Canadian Journal of Cardiology最新文献

{"title":"Right Ventricular Electrophysiology and Arrhythmias in Adults With Congenital Heart Disease: Scientific Basis for Management.","authors":"Stephanie Fuentes Rojas, Stanley Nattel, Roddy Hiram, Paul Khairy","doi":"10.1016/j.cjca.2025.01.033","DOIUrl":"10.1016/j.cjca.2025.01.033","url":null,"abstract":"<p><p>Right ventricular (RV) dysfunction and arrhythmias are major concerns in adults with congenital heart disease (CHD). The relationship between RV dysfunction and arrhythmogenesis is bidirectional, with structural and electrical remodeling contributing to arrhythmia development and, conversely, arrhythmias exacerbating RV failure. In addition to an RV in the standard subpulmonary position failing because of pressure and/or volume overload, other phenotypes associated with RV dysfunction in CHD include transposition of the great arteries with a systemic (subaortic) RV and univentricular hearts with a predominant RV morphology. The RV is better suited for low-pressure workloads. When it supports the systemic circulation, the RV undergoes remodeling changes that promote arrhythmias, which can provoke a cycle of worsening dysfunction and arrhythmogenesis. Arrhythmias can worsen RV dysfunction by impairing hemodynamic stability, reducing cardiac output, provoking dyssynchrony, and inducing tachycardia-induced cardiomyopathy. Cellular mechanisms, including myocardial fibrosis, dysregulation of ion channels, and abnormal gap junction function, are central to this process, facilitating both re-entrant and triggered arrhythmias. Conduction disturbances, whether inherent or caused by fibrosis or pacing, compound these effects, aggravating both RV dysfunction and arrhythmia perpetuation. Management strategies must be comprehensive and include pre-emptive approaches to minimize arrhythmias, alongside early detection. Individualized therapies may include catheter ablation and cardiac implantable electronic devices, with treatment tailored to the specific RV phenotype and arrhythmia type. In this review we emphasize the importance of personalized interventions to prevent the vicious cycle of RV dysfunction and arrhythmias in CHD. Further research is essential to optimize therapeutic strategies and address care-limiting knowledge gaps.</p>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373852","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":"Obesity and Cardiometabolic Disease: Insights From Genetic Studies.","authors":"Satya Dash","doi":"10.1016/j.cjca.2025.01.034","DOIUrl":"10.1016/j.cjca.2025.01.034","url":null,"abstract":"<p><p>Obesity is a highly prevalent chronic disease and major driver of both atherosclerotic heart disease and heart failure. Obesity is also a heritable neuronal disease with heritability estimates of up to 70%. In this work I review how common genetic variants, usually with small effect sizes, contribute to the risk for developing obesity and cardiometabolic disease in the majority of people and how this can be further modulated by environmental factors. In some individuals, rare genetic variants with large effect sizes can influence the risk of developing obesity, in some cases in a Mendelian manner. I also address how identification of these rare variants has led to fundamental biologic insights into how satiety and reward are biologic processes, has led to more personalized treatments, and has identified potential novel drug treatments. Biologic insights derived from genetic studies of obesity have also improved our understanding of the causal mediators between obesity and cardiovascular disease. A major limitation of studies to date is that they involved mostly people of European ancestry. Studying more diverse populations will improve our understanding of obesity and cardiometabolic disease. Lessons derived from genetic studies make a compelling case for increasing accessibility to therapies that have sustained efficacy in managing obesity and improving health. This increased knowledge must also inform public health initiatives that will reduce the prevalence of obesity in the coming decades.</p>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373850","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":"Enhancing Care in Cardiogenic Shock: Role of Palliative Care in Acute Cardiogenic Shock Through Destination Therapy.","authors":"Annie Hung, Michael Slawnych, Caroline McGuinty","doi":"10.1016/j.cjca.2025.01.032","DOIUrl":"10.1016/j.cjca.2025.01.032","url":null,"abstract":"<p><p>Despite advances in the management of cardiogenic shock (CS), morbidity and mortality in CS remain exceedingly high and one third of patients do not survive their admission. Palliative care (PC) is an interdisciplinary approach focussed on improving the quality of life of patients and families facing life-threatening illness. Rates of PC use in CS remain low, despite evidence suggesting decreased symptom burden and reduced use of health care in patients with heart failure and in critical care settings. PC should occur in tandem with mobilization of aggressive life-sustaining measures such as mechanical circulatory support (MCS) and extracorporeal membrane oxygenation (ECMO) in the care of patients presenting with CS. In this review, we describe the role of PC throughout the care continuum of patients with acute CS through to destination therapy with a left ventricular assist device. We explore the current use of PC in CS and challenges to goals-of-care discussions posed by MCS and ECMO, and highlight strategies on integrating PC in acute and chronic CS. Finally, we demonstrate the importance of incorporating PC early in management and challenge the traditional use of PC primarily as an end-of-life intervention.</p>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363685","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":"Deep Learning-based 12-Lead Electrocardiogram for Low Left Ventricular Ejection Fraction Detection in Patients","authors":"Yuxin Hou MS ,&nbsp;Zhiping Fan PhD ,&nbsp;Jiaqi Li MS ,&nbsp;Zi Zeng MS ,&nbsp;Gang Lv MS ,&nbsp;Jingsheng Lin MS ,&nbsp;Liang Zhou PhD ,&nbsp;Tao Wu PhD ,&nbsp;Qing Cao PhD","doi":"10.1016/j.cjca.2024.09.018","DOIUrl":"10.1016/j.cjca.2024.09.018","url":null,"abstract":"<div><h3>Background</h3><div>Reduced left ventricular ejection fraction (LVEF) initiates heart failure, and promptly identifying low ejection fraction is crucial for managing progression and averting mortality. In this study we developed an artificial intelligence-enabled electrocardiogram (AI-ECG) algorithm to identify patients with low ejection fraction and predict LVEF values.</div></div><div><h3>Methods</h3><div>The electrocardiogram data were used as input, and the algorithm generated the probability of the patient suffering a low ejection fraction and estimated the LVEF value. A 5-year follow-up study on a group of individuals who initially had normal LVEF values was also performed. Furthermore, external validation of the algorithm performance was conducted using the Medical Information Mart for Intensive Care-IV database.</div></div><div><h3>Results</h3><div>The algorithm’s performance on the test set yielded an area under the curve value of 0.965 for detecting LVEF ≤ 50%. The algorithm had an accuracy of 92.8%, sensitivity of 88.8%, and specificity of 92.9%. For LVEF regression, the method showed a mean absolute error of 5.28 (95% confidence interval, 5.23-5.33) for the testing set. Additionally, the algorithm obtained an area under the curve value of 0.848 and a mean absolute error value of 9.56 during external validation. Patients with false positive results had a significantly greater likelihood of developing a low ejection fraction compared with patients who received true negative results (26.2% vs 2.0%; <em>P</em> &lt; 0.0001).</div></div><div><h3>Conclusions</h3><div>The AI-ECG algorithm is capable of identifying low ejection fraction in patients with high accuracy. The AI-ECG algorithm is an efficient, prompt, and cost-effective screening tool for early heart failure.</div></div>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 2","pages":"Pages 278-290"},"PeriodicalIF":5.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342224","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":"Impaired Atrial and Ventricular Strain Predicts Heart Failure in Arrhythmogenic Right Ventricular Cardiomyopathy","authors":"Xander Jacquemyn BSc ,&nbsp;Jef Van den Eynde MD ,&nbsp;Junzhen Zhan MD, PhD ,&nbsp;Ashish N. Doshi MD, PhD ,&nbsp;William J. Ravekes MD ,&nbsp;Nisha A. Gilotra MD ,&nbsp;Paul Scheel MD ,&nbsp;Katherine C. Wu MD ,&nbsp;Alessio Gasperetti MD ,&nbsp;Cynthia A. James PhD ,&nbsp;Hugh Calkins MD ,&nbsp;Brittney Murray MS ,&nbsp;Crystal Tichnell MGC, RN ,&nbsp;Allison G. Hays MD ,&nbsp;Shelby Kutty MD, PhD, MHCM, FRCP","doi":"10.1016/j.cjca.2024.11.024","DOIUrl":"10.1016/j.cjca.2024.11.024","url":null,"abstract":"<div><h3>Background</h3><div>Arrhythmogenic right ventricular cardiomyopathy (ARVC) increases the risk of heart failure (HF) and arrhythmias. Speckle-tracking echocardiography (STE) detects myocardial dysfunction, but its predictive role for HF in this population remains unclear.</div></div><div><h3>Methods</h3><div>Seventy-one patients with ARVC (age 43.7 ± 14.8 years, 53.5% male) without prevalent HF at baseline who were enrolled in the Johns Hopkins ARVC Registry were retrospectively included. Global strain (GS) and strain rate (SR) of the left ventricle (LV), right ventricle free wall (RVFW), left atrium (LA), and right atrium (RA) were measured by a blinded operator. Cox regression models assessed their association with incident HF.</div></div><div><h3>Results</h3><div>Incident HF developed in 23 patients (age 49.3 ± 12.5 years, 52.2% male) during a median follow-up of 2.7 years. Decreases in strain were significantly associated with HF: LV peak global longitudinal systolic strain (GLS; hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.06-1.35; <em>P</em> = 0.003), RVFW strain (HR 1.11, 95% CI 1.04-1.18; <em>P</em> = 0.003), LA GS (HR 1.05, 95% CI 1.00-1.09; <em>P</em> = 0.030), and RA GS (HR 1.07, 95% CI 1.03-1.12; <em>P</em> &lt; 0.001). Associations for LV GLS, RVFW strain, and RA GS remained significant after adjusting for age and sex. Strain values frequently fell below established reference ranges. Any strain value (LV GLS, RVFW strain, LA GS, or RA GS) below the normal limit was associated with an 8-fold increase in HF (HR 8.43, 95% CI 1.97-36.02; <em>P</em> = 0.004), and each individual component below the normal threshold doubled the risk (HR 2.35, 95% CI 1.60-3.45; <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>STE deformation abnormalities are associated with incident HF in ARVC patients. Echocardiographic strain may aid in identifying patients at risk of HF for closer follow-up and management.</div></div>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 2","pages":"Pages 215-223"},"PeriodicalIF":5.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766548","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":"Invited Commentary: Long-term Outcomes After Transcatheter Aortic Valve Replacement: Are All Platforms Equal?","authors":"David Meier MD ,&nbsp;Stefan Toggweiler MD, PhD ,&nbsp;Olivier Muller MD, PhD ,&nbsp;Stephane Fournier MD, PhD","doi":"10.1016/j.cjca.2024.12.002","DOIUrl":"10.1016/j.cjca.2024.12.002","url":null,"abstract":"","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 2","pages":"Pages 272-274"},"PeriodicalIF":5.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784267","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":"NDRG1 Regulates Iron Metabolism and Inhibits Pathologic Cardiac Hypertrophy","authors":"Jiali Yuan MD ,&nbsp;Chengye Yin MD ,&nbsp;Hong Peng MD ,&nbsp;Guojian Fang MD,&nbsp;Binfeng Mo MD,&nbsp;Xiji Qin MD,&nbsp;Yuhan Chen MD,&nbsp;Zhengshuai Wang MD,&nbsp;Yichi Yu MD,&nbsp;Yuepeng Wang PhD,&nbsp;Qunshan Wang MD, PhD","doi":"10.1016/j.cjca.2024.10.011","DOIUrl":"10.1016/j.cjca.2024.10.011","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac pathologic hypertrophy, a pathologic physiological alteration in many cardiovascular diseases, can progress to heart failure. The cellular biology underlying myocardial hypertrophy remains to be fully elucidated. Although N-myc downstream-regulated gene 1 (NDRG1) has been reported to participate in cellular proliferation, differentiation, and cellular stress responses, its role in cardiac diseases remains unexplored. Here, we investigated the role of NDRG1 in pathologic hypertrophy.</div></div><div><h3>Method</h3><div>Cardiomyocyte-specific NDRG1 knockout (KO) transgenic mice and NDRG1-AAV9 were used in mice. Angiotensin II (AngII) stimulation was applied to induce hypertrophy. Histologic, molecular, and RNA-sequencing analyses were performed, and ferroptosis markers and iron levels were studied. We used co-immunoprecipitation (Co-IP) and application of iron chelator to further studied the mechanisms of NDRG1 in cardiac hypertrophy.</div></div><div><h3>Results</h3><div>We found that NDRG1 expression is decreased in pathologic hypertrophy induced by AngII stimulation. Conditional KO of NDRG1 in mouse cardiomyocytes led to progressive cardiac hypertrophy and heart failure. Cardiomyocyte-specific overexpression of NDRG1 via AAV9 significantly reversed AngII-induced ventricular hypertrophy and fibrosis. Mechanistically, NDRG1-deficient cardiomyocytes exhibited iron overload and increased ferroptosis, accompanied by elevated levels of reactive oxygen species (ROS) and lipid peroxidation. Subsequently, we confirmed the involvement of NDRG1 in regulating ferroptosis and iron metabolism in myocardial cells. Finally, we identified an interaction between NDRG1 and transferrin in cells. The iron chelator Dp44mT effectively reduced myocardial iron overload and ventricular remodelling induced by NDRG1 deficiency.</div></div><div><h3>Conclusions</h3><div>These findings highlight critical role of NDRG1 in iron metabolism and ferroptosis in cardiomyocytes, suggesting that NDRG1 or iron metabolism may serve as therapeutic targets for cardiac hypertrophy.</div></div>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 2","pages":"Pages 224-240"},"PeriodicalIF":5.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142458671","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":"Routine Nil Per Os Before All Cardiac Catheterisations: Time to Reconsider?","authors":"Sammy Arab MBBS, BSc ,&nbsp;Karan Josan BMedSci ,&nbsp;Jude Merzah MBBChBAO ,&nbsp;Issam Motairek MD ,&nbsp;Andrew M. Goldsweig MD, MS","doi":"10.1016/j.cjca.2024.11.023","DOIUrl":"10.1016/j.cjca.2024.11.023","url":null,"abstract":"<div><div><em>Nil per os</em> (NPO) is a common instruction before cardiac catheterisation. NPO was originally adopted from general surgery to minimise gastric contents during procedures and reduce the risk of pulmonary aspiration in case of vomiting. However, NPO has since been associated with adverse effects on patient well-being, fasting-related complications, and increased health care costs. These burdens are multiplied by the large number of cardiac catheterisations performed. Advances in anaesthesia and contrast agents may have rendered preprocedural fasting obsolete. Here, we examine the evidence for and against routine NPO practices and consider the possible value of a more targeted approach. Current evidence strongly suggests that not fasting before cardiac catheterisation does not significantly increase the risk of pulmonary aspiration or other complications. Therefore, while further large-scale trials are on-going to confirm the safety of nonfasting, hospitals should begin to reduce fasting periods whenever possible. New guidelines should stratify patients by their risk of aspiration, reserving NPO only for those at high risk.</div></div>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 2","pages":"Pages 256-263"},"PeriodicalIF":5.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754799","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":"Invited Commentary: The Little Things Matter: Electron Microscopy and Amyloidosis","authors":"Michael A. Seidman MD, PhD","doi":"10.1016/j.cjca.2024.12.001","DOIUrl":"10.1016/j.cjca.2024.12.001","url":null,"abstract":"","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 2","pages":"Pages 254-255"},"PeriodicalIF":5.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784269","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 High-Sensitivity Cardiac Troponin I Elevation After On- and Off-Pump Coronary Artery Bypass Grafting on Long-Term Prognosis","authors":"Juncheng Wang MD, PhD ,&nbsp;Peng Wang MD, PhD ,&nbsp;Hanning Liu MD, PhD ,&nbsp;Yan Zhao MD ,&nbsp;Wei Feng MD, PhD ,&nbsp;Sheng Liu MD, PhD ,&nbsp;Zhe Zheng MD, PhD","doi":"10.1016/j.cjca.2024.10.018","DOIUrl":"10.1016/j.cjca.2024.10.018","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative myocardial injury is correlated with long-term prognosis after coronary artery bypass grafting (CABG) and is diagnosed according to troponin levels, which vary substantially upon surgical strategies. We aimed to explore the troponin I cutoff values for prognostically significant myocardial injury separately in on-pump and off-pump procedures with the use of a high-sensitivity assay (hs-cTnI).</div></div><div><h3>Methods</h3><div>Patients who underwent isolated CABG from 2018 to 2020 with available perioperative hs-cTnI measurements were included in this study. We explored the relationships between hs-cTnI levels and different outcomes. To identify hs-cTnI threshold levels indicative of higher risks, restrictive spline regressions were performed for on-pump and off-pump procedures.</div></div><div><h3>Results</h3><div>A total of 7813 patients were included with a median follow-up of 2.7 years (interquartile range 1.7-3.3 years), 218 (2.8%) of whom died. Adjusting for clinical variables, the study found a significant association between peak hs-cTnI levels within the first 48 hours after surgery and all end points. The spline regressions demonstrated that the hs-cTnI levels measured within 48 hours after surgery that were associated with a hazard ratio of more than 1.00 for all-cause death were 1446 ng/L (55.6 × upper reference limit [URL], 95% confidence interval [CI] 45.0-106.5 × URL) for on-pump and 564 ng/L (21.7 × URL, 95% CI 21.0-30.2 × URL) for off-pump.</div></div><div><h3>Conclusions</h3><div>Elevated hs-cTnI levels after CABG were associated with poorer longer-term outcomes. A prognosis-relevant hs-cTnI cutoff value within 48 hours after CABG for on-pump is significantly higher than that for off-pump.</div></div>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 2","pages":"Pages 294-305"},"PeriodicalIF":5.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567269","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}