Pub Date : 2026-02-01Epub Date: 2025-10-21DOI: 10.1016/j.cjco.2025.10.003
Mina Garas MBBCh , Paul Mundra MD , Brian McGrath MB, BCh, BAO , Marc-André d’Entremont MD, MPH , Denise Tiong MBChB , Giacomo Maria Cioffi MD , Turki Al Garni MD , Omar Ibrahim MD , Ibrahim Alharbi MD , Mehdi Madanchi MD , Karen Mosleh MSc , Renu Syal BA , Julie Hoyle RN, MN , Samuel Lemaire-Paquette MSc , Natalia Pinilla-Echeverri MD , Michael Tsang MD MSc HSE , Matthew Sibbald MD, MHPE, MSc, PhD , Sanjit Jolly MD, MSc , Nicholas Valettas MD , James Velianou MD , JD Schwalm MD, MSc
Background
In many Canadian regions, ST-elevation myocardial infarction (STEMI) patients are managed in a “hub and spoke” model with early repatriation to referring hospitals and rapid discharge pathways that may lead to suboptimal secondary prevention during the critical postdischarge period. We implemented a regional virtual STEMI clinic (VSC) to identify and address gaps in postdischarge care.
Methods
We performed standardized virtual follow-ups for STEMI patients who presented at one tertiary hospital (hub) between November 2023 and November 2024. Standardized VSC follow-up data were used to describe baseline characteristics and secondary prevention interventions. Poisson regression was used to identify baseline characteristics associated with the likelihood of requiring secondary prevention interventions to achieve guideline-directed post-STEMI care.
Results
A total of 586 patients were seen in the VSC within a median of 3.9 weeks (interquartile range 2.6) post-STEMI, representing 74.6% of all STEMI patients treated at our centre. Notably, 62.2% of diabetic patients had inadequate glucose control, 19.9% of all patients had a suboptimal lipid status, and 6.6% were newly identified as prediabetic. A total of 73.1% of patients received at least one intervention, including guideline-recommended medication adjustment (35.7%), bloodwork recommendation (31.0%), and referral to cardiac rehabilitation (30.6%). Diabetes was associated with an increase in the rate of new interventions, and every 10-year increase in age was associated with a decrease. The discharging hospital was not a significant predictor of new interventions.
Conclusions
A structured VSC enabled timely post-STEMI follow-up, identifying and addressing key gaps in secondary prevention postdischarge, including lifestyle modification, guideline-recommended medication optimization, and appropriate follow-up care.
{"title":"Secondary Prevention in STEMI Patients: Insights from a Regional Virtual STEMI Clinic","authors":"Mina Garas MBBCh , Paul Mundra MD , Brian McGrath MB, BCh, BAO , Marc-André d’Entremont MD, MPH , Denise Tiong MBChB , Giacomo Maria Cioffi MD , Turki Al Garni MD , Omar Ibrahim MD , Ibrahim Alharbi MD , Mehdi Madanchi MD , Karen Mosleh MSc , Renu Syal BA , Julie Hoyle RN, MN , Samuel Lemaire-Paquette MSc , Natalia Pinilla-Echeverri MD , Michael Tsang MD MSc HSE , Matthew Sibbald MD, MHPE, MSc, PhD , Sanjit Jolly MD, MSc , Nicholas Valettas MD , James Velianou MD , JD Schwalm MD, MSc","doi":"10.1016/j.cjco.2025.10.003","DOIUrl":"10.1016/j.cjco.2025.10.003","url":null,"abstract":"<div><h3>Background</h3><div>In many Canadian regions, ST-elevation myocardial infarction (STEMI) patients are managed in a “hub and spoke” model with early repatriation to referring hospitals and rapid discharge pathways that may lead to suboptimal secondary prevention during the critical postdischarge period. We implemented a regional virtual STEMI clinic (VSC) to identify and address gaps in postdischarge care.</div></div><div><h3>Methods</h3><div>We performed standardized virtual follow-ups for STEMI patients who presented at one tertiary hospital (hub) between November 2023 and November 2024. Standardized VSC follow-up data were used to describe baseline characteristics and secondary prevention interventions. Poisson regression was used to identify baseline characteristics associated with the likelihood of requiring secondary prevention interventions to achieve guideline-directed post-STEMI care.</div></div><div><h3>Results</h3><div>A total of 586 patients were seen in the VSC within a median of 3.9 weeks (interquartile range 2.6) post-STEMI, representing 74.6% of all STEMI patients treated at our centre. Notably, 62.2% of diabetic patients had inadequate glucose control, 19.9% of all patients had a suboptimal lipid status, and 6.6% were newly identified as prediabetic. A total of 73.1% of patients received at least one intervention, including guideline-recommended medication adjustment (35.7%), bloodwork recommendation (31.0%), and referral to cardiac rehabilitation (30.6%). Diabetes was associated with an increase in the rate of new interventions, and every 10-year increase in age was associated with a decrease. The discharging hospital was not a significant predictor of new interventions.</div></div><div><h3>Conclusions</h3><div>A structured VSC enabled timely post-STEMI follow-up, identifying and addressing key gaps in secondary prevention postdischarge, including lifestyle modification, guideline-recommended medication optimization, and appropriate follow-up care.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 2","pages":"Pages 222-230"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327539","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 : 2026-02-01Epub Date: 2025-11-07DOI: 10.1016/j.cjco.2025.10.017
Bennett Collis MD , Takaaki Kobayashi MD, PhD, MPH , Evan Hall MD , Talal Alnabelsi MD , Chloe Cao MD , Meredith Johnson MD , John Gurley MD , Hassan Reda MD , Tessa London MD , Erinn Ogburn MD , Michael Sekela MD , Bobbi Jo Stoner PharmD , Sami El-Dalati MD
Background
Prosthetic valve endocarditis (PVE) is a serious complication of valve replacement associated with significant morbidity and mortality. However, outcomes for medical vs surgical strategies remain incompletely characterized.
Methods
We conducted a retrospective cohort study of adult patients with PVE, defined by modified Duke criteria, evaluated by a multidisciplinary endocarditis team at a tertiary-care centre between September 2021 and February 2024. Demographic, clinical, management, and outcome data were collected. Logistic regression analyses were performed to identify factors associated with in-hospital mortality.
Results
Among 67 patients with PVE, 58.2% (n = 39) were managed medically, and 41.8% (n = 28) underwent surgical intervention during the index hospitalization. Baseline characteristics and comorbidities were similar across groups. The in-hospital mortality incidence was 7.7% in the medical cohort and 10.7% in the surgical cohort, and the incidence of 90-day mortality was 30.8% and 21.4%, respectively. Surgical patients had a longer median length of stay (28 days vs 15 days). Readmission and reinfection rates were comparable. Acute renal failure was the only independent predictor of in-hospital mortality on multivariable analysis (odds ratio, 9.61; 95% confidence interval, 1.19-77.67; P = 0.04). Medical management was not independently associated with increased in-hospital mortality (odds ratio, 0.97; 95% confidence interval, 0.14-6.68; P = 0.97).
Conclusions
In this cohort of patients with PVE, individualized treatment guided by a multidisciplinary team was associated with favourable short-term outcomes. Medical therapy may be a safe alternative in selected patients without surgical indications. Early identification of acute renal dysfunction may assist in prognostication and inform management decisions.
{"title":"Outcomes of Prosthetic Valve Endocarditis Managed by a Multidisciplinary Endocarditis Team: A Retrospective Cohort Study","authors":"Bennett Collis MD , Takaaki Kobayashi MD, PhD, MPH , Evan Hall MD , Talal Alnabelsi MD , Chloe Cao MD , Meredith Johnson MD , John Gurley MD , Hassan Reda MD , Tessa London MD , Erinn Ogburn MD , Michael Sekela MD , Bobbi Jo Stoner PharmD , Sami El-Dalati MD","doi":"10.1016/j.cjco.2025.10.017","DOIUrl":"10.1016/j.cjco.2025.10.017","url":null,"abstract":"<div><h3>Background</h3><div>Prosthetic valve endocarditis (PVE) is a serious complication of valve replacement associated with significant morbidity and mortality. However, outcomes for medical vs surgical strategies remain incompletely characterized.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of adult patients with PVE, defined by modified Duke criteria, evaluated by a multidisciplinary endocarditis team at a tertiary-care centre between September 2021 and February 2024. Demographic, clinical, management, and outcome data were collected. Logistic regression analyses were performed to identify factors associated with in-hospital mortality.</div></div><div><h3>Results</h3><div>Among 67 patients with PVE, 58.2% (n = 39) were managed medically, and 41.8% (n = 28) underwent surgical intervention during the index hospitalization. Baseline characteristics and comorbidities were similar across groups. The in-hospital mortality incidence was 7.7% in the medical cohort and 10.7% in the surgical cohort, and the incidence of 90-day mortality was 30.8% and 21.4%, respectively. Surgical patients had a longer median length of stay (28 days vs 15 days). Readmission and reinfection rates were comparable. Acute renal failure was the only independent predictor of in-hospital mortality on multivariable analysis (odds ratio, 9.61; 95% confidence interval, 1.19-77.67; <em>P</em> = 0.04). Medical management was not independently associated with increased in-hospital mortality (odds ratio, 0.97; 95% confidence interval, 0.14-6.68; <em>P</em> = 0.97).</div></div><div><h3>Conclusions</h3><div>In this cohort of patients with PVE, individualized treatment guided by a multidisciplinary team was associated with favourable short-term outcomes. Medical therapy may be a safe alternative in selected patients without surgical indications. Early identification of acute renal dysfunction may assist in prognostication and inform management decisions.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 2","pages":"Pages 150-159"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327381","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 : 2026-02-01Epub Date: 2025-10-25DOI: 10.1016/j.cjco.2025.10.009
Jason Weatherald MD , Steeve Provencher MD , Jillian Murray MPH , Matthew Badin MBA, MSc , Shane Golden MSc , Lisa Mielniczuk MD , John Swiston MD , Chang Zhang PhD , Cindy Y.Y. Yip PhD , Jean-Claude Mamputu PhD , Brad Millson MBS
Background
Safety and tolerability of selexipag in pulmonary arterial hypertension (PAH) was demonstrated in a phase 3 clinical trial. In this trial, up to 14% of patients receiving selexipag over a median period of 70 weeks prematurely discontinued therapy due to adverse events. However, no data are available on real-world persistence on selexipag in Canada. This study aimed to describe selexipag short and long-term persistence, and predictors of persistence in the Canadian population.
Methods
This retrospective claims-database analysis included adult PAH patients with ≥ 1 selexipag claim between April 2016 and July 2021. Patients were followed for a maximum of 64 months. Kaplan-Meier estimates of persistence were calculated from the index date to the earliest date of discontinuation or censoring. Four models were used to select predictors of persistence, and the 12 most important features based on average rank were built into a Cox proportional hazards model to assess the impact of these predictors on patient persistence with selexipag.
Results
A total of 311 patients (70% female; 71% aged 50-79 years) were included in the study. The Kaplan-Meier estimates of persistence at 6, 12, 24, and 36 months were 76.1%, 61.7%, 48.3%, and 40.2% respectively. The median duration of persistence for the overall cohort was 22 months. No predictors in the final model were significant.
Conclusions
Real-world data from the Canadian population suggest a low level of long-term persistence on selexipag, although the level of persistence is similar to reported rates for other PAH therapies. Further research into predictors of selexipag persistence is needed to help optimize potential treatment outcomes.
{"title":"Real-world Persistence on Selexipag for Pulmonary Arterial Hypertension in Canada","authors":"Jason Weatherald MD , Steeve Provencher MD , Jillian Murray MPH , Matthew Badin MBA, MSc , Shane Golden MSc , Lisa Mielniczuk MD , John Swiston MD , Chang Zhang PhD , Cindy Y.Y. Yip PhD , Jean-Claude Mamputu PhD , Brad Millson MBS","doi":"10.1016/j.cjco.2025.10.009","DOIUrl":"10.1016/j.cjco.2025.10.009","url":null,"abstract":"<div><h3>Background</h3><div>Safety and tolerability of selexipag in pulmonary arterial hypertension (PAH) was demonstrated in a phase 3 clinical trial. In this trial, up to 14% of patients receiving selexipag over a median period of 70 weeks prematurely discontinued therapy due to adverse events. However, no data are available on real-world persistence on selexipag in Canada. This study aimed to describe selexipag short and long-term persistence, and predictors of persistence in the Canadian population.</div></div><div><h3>Methods</h3><div>This retrospective claims-database analysis included adult PAH patients with ≥ 1 selexipag claim between April 2016 and July 2021. Patients were followed for a maximum of 64 months. Kaplan-Meier estimates of persistence were calculated from the index date to the earliest date of discontinuation or censoring. Four models were used to select predictors of persistence, and the 12 most important features based on average rank were built into a Cox proportional hazards model to assess the impact of these predictors on patient persistence with selexipag.</div></div><div><h3>Results</h3><div>A total of 311 patients (70% female; 71% aged 50-79 years) were included in the study. The Kaplan-Meier estimates of persistence at 6, 12, 24, and 36 months were 76.1%, 61.7%, 48.3%, and 40.2% respectively. The median duration of persistence for the overall cohort was 22 months. No predictors in the final model were significant.</div></div><div><h3>Conclusions</h3><div>Real-world data from the Canadian population suggest a low level of long-term persistence on selexipag, although the level of persistence is similar to reported rates for other PAH therapies. Further research into predictors of selexipag persistence is needed to help optimize potential treatment outcomes.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 2","pages":"Pages 231-238"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327430","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 : 2026-02-01Epub Date: 2025-10-31DOI: 10.1016/j.cjco.2025.10.013
Dennis Rottländer MD , Jörg Hausleiter MD , Thomas Schmitz MD , Alexander Bufe MD , Melchior Seyfarth MD , Harald Beucher MD , Taoufik Ouarrak Msc , Steffen Schneider PhD , Peter Boekstegers MD , MITRA-PRO investigators
Background
Chronic kidney disease (CKD) and postprocedural acute kidney injury (AKI) are predictors of survival after mitral transcatheter edge-to-edge repair (TEER). This study aimed to assess the impact of residual mitral regurgitation (MR) on 3-year mortality in patients with vs without CKD or AKI.
Methods
Patients from the prospective, multicentre MITRAClip PROgnosis (MITRA-PRO) registry (n = 1491) were stratified by baseline estimated glomerular filtration rate (eGFR), into 3 groups: > 50, 30–50, and < 30 mL/min per 1.73 m2. Residual MR was quantified using the multimodal MitraScore(≤3, mild; ≥4, relevant).
Results
Patients with eGFR < 30 had significantly higher 3-year mortality (55.4%) compared to those with eGFR 30-50 (40.8%) and eGFR > 50 (27.7%, P < 0.001). Compared to patients with eGFR < 30, the adjusted hazard ratio for mortality was 0.64 (95% confidence interval: 0.51-0.80, P < 0.0001) in the eGFR 30-50 group, and 0.41 (95%confidence interval: 0.32-0.52, P < 0.0001) in the eGFR > 50 group. Relevant residual MR was more frequent in the eGFR < 30 group (33.2%). The combination of relevant residual MR and reduced baseline renal function was associated with worse long-term survival after mitral TEER. Furthermore, the overall cohort was divided into those with (i) no postprocedural AKI (n = 1381) and (ii) postprocedural AKI (n = 105). Postprocedural AKI occurred in 7% of the cohort and was linked to increased mortality (61.5% vs 35.8%, P < 0.001). Patients with both AKI and relevant residual MR had the highest mortality rate.
Conclusions
Residual MR following TEER is a strong predictor of long-term mortality, particularly in patients with CKD. Minimizing residual MR may reduce postprocedural AKI and improve survival outcomes in patients with CKD.
{"title":"Residual Mitral Regurgitation After Transcatheter Edge-to-Edge Repair Worsens Survival in Patients with Renal Dysfunction","authors":"Dennis Rottländer MD , Jörg Hausleiter MD , Thomas Schmitz MD , Alexander Bufe MD , Melchior Seyfarth MD , Harald Beucher MD , Taoufik Ouarrak Msc , Steffen Schneider PhD , Peter Boekstegers MD , MITRA-PRO investigators","doi":"10.1016/j.cjco.2025.10.013","DOIUrl":"10.1016/j.cjco.2025.10.013","url":null,"abstract":"<div><h3>Background</h3><div>Chronic kidney disease (CKD) and postprocedural acute kidney injury (AKI) are predictors of survival after mitral transcatheter edge-to-edge repair (TEER). This study aimed to assess the impact of residual mitral regurgitation (MR) on 3-year mortality in patients with vs without CKD or AKI.</div></div><div><h3>Methods</h3><div>Patients from the prospective, multicentre MITRAClip PROgnosis (MITRA-PRO) registry (n = 1491) were stratified by baseline estimated glomerular filtration rate (eGFR), into 3 groups: > 50, 30–50, and < 30 mL/min per 1.73 m<sup>2</sup>. Residual MR was quantified using the multimodal MitraScore(≤3, mild; ≥4, relevant).</div></div><div><h3>Results</h3><div>Patients with eGFR < 30 had significantly higher 3-year mortality (55.4%) compared to those with eGFR 30-50 (40.8%) and eGFR > 50 (27.7%, <em>P</em> < 0.001). Compared to patients with eGFR < 30, the adjusted hazard ratio for mortality was 0.64 (95% confidence interval: 0.51-0.80, <em>P</em> < 0.0001) in the eGFR 30-50 group, and 0.41 (95%confidence interval: 0.32-0.52, <em>P</em> < 0.0001) in the eGFR > 50 group. Relevant residual MR was more frequent in the eGFR < 30 group (33.2%). The combination of relevant residual MR and reduced baseline renal function was associated with worse long-term survival after mitral TEER. Furthermore, the overall cohort was divided into those with (i) no postprocedural AKI (n = 1381) and (ii) postprocedural AKI (n = 105). Postprocedural AKI occurred in 7% of the cohort and was linked to increased mortality (61.5% vs 35.8%, <em>P</em> < 0.001). Patients with both AKI and relevant residual MR had the highest mortality rate.</div></div><div><h3>Conclusions</h3><div>Residual MR following TEER is a strong predictor of long-term mortality, particularly in patients with CKD. Minimizing residual MR may reduce postprocedural AKI and improve survival outcomes in patients with CKD.</div></div><div><h3>Clinical Trial Registration</h3><div>DRKS00012288.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 2","pages":"Pages 174-186"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327416","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 : 2026-02-01Epub Date: 2025-11-17DOI: 10.1016/j.cjco.2025.10.020
Gaspard Suc MD, PhD , Lawrence Lau MD , Serah Seo MD , Francois Auclair MD , Vicente Corrales-Medina MD , Vincent Chan MD, PhD , Ian G. Burwash MD , Roja Gauda MSc , Fraser Rubens MD, MSc , Kwan L. Chan MD , David Messika-Zeitoun MD, PhD
Background
Mitral annular calcification (MAC) poses unique challenges in infective endocarditis (IE). This study aimed to characterize echocardiographic features of IE involving MAC and assess its management and outcomes.
Methods
We reviewed cases discussed during our IE multidisciplinary meetings, 2021-2024. Clinical data, imaging findings, and outcomes were collected through chart review.
Results
Among 741 patients evaluated, 51 patients (7%; aged 73 ± 11 years; 45% female) had possible or definite IE and moderate-severe MAC. IE involved the mitral valve in 24 patients (47%). Mitral IE was more frequent in women (63% vs 30%, P = 0.02) and was less commonly associated with prior aortic valve replacement (17% vs 59%, P < 0.01). Staphylococcus aureus was the most common pathogen, with no difference between groups (38% vs 30% in the mitral vs nonmitral IE groups, respectively, P = 0.55). Patients with mitral IE often presented with large vegetations (median 13 mm), frequent valvular or perivalvular complications (moderate or greater mitral regurgitation in 54%, perforation in 33%, and perivalvular abscess in 13%). A succulent aspect of the vegetation mass with abnormal MAC mobility, described as "rocking," was observed in 7 patients (29%). Surgical indications were found in 63% of patients, but only 40% underwent surgery due to high perceived risk. The in-hospital mortality incidence was not different between the mitral and nonmitral IE groups (29% vs 15%, P = 0.32).
Conclusions
In patients with IE and MAC, the mitral valve was often primarily affected, showing large, mobile vegetations with a “rocking” motion. Despite frequent surgical indications, few underwent surgery, highlighting the need for improved management in this high-risk group.
背景：二尖瓣环钙化（MAC）在感染性心内膜炎（IE）中提出了独特的挑战。本研究旨在描述涉及MAC的IE超声心动图特征，并评估其管理和结果。方法：我们回顾了2021-2024年IE多学科会议上讨论的病例。通过图表回顾收集临床资料、影像学表现和结果。结果：在741例患者中，51例（7%；年龄73±11岁；45%女性）可能或明确有IE和中重度MAC。IE累及二尖瓣24例（47%）。二尖瓣IE在女性中更为常见（63%对30%，P = 0.02），而与先前主动脉瓣置换术相关的发生率较低（17%对59%，P < 0.01）。金黄色葡萄球菌是最常见的病原体，两组间无差异（二尖瓣组和非二尖瓣IE组分别为38%和30%，P = 0.55）。二尖瓣IE患者通常表现为大的赘生物（中位13mm），频繁的瓣膜或瓣膜周围并发症（中度或重度二尖瓣反流54%，穿孔33%，瓣膜周围脓肿13%）。7例（29%）患者观察到具有异常MAC移动的植被块的多肉性方面，称为“摇晃”。63%的患者发现了手术适应症，但只有40%的患者因感知风险高而接受了手术。二尖瓣组和非二尖瓣IE组的住院死亡率无差异（29% vs 15%, P = 0.32）。结论：在IE和MAC患者中，二尖瓣通常主要受影响，表现为大的、可移动的植物，并伴有“摇摆”运动。尽管手术指征频繁，但很少有人接受手术治疗，这突出了对这一高危群体改进管理的必要性。
{"title":"Infective Endocarditis in Patients with Mitral Annular Calcification: Clinical and Echocardiographic Presentation, Management, and Outcomes","authors":"Gaspard Suc MD, PhD , Lawrence Lau MD , Serah Seo MD , Francois Auclair MD , Vicente Corrales-Medina MD , Vincent Chan MD, PhD , Ian G. Burwash MD , Roja Gauda MSc , Fraser Rubens MD, MSc , Kwan L. Chan MD , David Messika-Zeitoun MD, PhD","doi":"10.1016/j.cjco.2025.10.020","DOIUrl":"10.1016/j.cjco.2025.10.020","url":null,"abstract":"<div><h3>Background</h3><div>Mitral annular calcification (MAC) poses unique challenges in infective endocarditis (IE). This study aimed to characterize echocardiographic features of IE involving MAC and assess its management and outcomes.</div></div><div><h3>Methods</h3><div>We reviewed cases discussed during our IE multidisciplinary meetings, 2021-2024. Clinical data, imaging findings, and outcomes were collected through chart review.</div></div><div><h3>Results</h3><div>Among 741 patients evaluated, 51 patients (7%; aged 73 ± 11 years; 45% female) had possible or definite IE and moderate-severe MAC. IE involved the mitral valve in 24 patients (47%). Mitral IE was more frequent in women (63% vs 30%, <em>P</em> = 0.02) and was less commonly associated with prior aortic valve replacement (17% vs 59%, <em>P</em> < 0.01). <em>Staphylococcus aureus</em> was the most common pathogen, with no difference between groups (38% vs 30% in the mitral vs nonmitral IE groups, respectively, <em>P</em> = 0.55). Patients with mitral IE often presented with large vegetations (median 13 mm), frequent valvular or perivalvular complications (moderate or greater mitral regurgitation in 54%, perforation in 33%, and perivalvular abscess in 13%). A succulent aspect of the vegetation mass with abnormal MAC mobility, described as \"rocking,\" was observed in 7 patients (29%). Surgical indications were found in 63% of patients, but only 40% underwent surgery due to high perceived risk. The in-hospital mortality incidence was not different between the mitral and nonmitral IE groups (29% vs 15%, <em>P</em> = 0.32).</div></div><div><h3>Conclusions</h3><div>In patients with IE and MAC, the mitral valve was often primarily affected, showing large, mobile vegetations with a “rocking” motion. Despite frequent surgical indications, few underwent surgery, highlighting the need for improved management in this high-risk group.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 2","pages":"Pages 140-149"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327415","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 : 2026-02-01Epub Date: 2025-12-04DOI: 10.1016/j.cjco.2025.10.019
Melanie A. Gunawardene MD , Nele Gessler MD , Peter Wohlmuth PhD , Daniel Steven MD , Lars Eckardt MD , Boris A. Hoffmann MD , Andreas Metzner MD , Christian-Hendrik Heeger MD , Malte Kuniss MD , Joachim R. Ehrlich MD , Abdul Shokor Parwani MD , Philipp Bengel MD , Claudia Kalkowski , Stephan Willems MD , EMERGE Cryo Investigators
Evidence is limited on an early treatment strategy for any type of recent-onset atrial fibrillation (AF), comparing anti-arrhythmic drug (AAD) therapy to catheter ablation of patients presenting to the emergency department (ED). The purpose of the EMERGE Cryo study is to investigate the impact of early catheter ablation in patients presenting to the ED with recent-onset AF.
The EMERGE Cryo study is a prospective, 2-arm, randomized, open-label, blinded endpoint, multicentre study to investigate the impact of first-line ablation vs AAD in patients presenting to the ED (within the preceding 2 weeks) with recent-onset (≤ 1 year) paroxysmal or persistent AF (longest AF episode < 6-month duration). All study participants receive an implantable loop recorder. Randomization is based on a 1:1 ratio into 2 study arms: (i) cryo-AF-ablation: pulmonary vein isolation performed with cryoballoon; and (ii) usual care: AAD therapy, including electrical cardioversion, if necessary. A total of 350 patients will be randomized.
Both arms have a blanking period or an AAD optimization period of 3 months, during which adapting the therapy will be allowed. This trial is designed to elaborate whether early AF ablation is superior to usual care. The primary effectiveness endpoint is freedom from any atrial tachyarrhythmia (> 30 seconds) through 3-12 months of follow-up on implantable loop recorder monitoring. Patients will be followed up for 36 months in total.
EMERGE Cryo aims to determine the value of early catheter ablation in AF patients presenting with any type of AF to the ED.
{"title":"From the Emergency Department, Directly to Ablation of Atrial Fibrillation: Rationale and Design of the EMERGE Cryo Study","authors":"Melanie A. Gunawardene MD , Nele Gessler MD , Peter Wohlmuth PhD , Daniel Steven MD , Lars Eckardt MD , Boris A. Hoffmann MD , Andreas Metzner MD , Christian-Hendrik Heeger MD , Malte Kuniss MD , Joachim R. Ehrlich MD , Abdul Shokor Parwani MD , Philipp Bengel MD , Claudia Kalkowski , Stephan Willems MD , EMERGE Cryo Investigators","doi":"10.1016/j.cjco.2025.10.019","DOIUrl":"10.1016/j.cjco.2025.10.019","url":null,"abstract":"<div><div>Evidence is limited on an early treatment strategy for any type of recent-onset atrial fibrillation (AF), comparing anti-arrhythmic drug (AAD) therapy to catheter ablation of patients presenting to the emergency department (ED). The purpose of the EMERGE Cryo study is to investigate the impact of early catheter ablation in patients presenting to the ED with recent-onset AF.</div><div>The EMERGE Cryo study is a prospective, 2-arm, randomized, open-label, blinded endpoint, multicentre study to investigate the impact of first-line ablation vs AAD in patients presenting to the ED (within the preceding 2 weeks) with recent-onset (≤ 1 year) paroxysmal or persistent AF (longest AF episode < 6-month duration). All study participants receive an implantable loop recorder. Randomization is based on a 1:1 ratio into 2 study arms: (i) cryo-AF-ablation: pulmonary vein isolation performed with cryoballoon; and (ii) usual care: AAD therapy, including electrical cardioversion, if necessary. A total of 350 patients will be randomized.</div><div>Both arms have a blanking period or an AAD optimization period of 3 months, during which adapting the therapy will be allowed. This trial is designed to elaborate whether early AF ablation is superior to usual care. The primary effectiveness endpoint is freedom from any atrial tachyarrhythmia (> 30 seconds) through 3-12 months of follow-up on implantable loop recorder monitoring. Patients will be followed up for 36 months in total.</div><div>EMERGE Cryo aims to determine the value of early catheter ablation in AF patients presenting with any type of AF to the ED.</div></div><div><h3>Clinical Trial Registration</h3><div>NCT05294445.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 2","pages":"Pages 197-205"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327473","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 : 2026-02-01Epub Date: 2025-11-03DOI: 10.1016/j.cjco.2025.10.014
Muhtashim Mian MD MSc , Ahmed T. Moustafa MB, BCh, FRCPC , Habib R. Khan MBBS, FRCPUK, PhD
Background
Low diastolic blood pressure (DBP) and high pulse pressure (PP), markers of vascular stiffness, are linked to higher stroke risk and cognitive impairment. Increasing resting heart rate (HR) in pacemaker patients could lower PP and enhance cerebral perfusion. This study examines how raising resting HR affects PP in patients with higher vascular risk.
Methods
A cross-sectional interventional study involved 21 patients (mean age, 77 years; 9 male, 12 female) over age 65 years with dual-chamber permanent pacemakers and normal ventricular function. Hemodynamic parameters were measured at 5-minute intervals at baseline and every 10 beats per minute (bpm) up to 100 bpm using the Finapres NOVA plethysmograph. The effects of higher pacing rates on PP, systolic BP, DBP, and cardiac output were analyzed.
Results
Increasing resting HR significantly reduced PP (p < 0.001) from a median of 71 mmHg at 60 bpm to 53 mmHg at 100 bpm. No significant changes were found in systolic blood pressure (P = 0.32), DBP (P = 0.08), or cardiac index (P = 0.25) among different HRs. All patients remained asymptomatic, and no adverse events were observed during the study. The findings indicated variability in response, with most patients showing decreased PP at higher HRs.
Conclusions
An increased HR to 70 bpm reduced PP in most patients with dual-chamber permanent pacemakers and sinus rhythm, suggesting a way to improve hemodynamics in patients with poor vascular compliance. Customized HR settings may optimize PP and reduce the risk of cognitive decline or stroke. Further research is needed to evaluate for risks of pacemaker-induced cardiomyopathy in individuals requiring frequent ventricular pacing.
{"title":"Elucidating the Relationship Between Pacemaker Heart Rates and Pulse Pressure: A Clue to Optimal Programming in Elderly Patients with Cardiovascular Risk","authors":"Muhtashim Mian MD MSc , Ahmed T. Moustafa MB, BCh, FRCPC , Habib R. Khan MBBS, FRCPUK, PhD","doi":"10.1016/j.cjco.2025.10.014","DOIUrl":"10.1016/j.cjco.2025.10.014","url":null,"abstract":"<div><h3>Background</h3><div>Low diastolic blood pressure (DBP) and high pulse pressure (PP), markers of vascular stiffness, are linked to higher stroke risk and cognitive impairment. Increasing resting heart rate (HR) in pacemaker patients could lower PP and enhance cerebral perfusion. This study examines how raising resting HR affects PP in patients with higher vascular risk.</div></div><div><h3>Methods</h3><div>A cross-sectional interventional study involved 21 patients (mean age, 77 years; 9 male, 12 female) over age 65 years with dual-chamber permanent pacemakers and normal ventricular function. Hemodynamic parameters were measured at 5-minute intervals at baseline and every 10 beats per minute (bpm) up to 100 bpm using the Finapres NOVA plethysmograph. The effects of higher pacing rates on PP, systolic BP, DBP, and cardiac output were analyzed.</div></div><div><h3>Results</h3><div>Increasing resting HR significantly reduced PP (p < 0.001) from a median of 71 mmHg at 60 bpm to 53 mmHg at 100 bpm. No significant changes were found in systolic blood pressure (<em>P</em> = 0.32), DBP (<em>P</em> = 0.08), or cardiac index (<em>P</em> = 0.25) among different HRs. All patients remained asymptomatic, and no adverse events were observed during the study. The findings indicated variability in response, with most patients showing decreased PP at higher HRs.</div></div><div><h3>Conclusions</h3><div>An increased HR to 70 bpm reduced PP in most patients with dual-chamber permanent pacemakers and sinus rhythm, suggesting a way to improve hemodynamics in patients with poor vascular compliance. Customized HR settings may optimize PP and reduce the risk of cognitive decline or stroke. Further research is needed to evaluate for risks of pacemaker-induced cardiomyopathy in individuals requiring frequent ventricular pacing.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 2","pages":"Pages 190-196"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327475","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 : 2026-02-01Epub Date: 2025-10-29DOI: 10.1016/j.cjco.2025.10.011
Catherine R. Jarvis MSc , Pishoy Gouda MB, BCh, BAO, MSc, FRCPC , Justin Ezekowitz MBBCh, MSc, FRCPC , Holly Smith BScN , Benjamin Tyrrell MD, FRCPC , Robert C. Welsh MD, FRCPC
Background
Transcatheter aortic valve insertion (TAVI) is heralded for being minimally invasive and requiring shorter recovery, compared to surgical aortic valve replacement. In 2023, the Canadian Cardiovascular Society published guidelines recommending a 1-month driving (noncommercial drivers) restriction for both procedures. A 2024 Canadian physician survey study showed overwhelming support for a shorter TAVI guideline.
Methods
An observational prospective assessment of TAVI patient recovery was conducted from June 2024 to January 2025 at the Mazankowski Alberta Heart Institute. Post-TAVI patients were followed clinically and completed a 17-question survey examining symptoms, clinical events, and opinions on driving.
Results
Of 111 participants, 96.4% received transfemoral (TF) TAVI. Of patients requiring pacemaker insertion (n = 20), 95% were symptomatic within 1 week of their procedure (1 was symptomatic at 2 weeks). A total of 65% of pacemaker-requiring patients (n = 13 of 20) were implanted during TAVI admission. Readmission for pacemaker insertion (n = 7) occurred in 71.4% (n = 5) within 2 weeks and 28.6% (n = 2) after 3 weeks, a calculated population on-the-road risk of harm of 0.0014%. A total of 90% of pacemaker patients had pre- and/or post-TAVI conduction abnormalities. Two patients developed atrial fibrillation and new right bundle branch block requiring pacemaker insertion at, respectively, 4 and 7 days post-TAVI—a 0.0004% risk. A total of 52.3% expressed that a 1-month driving restriction was “too long.”
Conclusions
With calculated population on-the-road risks of harm well below the established Canadian Cardiovascular Society threshold of 0.005% (1 of 20,000), we propose shortening noncommercial driving restrictions, to 48 hours for patients with successful uncomplicated transfemoral TAVI without conduction disturbances, and to 2 weeks for those with asymptomatic conduction abnormalities who do not receive a pacemaker.
{"title":"An Analysis of Patient Recovery and Opinions on Driving Post–Transcatheter Aortic Valve Insertion (TAVI): the TAVI-D Study","authors":"Catherine R. Jarvis MSc , Pishoy Gouda MB, BCh, BAO, MSc, FRCPC , Justin Ezekowitz MBBCh, MSc, FRCPC , Holly Smith BScN , Benjamin Tyrrell MD, FRCPC , Robert C. Welsh MD, FRCPC","doi":"10.1016/j.cjco.2025.10.011","DOIUrl":"10.1016/j.cjco.2025.10.011","url":null,"abstract":"<div><h3>Background</h3><div>Transcatheter aortic valve insertion (TAVI) is heralded for being minimally invasive and requiring shorter recovery, compared to surgical aortic valve replacement. In 2023, the Canadian Cardiovascular Society published guidelines recommending a 1-month driving (noncommercial drivers) restriction for both procedures. A 2024 Canadian physician survey study showed overwhelming support for a shorter TAVI guideline.</div></div><div><h3>Methods</h3><div>An observational prospective assessment of TAVI patient recovery was conducted from June 2024 to January 2025 at the Mazankowski Alberta Heart Institute. Post-TAVI patients were followed clinically and completed a 17-question survey examining symptoms, clinical events, and opinions on driving.</div></div><div><h3>Results</h3><div>Of 111 participants, 96.4% received transfemoral (TF) TAVI. Of patients requiring pacemaker insertion (n = 20), 95% were symptomatic within 1 week of their procedure (1 was symptomatic at 2 weeks). A total of 65% of pacemaker-requiring patients (n = 13 of 20) were implanted during TAVI admission. Readmission for pacemaker insertion (n = 7) occurred in 71.4% (n = 5) within 2 weeks and 28.6% (n = 2) after 3 weeks, a calculated population on-the-road risk of harm of 0.0014%. A total of 90% of pacemaker patients had pre- and/or post-TAVI conduction abnormalities. Two patients developed atrial fibrillation and new right bundle branch block requiring pacemaker insertion at, respectively, 4 and 7 days post-TAVI—a 0.0004% risk. A total of 52.3% expressed that a 1-month driving restriction was “too long.”</div></div><div><h3>Conclusions</h3><div>With calculated population on-the-road risks of harm well below the established Canadian Cardiovascular Society threshold of 0.005% (1 of 20,000), we propose shortening noncommercial driving restrictions, to 48 hours for patients with successful uncomplicated transfemoral TAVI without conduction disturbances, and to 2 weeks for those with asymptomatic conduction abnormalities who do not receive a pacemaker.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 2","pages":"Pages 164-173"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327327","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 : 2026-02-01Epub Date: 2025-11-07DOI: 10.1016/j.cjco.2025.10.016
Amy N. Brown MD, MSc, MPH , Kailey Stevens MSc , Tiffany Kim MPH, PhD , Shayan Hemmati MD , Hannah Koury MD , Jatinder Sandhu , Cheryl Harten BScPhm, MPA(M) , Toshiro W.S. Sembo MD , William D.T. Kent MD, MSc , Corey Adams MD, MSc , Ali Fatehi Hassanabad MD, MSc, PhD
Background
No Canadian data are available on the economic impact of cardiac surgery hospitalizations for injection drug use-related infective endocarditis (IDU-IE) during the current opioid crisis. This study aimed to quantify the healthcare system cost of care for patients with IDU-IE who required cardiac surgery in Calgary, Alberta, Canada.
Methods
A retrospective cohort analysis of the cost of care for patients diagnosed with IDU-IE who had cardiac surgery between 2013 and 2019 was performed. The overall and categorical costs to the Canadian healthcare system for this specific population were quantified using the Alberta Health Services patient coding system and the Alberta Financial General Ledger.
Results
Eighteen patients were diagnosed with IDU-IE and had cardiac surgery. The majority of patients underwent isolated tricuspid valve surgery. The mean postoperative intensive care unit and total hospital stays were 5.2 days and 24.9 days, respectively. No 30-day or in-hospital mortalities occurred. The average cost per patient from diagnosis to discharge was CAD$131,072 ± $17,844. The average cost of surgical intervention and postoperative course was CAD$63,090 ± $7983. The highest cost contributor was the cost of in-hospital nursing care.
Conclusions
Patients diagnosed with IDU-IE who have cardiac surgery have higher per-patient cost than the general cardiac surgery population, as shown by comparison to other available data. This specific patient population has unique care needs that should be optimized to improve patient outcomes and improve healthcare resource utilization.
{"title":"A Single-Centre Canadian Cost Analysis for the Care and Management of Injection Drug Use-Associated Infective Endocarditis Requiring Cardiac Surgery","authors":"Amy N. Brown MD, MSc, MPH , Kailey Stevens MSc , Tiffany Kim MPH, PhD , Shayan Hemmati MD , Hannah Koury MD , Jatinder Sandhu , Cheryl Harten BScPhm, MPA(M) , Toshiro W.S. Sembo MD , William D.T. Kent MD, MSc , Corey Adams MD, MSc , Ali Fatehi Hassanabad MD, MSc, PhD","doi":"10.1016/j.cjco.2025.10.016","DOIUrl":"10.1016/j.cjco.2025.10.016","url":null,"abstract":"<div><h3>Background</h3><div>No Canadian data are available on the economic impact of cardiac surgery hospitalizations for injection drug use-related infective endocarditis (IDU-IE) during the current opioid crisis. This study aimed to quantify the healthcare system cost of care for patients with IDU-IE who required cardiac surgery in Calgary, Alberta, Canada.</div></div><div><h3>Methods</h3><div>A retrospective cohort analysis of the cost of care for patients diagnosed with IDU-IE who had cardiac surgery between 2013 and 2019 was performed. The overall and categorical costs to the Canadian healthcare system for this specific population were quantified using the Alberta Health Services patient coding system and the Alberta Financial General Ledger.</div></div><div><h3>Results</h3><div>Eighteen patients were diagnosed with IDU-IE and had cardiac surgery. The majority of patients underwent isolated tricuspid valve surgery. The mean postoperative intensive care unit and total hospital stays were 5.2 days and 24.9 days, respectively. No 30-day or in-hospital mortalities occurred. The average cost per patient from diagnosis to discharge was CAD$131,072 ± $17,844. The average cost of surgical intervention and postoperative course was CAD$63,090 ± $7983. The highest cost contributor was the cost of in-hospital nursing care.</div></div><div><h3>Conclusions</h3><div>Patients diagnosed with IDU-IE who have cardiac surgery have higher per-patient cost than the general cardiac surgery population, as shown by comparison to other available data. This specific patient population has unique care needs that should be optimized to improve patient outcomes and improve healthcare resource utilization.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 2","pages":"Pages 133-139"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327276","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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