Canadian Journal of Cardiology最新文献

{"title":"Current State of Canadian Cardiovascular Trainees' Professional Needs: A National Survey.","authors":"Yuan Qiu, Nicholas Grubic, Mathew Hindi, Michael D Elfassy, Tiffany Yuen, Varinder Randhawa, Laurie-Anne Boivin-Proulx","doi":"10.1016/j.cjca.2025.04.013","DOIUrl":"https://doi.org/10.1016/j.cjca.2025.04.013","url":null,"abstract":"","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143954015","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":"Predicting Mortality and Periprocedural Adverse Events in Patients Undergoing Complex and Higher Risk Percutaneous Coronary Intervention.","authors":"Enrico Poletti, Kathleen E Kearney, Christine J Chung, David Elison, Zachary L Steinberg, William L Lombardi, James M McCabe, David E Hamilton, Lorenzo Azzalini","doi":"10.1016/j.cjca.2025.04.014","DOIUrl":"10.1016/j.cjca.2025.04.014","url":null,"abstract":"<p><strong>Background: </strong>The estimation of periprocedural risk in patients undergoing complex and higher risk percutaneous coronary intervention (CHIP-PCI) is challenging. In this study we aimed to compare the performance of 3 different risk-scoring systems---National Cardiovascular Data Registry (NCDR) CathPCI, British Cardiovascular Intervention Society (BCIS)-CHIP, and Blue Cross Blue Shield of Michigan Cardiovascular Consortium 2 (BMC2)---in predicting mortality and major adverse cardiac and cerebrovascular events (MACCEs) in a population of patients undergoing CHIP-PCI at a specialized centre.</p><p><strong>Methods: </strong>The primary endpoints of this study were in-hospital mortality and MACCE. Score performances were evaluated based on discrimination ability (area under the curve [AUC] method) and calibration.</p><p><strong>Results: </strong>The study included 4287 patients, with rates of in-hospital mortality and MACCE of 2.5% and 3.3%, respectively. The BMC2 score (AUC = 0.93, 95% confidence interval [CI] 0.91-0.95; and AUC = 0.87, 95% CI 0.84-0.90) outperformed both the NCDR CathPCI (AUC = 0.89, 95% CI 0.85-0.92, P = 0.002; and AUC = 0.83, 95% CI 0.80-0.87, P = 0.009) and BCIS-CHIP (AUC = 0.81, 95% CI 0.76-0.85, P < 0.001; and AUC = 0.78, 95% CI 0.73-0.82, P < 0.001) scores for the prediction of both mortality and MACCE. Accuracy metrics showed a similar pattern. In subanalyses, the superior performance of the BMC2 model was even more pronounced in chronic total occlusion and multivessel PCI. Calibration analysis revealed good predictive accuracy but highlighted a trend toward overestimation in low-risk patients for the BMC2 score.</p><p><strong>Conclusions: </strong>The BMC2 risk score demonstrated superior performance in predicting in-hospital mortality and MACCEs in a large cohort of patients undergoing CHIP-PCI.</p>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977388","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":"Impact of Metabolic Dysfunction-associated Steatotic Liver Disease on Cardiovascular Structure, Function, and the Risk of Heart Failure.","authors":"Bhavik Bansal, Fannie Lajeunesse-Trempe, Neil Keshvani, Carl J Lavie, Ambarish Pandey","doi":"10.1016/j.cjca.2025.04.012","DOIUrl":"10.1016/j.cjca.2025.04.012","url":null,"abstract":"<p><p>Mounting evidence has established metabolic dysfunction-associated steatotic liver disease (MASLD) as an independent risk factor for heart failure (HF), particularly HF with preserved ejection fraction (HFpEF). In this narrative review we explore the impact of MASLD on cardiovascular structure and function. We summarize findings from multiple cohort studies demonstrating that MASLD is associated with distinct patterns of adverse cardiac remodeling, including increased left ventricular concentricity and impaired diastolic function. These subclinical changes in cardiac structure and function often precede overt HF development and appear to occur in the context of multiple interconnected pathways involving metabolic dysfunction, systemic inflammation, adipose tissue dysregulation, vascular dysfunction, and altered hepatic hemodynamics. Early identification of cardiac structural and functional abnormalities through systematic screening may enable timely intervention in this high-risk population. Lifestyle modifications remain foundational, but achieving and maintaining significant weight loss is challenging. Recent clinical trials have shown promising results with cardiometabolic agents, particularly glucagon-like protein 1 receptor agonists, which demonstrate significant weight loss and hepatic and cardiovascular benefits. Despite these advances, key knowledge gaps remain regarding optimal screening strategies, mechanisms linking MASLD to HF, and targeted therapeutic approaches. Addressing these gaps will be essential for developing effective prevention and treatment strategies in this high-risk population.</p>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977239","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":"Role of Percutaneous Mechanical Aspiration for Right-sided Endocarditis in People Who Inject Drugs.","authors":"Asher Frydman, Therese Servito, Jonathan Hong, Zubair Luqman, Bobby Yanagawa, Andrew Fagan","doi":"10.1016/j.cjca.2025.04.011","DOIUrl":"10.1016/j.cjca.2025.04.011","url":null,"abstract":"","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960346","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":"A Collateral Coronary Network: Friend or Foe?","authors":"Diego Nastasi, Davide Capodanno","doi":"10.1016/j.cjca.2025.04.010","DOIUrl":"https://doi.org/10.1016/j.cjca.2025.04.010","url":null,"abstract":"","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981750","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":"Evaluating Large Language Models in Cardiovascular Antithrombotic Care: Performance, Accuracy, and Implications for Clinical Practice.","authors":"Pavel Antiperovitch, Iris Liu, Ahmed T Mokhtar, Anthony Tang","doi":"10.1016/j.cjca.2025.04.008","DOIUrl":"10.1016/j.cjca.2025.04.008","url":null,"abstract":"<p><strong>Background: </strong>Large language models (LLMs) are increasingly accessible for medical decision making and are often used by medical practitioners and patients. However, previous studies have raised concerns about the accuracy of individual LLMs in assisting with patient management.</p><p><strong>Methods: </strong>This study assessed the performance of 7 publicly available LLMs on validated cardiovascular antithrombotic care scenarios, evaluated by 3 independent clinicians for accuracy and reasoning. The results were compared with the performance of volunteer clinicians, based on a survey conducted at the Canadian Cardiovascular Congress in 2023. Statistical analyses ensured interobserver reliability and evaluated performance differences among models.</p><p><strong>Results: </strong>Claude 3 Opus correctly answered 85% of clinical scenarios, significantly outperforming both other LLMs (P = < 0.001) and all clinician groups. Among clinicians, cardiologists, and senior residents achieved the highest accuracy rates: 43% (95 confidence interval [CI], 32%-52%) and 47% (95 CI, 39%-56%) respectively, comparable with GPT-4o (55%) and Claude 3.5 Sonnet (44%). General practitioners performed similarly to Claude 3 Sonnet and Gemini 1.5: 22% (95 CI, 11%-33%) vs 26% vs 30%, whereas medical students achieved 8.3% (95 CI, 2%-15%), closely aligning with GPT-3.5 (10%).</p><p><strong>Conclusions: </strong>The performance of LLMs in cardiovascular clinical scenarios varied widely, with some models outperforming clinicians, and some free-tier models providing inappropriate medical advice to clinicians. However, all tested models demonstrated acceptable performance for delivering patient advice regarding lifestyle and dietary recommendations. Clinicians and patients should exercise caution when using LLMs, select the best LLM for the task, and crosscheck provided references to ensure safe use of LLMs in practice.</p><p><strong>Clinical trial registration: </strong>NCT05923658.</p>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977451","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":"Moving From Reaction to Prevention in Sudden Cardiac Arrest: Causal Clues and Caveats From Mendelian Randomisation Studies.","authors":"Nicholas Grubic, Dakota Gustafson","doi":"10.1016/j.cjca.2025.03.019","DOIUrl":"https://doi.org/10.1016/j.cjca.2025.03.019","url":null,"abstract":"","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985412","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 Assistance: Are Large Language Models Ready for Autonomous Electrocardiogram Interpretation?","authors":"Hoang H Nguyen","doi":"10.1016/j.cjca.2025.04.009","DOIUrl":"https://doi.org/10.1016/j.cjca.2025.04.009","url":null,"abstract":"","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966403","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":"Determinants of Late Supraventricular Arrhythmia After Patent Foramen Ovale Closure: Insights From a Prospective Cohort.","authors":"Louis Giovachini, Mikael Laredo, Marie Hauguel-Moreau, Michel Zeitouni, Thomas Rolland, Yassine Temmar, Delphine Brugier, Candice Sabben, Nefeli Valyraki, Sonia Alamowitch, Clemence Blanc, Niki Procopi, Anthony Elhadad, Gabriel Chevrot, Marie Dupuy, Arnaud Ferrante, Stéphanie Rouanet, Nadjib Hammoudi, Johanne Silvain, Gilles Montalescot, Paul Guedeney","doi":"10.1016/j.cjca.2025.04.007","DOIUrl":"https://doi.org/10.1016/j.cjca.2025.04.007","url":null,"abstract":"<p><strong>Background: </strong>Early (≤ 28 days) supraventricular arrhythmia (SVA) is the most common complication that occurs after patent foramen ovale (PFO) closure, but little is known about the incidence and determinants of late (> 28 days) SVA. Our aim was to evaluate the determinants of late SVA after PFO closure.</p><p><strong>Methods: </strong>Patients with percutaneous PFO closure and risk of SVA were proposed to receive an implantable loop recorder (ILR) device from 2019 to 2023. All rhythmic events recorded on ILR were adjudicated by cardiac electrophysiologists. Primary outcome was any late SVA, either new onset or recurrence, defined as SVA occurring > 28 days after PFO closure and lasting ≥ 30 seconds. Determinants were analyzed using a multivariable Cox proportional hazards model.</p><p><strong>Results: </strong>Overall, 234 patients were included with a median duration of ILR rhythm monitoring of 21.6 (interquartile range, 15.5-30.6) months. An SVA after 28 days was recorded in 50 of 234 patients (2-year Kaplan-Meier estimate, 0.22 [0.16-0.27]), which were recurrent events in 29 of 50 (58.0%) cases and new-onset episodes in 21 of 50 (42.0%) cases. Incidence of new onset of SVA decreased significantly over time. In the multivariate analysis, determinants of late SVA were the early SVA burden (adjusted hazard ratio [aHR], 1.008; 95% confidence interval [CI], 1.003-1.013 per hour of SVA occurring in the first 28 days), male sex (aHR, 2.29; 95% CI, 1.19-4.42), and large left disc diameter (aHR, 2.50; 95% CI, 1.32-4.72).</p><p><strong>Conclusions: </strong>Determinants of late SVA after PFO closure were SVA burden during the first month, male sex and large left disc diameter.</p>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978107","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":"High Heterogeneity in Prenatal Detection of Severe Congenital Heart Defects Among Physicians, Hospitals and Regions in Quebec.","authors":"Sara Khalilipalandi, Mikhail-Paul Cardinal, Louis-Olivier Roy, Laurence Vaujois, Tiscar Cavallé-Garrido, Jean-Luc Bigras, Marie-Ève Roy-Lacroix, Frederic Dallaire","doi":"10.1016/j.cjca.2025.04.006","DOIUrl":"https://doi.org/10.1016/j.cjca.2025.04.006","url":null,"abstract":"<p><strong>Background: </strong>Prenatal detection rates (PDRs) of severe congenital heart defects (SCHDs) are often presented as regional and national aggregates, which might hide significant heterogeneity in PDRs among physicians, hospitals, and regions. The objective was to quantify the variability in the sensitivity of second-trimester ultrasound examination (U/S) to detect SCHDs, and to identify at which level this variability was the greatest.</p><p><strong>Methods: </strong>This was a retrospective observational cohort of all pregnancy-child dyads with SCHDs in Quebec between 2007 and 2015. We matched the clinical data from the hospitals with the administrative data from the health care system. The variability at each level was estimated using multilevel models by calculating intraclass correlation coefficients.</p><p><strong>Results: </strong>Of 1274 SCHD, 697 were diagnosed prenatally following a referral for a suspected cardiac anomaly on U/S, yielding a sensitivity of 54.7% (95% confidence interval [CI], 52.0%-57.4%). Significant heterogeneity was observed among physicians, hospitals, and regions with the greatest heterogeneity among physicians. The U/S sensitivities in the lowest quartile for physicians, hospitals, and regions were 27.4%, 29.0%, and 39.8%, and those in the highest quartile were 87.3%, 70.1%, and 62.9%, respectively. The mean difference of sensitivity between the lowest and highest quartiles was 59.9% (95% CI, 51.7-68.1) for physicians, and 41.1% (95% CI, 30.3-51.9) for hospitals. The intraclass correlation coefficients at the physician level indicated the greatest heterogeneity among physicians (intrahospital).</p><p><strong>Conclusions: </strong>There was considerable heterogeneity in PDRs between physicians and hospitals. The driver of the heterogeneity seemed to be at the physician level, with higher interphysician variability. Any measures of improvement should be directed to the physician level.</p>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959652","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}