Pub Date : 2025-09-01DOI: 10.1016/j.cjco.2025.05.020
Yuta Kobayashi MD, PhD , Yusuke Enta MD , Masaki Nakashima MD , Makoto Saigan MD , Natsuko Satomi MD , Yung Teng MD , Daishi Tazawa MD , Yoshiko Munehisa MD, PhD , Masataka Taguri PhD , Masaki Hata MD , Norio Tada MD, PhD
Background
Dynamic left ventricular outflow tract obstruction (LVOTO) following transcatheter aortic valve replacement (TAVR) is a potential complication that can cause severe hemodynamic instability. However, limited evidence is available regarding the incidence and predictors of LVOTO post-TAVR. This study aimed to clarify the incidence and identify the predictors of LVOTO following TAVR and to investigate whether LVOTO is associated with clinical outcomes.
Methods
This retrospective, single-centre study analyzed 2068 consecutive patients with aortic stenosis who underwent TAVR between January 2014 and December 2023. Transthoracic echocardiography was performed both before and after TAVR. LVOTO was defined as a peak pressure gradient exceeding 30 mm Hg.
Results
LVOTO occurred in 25 of 1963 patients (1.3%), with 6 patients developing acute hemodynamic compromise immediately after TAVR. Least absolute shrinkage and selection operator-penalized regression analysis identified the left ventricular outflow tract dimension (LVOTD), interventricular septum (IVS) thickness, transvalvular velocity, LVOT maximum velocity (Vmax), and aortic annulus-to-LVOT area ratio (A/L ratio) as independent predictors of LVOTO following TAVR. Kaplan-Meier analysis revealed no association between LVOTO following TAVR and all-cause mortality or rehospitalization for heart failure.
Conclusions
The incidence of LVOTO after TAVR was 1.27%. Predictors of LVOTO were the IVS thickness, transvalvular velocity, LVOTD, LVOT Vmax, and A/L ratio. Notably, LVOTO following TAVR was not associated with the composite outcome of all-cause mortality or heart failure hospitalization.
{"title":"Incidence, Predictors, and Prognostic Impact of Left Ventricular Outflow Tract Obstruction Following Transcatheter Aortic Valve Replacement","authors":"Yuta Kobayashi MD, PhD , Yusuke Enta MD , Masaki Nakashima MD , Makoto Saigan MD , Natsuko Satomi MD , Yung Teng MD , Daishi Tazawa MD , Yoshiko Munehisa MD, PhD , Masataka Taguri PhD , Masaki Hata MD , Norio Tada MD, PhD","doi":"10.1016/j.cjco.2025.05.020","DOIUrl":"10.1016/j.cjco.2025.05.020","url":null,"abstract":"<div><h3>Background</h3><div>Dynamic left ventricular outflow tract obstruction (LVOTO) following transcatheter aortic valve replacement (TAVR) is a potential complication that can cause severe hemodynamic instability. However, limited evidence is available regarding the incidence and predictors of LVOTO post-TAVR. This study aimed to clarify the incidence and identify the predictors of LVOTO following TAVR and to investigate whether LVOTO is associated with clinical outcomes.</div></div><div><h3>Methods</h3><div>This retrospective, single-centre study analyzed 2068 consecutive patients with aortic stenosis who underwent TAVR between January 2014 and December 2023. Transthoracic echocardiography was performed both before and after TAVR. LVOTO was defined as a peak pressure gradient exceeding 30 mm Hg.</div></div><div><h3>Results</h3><div>LVOTO occurred in 25 of 1963 patients (1.3%), with 6 patients developing acute hemodynamic compromise immediately after TAVR. Least absolute shrinkage and selection operator-penalized regression analysis identified the left ventricular outflow tract dimension (LVOTD), interventricular septum (IVS) thickness, transvalvular velocity, LVOT maximum velocity (V<sub>max</sub>), and aortic annulus-to-LVOT area ratio (A/L ratio) as independent predictors of LVOTO following TAVR. Kaplan-Meier analysis revealed no association between LVOTO following TAVR and all-cause mortality or rehospitalization for heart failure.</div></div><div><h3>Conclusions</h3><div>The incidence of LVOTO after TAVR was 1.27%. Predictors of LVOTO were the IVS thickness, transvalvular velocity, LVOTD, LVOT V<sub>max</sub>, and A/L ratio. Notably, LVOTO following TAVR was not associated with the composite outcome of all-cause mortality or heart failure hospitalization.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 9","pages":"Pages 1236-1243"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061754","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 : 2025-09-01DOI: 10.1016/j.cjco.2025.05.012
Karan Shahi MSc , Robert J.H. Miller MD , Steven Dykstra PhD , Yuanchao Feng PhD , Jonathan G. Howlett MD , Victor Jimenez-Zepeda MD , Jan Veenhuyzen RN, BScN , James A. White MD , Nowell M. Fine MD, SM
Background
Tafamidis is an oral transthyretin stabilizer that improves survival in transthyretin amyloidosis cardiomyopathy (ATTR-CM), but only limited real-world data describe serial cardiac biomarker changes following treatment initiation. The primary objective of this study was to characterize longitudinal changes across multiple cardiac biomarker domains in tafamidis-treated ATTR-CM patients, to describe how these parameters evolve over time in routine clinical practice. We also report the same outcomes in untreated patients to reflect the natural disease history in a modern real-world cohort.
Methods
Clinical, biochemical, and cardiac imaging parameters were serially assessed at baseline and 1-year follow-up for 145 ATTR-CM patients, both those treated and those untreated with tafamidis.
Results
The median age was 80 years (range: 73-86), and 80 patients (55%) received tafamidis. At baseline, the treated group was younger and exhibited less advanced disease, relative to the untreated group. Treatment with tafamadis was associated with stabilization in N-terminal pro-B-type natriuretic peptide (NTproBNP) level, troponin-T level, and New York Heart Association functional class at 1-year follow-up, whereas the untreated group demonstrated worsening (all comparisons P < 0.05). Tafamidis treatment status was not significantly associated with National Amyloidosis Center or Mayo Clinic disease stage.
Conclusions
NTproBNP level, troponin-T level, and New York Heart Association functional class remain stable over 1 year in a real-world cohort of tafamidis-treated ATTR-CM patients. These results may help inform therapeutic monitoring strategies in clinical practice.
{"title":"Longitudinal Changes in Multiple Cardiac Biomarkers in Transthyretin Amyloidosis Cardiomyopathy Patients Treated Vs Untreated with Tafamidis","authors":"Karan Shahi MSc , Robert J.H. Miller MD , Steven Dykstra PhD , Yuanchao Feng PhD , Jonathan G. Howlett MD , Victor Jimenez-Zepeda MD , Jan Veenhuyzen RN, BScN , James A. White MD , Nowell M. Fine MD, SM","doi":"10.1016/j.cjco.2025.05.012","DOIUrl":"10.1016/j.cjco.2025.05.012","url":null,"abstract":"<div><h3>Background</h3><div>Tafamidis is an oral transthyretin stabilizer that improves survival in transthyretin amyloidosis cardiomyopathy (ATTR-CM), but only limited real-world data describe serial cardiac biomarker changes following treatment initiation. The primary objective of this study was to characterize longitudinal changes across multiple cardiac biomarker domains in tafamidis-treated ATTR-CM patients, to describe how these parameters evolve over time in routine clinical practice. We also report the same outcomes in untreated patients to reflect the natural disease history in a modern real-world cohort.</div></div><div><h3>Methods</h3><div>Clinical, biochemical, and cardiac imaging parameters were serially assessed at baseline and 1-year follow-up for 145 ATTR-CM patients, both those treated and those untreated with tafamidis.</div></div><div><h3>Results</h3><div>The median age was 80 years (range: 73-86), and 80 patients (55%) received tafamidis. At baseline, the treated group was younger and exhibited less advanced disease, relative to the untreated group. Treatment with tafamadis was associated with stabilization in N-terminal pro-B-type natriuretic peptide (NTproBNP) level, troponin-T level, and New York Heart Association functional class at 1-year follow-up, whereas the untreated group demonstrated worsening (all comparisons <em>P</em> < 0.05). Tafamidis treatment status was not significantly associated with National Amyloidosis Center or Mayo Clinic disease stage.</div></div><div><h3>Conclusions</h3><div>NTproBNP level, troponin-T level, and New York Heart Association functional class remain stable over 1 year in a real-world cohort of tafamidis-treated ATTR-CM patients. These results may help inform therapeutic monitoring strategies in clinical practice.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 9","pages":"Pages 1190-1197"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061778","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 : 2025-09-01DOI: 10.1016/j.cjco.2025.06.013
Orlane Neuilly MSc , Ngoc Anh Lisa Le MSc , Paul Khairy MD, PhD , Roddy Hiram PhD
Conditions provoking the electrical and structural-functional remodelling of the myocardium can lead to the development of heart rhythm disorders, including atrial fibrillation (AF) and ventricular tachyarrhythmias that can cause sudden cardiac death. Right heart disease (RHD) causes progressive structural and functional remodelling of the right heart responsible for right ventricular and atrial dysfunction and arrhyhmias. Conditions contributing to the development of RHD include left heart disease, pulmonary arterial hypertension, congenital heart disease, right-sided myocardial infarction due to coronary artery occlusion, and amyloidosis. In adult patients with RHD associated with pulmonary arterial hypertension, the prevalence of AF is about 20%, and in adult patients with arrhythmogenic right ventricular cardiomyopathy, it is 14%. A study has suggested that compared to non patients without congenital heart disease, AF appears 30 years earlier in adult patients with congenital heart disease, with a 10-20-fold-higher incidence. This narrative review article aims to review knowledge about the pathophysiology of RHD associated with cardiac arrhythmia. Evidence is reported about the mechanisms underlying the initiation and maintenance of the arrhythmogenic substrate in RHD. We summarize the available experimental approaches to study RHD associated with cardiac arrhythmia, including in vitro models (isolated cardiomyocytes, fibroblasts) and in vivo models (monocrotaline, pulmonary artery banding, Sugen/hypoxia). In addition, we discuss potential future strategies targeting myocardial inflammation and fibrosis in the prevention of cardiac arrhythmia in RHD.
{"title":"Consequences of Right Heart Disease for Cardiac Electrophysiology and Arrhythmias: Cellular and Structural Mechanisms","authors":"Orlane Neuilly MSc , Ngoc Anh Lisa Le MSc , Paul Khairy MD, PhD , Roddy Hiram PhD","doi":"10.1016/j.cjco.2025.06.013","DOIUrl":"10.1016/j.cjco.2025.06.013","url":null,"abstract":"<div><div>Conditions provoking the electrical and structural-functional remodelling of the myocardium can lead to the development of heart rhythm disorders, including atrial fibrillation (AF) and ventricular tachyarrhythmias that can cause sudden cardiac death. Right heart disease (RHD) causes progressive structural and functional remodelling of the right heart responsible for right ventricular and atrial dysfunction and arrhyhmias. Conditions contributing to the development of RHD include left heart disease, pulmonary arterial hypertension, congenital heart disease, right-sided myocardial infarction due to coronary artery occlusion, and amyloidosis. In adult patients with RHD associated with pulmonary arterial hypertension, the prevalence of AF is about 20%, and in adult patients with arrhythmogenic right ventricular cardiomyopathy, it is 14%. A study has suggested that compared to non patients without congenital heart disease, AF appears 30 years earlier in adult patients with congenital heart disease, with a 10-20-fold-higher incidence. This narrative review article aims to review knowledge about the pathophysiology of RHD associated with cardiac arrhythmia. Evidence is reported about the mechanisms underlying the initiation and maintenance of the arrhythmogenic substrate in RHD. We summarize the available experimental approaches to study RHD associated with cardiac arrhythmia, including <em>in vitro</em> models (isolated cardiomyocytes, fibroblasts) and <em>in vivo</em> models (monocrotaline, pulmonary artery banding, Sugen/hypoxia). In addition, we discuss potential future strategies targeting myocardial inflammation and fibrosis in the prevention of cardiac arrhythmia in RHD.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 9","pages":"Pages 1170-1189"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061777","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 : 2025-09-01DOI: 10.1016/j.cjco.2025.06.015
Kutaiba Nazif DO , Aakash Bavishi MD, MSCI , Matthew W. Martinez MD
Transthoracic echocardiography imaging has traditionally been used to screen for left ventricular outflow tract (LVOT) obstruction in hypertrophic cardiomyopathy. However, there may be limitations in the ability to diagnose LVOT obstruction using transthoracic echocardiography (TTE). We present 6 symptomatic hypertrophic cardiomyopathy patients without significant LVOT obstruction on TTE imaging who underwent transesophageal echocardiography (TEE) with isoproterenol provocation. Four of the 6 patients developed significant obstruction. Three patients underwent septal myectomy and 1 chose cardiac myosin inhibitor therapy, with significant improvement in their symptoms. Our findings suggest that provocation with isoproterenol during TEE can provide a sensitive assessment for latent systolic anterior motion.
{"title":"Utility of Transesophageal Echocardiography and Isoproterenol Provocation in Detecting Latent Obstruction in Hypertrophic Cardiomyopathy","authors":"Kutaiba Nazif DO , Aakash Bavishi MD, MSCI , Matthew W. Martinez MD","doi":"10.1016/j.cjco.2025.06.015","DOIUrl":"10.1016/j.cjco.2025.06.015","url":null,"abstract":"<div><div>Transthoracic echocardiography imaging has traditionally been used to screen for left ventricular outflow tract (LVOT) obstruction in hypertrophic cardiomyopathy. However, there may be limitations in the ability to diagnose LVOT obstruction using transthoracic echocardiography (TTE). We present 6 symptomatic hypertrophic cardiomyopathy patients without significant LVOT obstruction on TTE imaging who underwent transesophageal echocardiography (TEE) with isoproterenol provocation. Four of the 6 patients developed significant obstruction. Three patients underwent septal myectomy and 1 chose cardiac myosin inhibitor therapy, with significant improvement in their symptoms. Our findings suggest that provocation with isoproterenol during TEE can provide a sensitive assessment for latent systolic anterior motion.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 9","pages":"Pages 1201-1203"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061759","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 : 2025-09-01DOI: 10.1016/j.cjco.2025.06.005
Amr Saleh BSc , Jason G. Andrade MD , Patrick Bergin MD , Derek S. Chew MD MSc , Larry Sterns MD , Christian Steinberg MD , Mehdrad Golian MD , Evan Lockwood MD , Min-Shien Chen MD , Stephen Duffett MD , Jeff S. Healey MD MSc , Ratika Parkash MD , Lena Rivard MD , Colette M. Seifer MD , Satish Toal MD , William F. McIntyre MD, PhD
Background
Continuous ambulatory electrocardiographic (ECG) monitors are essential for diagnosing cardiac arrhythmias. In Canada, individual provinces dictate access to and reimbursement for these services. This study examines variations in access to continuous ambulatory ECG monitoring in Canada.
Methods
We reviewed publicly available provincial schedules of benefits, to identify the durations of continuous ambulatory ECG monitoring reimbursed across Canadian provinces. We abstracted data on the duration, modality, and reimbursement criteria for monitoring services. Additionally, at least one specialist from each province provided information on the types of monitors available, their accessibility, and further information on local reimbursement processes.
Results
We found significant variability in continuous ambulatory ECG monitoring coverage across provinces. Shorter monitoring durations (24 and 48 hours) are available in all provinces, but coverage for longer durations varies. Only patients in Ontario, Nova Scotia, and Saskatchewan can access publicly funded, 14-day, continuous, ambulatory ECG monitors. Ambulatory ECG monitoring is available from hospitals in all provinces. Direct-to-patient device delivery is available in all but 4 provinces (Alberta, Saskatchewan, Manitoba, and Nova Scotia). Testing by private entities is available in 5 provinces (British Columbia, Alberta, Saskatchewan, Ontario, and Quebec).
Conclusions
The availability of continuous, ambulatory, ECG monitoring across Canadian provinces has considerable variability. Measures are needed to ensure equitable access to ambulatory ECG monitoring services nationwide. Creating national monitoring guidelines could set goals for provinces to work toward, enhancing access for all Canadians and reinforcing values of the Canada Health Act.
{"title":"Variation in Availability of Continuous Ambulatory Electrocardiographic Monitors Across Canadian Provinces","authors":"Amr Saleh BSc , Jason G. Andrade MD , Patrick Bergin MD , Derek S. Chew MD MSc , Larry Sterns MD , Christian Steinberg MD , Mehdrad Golian MD , Evan Lockwood MD , Min-Shien Chen MD , Stephen Duffett MD , Jeff S. Healey MD MSc , Ratika Parkash MD , Lena Rivard MD , Colette M. Seifer MD , Satish Toal MD , William F. McIntyre MD, PhD","doi":"10.1016/j.cjco.2025.06.005","DOIUrl":"10.1016/j.cjco.2025.06.005","url":null,"abstract":"<div><h3>Background</h3><div>Continuous ambulatory electrocardiographic (ECG) monitors are essential for diagnosing cardiac arrhythmias. In Canada, individual provinces dictate access to and reimbursement for these services. This study examines variations in access to continuous ambulatory ECG monitoring in Canada.</div></div><div><h3>Methods</h3><div>We reviewed publicly available provincial schedules of benefits, to identify the durations of continuous ambulatory ECG monitoring reimbursed across Canadian provinces. We abstracted data on the duration, modality, and reimbursement criteria for monitoring services. Additionally, at least one specialist from each province provided information on the types of monitors available, their accessibility, and further information on local reimbursement processes.</div></div><div><h3>Results</h3><div>We found significant variability in continuous ambulatory ECG monitoring coverage across provinces. Shorter monitoring durations (24 and 48 hours) are available in all provinces, but coverage for longer durations varies. Only patients in Ontario, Nova Scotia, and Saskatchewan can access publicly funded, 14-day, continuous, ambulatory ECG monitors. Ambulatory ECG monitoring is available from hospitals in all provinces. Direct-to-patient device delivery is available in all but 4 provinces (Alberta, Saskatchewan, Manitoba, and Nova Scotia). Testing by private entities is available in 5 provinces (British Columbia, Alberta, Saskatchewan, Ontario, and Quebec).</div></div><div><h3>Conclusions</h3><div>The availability of continuous, ambulatory, ECG monitoring across Canadian provinces has considerable variability. Measures are needed to ensure equitable access to ambulatory ECG monitoring services nationwide. Creating national monitoring guidelines could set goals for provinces to work toward, enhancing access for all Canadians and reinforcing values of the Canada Health Act.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 9","pages":"Pages 1157-1161"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145060785","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}
Angiopoietin-like protein 3 (ANGPTL3) regulates lipoprotein metabolism, and its genetic deficiency reduces the risk of atherosclerotic cardiovascular disease. However, the association between ANGPTL3 expression and atherosclerotic plaque formation remains unclear.
Methods
We analyzed 58 patients with coronary artery disease (89 non-culprit lesions) who underwent optical coherence tomography (OCT)-guided percutaneous coronary intervention. ANGPTL3 levels were measured by an enzymatic method (Immuno-Biological Laboratories, Gunma, Japan). Clinical demographics and OCT-derived plaque features were compared among patients stratified according to tertiles of ANGPTL3 levels.
Results
The ANGPTL3 level was 356.2 ± 158.9 ng/mL (statin = 98.2%; low-density lipoprotein cholesterol = 74.5 ± 21.7 mg/dL). Patients in tertile 3 of ANGPTL3 level were older (P = 0.025) and had a lower estimated glomerular filtration rate (eGFR; P = 0.010). On OCT imaging, the lipid arc (P = 0.139), fibrous cap thickness (P = 0.826), and other plaque microstructures did not significantly differ among the 3 groups, whereas increased ANGPTL3 levels were associated with a larger calcification arc (P < 0.001) and a longer calcification length (P < 0.001). Multivariate analysis demonstrated that ANGPTL3 (β-coefficient = 0.143, 95% confidence interval [CI] = 0.07–0.21, P < 0.001) and eGFR (β-coefficient = −1.380, 95% CI = −2.53-0.22, P = 0.019) are independent factors affecting the maximum calcification arc. ANGPTL3 (β-coefficient = 0.013, 95% CI = 0.010-0.016, P < 0.001) levels remained independently associated with calcification length. Receiver operating characteristic curve analyses revealed that ANGPTL3 ≥ 410.9 ng/mL (area under the curve = 0.815, 95% CI = 0.718–0.913, P < 0.001) and eGFR ≤ 65.2 mL/min per 1.73 m2 (area under the curve = 0.759, 95% CI = 0.645–0.873, P < 0.001) are the best cutoff values for predicting OCT-derived greater calcification (calcification arc > 87.7° + calcification length > 5.6 mm). The proportion of patients with greater calcification increased with the number of these features (P < 0.001).
Conclusions
ANGPTL3 expression was associated with plaque calcification in patients with coronary artery disease. Further studies are required to confirm ANGPTL3 as a therapeutic target for modulating calcification.
生成素样蛋白3 （ANGPTL3）调节脂蛋白代谢，其基因缺乏可降低动脉粥样硬化性心血管疾病的风险。然而，ANGPTL3表达与动脉粥样硬化斑块形成之间的关系尚不清楚。方法对58例冠状动脉疾病患者（其中非罪魁祸首病变89例）行光学相干断层扫描（OCT）引导下经皮冠状动脉介入治疗进行分析。用酶法测定ANGPTL3水平（日本群马免疫生物实验室）。根据ANGPTL3水平的分位数进行分层，比较患者的临床人口学特征和oct衍生斑块特征。结果ANGPTL3水平为356.2±158.9 ng/mL（他汀类药物= 98.2%，低密度脂蛋白胆固醇= 74.5±21.7 mg/dL）。ANGPTL3水平的第3组患者年龄较大（P = 0.025），估计肾小球滤过率（eGFR; P = 0.010）较低。在OCT成像上，三组患者的脂质弧（P = 0.139）、纤维帽厚度（P = 0.826）和其他斑块微结构无显著差异，而ANGPTL3水平升高与更大的钙化弧（P < 0.001）和更长的钙化长度（P < 0.001）相关。多因素分析表明，ANGPTL3 （β-系数= 0.143,95%可信区间[CI] = 0.07-0.21, P < 0.001）和eGFR （β-系数= - 1.380,95% CI = - 2.53-0.22, P = 0.019）是影响最大钙化弧的独立因素。ANGPTL3 （β-系数= 0.013,95% CI = 0.010-0.016, P < 0.001）水平与钙化长度独立相关。受试者工作特征曲线分析显示，ANGPTL3≥410.9 ng/mL（曲线下面积= 0.815,95% CI = 0.718-0.913, P < 0.001）和eGFR≤65.2 mL/min / 1.73 m2（曲线下面积= 0.759,95% CI = 0.645-0.873, P < 0.001）是预测oct衍生的更严重钙化（钙化弧度>； 87.7°+钙化长度>； 5.6 mm）的最佳截止值。钙化程度较高的患者比例随着这些特征的增多而增加（P < 0.001）。结论sangptl3表达与冠心病患者斑块钙化有关。需要进一步的研究来证实ANGPTL3作为调节钙化的治疗靶点。
{"title":"Circulating Angiopoietin-Like Protein 3 Level and Plaque Calcification: An Optical Coherence Tomography Imaging Analysis","authors":"Yu Kataoka MD, PhD , Kota Murai MD , Stephen J. Nicholls MBBS, PhD , Yoshiyuki Tomishima MD , Takamasa Iwai MD , Kenichiro Sawada MD , Hideo Matama MD , Satoshi Honda MD, PhD , Kensuke Takagi MD, PhD , Masashi Fujino MD, PhD , Shuichi Yoneda MD, PhD , Kazuhiro Nakao MD, PhD , Fumiyuki Otsuka MD, PhD , Yasuhide Asaumi MD, PhD , Teruo Noguchi MD, PhD","doi":"10.1016/j.cjco.2025.06.006","DOIUrl":"10.1016/j.cjco.2025.06.006","url":null,"abstract":"<div><h3>Background</h3><div>Angiopoietin-like protein 3 (ANGPTL3) regulates lipoprotein metabolism, and its genetic deficiency reduces the risk of atherosclerotic cardiovascular disease. However, the association between ANGPTL3 expression and atherosclerotic plaque formation remains unclear.</div></div><div><h3>Methods</h3><div>We analyzed 58 patients with coronary artery disease (89 non-culprit lesions) who underwent optical coherence tomography (OCT)-guided percutaneous coronary intervention. ANGPTL3 levels were measured by an enzymatic method (Immuno-Biological Laboratories, Gunma, Japan). Clinical demographics and OCT-derived plaque features were compared among patients stratified according to tertiles of ANGPTL3 levels.</div></div><div><h3>Results</h3><div>The ANGPTL3 level was 356.2 ± 158.9 ng/mL (statin = 98.2%; low-density lipoprotein cholesterol = 74.5 ± 21.7 mg/dL). Patients in tertile 3 of ANGPTL3 level were older (<em>P</em> = 0.025) and had a lower estimated glomerular filtration rate (eGFR; <em>P</em> = 0.010). On OCT imaging, the lipid arc (<em>P</em> = 0.139), fibrous cap thickness (<em>P</em> = 0.826), and other plaque microstructures did not significantly differ among the 3 groups, whereas increased ANGPTL3 levels were associated with a larger calcification arc (<em>P</em> < 0.001) and a longer calcification length (<em>P</em> < 0.001). Multivariate analysis demonstrated that ANGPTL3 (β-coefficient = 0.143, 95% confidence interval [CI] = 0.07–0.21, <em>P</em> < 0.001) and eGFR (β-coefficient = −1.380, 95% CI = −2.53-0.22, <em>P</em> = 0.019) are independent factors affecting the maximum calcification arc. ANGPTL3 (β-coefficient = 0.013, 95% CI = 0.010-0.016, <em>P</em> < 0.001) levels remained independently associated with calcification length. Receiver operating characteristic curve analyses revealed that ANGPTL3 ≥ 410.9 ng/mL (area under the curve = 0.815, 95% CI = 0.718–0.913, <em>P</em> < 0.001) and eGFR ≤ 65.2 mL/min per 1.73 m<sup>2</sup> (area under the curve = 0.759, 95% CI = 0.645–0.873, <em>P</em> < 0.001) are the best cutoff values for predicting OCT-derived greater calcification (calcification arc > 87.7° + calcification length > 5.6 mm). The proportion of patients with greater calcification increased with the number of these features (<em>P</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>ANGPTL3 expression was associated with plaque calcification in patients with coronary artery disease. Further studies are required to confirm ANGPTL3 as a therapeutic target for modulating calcification.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 9","pages":"Pages 1204-1213"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061761","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 : 2025-09-01DOI: 10.1016/j.cjco.2025.06.003
Intisar Ahmed MBBS, FCPS , Chloe Netlefold MBBS, FRACP , Robert D. Anderson MBBS, PhD, Stephane Masse MASc, Melanie R. Burg MD, MSc, Tirone E. David MD, FRCSC, Jane Heggie MD, FRCP, Maral Ouzounian MD, PhD, Kumaraswamy Nanthakumar MD, FRCPC
Background
Despite advancements in postoperative temporary epicardial pacing leads, sensing malfunction can still happen. Oversensing presents as inappropriate inhibition of pacing (a major concern for pacemaker-dependent patients), whereas undersensing may lead to an extremely rare complication of ventricular fibrillation from R on T. The single-lead and dual-lead configurations have key structural differences related to the size of the bipole electrodes and the spacing between them. We assessed how this affects the sensing function.
Methods
Five porcine studies were conducted using open chest and Langendorff models. We used 2 pacing wire configurations and compared the sensed electrograms. We compared a newer single-lead configuration (small, closely spaced electrodes) with a dual-lead (large, widely spaced) configuration. The primary outcome was the amplitude of the R wave. Secondary outcomes were the relative size of the T wave and the effect of sampling frequency and low-pass filtering.
Results
The sensed QRS was significantly larger in the widely spaced, larger electrodes when compared with closely spaced, smaller electrodes across all sampling frequencies and filter settings (6.9-29.7 mV vs 1.7-8.6 mV, P < 0.001). The average amplitude of the T wave was closer to the average QRS amplitude with the newer configuration across all settings. The mean T wave to R wave difference ranged from 3.0 to 3.7 mV for the single lead and 1.0 to 21.5 mV for the dual lead configuration. Large, widely spaced electrodes resulted in much larger sensed QRS signals and a safer programming window for sensitivity.
Conclusions
The smaller, closely spaced electrodes detect a relatively small QRS and a larger T wave, leading to a narrower safety window and an increased risk of sensing malfunction (Central Illustration). To avert catastrophic consequences, the electrophysiologic implications of new temporary pacing wires must be considered during postoperative care.
背景：尽管术后临时心外膜起搏导线取得了进展，但仍可能发生感应功能障碍。过度敏感表现为对起搏的不适当抑制（这是起搏器依赖患者的一个主要问题），而感知不足可能导致从R到t的心室颤动的极其罕见的并发症。单导联和双导联配置具有关键的结构差异，与双极电极的大小和它们之间的间距有关。我们评估了这对感知功能的影响。方法采用开胸和Langendorff模型对5只猪进行研究。我们采用两种起搏导线配置，并比较感应电图。我们比较了一种新的单引线结构（小的，紧密间隔的电极）和双引线结构（大的，广泛间隔的）。主要结果是R波的振幅。次要结果是T波的相对大小以及采样频率和低通滤波的影响。结果在所有采样频率和滤波器设置下（6.9-29.7 mV vs 1.7-8.6 mV, P < 0.001），宽间距、大间距电极的感应QRS明显大于窄间距、小间距电极。在所有设置中，在较新的配置下，T波的平均振幅更接近平均QRS振幅。单引线的平均T波和R波差为3.0 ~ 3.7 mV，双引线配置的平均T波和R波差为1.0 ~ 21.5 mV。大而宽间距的电极产生了更大的感应QRS信号和更安全的灵敏度编程窗口。更小、间距更近的电极检测到相对较小的QRS和更大的T波，导致更窄的安全窗口和更大的传感故障风险（中央插图）。为了避免灾难性的后果，在术后护理中必须考虑到新的临时起搏导线的电生理影响。
{"title":"Postsurgical Temporary Epicardial Pacing: Electrophysiological Implications of Contemporary Pacing Lead Designs","authors":"Intisar Ahmed MBBS, FCPS , Chloe Netlefold MBBS, FRACP , Robert D. Anderson MBBS, PhD, Stephane Masse MASc, Melanie R. Burg MD, MSc, Tirone E. David MD, FRCSC, Jane Heggie MD, FRCP, Maral Ouzounian MD, PhD, Kumaraswamy Nanthakumar MD, FRCPC","doi":"10.1016/j.cjco.2025.06.003","DOIUrl":"10.1016/j.cjco.2025.06.003","url":null,"abstract":"<div><h3>Background</h3><div>Despite advancements in postoperative temporary epicardial pacing leads, sensing malfunction can still happen. Oversensing presents as inappropriate inhibition of pacing (a major concern for pacemaker-dependent patients), whereas undersensing may lead to an extremely rare complication of ventricular fibrillation from R on T. The single-lead and dual-lead configurations have key structural differences related to the size of the bipole electrodes and the spacing between them. We assessed how this affects the sensing function.</div></div><div><h3>Methods</h3><div>Five porcine studies were conducted using open chest and Langendorff models. We used 2 pacing wire configurations and compared the sensed electrograms. We compared a newer single-lead configuration (small, closely spaced electrodes) with a dual-lead (large, widely spaced) configuration. The primary outcome was the amplitude of the R wave. Secondary outcomes were the relative size of the T wave and the effect of sampling frequency and low-pass filtering.</div></div><div><h3>Results</h3><div>The sensed QRS was significantly larger in the widely spaced, larger electrodes when compared with closely spaced, smaller electrodes across all sampling frequencies and filter settings (6.9-29.7 mV vs 1.7-8.6 mV, <em>P</em> < 0.001). The average amplitude of the T wave was closer to the average QRS amplitude with the newer configuration across all settings. The mean T wave to R wave difference ranged from 3.0 to 3.7 mV for the single lead and 1.0 to 21.5 mV for the dual lead configuration. Large, widely spaced electrodes resulted in much larger sensed QRS signals and a safer programming window for sensitivity.</div></div><div><h3>Conclusions</h3><div>The smaller, closely spaced electrodes detect a relatively small QRS and a larger T wave, leading to a narrower safety window and an increased risk of sensing malfunction (Central Illustration). To avert catastrophic consequences, the electrophysiologic implications of new temporary pacing wires must be considered during postoperative care.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 9","pages":"Pages 1162-1169"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145060786","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.2025.05.002
Shijie Zhou MD , Douglas S. Lee MD, PhD , Francis Nguyen MPH , Harsukh Benipal MD, MSc , Richard Perez PhD , Peter C. Austin PhD , Husam Abdel-Qadir MD, PhD , Jacob A. Udell MD, MPH , Catherine Demers MD, MSc
Background
To support family physicians (FPs) in managing patients with heart failure (HF), the Ministry of Health in Ontario, Canada implemented the Q050A billing code in 2008, a pay-for-performance incentive for guideline-based HF care. We studied whether the incentive was associated with any change in the prescription of HF medications.
Methods
We identified all patients with HF in Ontario aged ≥ 66 years who were managed by FPs claiming the Q050A incentive between 2008 and 2021. We determined the proportion of patients who were prescribed renin-angiotensin system inhibitors (RASis), beta-blockers (BBs), mineralocorticoid receptor antagonists (MRAs), and diuretics 3 months before and after the Q050A billing code was used in claims for these patients. As applicable, we classified the agents by whether they are guideline-directed as recommended by the Canadian Cardiovascular Society.
Results
We included 39,425 HF patients in the study. The median age was 80 years (interquartile range, 73-85); 49% were female. Compared to the pre-Q050A period, prescriptions increased after the incentive was implemented, from 45.2% to 45.8% for RASis, 51.9% to 54.4% for BBs, 9.2% to 11.7% for MRAs, and 63.2% to 65.7% for diuretics (P < 0.05). The proportion of those who were not on any HF medications decreased from 27.5% to 24.9% (P < 0.001). Those with newly diagnosed HF and prompt follow-up with FPs experienced the largest—but a clinically modest—increase in HF medications.
Conclusions
The Q050A incentive led to a minimal increase in the prescription of HF medications; disease-modifying agents are underutilized.
{"title":"The Effect of an Incentive Billing Code on Heart Failure Management in Primary Care: A Population-Based Study","authors":"Shijie Zhou MD , Douglas S. Lee MD, PhD , Francis Nguyen MPH , Harsukh Benipal MD, MSc , Richard Perez PhD , Peter C. Austin PhD , Husam Abdel-Qadir MD, PhD , Jacob A. Udell MD, MPH , Catherine Demers MD, MSc","doi":"10.1016/j.cjco.2025.05.002","DOIUrl":"10.1016/j.cjco.2025.05.002","url":null,"abstract":"<div><h3>Background</h3><div>To support family physicians (FPs) in managing patients with heart failure (HF), the Ministry of Health in Ontario, Canada implemented the Q050A billing code in 2008, a pay-for-performance incentive for guideline-based HF care. We studied whether the incentive was associated with any change in the prescription of HF medications.</div></div><div><h3>Methods</h3><div>We identified all patients with HF in Ontario aged ≥ 66 years who were managed by FPs claiming the Q050A incentive between 2008 and 2021. We determined the proportion of patients who were prescribed renin-angiotensin system inhibitors (RASis), beta-blockers (BBs), mineralocorticoid receptor antagonists (MRAs), and diuretics 3 months before and after the Q050A billing code was used in claims for these patients. As applicable, we classified the agents by whether they are guideline-directed as recommended by the Canadian Cardiovascular Society.</div></div><div><h3>Results</h3><div>We included 39,425 HF patients in the study. The median age was 80 years (interquartile range, 73-85); 49% were female. Compared to the pre-Q050A period, prescriptions increased after the incentive was implemented, from 45.2% to 45.8% for RASis, 51.9% to 54.4% for BBs, 9.2% to 11.7% for MRAs, and 63.2% to 65.7% for diuretics (<em>P</em> < 0.05). The proportion of those who were not on any HF medications decreased from 27.5% to 24.9% (<em>P</em> < 0.001). Those with newly diagnosed HF and prompt follow-up with FPs experienced the largest—but a clinically modest—increase in HF medications.</div></div><div><h3>Conclusions</h3><div>The Q050A incentive led to a minimal increase in the prescription of HF medications; disease-modifying agents are underutilized.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 8","pages":"Pages 1007-1013"},"PeriodicalIF":2.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858117","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.2025.02.008
Wade Thompson PharmD, PhD , Brendan Wong MD , Atul Sivaswamy MSc , Laura Ferreira-Legere MScN , Douglas S. Lee MD, PhD , Husam Abdel-Qadir MD, PhD , Dennis T. Ko MD, MSc , Alanna Weisman MD, PhD , Sheldon Tobe MD, MSc , Cynthia A. Jackevicius PharmD, MSc , Shaun G. Goodman MD, MSc , Michael E. Farkouh MD , Jacob A. Udell MD, MPH
Background
A cardiovascular (CV) hospitalization is a seminal opportunity to implement guideline-directed medical therapy (GDMT). Sodium-glucose transporter 2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP1RAs) can improve outcomes among those with type 2 diabetes mellitus (T2DM) and CV disease.
Methods
We conducted a population-based cohort study among patients aged ≥ 66 years with T2DM in Ontario hospitalized for a CV event (myocardial infarction, heart failure, peripheral arterial disease, ischemic stroke) from June 2015 to March 2022, who were followed until March 2023. We examined use of GDMT before vs after the index event, including use of SGLT2is, GLP1RAs, statins, and others medications.
Results
We identified 75,869 people aged ≥ 66 years with T2DM (median age 78 years; 43% female). The proportion receiving SGLT2is was 9% before index hospitalization and 29% during the follow-up period. GLP1RA was used for 1% before vs 9% after, compared with 65% before and 86% after for statins. Use of novel GDMT increased across the follow-up period. The incidence of SGLT2i use 1-year posthospitalization was 4% in 2016 vs 39% in 2021; for GLP1RA use, the incidence was 0% in 2016 vs 11% in 2021.
Conclusions
A rise in the use of novel GDMT suggests increasing adoption of therapies to optimize secondary prevention in patients with T2DM and CV disease after index CV events.
{"title":"Uptake of novel evidence-based therapies in patients with type 2 diabetes after a cardiovascular event: insights from CANHEART","authors":"Wade Thompson PharmD, PhD , Brendan Wong MD , Atul Sivaswamy MSc , Laura Ferreira-Legere MScN , Douglas S. Lee MD, PhD , Husam Abdel-Qadir MD, PhD , Dennis T. Ko MD, MSc , Alanna Weisman MD, PhD , Sheldon Tobe MD, MSc , Cynthia A. Jackevicius PharmD, MSc , Shaun G. Goodman MD, MSc , Michael E. Farkouh MD , Jacob A. Udell MD, MPH","doi":"10.1016/j.cjco.2025.02.008","DOIUrl":"10.1016/j.cjco.2025.02.008","url":null,"abstract":"<div><h3>Background</h3><div>A cardiovascular (CV) hospitalization is a seminal opportunity to implement guideline-directed medical therapy (GDMT). Sodium-glucose transporter 2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP1RAs) can improve outcomes among those with type 2 diabetes mellitus (T2DM) and CV disease.</div></div><div><h3>Methods</h3><div>We conducted a population-based cohort study among patients aged ≥ 66 years with T2DM in Ontario hospitalized for a CV event (myocardial infarction, heart failure, peripheral arterial disease, ischemic stroke) from June 2015 to March 2022, who were followed until March 2023. We examined use of GDMT before vs after the index event, including use of SGLT2is, GLP1RAs, statins, and others medications.</div></div><div><h3>Results</h3><div>We identified 75,869 people aged ≥ 66 years with T2DM (median age 78 years; 43% female). The proportion receiving SGLT2is was 9% before index hospitalization and 29% during the follow-up period. GLP1RA was used for 1% before vs 9% after, compared with 65% before and 86% after for statins. Use of novel GDMT increased across the follow-up period. The incidence of SGLT2i use 1-year posthospitalization was 4% in 2016 vs 39% in 2021; for GLP1RA use, the incidence was 0% in 2016 vs 11% in 2021.</div></div><div><h3>Conclusions</h3><div>A rise in the use of novel GDMT suggests increasing adoption of therapies to optimize secondary prevention in patients with T2DM and CV disease after index CV events.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 8","pages":"Pages 1055-1061"},"PeriodicalIF":2.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858113","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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