In this study we sought to characterize the prevalence, clinical characteristics, and outcomes of malnutrition in patients with atrial functional mitral regurgitation (AFMR).
Methods
This multicentre, observational study included 802 patients diagnosed with AFMR. The Geriatric Nutritional Risk Index (GNRI) was used as a nutritional risk metric. Patients were divided into 4 groups on the basis of the GNRI: normal (> 98; n = 342), mild nutritional risk (92-98; n = 196), moderate risk (82 to < 92; n = 166), and severe risk (< 82; n = 98). The primary outcome was a composite of heart failure admission and all-cause death.
Results
At least mild nutrition risk (GNRI ≤ 98) was present in 57% of patients with AFMR. Patients with lower GNRI were older, had lower body mass index, hemoglobin levels, and renal function, and had a higher prevalence of New York Heart Association class III or IV, dementia, and impaired activities of daily living. During the median follow-up duration of 978 (interquartile range, 492-1141) days, 254 primary outcomes were observed. Increasing severity of malnutrition risk categories was associated with higher rates of the primary outcome. Multivariable analysis revealed that a continuous metric of GNRI was associated with the primary outcome after adjusting for multiple confounders (adjusted hazard ratio, 0.76 per 1 standard deviation increment; 95% confidence interval, 0.66-0.87; P < 0.01). Follow-up GNRI values were available in 234 patients (29.2%). Patients with a decreased GNRI over time had higher rates of the composite outcome than those with preserved GNRI (adjusted hazard ratio, 3.83; 95% confidence interval, 1.97-7.43; P < 0.01).
Conclusions
Patients with AFMR and malnutrition represent a vulnerable population with worse clinical outcomes.
{"title":"Characterization of Malnutrition in Atrial Functional Mitral Regurgitation","authors":"Tsukasa Murakami MD, PhD , Nobuyuki Kagiyama MD, PhD , Tomohiro Kaneko MD, PhD , Kazuki Kagami MD, PhD , Masashi Amano MD, PhD , Taiji Okada MD, PhD , Yukio Sato MD, PhD , Yohei Ohno MD, PhD , Kimi Sato MD, PhD , Kojiro Morita MPH, PhD, RN, PHN , Tomoko Machino-Ohtsuka MD, PhD , Yukio Abe MD, PhD , Hideki Ishii MD, PhD , Masaru Obokata MD, PhD","doi":"10.1016/j.cjco.2025.05.007","DOIUrl":"10.1016/j.cjco.2025.05.007","url":null,"abstract":"<div><h3>Background</h3><div>In this study we sought to characterize the prevalence, clinical characteristics, and outcomes of malnutrition in patients with atrial functional mitral regurgitation (AFMR).</div></div><div><h3>Methods</h3><div>This multicentre, observational study included 802 patients diagnosed with AFMR. The <strong>G</strong>eriatric <strong>N</strong>utritional <strong>R</strong>isk <strong>I</strong>ndex (GNRI) was used as a nutritional risk metric. Patients were divided into 4 groups on the basis of the GNRI: normal (> 98; n = 342), mild nutritional risk (92-98; n = 196), moderate risk (82 to < 92; n = 166), and severe risk (< 82; n = 98). The primary outcome was a composite of heart failure admission and all-cause death.</div></div><div><h3>Results</h3><div>At least mild nutrition risk (GNRI ≤ 98) was present in 57% of patients with AFMR. Patients with lower GNRI were older, had lower body mass index, hemoglobin levels, and renal function, and had a higher prevalence of New York Heart Association class III or IV, dementia, and impaired activities of daily living. During the median follow-up duration of 978 (interquartile range, 492-1141) days, 254 primary outcomes were observed. Increasing severity of malnutrition risk categories was associated with higher rates of the primary outcome. Multivariable analysis revealed that a continuous metric of GNRI was associated with the primary outcome after adjusting for multiple confounders (adjusted hazard ratio, 0.76 per 1 standard deviation increment; 95% confidence interval, 0.66-0.87; <em>P</em> < 0.01). Follow-up GNRI values were available in 234 patients (29.2%). Patients with a decreased GNRI over time had higher rates of the composite outcome than those with preserved GNRI (adjusted hazard ratio, 3.83; 95% confidence interval, 1.97-7.43; <em>P</em> < 0.01).</div></div><div><h3>Conclusions</h3><div>Patients with AFMR and malnutrition represent a vulnerable population with worse clinical outcomes.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 8","pages":"Pages 1038-1047"},"PeriodicalIF":2.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-01DOI: 10.1016/j.cjco.2025.05.008
Shamir R. Mehta MD, MSc , Anita Asgar MD , Robert Boone MD , Josep Rodes-Cabau MD, PhD , Eric A. Cohen MD , Andrew Czarnecki MD , Marino Labinaz MD , Shahar Lavi MD , Nicolo Piazza MD , Kevin R. Bainey MD , Akshay Bagai MD , Jean-Michel Paradis MD , J.D. Schwalm MD , Douglas Wright MD , Helen Nguyen BSc , Tara McCready PhD , Rajibul Mian PhD , John Webb MD , Neil Fam MD
Background
Mitral transcatheter edge-to-edge repair (M-TEER) is a treatment option for patients with symptomatic mitral regurgitation (MR). The real-world experience with M-TEER in Canada has not been reported previously.
Methods
We conducted an observational study of 1191 patients from 11 Canadian centres undergoing M-TEER with a MitraClip device (Abbott, location). M-TEER databases from each centre were collected centrally and merged into a single Canada-wide database. The primary outcome was MR severity before M-TEER vs at up to 1 year after M-TEER. Secondary outcomes included hospitalizations for heart failure (HF) and New York Heart Association (NYHA) functional class.
Results
MR etiology was degenerative in 41%, and functional in 59%. The mean age was 76 years, and 36% were women. The proportion with MR ≥ 3+ was 97.3% before vs 11.0% at up to 1 year after M-TEER (absolute risk difference [ARD] 86.4%, P < 0.001). Hospitalization for HF occurred in 50.7% before vs 10.3% at up to 1 year after M-TEER (ARD 40.4%, P < 0.001), with similar benefit in patients with functional (ARD 44.8%, 95% confidence interval 39.5-50.1) and degenerative (ARD 34.8%, 95% confidence interval 29.0-40.6) MR. NYHA class III-IV HF was present in 82.8% before vs in 16.6% at up to 1 year after M-TEER (ARD 66.2%, P < 0.001). Single-leaflet detachment (1.0%) and mitral valve surgery (2.2%) were infrequent. Mortality was 1.3% in-hospital, and 12.7% at 1 year.
Conclusions
In this first national registry of patients undergoing M-TEER in Canada, M-TEER resulted in a sustained reduction in MR and was associated with reduced HF hospitalizations and improvement in NYHA functional class, with a high degree of safety. This benefit was consistent in patients with functional and degenerative MR.
背景：二尖瓣经导管边缘到边缘修复（M-TEER）是治疗症状性二尖瓣反流（MR）患者的一种治疗选择。加拿大M-TEER的实际经验以前没有报道过。方法：我们对来自加拿大11个中心的1191例患者进行了一项观察性研究，这些患者使用MitraClip装置（Abbott, location）接受M-TEER治疗。每个中心的M-TEER数据库集中收集，并合并为一个加拿大范围的数据库。主要结局是M-TEER前MR严重程度与M-TEER后1年的MR严重程度。次要结局包括因心力衰竭（HF）住院和纽约心脏协会（NYHA）功能分级。结果smr病因中退行性占41%，功能性占59%。平均年龄为76岁，其中36%为女性。术前MR≥3+的比例为97.3%，M-TEER后1年为11.0%(绝对风险差[ARD] 86.4%, P <；0.001)。术前HF住院率为50.7%，而M-TEER术后1年内住院率为10.3% (P <；0.001)，在功能性（ARD 44.8%， 95%可信区间39.5-50.1）和退行性（ARD 34.8%， 95%可信区间29.0-40.6）患者中，NYHA III-IV级HF的发生率为82.8%，而在M-TEER后1年内为16.6% (ARD 66.2%, P <；0.001)。单小叶脱离（1.0%）和二尖瓣手术（2.2%）少见。住院死亡率为1.3%，1年死亡率为12.7%。结论：在加拿大第一个接受M-TEER的国家登记患者中，M-TEER导致MR持续降低，并与HF住院率降低和NYHA功能分级改善相关，具有高度的安全性。这种益处在功能性和退行性MR患者中是一致的。
{"title":"Efficacy and Safety of Transcatheter Mitral Valve Edge-to-Edge Repair with a MitraClip Device in Real-World Canadian Practice","authors":"Shamir R. Mehta MD, MSc , Anita Asgar MD , Robert Boone MD , Josep Rodes-Cabau MD, PhD , Eric A. Cohen MD , Andrew Czarnecki MD , Marino Labinaz MD , Shahar Lavi MD , Nicolo Piazza MD , Kevin R. Bainey MD , Akshay Bagai MD , Jean-Michel Paradis MD , J.D. Schwalm MD , Douglas Wright MD , Helen Nguyen BSc , Tara McCready PhD , Rajibul Mian PhD , John Webb MD , Neil Fam MD","doi":"10.1016/j.cjco.2025.05.008","DOIUrl":"10.1016/j.cjco.2025.05.008","url":null,"abstract":"<div><h3>Background</h3><div>Mitral transcatheter edge-to-edge repair (M-TEER) is a treatment option for patients with symptomatic mitral regurgitation (MR). The real-world experience with M-TEER in Canada has not been reported previously.</div></div><div><h3>Methods</h3><div>We conducted an observational study of 1191 patients from 11 Canadian centres undergoing M-TEER with a MitraClip device (Abbott, location). M-TEER databases from each centre were collected centrally and merged into a single Canada-wide database. The primary outcome was MR severity before M-TEER vs at up to 1 year after M-TEER. Secondary outcomes included hospitalizations for heart failure (HF) and New York Heart Association (NYHA) functional class.</div></div><div><h3>Results</h3><div>MR etiology was degenerative in 41%, and functional in 59%. The mean age was 76 years, and 36% were women. The proportion with MR ≥ 3+ was 97.3% before vs 11.0% at up to 1 year after M-TEER (absolute risk difference [ARD] 86.4%, <em>P</em> < 0.001). Hospitalization for HF occurred in 50.7% before vs 10.3% at up to 1 year after M-TEER (ARD 40.4%, <em>P</em> < 0.001), with similar benefit in patients with functional (ARD 44.8%, 95% confidence interval 39.5-50.1) and degenerative (ARD 34.8%, 95% confidence interval 29.0-40.6) MR. NYHA class III-IV HF was present in 82.8% before vs in 16.6% at up to 1 year after M-TEER (ARD 66.2%, <em>P</em> < 0.001). Single-leaflet detachment (1.0%) and mitral valve surgery (2.2%) were infrequent. Mortality was 1.3% in-hospital, and 12.7% at 1 year.</div></div><div><h3>Conclusions</h3><div>In this first national registry of patients undergoing M-TEER in Canada, M-TEER resulted in a sustained reduction in MR and was associated with reduced HF hospitalizations and improvement in NYHA functional class, with a high degree of safety. This benefit was consistent in patients with functional and degenerative MR.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 8","pages":"Pages 1048-1054"},"PeriodicalIF":2.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-01DOI: 10.1016/j.cjco.2025.04.017
Stefanie Marek-Iannucci MD, PhD , Estefania Oliveros MD , Francesco Fedele MD , Indranee N. Rajapreyar MD
Women remain severely underrepresented in clinical trials, leading to a significant disparity in clinical care and outcome among male vs female patients with advanced heart failure (HF). Sex-specific disparities regarding the etiology of HF, time to diagnosis, severity of disease at time of index hospitalization, response to treatment, and treatment options, including use of temporary or durable mechanical circulatory support devices, may affect women unfavourably. Lack of knowledge regarding sex-specific complications has had an impact on the overall higher mortality level in women vs men. Increasing the awareness regarding this sex-specific imbalance is imperative. The inclusion of women in clinical mechanical circulatory support trials is critical, to improve female patient outcomes in stage D HF with reduced ejection fraction.
{"title":"Sex-Specific Disparities in the Female Vs Male Patient Population in Left Ventricular Assist Device Use","authors":"Stefanie Marek-Iannucci MD, PhD , Estefania Oliveros MD , Francesco Fedele MD , Indranee N. Rajapreyar MD","doi":"10.1016/j.cjco.2025.04.017","DOIUrl":"10.1016/j.cjco.2025.04.017","url":null,"abstract":"<div><div>Women remain severely underrepresented in clinical trials, leading to a significant disparity in clinical care and outcome among male vs female patients with advanced heart failure (HF). Sex-specific disparities regarding the etiology of HF, time to diagnosis, severity of disease at time of index hospitalization, response to treatment, and treatment options, including use of temporary or durable mechanical circulatory support devices, may affect women unfavourably. Lack of knowledge regarding sex-specific complications has had an impact on the overall higher mortality level in women vs men. Increasing the awareness regarding this sex-specific imbalance is imperative. The inclusion of women in clinical mechanical circulatory support trials is critical, to improve female patient outcomes in stage D HF with reduced ejection fraction.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 8","pages":"Pages 1140-1147"},"PeriodicalIF":2.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-01DOI: 10.1016/j.cjco.2025.02.004
Javad Heshmati BSc, MSc, PhD , Emma Lynn Bates BA, MPH , Spencer Shahen BSc, MSc , Kathryn L. Walker MScPT , Andrew Pipe CM, MD , Kerri-Anne Mullen BSc, MSc, PhD , Hassan Mir BSc, MD, MPH, MHI, FRCPC
Background
E-cigarettes are promoted for smoking cessation due to their having lower toxicity than cigarettes, but they are often used recreationally and linked to cardiovascular, respiratory, and mental health risks. Clinicians must understand usage patterns and influencing factors to guide patients in reducing or quitting their use.
Methods
We surveyed consecutive cardiac inpatients admitted to the University of Ottawa Heart Institute between November 2019 and May 2020. Surveys were conducted in-person or via telephone. Descriptive statistics and logistic regression were used to examine factors associated with vaping status.
Results
During the evaluation, 1616 cardiac patients were admitted and discharged; 124 (7.7%) were ineligible, and 403 (24.9%) refused or were unreachable. A total of 1089 (73.0%) completed the survey. Among them, 10.3% had ever vaped, and 5.5% were current vapers. Of ever-users, 66.1% used vaping to quit smoking. Adjusted analysis showed that younger age, tobacco co-use, secondhand exposure at home, and lower education levels were significantly associated with e-cigarette use.
Conclusions
This evaluation found a low overall rate of e-cigarette use among cardiac inpatients. However, e-cigarette use was more common among younger patients, tobacco users, and those exposed to tobacco or e-cigarettes at home. These factors highlight the importance of advising patients to reduce their exposure to tobacco and e-cigarettes in their home and social environments, as doing so may improve their chances of quitting. Incorporating future prospective research in additional populations and settings would help support the generalizability of these results and assess their impact on clinical outcomes.
{"title":"Patterns of E-Cigarette Use Among Cardiac Inpatients at a Tertiary-Care Hospital: A Cross-Sectional Survey","authors":"Javad Heshmati BSc, MSc, PhD , Emma Lynn Bates BA, MPH , Spencer Shahen BSc, MSc , Kathryn L. Walker MScPT , Andrew Pipe CM, MD , Kerri-Anne Mullen BSc, MSc, PhD , Hassan Mir BSc, MD, MPH, MHI, FRCPC","doi":"10.1016/j.cjco.2025.02.004","DOIUrl":"10.1016/j.cjco.2025.02.004","url":null,"abstract":"<div><h3>Background</h3><div>E-cigarettes are promoted for smoking cessation due to their having lower toxicity than cigarettes, but they are often used recreationally and linked to cardiovascular, respiratory, and mental health risks. Clinicians must understand usage patterns and influencing factors to guide patients in reducing or quitting their use.</div></div><div><h3>Methods</h3><div>We surveyed consecutive cardiac inpatients admitted to the University of Ottawa Heart Institute between November 2019 and May 2020. Surveys were conducted in-person or via telephone. Descriptive statistics and logistic regression were used to examine factors associated with vaping status.</div></div><div><h3>Results</h3><div>During the evaluation, 1616 cardiac patients were admitted and discharged; 124 (7.7%) were ineligible, and 403 (24.9%) refused or were unreachable. A total of 1089 (73.0%) completed the survey. Among them, 10.3% had ever vaped, and 5.5% were current vapers. Of ever-users, 66.1% used vaping to quit smoking. Adjusted analysis showed that younger age, tobacco co-use, secondhand exposure at home, and lower education levels were significantly associated with e-cigarette use.</div></div><div><h3>Conclusions</h3><div>This evaluation found a low overall rate of e-cigarette use among cardiac inpatients. However, e-cigarette use was more common among younger patients, tobacco users, and those exposed to tobacco or e-cigarettes at home. These factors highlight the importance of advising patients to reduce their exposure to tobacco and e-cigarettes in their home and social environments, as doing so may improve their chances of quitting. Incorporating future prospective research in additional populations and settings would help support the generalizability of these results and assess their impact on clinical outcomes.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 8","pages":"Pages 1083-1092"},"PeriodicalIF":2.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-01DOI: 10.1016/j.cjco.2025.05.006
Zhenyu Li MSc , Aliya Izumi HBSc , Dominique Vervoort MD, MPH, CPH, MBA , Anika Ranadive HBSc , Subodh Verma MD , Stephen E. Fremes MD, MSc
Background
The win ratio (WR), introduced in 2012, has emerged as a method to analyze hierarchical composite outcomes by prioritizing clinically significant events, unlike traditional composite time-to-event analyses, which treat events equally. However, use of the WR in biomedical research beyond cardiovascular trials remains unexplored. The study aims to investigate trends in the use of the WR in biomedical research and determine the characteristics of these articles.
Methods
Biomedical articles indexed in Web of Science and PubMed were retrieved for 2012-2024. Data extraction included bibliometric information and content details. Statistical analyses utilized descriptive statistics, correlation, and linear regression to assess publication trends and the distribution of WR methodologies across disciplines.
Results
A total of 82 studies were analyzed. Publication counts using the WR have grown significantly since its introduction, with an annual compounded growth rate of 30.2%. Most articles were randomized controlled trials (n = 68; 82.9%). Of the 68 randomized controlled trials, 46 (67.6%) were in the field of cardiology. The unmatched WR was the predominant WR approach (n = 57; 69.5%). Mortality was the highest-ranked outcome in most studies (n = 55; 67.1%), and time-to-event variables were the most frequently used across all hierarchical outcome ranks (n = 173).
Conclusions
The WR has gained acceptance as a robust and clinically meaningful method for analyzing composite endpoints, particularly for cardiovascular trials. Although challenges remain, its adaptability and ability to prioritize clinically relevant outcomes make it a promising tool for future biomedical research across various disciplines.
win ratio （WR）于2012年引入，是一种通过优先处理临床重要事件来分析分层复合结果的方法，与传统的综合时间-事件分析不同，传统的综合时间-事件分析是平等对待事件。然而，在心血管试验以外的生物医学研究中使用WR仍未得到探索。该研究旨在调查生物医学研究中使用WR的趋势，并确定这些文章的特征。方法检索Web of Science和PubMed检索的2012-2024年生物医学文献。数据提取包括文献计量信息和内容细节。统计分析利用描述性统计、相关性和线性回归来评估出版物趋势和跨学科WR方法的分布。结果共分析了82项研究。自引入WR以来，使用WR的出版物数量显著增长，年复合增长率为30.2%。大多数文章为随机对照试验(n = 68；82.9%)。在68个随机对照试验中，46个（67.6%）在心脏病学领域。不匹配WR是主要的WR入路(n = 57；69.5%)。在大多数研究中，死亡率是排名最高的结局(n = 55；67.1%)，事件发生时间变量在所有分级结果中使用频率最高（n = 173）。结论：WR作为一种可靠且具有临床意义的综合终点分析方法，已被广泛接受，特别是在心血管试验中。尽管挑战依然存在，但其适应性和优先考虑临床相关结果的能力使其成为未来跨学科生物医学研究的有希望的工具。
{"title":"Win Ratio in Biomedical Science: A Bibliometric Analysis","authors":"Zhenyu Li MSc , Aliya Izumi HBSc , Dominique Vervoort MD, MPH, CPH, MBA , Anika Ranadive HBSc , Subodh Verma MD , Stephen E. Fremes MD, MSc","doi":"10.1016/j.cjco.2025.05.006","DOIUrl":"10.1016/j.cjco.2025.05.006","url":null,"abstract":"<div><h3>Background</h3><div>The win ratio (WR), introduced in 2012, has emerged as a method to analyze hierarchical composite outcomes by prioritizing clinically significant events, unlike traditional composite time-to-event analyses, which treat events equally. However, use of the WR in biomedical research beyond cardiovascular trials remains unexplored. The study aims to investigate trends in the use of the WR in biomedical research and determine the characteristics of these articles.</div></div><div><h3>Methods</h3><div>Biomedical articles indexed in Web of Science and PubMed were retrieved for 2012-2024. Data extraction included bibliometric information and content details. Statistical analyses utilized descriptive statistics, correlation, and linear regression to assess publication trends and the distribution of WR methodologies across disciplines.</div></div><div><h3>Results</h3><div>A total of 82 studies were analyzed. Publication counts using the WR have grown significantly since its introduction, with an annual compounded growth rate of 30.2%. Most articles were randomized controlled trials (n = 68; 82.9%). Of the 68 randomized controlled trials, 46 (67.6%) were in the field of cardiology. The unmatched WR was the predominant WR approach (n = 57; 69.5%). Mortality was the highest-ranked outcome in most studies (n = 55; 67.1%), and time-to-event variables were the most frequently used across all hierarchical outcome ranks (n = 173).</div></div><div><h3>Conclusions</h3><div>The WR has gained acceptance as a robust and clinically meaningful method for analyzing composite endpoints, particularly for cardiovascular trials. Although challenges remain, its adaptability and ability to prioritize clinically relevant outcomes make it a promising tool for future biomedical research across various disciplines.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 8","pages":"Pages 1097-1107"},"PeriodicalIF":2.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Left atrial (LA) reservoir strain (LARS) is emerging as an early marker of cardiac remodelling, providing significant prognostic information. The present study investigated the prevalence of LA dysfunction and its association with pulmonary hemodynamics and cardiovascular (CV) outcomes in systemic sclerosis (SSc) patients.
Methods
We included 52 patients who had SSc without structural cardiac disease. All patients underwent 2-dimensional transthoracic echocardiography and right heart catheterization. LARS was assessed by using speckle-tracking analysis. The study outcome was a composite of heart failure or pulmonary hypertension (PH)–related hospitalization, lung transplantation, and CV death.
Results
Abnormal LARS (< 24%) was present in 18 patients (34.6%). Despite the similar prevalence of PH between groups with abnormal vs normal LARS (P = 0.322), patients with LA dysfunction had significantly higher pulmonary vascular resistance (3.5 Wood Units [1.9-5.2] vs 2.0 Wood Units [1.3-2.9], P = 0.029) and reduced pulmonary artery compliance (2.4 [2.1-4.1] ml/mm Hg vs. 3.9 [2.5-5.0] ml/mm Hg, p=0.024) than those with normal LARS. During a median follow-up of 3.2 years, patients with LA dysfunction displayed worse event-free survival than their counterparts (log-rank P = 0.036). The combination of LA function and PH status provided better risk stratification for composite CV outcome, as the highest incidence of adverse outcome was observed in patients with LA dysfunction and PH (40.0%), followed by those with LA dysfunction or PH alone (13.6%), and finally those without LA dysfunction and PH (0%, P = 0.008).
Conclusions
LA dysfunction was related to unfavourable pulmonary artery remodelling and adverse outcomes in SSc patients without structural cardiac disease.
背景：左心房（LA）储层应变（LARS）正成为心脏重构的早期标志物，提供了重要的预后信息。本研究调查了系统性硬化症（SSc）患者LA功能障碍的患病率及其与肺血流动力学和心血管（CV）结局的关系。方法纳入52例无结构性心脏病的SSc患者。所有患者均行二维经胸超声心动图和右心导管检查。利用斑点跟踪分析评估LARS。研究结果是心力衰竭或肺动脉高压（PH）相关住院、肺移植和CV死亡的综合结果。结果LARS异常(<；24%)， 18例（34.6%）。尽管LARS异常组与正常组之间的PH患病率相似（P = 0.322），但与LARS正常组相比，LA功能障碍患者的肺血管阻力明显更高（3.5 Wood Units [1.9-5.2] vs 2.0 Wood Units [1.3-2.9], P = 0.029），肺动脉顺应性明显降低（2.4 [2.1-4.1]ml/mm Hg vs 3.9 [2.5-5.0] ml/mm Hg, P =0.024）。在中位随访3.2年期间，LA功能障碍患者的无事件生存率比对照组更差（log-rank P = 0.036）。LA功能和PH状态的联合为复合CV结局提供了更好的风险分层，因为不良结局发生率最高的是LA功能障碍和PH患者（40.0%），其次是LA功能障碍或PH单独患者（13.6%），最后是没有LA功能障碍和PH的患者（0%,P = 0.008）。结论在无结构性心脏病的SSc患者中，sla功能障碍与不利的肺动脉重构和不良结局有关。
{"title":"Association of Left Atrial Dysfunction with Pulmonary Hemodynamics and Cardiovascular Outcomes in Patients with Systemic Sclerosis","authors":"Kazutoshi Hirose MD , Koki Nakanishi MD , Masao Daimon MD , Hikari Seki MD , Yuriko Yoshida MD , Megumi Hirokawa MD , Tomoko Nakao MD , Koichi Kimura MD , Shun Minatsuki MD , Masaru Hatano MD , Hiroyuki Morita MD , Marco R. Di Tullio MD , Shunichi Homma MD , Makoto Kurano MD , Norihiko Takeda MD","doi":"10.1016/j.cjco.2025.02.006","DOIUrl":"10.1016/j.cjco.2025.02.006","url":null,"abstract":"<div><h3>Background</h3><div>Left atrial (LA) reservoir strain (LARS) is emerging as an early marker of cardiac remodelling, providing significant prognostic information. The present study investigated the prevalence of LA dysfunction and its association with pulmonary hemodynamics and cardiovascular (CV) outcomes in systemic sclerosis (SSc) patients.</div></div><div><h3>Methods</h3><div>We included 52 patients who had SSc without structural cardiac disease. All patients underwent 2-dimensional transthoracic echocardiography and right heart catheterization. LARS was assessed by using speckle-tracking analysis. The study outcome was a composite of heart failure or pulmonary hypertension (PH)–related hospitalization, lung transplantation, and CV death.</div></div><div><h3>Results</h3><div>Abnormal LARS (< 24%) was present in 18 patients (34.6%). Despite the similar prevalence of PH between groups with abnormal vs normal LARS (<em>P</em> = 0.322), patients with LA dysfunction had significantly higher pulmonary vascular resistance (3.5 Wood Units [1.9-5.2] vs 2.0 Wood Units [1.3-2.9], <em>P</em> = 0.029) and reduced pulmonary artery compliance (2.4 [2.1-4.1] ml/mm Hg vs. 3.9 [2.5-5.0] ml/mm Hg, p=0.024) than those with normal LARS. During a median follow-up of 3.2 years, patients with LA dysfunction displayed worse event-free survival than their counterparts (log-rank <em>P</em> = 0.036). The combination of LA function and PH status provided better risk stratification for composite CV outcome, as the highest incidence of adverse outcome was observed in patients with LA dysfunction and PH (40.0%), followed by those with LA dysfunction or PH alone (13.6%), and finally those without LA dysfunction and PH (0%, <em>P</em> = 0.008).</div></div><div><h3>Conclusions</h3><div>LA dysfunction was related to unfavourable pulmonary artery remodelling and adverse outcomes in SSc patients without structural cardiac disease.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 8","pages":"Pages 1132-1139"},"PeriodicalIF":2.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-01DOI: 10.1016/j.cjco.2025.02.005
Lior Zornitzki MD , Dana Viskin MD , Ophir Freund MD , Ido Wolf MD , Anna Rozenfeld Hemed MD , Noam Weiss MS , Shir Frydman MD, Ms , Maor Tzuberi MS , Shafik Khoury MD , Ofer Havakuk MD , Yan Topilsky MD , Shmuel Banai MD , Michal Laufer-Perl MD, MHA
Background
Immune checkpoint inhibitors (ICIs) have revolutionized the clinical outcomes of cancer. Nevertheless, their use may lead to myocardial injury. The 2022 European Society of Cardiology cardio-oncology guidelines recommend routine follow-up of troponin level; however, current guidelines do not provide specific protocols for managing elevated troponin levels during ICI therapy. We aimed to describe the real-life assessment of patients treated with ICIs, presenting with an elevated high-sensitivity troponin I (hs-TnI) level following therapy.
Methods
Tel Aviv Sourasky Medical Center has implemented a routine follow-up of hs-TnI level measurement during ICI therapy. We performed a retrospective analysis evaluating the clinical assessment and management of patients presenting with an elevated hs-Tnl level (> 50 ng/L) following therapy.
Results
Among 455 patients performing baseline and follow-up hs-TnI measurements, 50 patients (11%) presented with an elevated hs-TnI level (median 159 ng/L; interquartile range 76-362) following ICI therapy. All patients underwent an electrocardiogram, showing changes in 5 patients (10%). Among 24 patients (48%) who received echocardiography, 4 (8%) showed abnormalities. A cardiology consultation was ordered for 17 patients (34%), and none received cardiac magnetic resonance imaging or coronary angiography. A total of 13 patients (26%) were diagnosed with probable or possible myocarditis, resulting in corticosteroid therapy and discontinuation of ICI therapy in 84% and 92% of the patients, respectively. Only 2 patients reinitiated ICI therapy at a later stage.
Conclusions
We describe for the first time the management of elevated hs-TnI levels following ICI therapy, which was diagnosed in routine serial surveillance. We found a wide diversity in management, low cardiology involvement, and high interruption of therapy, emphasizing the need for standardized protocol management guidelines.
{"title":"Real-Life Management of Elevated Troponin Level in Patients Treated with Immune Checkpoint Inhibitors","authors":"Lior Zornitzki MD , Dana Viskin MD , Ophir Freund MD , Ido Wolf MD , Anna Rozenfeld Hemed MD , Noam Weiss MS , Shir Frydman MD, Ms , Maor Tzuberi MS , Shafik Khoury MD , Ofer Havakuk MD , Yan Topilsky MD , Shmuel Banai MD , Michal Laufer-Perl MD, MHA","doi":"10.1016/j.cjco.2025.02.005","DOIUrl":"10.1016/j.cjco.2025.02.005","url":null,"abstract":"<div><h3>Background</h3><div>Immune checkpoint inhibitors (ICIs) have revolutionized the clinical outcomes of cancer. Nevertheless, their use may lead to myocardial injury. The 2022 European Society of Cardiology cardio-oncology guidelines recommend routine follow-up of troponin level; however, current guidelines do not provide specific protocols for managing elevated troponin levels during ICI therapy. We aimed to describe the real-life assessment of patients treated with ICIs, presenting with an elevated high-sensitivity troponin I (hs-TnI) level following therapy.</div></div><div><h3>Methods</h3><div>Tel Aviv Sourasky Medical Center has implemented a routine follow-up of hs-TnI level measurement during ICI therapy. We performed a retrospective analysis evaluating the clinical assessment and management of patients presenting with an elevated hs-Tnl level (> 50 ng/L) following therapy.</div></div><div><h3>Results</h3><div>Among 455 patients performing baseline and follow-up hs-TnI measurements, 50 patients (11%) presented with an elevated hs-TnI level (median 159 ng/L; interquartile range 76-362) following ICI therapy. All patients underwent an electrocardiogram, showing changes in 5 patients (10%). Among 24 patients (48%) who received echocardiography, 4 (8%) showed abnormalities. A cardiology consultation was ordered for 17 patients (34%), and none received cardiac magnetic resonance imaging or coronary angiography. A total of 13 patients (26%) were diagnosed with probable or possible myocarditis, resulting in corticosteroid therapy and discontinuation of ICI therapy in 84% and 92% of the patients, respectively. Only 2 patients reinitiated ICI therapy at a later stage.</div></div><div><h3>Conclusions</h3><div>We describe for the first time the management of elevated hs-TnI levels following ICI therapy, which was diagnosed in routine serial surveillance. We found a wide diversity in management, low cardiology involvement, and high interruption of therapy, emphasizing the need for standardized protocol management guidelines.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 8","pages":"Pages 1075-1082"},"PeriodicalIF":2.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-01DOI: 10.1016/j.cjco.2025.05.005
Hassan Mir MD, MHI, MPH, FRCPC, FACP , Kerri-Anne Mullen PhD , Javad Heshmati PhD , Ashley Baldwin BAHsc , Evyanne Quirouette BSc , Emilie Serano RN, MN , Mustafa Coja BPHE, BA , Andrew L. Pipe MD , Robert D. Reid PhD
Background
Cytisine use has proven efficacy for smoking cessation. We plan to investigate whether cytisine use is effective for relapse recovery and conducted a pilot randomized trial to assess the feasibility of a definitive trial.
Methods
A 2-group, single-site pilot randomized controlled trial was conducted. Adults with heart disease, who were actively enrolled in a smoking-cessation program and had relapsed to smoking, were randomly assigned to receive cytisine or combination nicotine replacement therapy for 25 days. Primary outcomes were rates of participant recruitment and treatment adherence, compared to targets. Secondary outcomes included end-of-treatment abstinence and treatment effects on cigarettes smoked per day and tobacco-withdrawal symptoms.
Results
Over the course of 18 months, we screened 62 relapsed smokers, identifying 32 (52%) who were eligible. We recruited 13 participants (41% of eligible), of whom 9 (69%) completed the study. A total of 5 of 13 participants (38.5%) used study medication on ≥ 80% of the days during the treatment period (50.0% in the cytisine group vs 28.6% in the nicotine replacement therapy group). At 25 days, 1 quitter was present in the cytisine group, and no quitters were present in the nicotine replacement therapy group (16.7% vs 0%). Cigarettes smoked per day decreased over the course of treatment.
Conclusions
Modifications to trial design, trial processes, and intervention delivery are required to make a definitive trial useful. To increase recruitment level, we will use a pragmatic design embedded within typical cessation-program practices, conduct a multisite study, and expand eligibility to include participants with other clinical conditions. To increase treatment adherence, we will use simplified dosing for cytisine. Sample size for the definitive trial will be based on the number needed to determine a clinically meaningful change in long-term abstinence.
{"title":"Cytisine Use Vs Nicotine Replacement Therapy in Relapsed Smokers with Heart Disease: Feasibility Results from a Pilot Randomized Trial","authors":"Hassan Mir MD, MHI, MPH, FRCPC, FACP , Kerri-Anne Mullen PhD , Javad Heshmati PhD , Ashley Baldwin BAHsc , Evyanne Quirouette BSc , Emilie Serano RN, MN , Mustafa Coja BPHE, BA , Andrew L. Pipe MD , Robert D. Reid PhD","doi":"10.1016/j.cjco.2025.05.005","DOIUrl":"10.1016/j.cjco.2025.05.005","url":null,"abstract":"<div><h3>Background</h3><div>Cytisine use has proven efficacy for smoking cessation. We plan to investigate whether cytisine use is effective for relapse recovery and conducted a pilot randomized trial to assess the feasibility of a definitive trial.</div></div><div><h3>Methods</h3><div>A 2-group, single-site pilot randomized controlled trial was conducted. Adults with heart disease, who were actively enrolled in a smoking-cessation program and had relapsed to smoking, were randomly assigned to receive cytisine or combination nicotine replacement therapy for 25 days. Primary outcomes were rates of participant recruitment and treatment adherence, compared to targets. Secondary outcomes included end-of-treatment abstinence and treatment effects on cigarettes smoked per day and tobacco-withdrawal symptoms.</div></div><div><h3>Results</h3><div>Over the course of 18 months, we screened 62 relapsed smokers, identifying 32 (52%) who were eligible. We recruited 13 participants (41% of eligible), of whom 9 (69%) completed the study. A total of 5 of 13 participants (38.5%) used study medication on ≥ 80% of the days during the treatment period (50.0% in the cytisine group vs 28.6% in the nicotine replacement therapy group). At 25 days, 1 quitter was present in the cytisine group, and no quitters were present in the nicotine replacement therapy group (16.7% vs 0%). Cigarettes smoked per day decreased over the course of treatment.</div></div><div><h3>Conclusions</h3><div>Modifications to trial design, trial processes, and intervention delivery are required to make a definitive trial useful. To increase recruitment level, we will use a pragmatic design embedded within typical cessation-program practices, conduct a multisite study, and expand eligibility to include participants with other clinical conditions. To increase treatment adherence, we will use simplified dosing for cytisine. Sample size for the definitive trial will be based on the number needed to determine a clinically meaningful change in long-term abstinence.</div></div><div><h3>Clincial Trial Registration</h3><div>NCT04286295.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 8","pages":"Pages 1062-1069"},"PeriodicalIF":2.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-01DOI: 10.1016/j.cjco.2025.05.010
Peter A. Kavsak PhD, Niklas Thießen MD, John W. Pickering PhD, Li Liu MD, PhD, Sameer Sharif MD, MSc, David Kirkwood MSc, Richard Perez MSc, Dennis T. Ko MD, MSc, Craig Ainsworth MD, Andrew Worster MD, MSc, Martin Than MD, Johannes T. Neumann MD, PhD, Allan S. Jaffe MD
{"title":"Common Change Criteria for High-Sensitivity Cardiac Troponin for Serial Measurements Greater Than 2 Hours Apart","authors":"Peter A. Kavsak PhD, Niklas Thießen MD, John W. Pickering PhD, Li Liu MD, PhD, Sameer Sharif MD, MSc, David Kirkwood MSc, Richard Perez MSc, Dennis T. Ko MD, MSc, Craig Ainsworth MD, Andrew Worster MD, MSc, Martin Than MD, Johannes T. Neumann MD, PhD, Allan S. Jaffe MD","doi":"10.1016/j.cjco.2025.05.010","DOIUrl":"10.1016/j.cjco.2025.05.010","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 8","pages":"Pages 1073-1074"},"PeriodicalIF":2.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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