Pub Date : 2025-12-01DOI: 10.1016/j.cjco.2025.08.008
Nadine Elias BSc, Kin , Dan Yedu Quansah PhD , Lisa A. McDonnell MSc, EMBA , Thais Coutinho MD , Robert D. Reid PhD, MBA , Hassan Mir MD, MPH, MHI , Kerri-Anne Mullen PhD
Women with heart disease face higher risks of death, cardiac events, depression, and reduced quality of life, compared to men. However, women’s participation level in cardiac rehabilitation programs remains low. Peer support programs, such as Women@Heart (W@H), led by women with lived experiences, can enhance program uptake and improve psychosocial well-being. Our pilot evaluation of W@H showed improvements in psychosocial and health behaviour measures, including coping skills and health empowerment. This program evaluation demonstrates the feasibility and effectiveness of W@H in addressing the unique needs of women with heart disease; however, further and large-scale evaluation is needed.
{"title":"Peer Support for Women with Heart Disease: Program Description and Evaluation of Women@Heart","authors":"Nadine Elias BSc, Kin , Dan Yedu Quansah PhD , Lisa A. McDonnell MSc, EMBA , Thais Coutinho MD , Robert D. Reid PhD, MBA , Hassan Mir MD, MPH, MHI , Kerri-Anne Mullen PhD","doi":"10.1016/j.cjco.2025.08.008","DOIUrl":"10.1016/j.cjco.2025.08.008","url":null,"abstract":"<div><div>Women with heart disease face higher risks of death, cardiac events, depression, and reduced quality of life, compared to men. However, women’s participation level in cardiac rehabilitation programs remains low. Peer support programs, such as Women@Heart (W@H), led by women with lived experiences, can enhance program uptake and improve psychosocial well-being. Our pilot evaluation of W@H showed improvements in psychosocial and health behaviour measures, including coping skills and health empowerment. This program evaluation demonstrates the feasibility and effectiveness of W@H in addressing the unique needs of women with heart disease; however, further and large-scale evaluation is needed.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 12","pages":"Pages 1638-1644"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765692","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 : 2025-12-01DOI: 10.1016/j.cjco.2025.08.003
Jianqiang Xu MD , Chi-chun Au MBChB , Kin Chio Li MBChB , Kevin Ka-ho Kam MBChB , Kent, Chak-yu So MBChB
{"title":"J-Valve Anchor for Valve-in-Valve Procedure to Treat Severe Aortic Stenosis with Extremely Large Annulus","authors":"Jianqiang Xu MD , Chi-chun Au MBChB , Kin Chio Li MBChB , Kevin Ka-ho Kam MBChB , Kent, Chak-yu So MBChB","doi":"10.1016/j.cjco.2025.08.003","DOIUrl":"10.1016/j.cjco.2025.08.003","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 12","pages":"Pages 1607-1609"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765686","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 : 2025-12-01DOI: 10.1016/j.cjco.2025.07.011
Chao-Lun Lai MD, PhD , K. Arnold Chan MD, ScD , Ting-Ju Lai MS , Ting-Chuan Wang MHA , Cheng-Hsuan Tsai MD , Zheng-Wei Chen MD , Tsung-Yu Ko MD , Min-Tsun Liao MD, PhD , Heng-Yu Pan MD , Sheng-Fu Liu MD , Hsien-Li Kao MD , Yi-Lwun Ho MD, PhD
Background
The influence of immortal time bias on estimates of survival of heart failure (HF) patients with improved ejection fraction (HFimpEF) has not been well elucidated.
Methods
This retrospective cohort study collected patients who had ever been hospitalized owing to HF between January 2012 and June 2022 at National Taiwan University Hospital (NTUH), the NTUH Hsin-Chu branch, or the NTUH Yun-Lin branch. Patients were classified as follows: (i) HF with reduced ejection fraction (HFrEF); (ii) HFimpEF; (iii) HF with mildly reduced ejection fraction (HFmrEF); and (iv) HF with preserved ejection fraction (HFpEF). Four different clinical scenarios were designed to illustrate the impact of the immortal time bias in estimating the long-term survival of patients with HFimpEF.
Results
Overall, 13,085 patients were categorized into 4 groups (HFrEF, n = 2029; HFimpEF, n = 1292; HFmrEF, n = 1849; and HFpEF, n = 7915). In our scenario 2, which retained the immortal time in HFimpEF patients, the HFimpEF group exhibited a substantially lower risk of all-cause mortality compared with the HFrEF group (adjusted hazard ratio 0.30, 95% confidence interval 0.27-0.33). After applying time-varying Cox regression analysis to appropriately account for immortal time bias in our scenario 4, model 4-2, the survival benefit was notably attenuated, yielding an adjusted hazard ratio of 0.77 (95% confidence interval 0.70-0.86) for the HFimpEF group relative to the HFrEF group.
Conclusions
Time-varying Cox regression analysis should be used to minimize the immortal time bias in retrospective studies concerning survival of patients with HFimpEF.
背景：不朽时间偏差对射血分数改善的心力衰竭（HF）患者生存估计的影响尚未得到很好的阐明。方法回顾性队列研究收集2012年1月至2022年6月在国立台湾大学附属医院（NTUH）、NTUH新竹分院和NTUH云林分院因心衰住院的患者。患者分类如下：(i) HF伴射血分数降低（HFrEF）；(2) HFimpEF;（iii） HF伴轻度射血分数降低（HFmrEF）；（iv）保留射血分数（HFpEF）的HF。设计了四种不同的临床场景来说明永生时间偏差对估计HFimpEF患者长期生存的影响。结果13085例患者共分为4组（HFrEF, n = 2029; HFimpEF, n = 1292; HFmrEF, n = 1849; HFpEF, n = 7915）。在我们的情景2中，HFimpEF患者保留了永生时间，与HFrEF组相比，HFimpEF组的全因死亡风险显著降低（校正风险比0.30,95%置信区间0.27-0.33）。在我们的情景4（模型4-2）中，应用时变Cox回归分析适当地解释了不朽的时间偏差后，生存获益明显减弱，相对于HFrEF组，HFimpEF组的调整风险比为0.77（95%置信区间0.70-0.86）。结论在回顾性研究HFimpEF患者的生存情况时，应采用时变Cox回归分析，以尽量减少不朽时间偏差。
{"title":"The Impact of Immortal Time Bias on Survival Estimates of Patients with Heart Failure with Improved Ejection Fraction","authors":"Chao-Lun Lai MD, PhD , K. Arnold Chan MD, ScD , Ting-Ju Lai MS , Ting-Chuan Wang MHA , Cheng-Hsuan Tsai MD , Zheng-Wei Chen MD , Tsung-Yu Ko MD , Min-Tsun Liao MD, PhD , Heng-Yu Pan MD , Sheng-Fu Liu MD , Hsien-Li Kao MD , Yi-Lwun Ho MD, PhD","doi":"10.1016/j.cjco.2025.07.011","DOIUrl":"10.1016/j.cjco.2025.07.011","url":null,"abstract":"<div><h3>Background</h3><div>The influence of immortal time bias on estimates of survival of heart failure (HF) patients with improved ejection fraction (HFimpEF) has not been well elucidated.</div></div><div><h3>Methods</h3><div>This retrospective cohort study collected patients who had ever been hospitalized owing to HF between January 2012 and June 2022 at National Taiwan University Hospital (NTUH), the NTUH Hsin-Chu branch, or the NTUH Yun-Lin branch. Patients were classified as follows: (i) HF with reduced ejection fraction (HFrEF); (ii) HFimpEF; (iii) HF with mildly reduced ejection fraction (HFmrEF); and (iv) HF with preserved ejection fraction (HFpEF). Four different clinical scenarios were designed to illustrate the impact of the immortal time bias in estimating the long-term survival of patients with HFimpEF.</div></div><div><h3>Results</h3><div>Overall, 13,085 patients were categorized into 4 groups (HFrEF, n = 2029; HFimpEF, n = 1292; HFmrEF, n = 1849; and HFpEF, n = 7915). In our scenario 2, which retained the immortal time in HFimpEF patients, the HFimpEF group exhibited a substantially lower risk of all-cause mortality compared with the HFrEF group (adjusted hazard ratio 0.30, 95% confidence interval 0.27-0.33). After applying time-varying Cox regression analysis to appropriately account for immortal time bias in our scenario 4, model 4-2, the survival benefit was notably attenuated, yielding an adjusted hazard ratio of 0.77 (95% confidence interval 0.70-0.86) for the HFimpEF group relative to the HFrEF group.</div></div><div><h3>Conclusions</h3><div>Time-varying Cox regression analysis should be used to minimize the immortal time bias in retrospective studies concerning survival of patients with HFimpEF.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 12","pages":"Pages 1549-1560"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765778","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 : 2025-12-01DOI: 10.1016/j.cjco.2025.08.006
Gordon Moe MD , Michael A. Campitelli MPH , Milan Gupta MD , Chi-Ming Chow MD , Dennis T. Ko MD , Tomi Odugbemi MSc , Isobel Sharpe MSc , Peter P. Liu MD , Joseph Y. Chu MD
Background
We previously demonstrated that the mortality rate following COVID-19 infection was higher in the Chinese population and lower in the South Asian population, compared to the general Ontario population. COVID-19 vaccines are effective in protecting against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-related diseases. Whether vaccination rates and the postvaccination risk of myocarditis and/or pericarditis are similar among ethnic groups is unclear.
Methods
We conducted a population-based, retrospective cohort study using linked health datasets from Ontario to compare COVID-19 vaccination and postvaccination myocarditisand/or pericarditis rates among the Chinese, South Asian, and general populations. Populations were identified using a surname-based algorithm. The cohort was defined on December 1, 2020, coinciding with vaccine availability, and followed until June 30, 2022, for first and second dose. Myocarditis and/or pericarditis hospital admissions and emergency department visits within 42 days postvaccination were analyzed.
Results
For the first dose, vaccination uptake was highest in the general population during the first 120 days. Afterwards, the Chinese and South Asian populations had a higher vaccine rate. A similar pattern was observed for the second dose. Postvaccination myocarditis and/or pericarditis rates were lower among the Chinese population (20 per 1,000,000 first doses) and the South Asian population (21 per 1,000,000 first doses), compared to that in the general population (51 per 1,000,000 first doses), with similar findings following the second dose. The standardized morbidity ratios, comparing observed vs expected myocarditis and/or pericarditis rates postvaccination were similar across the study groups.
Conclusions
A time-dependent differential uptake and lower incidence of postvaccination myocarditis and/or pericarditis occurred among the Chinese and South Asian populations, compared to the general population. Our findings help inform the design of future research and health delivery programs.
{"title":"COVID-19 Vaccination Uptake and Myocarditis and/or Pericarditis Complications Among Chinese and South Asian Individuals in Ontario","authors":"Gordon Moe MD , Michael A. Campitelli MPH , Milan Gupta MD , Chi-Ming Chow MD , Dennis T. Ko MD , Tomi Odugbemi MSc , Isobel Sharpe MSc , Peter P. Liu MD , Joseph Y. Chu MD","doi":"10.1016/j.cjco.2025.08.006","DOIUrl":"10.1016/j.cjco.2025.08.006","url":null,"abstract":"<div><h3>Background</h3><div>We previously demonstrated that the mortality rate following COVID-19 infection was higher in the Chinese population and lower in the South Asian population, compared to the general Ontario population. COVID-19 vaccines are effective in protecting against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-related diseases. Whether vaccination rates and the postvaccination risk of myocarditis and/or pericarditis are similar among ethnic groups is unclear.</div></div><div><h3>Methods</h3><div>We conducted a population-based, retrospective cohort study using linked health datasets from Ontario to compare COVID-19 vaccination and postvaccination myocarditisand/or pericarditis rates among the Chinese, South Asian, and general populations. Populations were identified using a surname-based algorithm. The cohort was defined on December 1, 2020, coinciding with vaccine availability, and followed until June 30, 2022, for first and second dose. Myocarditis and/or pericarditis hospital admissions and emergency department visits within 42 days postvaccination were analyzed.</div></div><div><h3>Results</h3><div>For the first dose, vaccination uptake was highest in the general population during the first 120 days. Afterwards, the Chinese and South Asian populations had a higher vaccine rate. A similar pattern was observed for the second dose. Postvaccination myocarditis and/or pericarditis rates were lower among the Chinese population (20 per 1,000,000 first doses) and the South Asian population (21 per 1,000,000 first doses), compared to that in the general population (51 per 1,000,000 first doses), with similar findings following the second dose. The standardized morbidity ratios, comparing observed vs expected myocarditis and/or pericarditis rates postvaccination were similar across the study groups.</div></div><div><h3>Conclusions</h3><div>A time-dependent differential uptake and lower incidence of postvaccination myocarditis and/or pericarditis occurred among the Chinese and South Asian populations, compared to the general population. Our findings help inform the design of future research and health delivery programs.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 12","pages":"Pages 1561-1570"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765695","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 : 2025-12-01DOI: 10.1016/j.cjco.2025.08.017
Allen A. Razavi MD , Aminah Sallam MD , Betemariam Sharew BA , Claire Perez MD , Mamoo Nakamura MD , Andrew Czarnecki MD , Michael E. Bowdish MD, MS , Natalia N. Egorova PhD , Joanna Chikwe MD , Derrick Y. Tam MD, PhD
The effectiveness of tricuspid transcatheter edge-to-edge repair (TEER) in reducing heart failure (HF) hospitalizations is unclear. Using Medicare and Medicaid data (2015-2019), 487 patients undergoing isolated tricuspid TEER (n = 258) or concomitant tricuspid and mitral TEER (n = 229) were identified. HF hospitalization rates were compared across 4 time periods (in days: 1-30, 31-90, 91-182, 183-365) using Poisson regression. Patients (median age: 80 years) had fewer HF hospitalizations after tricuspid TEER (adjusted rate ratio 0.55, 95% confidence interval: 0.43-0.70, P < 0.001) and when separated by concomitant tricuspid and mitral TEER (adjusted rate ratio 0.57, 95% confidence interval: 0.42-0.79, P < 0.001). In real-world analysis, tricuspid-TEER is associated with a reduced HF hospitalization rate.
{"title":"Impact of Transcatheter Tricuspid Valve Repair on Pre- and Post-Procedural Hospitalization Rates","authors":"Allen A. Razavi MD , Aminah Sallam MD , Betemariam Sharew BA , Claire Perez MD , Mamoo Nakamura MD , Andrew Czarnecki MD , Michael E. Bowdish MD, MS , Natalia N. Egorova PhD , Joanna Chikwe MD , Derrick Y. Tam MD, PhD","doi":"10.1016/j.cjco.2025.08.017","DOIUrl":"10.1016/j.cjco.2025.08.017","url":null,"abstract":"<div><div>The effectiveness of tricuspid transcatheter edge-to-edge repair (TEER) in reducing heart failure (HF) hospitalizations is unclear. Using Medicare and Medicaid data (2015-2019), 487 patients undergoing isolated tricuspid TEER (n = 258) or concomitant tricuspid and mitral TEER (n = 229) were identified. HF hospitalization rates were compared across 4 time periods (in days: 1-30, 31-90, 91-182, 183-365) using Poisson regression. Patients (median age: 80 years) had fewer HF hospitalizations after tricuspid TEER (adjusted rate ratio 0.55, 95% confidence interval: 0.43-0.70, <em>P</em> < 0.001) and when separated by concomitant tricuspid and mitral TEER (adjusted rate ratio 0.57, 95% confidence interval: 0.42-0.79, <em>P</em> < 0.001). In real-world analysis, tricuspid-TEER is associated with a reduced HF hospitalization rate.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 12","pages":"Pages 1602-1606"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765688","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 : 2025-12-01DOI: 10.1016/j.cjco.2025.08.001
Karim Khadir MD, Georgiana Pintea Bentea MD, PhD, Thomas Nguyen MD, Brahim Berdaoui MD, Jose Castro Rodriguez MD
Background
Flecainide is an antiarrhythmic drug effective against both ventricular and supraventricular arrhythmias. However, its use is limited by concerns over potential severe toxicity. This study aims to characterize flecainide toxicity in current clinical practice and identify its associated risk factors and markers.
Methods
We conducted a retrospective, single-centre analysis of all patients admitted to Brugmann Hospital, Brussels, Belgium during 2014-2022 who received flecainide and had a follow-up period of a minimum of 3 months. We compared baseline characteristics of patients who developed toxicity to flecainide with those of patients who did not.
Results
A total of 300 patients were included; 39 (13%) developed flecainide toxicity, with a mortality rate of 18% among these cases. Several risk factors and markers were associated with toxicity, including baseline sinus bradycardia, chronic kidney disease, hepatic cirrhosis, drug interactions, left ventricular ejection fraction during treatment, baseline QT interval duration, and prolongation of QRS and QT intervals during treatment. Baseline ischemic or structural heart disease, with or without left ventricular dysfunction, did not emerge as a risk factor for toxicity.
Conclusions
Flecainide toxicity remains of consequence as it is associated with significant morbidity and mortality. Classic contraindications, such as left ventricular dysfunction or structural heart disease, were not associated with an increased risk of toxicity. Instead, metabolic retention factors (chronic kidney disease, hepatic cirrhosis, or drug interactions) and preclinical markers of overdose (sinus bradycardia, left ventricular ejection fraction under treatment, baseline QT interval, and prolongation of QRS and QT intervals during treatment) increased the likelihood of toxicity.
{"title":"Risk Factors and Markers for Flecainide Toxicity in Clinical Practice","authors":"Karim Khadir MD, Georgiana Pintea Bentea MD, PhD, Thomas Nguyen MD, Brahim Berdaoui MD, Jose Castro Rodriguez MD","doi":"10.1016/j.cjco.2025.08.001","DOIUrl":"10.1016/j.cjco.2025.08.001","url":null,"abstract":"<div><h3>Background</h3><div>Flecainide is an antiarrhythmic drug effective against both ventricular and supraventricular arrhythmias. However, its use is limited by concerns over potential severe toxicity. This study aims to characterize flecainide toxicity in current clinical practice and identify its associated risk factors and markers.</div></div><div><h3>Methods</h3><div>We conducted a retrospective, single-centre analysis of all patients admitted to Brugmann Hospital, Brussels, Belgium during 2014-2022 who received flecainide and had a follow-up period of a minimum of 3 months. We compared baseline characteristics of patients who developed toxicity to flecainide with those of patients who did not.</div></div><div><h3>Results</h3><div>A total of 300 patients were included; 39 (13%) developed flecainide toxicity, with a mortality rate of 18% among these cases. Several risk factors and markers were associated with toxicity, including baseline sinus bradycardia, chronic kidney disease, hepatic cirrhosis, drug interactions, left ventricular ejection fraction during treatment, baseline QT interval duration, and prolongation of QRS and QT intervals during treatment. Baseline ischemic or structural heart disease, with or without left ventricular dysfunction, did not emerge as a risk factor for toxicity.</div></div><div><h3>Conclusions</h3><div>Flecainide toxicity remains of consequence as it is associated with significant morbidity and mortality. Classic contraindications, such as left ventricular dysfunction or structural heart disease, were not associated with an increased risk of toxicity. Instead, metabolic retention factors (chronic kidney disease, hepatic cirrhosis, or drug interactions) and preclinical markers of overdose (sinus bradycardia, left ventricular ejection fraction under treatment, baseline QT interval, and prolongation of QRS and QT intervals during treatment) increased the likelihood of toxicity.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 12","pages":"Pages 1621-1628"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765690","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 : 2025-12-01DOI: 10.1016/j.cjco.2025.08.009
Maha Al-Mohaissen MBBS, MRCP UK, SBIM, ArBIM , Terry Lee PHD , Mohammad Bara Qattea MBBS, SBIM, SBOC, NBE
Background
Diastolic dysfunction (DD) in heart failure with reduced ejection fraction (HFrEF) is relatively understudied, particularly regarding longitudinal changes in DD after HFrEF diagnosis and their clinical and echocardiographic associations.
Methods
This retrospective study included 360 patients with HFrEF who visited heart failure (HF) clinics in King Salman Heart Center, Riyadh, Saudi Arabia, between October 2019 and January 2020. Associations between DD grades and patients’ clinical characteristics and echocardiographic parameters at diagnosis and during follow-up were evaluated.
Results
At diagnosis, left ventricular ejection fraction (LVEF) was 26.7% ( ± 7.2%), and 43.1%, 29.4%, and 27.5% of patients had grade III, II, and I DD, respectively. After 3.4 years, 65% and 57.5% of patients with grades III and II DD, respectively, improved by at least one grade. Concordant improvements in almost all diastolic parameters were observed. DD grade improvement was predicted by increased LVEF (P < 0.001), nonischemic HF etiology, and absence of myocardial infarction (P < 0.001). No associations were found with HF medications or cardiovascular risk factors. DD improvement was independently associated with improved New York Heart Association class (P = 0.008), lower B-type natriuretic peptide level (P < 0.001), and higher systolic blood pressure (P < 0.001), regardless of LVEF, age, and time since diagnosis.
Conclusions
In HFrEF, DD improves with better LVEF and absence of ischemia or infarction. DD improvement is independently associated with improved New York Heart Association class, systolic blood pressure, and B-type natriuretic peptide level, suggesting that in HFrEF, diastolic HF coexists with and parallels systolic HF severity, and contributes independently to symptoms and hemodynamics.
{"title":"Longitudinal Changes in Diastolic Dysfunction in Heart Failure with Reduced Ejection Fraction: Clinical and Echocardiographic Associations","authors":"Maha Al-Mohaissen MBBS, MRCP UK, SBIM, ArBIM , Terry Lee PHD , Mohammad Bara Qattea MBBS, SBIM, SBOC, NBE","doi":"10.1016/j.cjco.2025.08.009","DOIUrl":"10.1016/j.cjco.2025.08.009","url":null,"abstract":"<div><h3>Background</h3><div>Diastolic dysfunction (DD) in heart failure with reduced ejection fraction (HFrEF) is relatively understudied, particularly regarding longitudinal changes in DD after HFrEF diagnosis and their clinical and echocardiographic associations.</div></div><div><h3>Methods</h3><div>This retrospective study included 360 patients with HFrEF who visited heart failure (HF) clinics in King Salman Heart Center, Riyadh, Saudi Arabia, between October 2019 and January 2020. Associations between DD grades and patients’ clinical characteristics and echocardiographic parameters at diagnosis and during follow-up were evaluated.</div></div><div><h3>Results</h3><div>At diagnosis, left ventricular ejection fraction (LVEF) was 26.7% ( ± 7.2%), and 43.1%, 29.4%, and 27.5% of patients had grade III, II, and I DD, respectively. After 3.4 years, 65% and 57.5% of patients with grades III and II DD, respectively, improved by at least one grade. Concordant improvements in almost all diastolic parameters were observed. DD grade improvement was predicted by increased LVEF (<em>P</em> < 0.001), nonischemic HF etiology, and absence of myocardial infarction (<em>P</em> < 0.001). No associations were found with HF medications or cardiovascular risk factors. DD improvement was independently associated with improved New York Heart Association class (<em>P</em> = 0.008), lower B-type natriuretic peptide level (<em>P</em> < 0.001), and higher systolic blood pressure (<em>P</em> < 0.001), regardless of LVEF, age, and time since diagnosis.</div></div><div><h3>Conclusions</h3><div>In HFrEF, DD improves with better LVEF and absence of ischemia or infarction. DD improvement is independently associated with improved New York Heart Association class, systolic blood pressure, and B-type natriuretic peptide level, suggesting that in HFrEF, diastolic HF coexists with and parallels systolic HF severity, and contributes independently to symptoms and hemodynamics.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 12","pages":"Pages 1571-1583"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765776","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 : 2025-12-01DOI: 10.1016/j.cjco.2025.09.003
Sanaz Lordfard BSc , Jian Wang MD , Adam D. McIntyre BSc , Brooke A. Kennedy BSc , Robert A. Hegele MD
Background
Heterozygous familial hypercholesterolemia (HeFH) is the most prevalent inherited dyslipidemia, and it predisposes individuals to premature atherosclerotic cardiovascular disease. Genetic testing can provide a definitive diagnosis. The spectrum of causal DNA variants in Ontario patients with hypercholesterolemia is not fully defined.
Methods
In Southwestern Ontario patients with a clinical diagnosis of HeFH, we performed targeted next-generation DNA sequencing and bioinformatic analysis to determine the qualitative and quantitative spectrum of pathogenic and likely pathogenic (P/LP) variants.
Results
We observed 101 unique P/LP variants in 254 patients, of which 6 were novel LDLR pathogenic variants. We observed 23 variants of uncertain significance among 30 patients. Phenotypic severity followed a descending biochemical gradient for the LDLR P/LP variant, the APOB variant, and the variants of uncertain significance subgroups. The 3 most commonly observed P/LP variants were APOB p.R3527Q, LDLR 15.8 kb French Canadian deletion, and LDLR p.C681X Middle Eastern variant, seen in 15.4%, 7.1%, and 3.1% of patients, respectively. About three-quarters of variants originated in Europe, with others from Asia, Africa, and the Middle East.
Conclusions
This study provides a comprehensive overview of the clinical and genetic spectrum of HeFH in Southwestern Ontario. The P/LP variant diversity reflects historical colonization and later migration patterns both from across the world and interprovincially from Quebec.
{"title":"Spectrum of DNA Variants in Southwestern Ontario Patients with Familial Hypercholesterolemia","authors":"Sanaz Lordfard BSc , Jian Wang MD , Adam D. McIntyre BSc , Brooke A. Kennedy BSc , Robert A. Hegele MD","doi":"10.1016/j.cjco.2025.09.003","DOIUrl":"10.1016/j.cjco.2025.09.003","url":null,"abstract":"<div><h3>Background</h3><div>Heterozygous familial hypercholesterolemia (HeFH) is the most prevalent inherited dyslipidemia, and it predisposes individuals to premature atherosclerotic cardiovascular disease. Genetic testing can provide a definitive diagnosis. The spectrum of causal DNA variants in Ontario patients with hypercholesterolemia is not fully defined.</div></div><div><h3>Methods</h3><div>In Southwestern Ontario patients with a clinical diagnosis of HeFH, we performed targeted next-generation DNA sequencing and bioinformatic analysis to determine the qualitative and quantitative spectrum of pathogenic and likely pathogenic (P/LP) variants.</div></div><div><h3>Results</h3><div>We observed 101 unique P/LP variants in 254 patients, of which 6 were novel <em>LDLR</em> pathogenic variants. We observed 23 variants of uncertain significance among 30 patients. Phenotypic severity followed a descending biochemical gradient for the <em>LDLR</em> P/LP variant, the <em>APOB</em> variant, and the variants of uncertain significance subgroups. The 3 most commonly observed P/LP variants were <em>APOB</em> p.R3527Q, <em>LDLR</em> 15.8 kb French Canadian deletion, and <em>LDLR</em> p.C681X Middle Eastern variant, seen in 15.4%, 7.1%, and 3.1% of patients, respectively. About three-quarters of variants originated in Europe, with others from Asia, Africa, and the Middle East.</div></div><div><h3>Conclusions</h3><div>This study provides a comprehensive overview of the clinical and genetic spectrum of HeFH in Southwestern Ontario. The P/LP variant diversity reflects historical colonization and later migration patterns both from across the world and interprovincially from Quebec.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 12","pages":"Pages 1645-1651"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765693","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 : 2025-12-01DOI: 10.1016/j.cjco.2025.08.013
Reem Alsaeid MD , Nitish K. Dhingra MD , James Stevenson MD , Rachel Heo MD , Juglans Alvarez MD, MSc , Chun Po S. Fan PhD , Farid Foroutan MD , Natasha Aleksova MD, MSc , Heather J. Ross MD, MHSc , Michael McDonald MD , Filio Billia MD, PhD , Pierre-Emmanuel Noly MD , Maxime Tremblay-Gravel MD, MSc , Dave Nagpal MD , Lauren Truby MD, MSc , Sharon Chih MD, PhD , Vivek Rao MD, PhD , Yasbanoo Moayedi MD, MHSc, FRCPC
Background
There is a clinical need for randomized evidence to establish the comparative efficacy of organ preservation techniques for heart transplantation in Canada. In this study we used a survey to evaluate the feasibility and value of a randomized trial comparing cold-static preservation with novel donor storage platforms.
Methods
A validated survey was distributed to 30 members of the Canadian Cardiac Transplant Network, including adult heart failure cardiologists, pediatric cardiologists, and cardiovascular surgeons. Survey sections addressed demographics, clinical scenarios, perceived benefits, barriers, and willingness to participate in a randomized trial.
Results
Twenty-six experts (87%) responded: 65% were adult heart failure cardiologists, 27% were women, and 54% practiced in Ontario. Respondents were evenly distributed across career stages. All expressed interest in participating in a trial, and 88% were comfortable with study blinding. Willingness to randomize declined with anticipated ischemic times: > 80% for < 6 hours, 42% for 6-8 hours, and 31% for > 8 hours. Key benefits identified included improved donor utilization (69%), better outcomes (58%), and enhanced scientific understanding (58%). The major barrier was device cost (73%).
Conclusions
Canadian experts reported interest and perceived equipoise for a randomized trial of organ preservation strategies, although cost remains a key barrier. Such a trial could standardize protocols and strengthen the evidence base guiding heart transplantation practice.
{"title":"Expert Perspectives on a Randomized Controlled Trial Comparing Novel Donor Storage Platforms to Cold-static Preservation for Heart Transplantation","authors":"Reem Alsaeid MD , Nitish K. Dhingra MD , James Stevenson MD , Rachel Heo MD , Juglans Alvarez MD, MSc , Chun Po S. Fan PhD , Farid Foroutan MD , Natasha Aleksova MD, MSc , Heather J. Ross MD, MHSc , Michael McDonald MD , Filio Billia MD, PhD , Pierre-Emmanuel Noly MD , Maxime Tremblay-Gravel MD, MSc , Dave Nagpal MD , Lauren Truby MD, MSc , Sharon Chih MD, PhD , Vivek Rao MD, PhD , Yasbanoo Moayedi MD, MHSc, FRCPC","doi":"10.1016/j.cjco.2025.08.013","DOIUrl":"10.1016/j.cjco.2025.08.013","url":null,"abstract":"<div><h3>Background</h3><div>There is a clinical need for randomized evidence to establish the comparative efficacy of organ preservation techniques for heart transplantation in Canada. In this study we used a survey to evaluate the feasibility and value of a randomized trial comparing cold-static preservation with novel donor storage platforms.</div></div><div><h3>Methods</h3><div>A validated survey was distributed to 30 members of the Canadian Cardiac Transplant Network, including adult heart failure cardiologists, pediatric cardiologists, and cardiovascular surgeons. Survey sections addressed demographics, clinical scenarios, perceived benefits, barriers, and willingness to participate in a randomized trial.</div></div><div><h3>Results</h3><div>Twenty-six experts (87%) responded: 65% were adult heart failure cardiologists, 27% were women, and 54% practiced in Ontario. Respondents were evenly distributed across career stages. All expressed interest in participating in a trial, and 88% were comfortable with study blinding. Willingness to randomize declined with anticipated ischemic times: > 80% for < 6 hours, 42% for 6-8 hours, and 31% for > 8 hours. Key benefits identified included improved donor utilization (69%), better outcomes (58%), and enhanced scientific understanding (58%). The major barrier was device cost (73%).</div></div><div><h3>Conclusions</h3><div>Canadian experts reported interest and perceived equipoise for a randomized trial of organ preservation strategies, although cost remains a key barrier. Such a trial could standardize protocols and strengthen the evidence base guiding heart transplantation practice.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 12","pages":"Pages 1652-1657"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765694","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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