT components.</div></div><div><h3>Conclusions</h3><div>There is a lack of uniformity in the assessment of key FITT variables to quantify training load within the field of sports cardiology, with many studies relying on subjective or incomplete methods. As cardiology moves into the precision medicine era, researchers and clinicians should seek to obtain objective training load information from their athletes according to the FITT framework, and data from use of objective wearable devices represent the optimal way to do this.</div></div>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 3","pages":"Pages 354-363"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142821942","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":"Invited Commentary: Problems Using the Cardiopulmonary Exercise Test in Cardiac Rehabilitation: It Is Time to Retire Outdated Protocols and Replace Them With Better Ones","authors":"Daniel A. Keir PhD","doi":"10.1016/j.cjca.2024.12.026","DOIUrl":"10.1016/j.cjca.2024.12.026","url":null,"abstract":"","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 3","pages":"Pages 491-493"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892380","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":"Call for Original Papers: Transplantation","authors":"","doi":"10.1016/S0828-282X(25)00166-7","DOIUrl":"10.1016/S0828-282X(25)00166-7","url":null,"abstract":"","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 3","pages":"Pages A9-A10"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143592271","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":"Information for Readers","authors":"","doi":"10.1016/S0828-282X(25)00143-6","DOIUrl":"10.1016/S0828-282X(25)00143-6","url":null,"abstract":"","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 3","pages":"Page A8"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143592270","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}