Pub Date : 2026-01-01Epub Date: 2025-09-16DOI: 10.1016/j.cjco.2025.09.005
Jooa Norha PhD, MHSc , Maria Saarenhovi MD, PhD , Petri Kallio MD , Tanja Sjöros PhD , Taru Garthwaite PhD , Saara Laine PhD , Noora Houttu PhD , Kirsi Laitinen (PhD) , Henri Vähä-Ypyä MSc (Tech) , Harri Sievänen PhD , Eliisa Löyttyniemi MSc , Tommi Vasankari (MD, PhD) , Juhani Knuuti (MD, PhD) , Kari K. Kalliokoski PhD , Ilkka H.A. Heinonen PhD
Background
Interventional studies on sedentary behaviour (SB) and cardiac health are missing. Therefore, this study investigates the effects of reducing SB on cardiac structure and function in inactive and sedentary adults with metabolic syndrome.
Methods
In this randomized controlled trial, the intervention group (n = 33) aimed at reducing SB by 1 h/d for 6 months. The control group (n = 31) continued their SB and physical activity (PA) as usual. All participants wore accelerometers throughout the study. Echocardiography was performed at rest and during incremental exercise tests before and after the intervention.
Results
No intervention effects were observed in any echocardiographic variables between the randomized groups. However, when participants were regrouped into a less sedentary (mean SB reduction 60 min/d) or a continuously sedentary group, based on their actual measured behaviour change, left ventricular (LV) mass index and end-diastolic diameter decreased more in the less sedentary than in the continuously sedentary group (group x time P = 0.045 and 0.020, respectively). Moreover, LV global longitudinal strain during exercise improved in the less sedentary group compared to the continuously sedentary group. Among all participants, the change in light PA was correlated inversely with the change in LV mass index (r = –0.32, P = 0.026), and the change in standing time was correlated with the change in the early diastolic flow velocity / lateral mitral annular velocity (E/e’) ratio (r = 0.28, P = 0.048).
Conclusions
A 6-month intervention aimed at reducing SB did not affect cardiac structure or function. However, in participants with successful SB reduction and increased light PA regardless of original randomization, LV mass index may have decreased, and LV function during exercise may have improved.
Clinical Trial Registration
NCT03101228.
背景：关于久坐行为（SB）和心脏健康的介入性研究尚缺乏。因此，本研究旨在探讨减少SB对不活动和久坐代谢综合征成人心脏结构和功能的影响。方法在随机对照试验中，干预组（n = 33）以降低SB 1 h/d为目标，持续6个月。对照组（n = 31）照常进行SB和体力活动（PA）。在整个研究过程中，所有参与者都佩戴了加速度计。在干预前后分别在休息和增量运动试验期间进行超声心动图检查。结果两组间超声心动图指标均无干预效果。然而，根据实际测量的行为变化，当参与者被重新分组为少坐组（平均SB减少60分钟/天）或连续久坐组时，少坐组的左心室（LV）质量指数和舒张末期直径比连续久坐组下降得更多（组x时间P分别= 0.045和0.020）。此外，与持续久坐组相比，少坐组运动时左心室整体纵向应变有所改善。在所有受试者中，轻PA的变化与左室质量指数的变化呈负相关（r = -0.32, P = 0.026），站立时间的变化与舒张早期血流速度/侧二尖瓣环速度（E/ E’）比值的变化呈相关（r = 0.28, P = 0.048）。结论6个月降低SB干预对心脏结构和功能无影响。然而，无论最初的随机分组如何，在成功减少SB和增加光PA的参与者中，左室质量指数可能下降，运动时左室功能可能改善。临床试验注册编号nct03101228。
{"title":"Effects of Reducing Sedentary Behaviour on Cardiac Structure and Function at Rest and During Exercise: A 6-Month Randomized Controlled Trial","authors":"Jooa Norha PhD, MHSc , Maria Saarenhovi MD, PhD , Petri Kallio MD , Tanja Sjöros PhD , Taru Garthwaite PhD , Saara Laine PhD , Noora Houttu PhD , Kirsi Laitinen (PhD) , Henri Vähä-Ypyä MSc (Tech) , Harri Sievänen PhD , Eliisa Löyttyniemi MSc , Tommi Vasankari (MD, PhD) , Juhani Knuuti (MD, PhD) , Kari K. Kalliokoski PhD , Ilkka H.A. Heinonen PhD","doi":"10.1016/j.cjco.2025.09.005","DOIUrl":"10.1016/j.cjco.2025.09.005","url":null,"abstract":"<div><h3>Background</h3><div>Interventional studies on sedentary behaviour (SB) and cardiac health are missing. Therefore, this study investigates the effects of reducing SB on cardiac structure and function in inactive and sedentary adults with metabolic syndrome.</div></div><div><h3>Methods</h3><div>In this randomized controlled trial, the intervention group (n = 33) aimed at reducing SB by 1 h/d for 6 months. The control group (n = 31) continued their SB and physical activity (PA) as usual. All participants wore accelerometers throughout the study. Echocardiography was performed at rest and during incremental exercise tests before and after the intervention.</div></div><div><h3>Results</h3><div>No intervention effects were observed in any echocardiographic variables between the randomized groups. However, when participants were regrouped into a less sedentary (mean SB reduction 60 min/d) or a continuously sedentary group, based on their actual measured behaviour change, left ventricular (LV) mass index and end-diastolic diameter decreased more in the less sedentary than in the continuously sedentary group (group x time <em>P</em> = 0.045 and 0.020, respectively). Moreover, LV global longitudinal strain during exercise improved in the less sedentary group compared to the continuously sedentary group. Among all participants, the change in light PA was correlated inversely with the change in LV mass index (<em>r</em> = –0.32, <em>P</em> = 0.026), and the change in standing time was correlated with the change in the early diastolic flow velocity / lateral mitral annular velocity (E/e’) ratio (<em>r</em> = 0.28, <em>P</em> = 0.048).</div></div><div><h3>Conclusions</h3><div>A 6-month intervention aimed at reducing SB did not affect cardiac structure or function. However, in participants with successful SB reduction and increased light PA regardless of original randomization, LV mass index may have decreased, and LV function during exercise may have improved.</div></div><div><h3>Clinical Trial Registration</h3><div>NCT03101228.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 1","pages":"Pages 69-81"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963109","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 : 2026-01-01Epub Date: 2025-10-04DOI: 10.1016/j.cjco.2025.09.010
Michael Reaume MD, MSc , Mathieu N. Labossière MD , Ricardo Batista MD, PhD , Navdeep Tangri MD, PhD , Claudio Rigatto MD, MSc , Clara Bohm MD, MPH , Denis Prud’homme MD, MSc , Peter Tanuseputro MD, MHSc , Lisa M. Lix PhD
Background
Patient-physician language concordance is associated with better outcomes. However, the mechanism(s) explaining these associations are poorly understood. Our objective was to determine if antihypertensive medication use mediates the association between patient-physician language concordance and major adverse cardiovascular events (MACEs).
Methods
Our population-based, retrospective cohort study used data from the Canadian Community Health Survey (CCHS) from January 1, 2003 to December 31, 2014. We identified Allophone-speaking respondents (ie, the language spoken most often at home is one other than English, French, or an Indigenous language) with self-reported hypertension. We defined patient-physician language concordance as agreement between language spoken most often at home and language spoken with one’s regular medical doctor. Survey responses were linked to hospitalization and mortality records. We identified all MACEs within 5 years after survey completion. The associations between patient-physician language concordance, antihypertensive medication use, and MACEs were explored using multivariable logistic and Cox proportional hazards regression, respectively. The mediating effect of antihypertensive medication use was tested with natural effect models.
Results
We studied 5013 Allophone-speaking patients, including 1708 (34.1%) who received language-concordant care and 3305 (65.9%) who received language-discordant care. Patients who received language-concordant care were 38% less likely to experience a MACE compared to patients who received language-discordant care (hazard ratio 0.62, 95% confidence interval 0.48-0.80). No evidence was found that this association was mediated by antihypertensive medication use.
Conclusions
Patient-physician language concordance was associated with a lower risk of a MACE. However, this association was not mediated by antihypertensive medication use. Further research could explore potentially modifiable mediators of this association.
{"title":"Patient-Physician Language Concordance, Antihypertensive Medications, and Cardiovascular Outcomes Among Allophone-Speaking Patients with Hypertension","authors":"Michael Reaume MD, MSc , Mathieu N. Labossière MD , Ricardo Batista MD, PhD , Navdeep Tangri MD, PhD , Claudio Rigatto MD, MSc , Clara Bohm MD, MPH , Denis Prud’homme MD, MSc , Peter Tanuseputro MD, MHSc , Lisa M. Lix PhD","doi":"10.1016/j.cjco.2025.09.010","DOIUrl":"10.1016/j.cjco.2025.09.010","url":null,"abstract":"<div><h3>Background</h3><div>Patient-physician language concordance is associated with better outcomes. However, the mechanism(s) explaining these associations are poorly understood. Our objective was to determine if antihypertensive medication use mediates the association between patient-physician language concordance and major adverse cardiovascular events (MACEs).</div></div><div><h3>Methods</h3><div>Our population-based, retrospective cohort study used data from the Canadian Community Health Survey (CCHS) from January 1, 2003 to December 31, 2014. We identified Allophone-speaking respondents (ie, the language spoken most often at home is one other than English, French, or an Indigenous language) with self-reported hypertension. We defined patient-physician language concordance as agreement between language spoken most often at home and language spoken with one’s regular medical doctor. Survey responses were linked to hospitalization and mortality records. We identified all MACEs within 5 years after survey completion. The associations between patient-physician language concordance, antihypertensive medication use, and MACEs were explored using multivariable logistic and Cox proportional hazards regression, respectively. The mediating effect of antihypertensive medication use was tested with natural effect models.</div></div><div><h3>Results</h3><div>We studied 5013 Allophone-speaking patients, including 1708 (34.1%) who received language-concordant care and 3305 (65.9%) who received language-discordant care. Patients who received language-concordant care were 38% less likely to experience a MACE compared to patients who received language-discordant care (hazard ratio 0.62, 95% confidence interval 0.48-0.80). No evidence was found that this association was mediated by antihypertensive medication use.</div></div><div><h3>Conclusions</h3><div>Patient-physician language concordance was associated with a lower risk of a MACE. However, this association was not mediated by antihypertensive medication use. Further research could explore potentially modifiable mediators of this association.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 1","pages":"Pages 103-114"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145962991","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 : 2026-01-01Epub Date: 2025-10-10DOI: 10.1016/j.cjco.2025.10.002
Omar Dewidar MSc , Anwar Abdi BSc , Hind Sabri BSc , Haben Dawit MSc , Sarisha Philip MPH , Victoria Barbeau BSc , Pierre Benoit MBA , Paulo Antunes MD , Jonathan Jetté MA , Joël Assaouré MBA , Diane Plourde MSc , Joy Seguin , Roland Sabbagh MD , Elie Skaff MD , Doug Archibald PhD , Vivian Welch PhD , Krystal Kehoe MacLeod PhD
Background
Poor mental health is a recognized risk factor for adverse cardiovascular outcomes, yet depression, anxiety, and stress remain underdiagnosed and undertreated in individuals with cardiovascular disease (CVD). Effective strategies to promote early recognition and management of these conditions are not well established. We conducted a rapid scoping review to identify interventions aimed at improving mental health recognition and management in adult CVD population without diagnosed mental health conditions.
Methods
We systematically searched MEDLINE, EMBASE, CENTRAL, PsycINFO, CINAHL, Web of Science, and Epistemonikos for articles published between January 1, 2014, and December 28, 2024.
Results
Of 11,645 screened studies, 24 met inclusion criteria: 12 systematic reviews and meta-analyses, and 12 randomized controlled trials (RCTs). Most focused on coronary artery disease or stroke patients. Interventions included mindfulness interventions (n = 9), routine screening (n = 2), interactive mHealth education (n = 2), psychosocial interventions (n = 4), caregiver education (n = 4), self-care (n = 1), and integrated care (n = 1). Interventions were multimodal pairing patient education with structured clinical encounters. Reporting of delivery methods was inconsistent and fewer than half assessed adherence. Only two RCTs involved patients in intervention design. Primary outcomes included changes in psychological distress symptoms and quality-of-life measures.
Conclusion
A variety of interventions target early recognition and management of mental health symptoms in CVD patients. The approach of combining self-management with clinician check-ins aligns with contemporary models of integrated care. Standardized reporting and greater interest-holder engagement are needed to improve intervention development, implementation, and evaluation.
{"title":"Interventions to Enhance Early Recognition and Management of Mental Health Symptoms in Patients with Cardiovascular Disease: A Rapid Scoping Review","authors":"Omar Dewidar MSc , Anwar Abdi BSc , Hind Sabri BSc , Haben Dawit MSc , Sarisha Philip MPH , Victoria Barbeau BSc , Pierre Benoit MBA , Paulo Antunes MD , Jonathan Jetté MA , Joël Assaouré MBA , Diane Plourde MSc , Joy Seguin , Roland Sabbagh MD , Elie Skaff MD , Doug Archibald PhD , Vivian Welch PhD , Krystal Kehoe MacLeod PhD","doi":"10.1016/j.cjco.2025.10.002","DOIUrl":"10.1016/j.cjco.2025.10.002","url":null,"abstract":"<div><h3>Background</h3><div>Poor mental health is a recognized risk factor for adverse cardiovascular outcomes, yet depression, anxiety, and stress remain underdiagnosed and undertreated in individuals with cardiovascular disease (CVD). Effective strategies to promote early recognition and management of these conditions are not well established. We conducted a rapid scoping review to identify interventions aimed at improving mental health recognition and management in adult CVD population without diagnosed mental health conditions.</div></div><div><h3>Methods</h3><div>We systematically searched MEDLINE, EMBASE, CENTRAL, PsycINFO, CINAHL, Web of Science, and Epistemonikos for articles published between January 1, 2014, and December 28, 2024.</div></div><div><h3>Results</h3><div>Of 11,645 screened studies, 24 met inclusion criteria: 12 systematic reviews and meta-analyses, and 12 randomized controlled trials (RCTs). Most focused on coronary artery disease or stroke patients. Interventions included mindfulness interventions (n = 9), routine screening (n = 2), interactive mHealth education (n = 2), psychosocial interventions (n = 4), caregiver education (n = 4), self-care (n = 1), and integrated care (n = 1). Interventions were multimodal pairing patient education with structured clinical encounters. Reporting of delivery methods was inconsistent and fewer than half assessed adherence. Only two RCTs involved patients in intervention design. Primary outcomes included changes in psychological distress symptoms and quality-of-life measures.</div></div><div><h3>Conclusion</h3><div>A variety of interventions target early recognition and management of mental health symptoms in CVD patients. The approach of combining self-management with clinician check-ins aligns with contemporary models of integrated care. Standardized reporting and greater interest-holder engagement are needed to improve intervention development, implementation, and evaluation.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 1","pages":"Pages 82-92"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963110","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 : 2026-01-01Epub Date: 2025-09-19DOI: 10.1016/j.cjco.2025.09.006
Gabriela Uriarte Zavala MD , Basilio Angulo-Lara MD , Daniel García Rodríguez MD , Isabel Dolores Poveda Pinedo MD , Susana Villar García MD
{"title":"Life-Threatening Left Atrial Thrombi: A Case Report and Review of Diagnosis and Management Approaches","authors":"Gabriela Uriarte Zavala MD , Basilio Angulo-Lara MD , Daniel García Rodríguez MD , Isabel Dolores Poveda Pinedo MD , Susana Villar García MD","doi":"10.1016/j.cjco.2025.09.006","DOIUrl":"10.1016/j.cjco.2025.09.006","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 1","pages":"Pages 20-23"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963431","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 : 2026-01-01Epub Date: 2025-10-10DOI: 10.1016/j.cjco.2025.09.016
Rubani S. Suri BHSc , Emilie P. Belley-Côté MD, PhD , Siobhan M. Baigent CCPA , Nicole P. Veloce CCPA , Muneeb Ahmed MD , P.J. Devereaux MD, PhD , Jeff S. Healey MD, MSc , Richard P. Whitlock MD, PhD , William F. McIntyre MD, PhD
Background
New-onset postoperative atrial fibrillation (POAF) complicates 30% of cardiac surgeries. Although POAF is often transient, structured follow-up care of patients with POAF may identify those with paroxysmal or persistent atrial fibrillation (AF) who will benefit from evidence-based therapies.
Methods
This retrospective study includes patients seen in a clinic dedicated to patients with POAF after cardiac surgery between 2020 and 2024. Per the clinic’s operating procedure, patients wore a 14-day continuous ambulatory electrocardiogram (ECG) monitor fpr 2 months after surgery and were assessed thereafter in clinic. The primary outcome was recurrent AF lasting ≥ 30 seconds, captured by 14-day continuous ambulatory ECG or during clinical care.
Results
The cohort included 881 patients, with a mean age of 68 ± 9 years, and a median Congestive Heart Failure, Hypertension, Age ≥ 75 Years, Diabetes Mellitus, Stroke, Vascular Disease, Age 65 to 74 Years, Sex Category (CHA2DS2-VASc) score of 2 (interquartile range [IQR] 1-3); 529 patients (60.0%) underwent isolated coronary artery bypass grafting. At discharge, 798 patients (90.6%) were prescribed amiodarone, and 435 (49.4%) were prescribed oral anticoagulation. The mean time between discharge and 14-day continuous ambulatory ECG monitor was 72 days (IQR 61-84). AF recurrence was detected in 94 patients (10.7%); 30 patients (36.1%) were not receiving oral anticoagulation at the time of recurrence. Among patients with recurrence detected by 14-day continuous ambulatory ECG, the median duration was 10 hours (IQR 2-253). Left atrial volume index was the only independent predictor of AF recurrence. Following the clinic visit, oral anticoagulation was continued in 122 patients (28.2%).
Conclusions
Among patients with POAF following cardiac surgery, 1 in 10 have AF recurrence, as determined by a structured 14-day continuous ambulatory ECG monitor utilized 2-3 months postoperatively.
{"title":"Recurrence of Postoperative Atrial Fibrillation After Cardiac Surgery: Insights from a Tertiary Follow-Up Clinic","authors":"Rubani S. Suri BHSc , Emilie P. Belley-Côté MD, PhD , Siobhan M. Baigent CCPA , Nicole P. Veloce CCPA , Muneeb Ahmed MD , P.J. Devereaux MD, PhD , Jeff S. Healey MD, MSc , Richard P. Whitlock MD, PhD , William F. McIntyre MD, PhD","doi":"10.1016/j.cjco.2025.09.016","DOIUrl":"10.1016/j.cjco.2025.09.016","url":null,"abstract":"<div><h3>Background</h3><div>New-onset postoperative atrial fibrillation (POAF) complicates 30% of cardiac surgeries. Although POAF is often transient, structured follow-up care of patients with POAF may identify those with paroxysmal or persistent atrial fibrillation (AF) who will benefit from evidence-based therapies.</div></div><div><h3>Methods</h3><div>This retrospective study includes patients seen in a clinic dedicated to patients with POAF after cardiac surgery between 2020 and 2024. Per the clinic’s operating procedure, patients wore a 14-day continuous ambulatory electrocardiogram (ECG) monitor fpr 2 months after surgery and were assessed thereafter in clinic. The primary outcome was recurrent AF lasting ≥ 30 seconds, captured by 14-day continuous ambulatory ECG or during clinical care.</div></div><div><h3>Results</h3><div>The cohort included 881 patients, with a mean age of 68 ± 9 years, and a median <strong>C</strong>ongestive Heart Failure, <strong>H</strong>ypertension, <strong>A</strong>ge ≥ 75 Years, <strong>D</strong>iabetes Mellitus, <strong>S</strong>troke, <strong>V</strong>ascular Disease, <strong>A</strong>ge 65 to 74 Years, <strong>S</strong>ex <strong>C</strong>ategory (CHA<sub>2</sub>DS<sub>2</sub>-VASc) score of 2 (interquartile range [IQR] 1-3); 529 patients (60.0%) underwent isolated coronary artery bypass grafting. At discharge, 798 patients (90.6%) were prescribed amiodarone, and 435 (49.4%) were prescribed oral anticoagulation. The mean time between discharge and 14-day continuous ambulatory ECG monitor was 72 days (IQR 61-84). AF recurrence was detected in 94 patients (10.7%); 30 patients (36.1%) were not receiving oral anticoagulation at the time of recurrence. Among patients with recurrence detected by 14-day continuous ambulatory ECG, the median duration was 10 hours (IQR 2-253). Left atrial volume index was the only independent predictor of AF recurrence. Following the clinic visit, oral anticoagulation was continued in 122 patients (28.2%).</div></div><div><h3>Conclusions</h3><div>Among patients with POAF following cardiac surgery, 1 in 10 have AF recurrence, as determined by a structured 14-day continuous ambulatory ECG monitor utilized 2-3 months postoperatively.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 1","pages":"Pages 24-30"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963100","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 : 2026-01-01Epub Date: 2025-07-08DOI: 10.1016/j.cjco.2025.06.020
Kevin Haddad MD, MSc , Andrei Lucian Ionescu MD , Radbod Pilehvar MD , Laurie-Anne Boivin-Proulx MD, MSc , Giovanni Romanelli MD , Brian J. Potter MDCM, SM , Alexis Matteau MD, SM , Mohamad J. Mansour MD , Samer Mansour MD
Background
Stress echocardiography (SE) is a well established method for diagnosing and assessing coronary artery disease (CAD). However, accurately identifying high-risk patients remains a challenge. The aim of the study is to explore the potential of novel predictors to enhance the diagnostic precision of SE for detecting left-main or triple-vessel CAD.
Methods
We included consecutive patients who underwent invasive coronary angiography within 6 months of SE between January 2018 and April 2022. Traditional high-risk SE features included extensive wall-motion abnormalities, a reduction in left ventricular ejection fraction 10% or left ventricular dilation at peak stress, and low ischemic threshold. Wall-motion score index and global longitudinal strain (GLS) at rest and peak stress, as well as the change in each from rest to peak were considered as potential additional indicators of high-risk anatomy, defined as significant stenoses in the left main and/or triple-vessel CAD.
Results
Of the 257 patients (mean age 66 ± 9 years) included in the analysis, 53 (21%) had high-risk CAD. Multivariate analyses identified traditional high-risk SE features, as well as ≥ 5% absolute reduction in GLS, as independent predictors of high-risk anatomy. Integrating GLS ≥ 5% into standard stress echocardiography evaluation significantly improved sensitivity from 69% to 90% (P = 0.003), with an associated specificity of 72%; also improved was the area under the curve of SE, increasing from 0.77 to 0.81 for detection of high-risk CAD.
Conclusions
In a real-world cohort, adding the change in GLS with exercise stress can improve the performance of SE for the detection of high-risk CAD.
{"title":"Improving Stress Echocardiography for Enhanced Detection of Left Main and Multivessel Coronary Artery Disease","authors":"Kevin Haddad MD, MSc , Andrei Lucian Ionescu MD , Radbod Pilehvar MD , Laurie-Anne Boivin-Proulx MD, MSc , Giovanni Romanelli MD , Brian J. Potter MDCM, SM , Alexis Matteau MD, SM , Mohamad J. Mansour MD , Samer Mansour MD","doi":"10.1016/j.cjco.2025.06.020","DOIUrl":"10.1016/j.cjco.2025.06.020","url":null,"abstract":"<div><h3>Background</h3><div>Stress echocardiography (SE) is a well established method for diagnosing and assessing coronary artery disease (CAD). However, accurately identifying high-risk patients remains a challenge. The aim of the study is to explore the potential of novel predictors to enhance the diagnostic precision of SE for detecting left-main or triple-vessel CAD.</div></div><div><h3>Methods</h3><div>We included consecutive patients who underwent invasive coronary angiography within 6 months of SE between January 2018 and April 2022. Traditional high-risk SE features included extensive wall-motion abnormalities, a reduction in left ventricular ejection fraction <span><math><mrow><mo>≥</mo></mrow></math></span> 10% or left ventricular dilation at peak stress, and low ischemic threshold. Wall-motion score index and global longitudinal strain (GLS) at rest and peak stress, as well as the change in each from rest to peak were considered as potential additional indicators of high-risk anatomy, defined as significant stenoses in the left main and/or triple-vessel CAD.</div></div><div><h3>Results</h3><div>Of the 257 patients (mean age 66 ± 9 years) included in the analysis, 53 (21%) had high-risk CAD. Multivariate analyses identified traditional high-risk SE features, as well as ≥ 5% absolute reduction in GLS, as independent predictors of high-risk anatomy. Integrating <span><math><mrow><mo>Δ</mo></mrow></math></span> GLS ≥ 5% into standard stress echocardiography evaluation significantly improved sensitivity from 69% to 90% (<em>P</em> = 0.003), with an associated specificity of 72%; also improved was the area under the curve of SE, increasing from 0.77 to 0.81 for detection of high-risk CAD.</div></div><div><h3>Conclusions</h3><div>In a real-world cohort, adding the change in GLS with exercise stress can improve the performance of SE for the detection of high-risk CAD.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 1","pages":"Pages 93-102"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963111","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 : 2025-12-01Epub Date: 2025-09-02DOI: 10.1016/j.cjco.2025.08.015
Gabrielle Viscardi BSc, RD , Sahba Eskandari BSc , Alyssa Chen PharmD , Nicholas Chiang PharmD, MD , Meaghan E. Kavanagh MSc, PhD , Songhee Back BSc , Micheal Vallis PhD , Mary J. Scourboutakos PhD, MD , Vasanti S. Malik ScD , Cyril W.C. Kendall PhD , David J.A. Jenkins MD, PhD , John L. Sievenpiper MD, PhD , Laura Chiavaroli MSc, PhD
Background
Cardiovascular disease (CVD) remains a leading cause of death in Canada. Although the Portfolio Diet, a dietary pattern of cholesterol-lowering foods, is supported by CVD clinical practice guidelines, its uptake in clinical practice remains limited. This study assessed the content and face validity of a healthcare provider (HCP)-facing toolkit (infographic and video), designed to support implementation of the Portfolio Diet.
Methods
HCPs were recruited for a 2-round evaluation. They assessed the toolkit using a questionnaire. Content validity of the infographic was assessed using a 4-point Likert scale (1 = irrelevant to 4 = extremely relevant) and face validity of the infographic and video was assessed using a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). Content-validity indices (CVIs) and face-validity indices (FVIs) were calculated, with ≥ 0.70/1.0 indicating validity. Qualitative feedback informed revisions made between rounds.
Results
In round 1 (N = 21), all but one section of the infographic met the CVI threshold, and all FVI values exceeded 0.70. Feedback highlighted the need for explicit food examples, an improved layout, and reduced use of jargon. In round 2 (N = 28), CVI (0.86-1.0) and FVI (0.79-1.0, infographic; 0.89-1.0, video) improved. HCPs reported that the toolkit increased their knowledge, their confidence in recommending the Portfolio Diet and PortfolioDiet.app to patients, and their confidence in recommending the toolkit to other clinicians (FVIinfographic = 0.89 to 1.0; FVIvideo = 0.89).
Conclusions
The toolkit demonstrated strong content and face validity. Repeated assessments and refinement guided by end-user feedback enhanced the toolkit, supporting HCPs in implementing the Portfolio Diet for CVD prevention and management in practice.
{"title":"Translating Cardiovascular Clinical Practice Guidelines on Nutrition Therapy: Validation of the Portfolio Diet Toolkit for Healthcare Providers","authors":"Gabrielle Viscardi BSc, RD , Sahba Eskandari BSc , Alyssa Chen PharmD , Nicholas Chiang PharmD, MD , Meaghan E. Kavanagh MSc, PhD , Songhee Back BSc , Micheal Vallis PhD , Mary J. Scourboutakos PhD, MD , Vasanti S. Malik ScD , Cyril W.C. Kendall PhD , David J.A. Jenkins MD, PhD , John L. Sievenpiper MD, PhD , Laura Chiavaroli MSc, PhD","doi":"10.1016/j.cjco.2025.08.015","DOIUrl":"10.1016/j.cjco.2025.08.015","url":null,"abstract":"<div><h3>Background</h3><div>Cardiovascular disease (CVD) remains a leading cause of death in Canada. Although the Portfolio Diet, a dietary pattern of cholesterol-lowering foods, is supported by CVD clinical practice guidelines, its uptake in clinical practice remains limited. This study assessed the content and face validity of a healthcare provider (HCP)-facing toolkit (infographic and video), designed to support implementation of the Portfolio Diet.</div></div><div><h3>Methods</h3><div>HCPs were recruited for a 2-round evaluation. They assessed the toolkit using a questionnaire. Content validity of the infographic was assessed using a 4-point Likert scale (1 = irrelevant to 4 = extremely relevant) and face validity of the infographic and video was assessed using a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). Content-validity indices (CVIs) and face-validity indices (FVIs) were calculated, with ≥ 0.70/1.0 indicating validity. Qualitative feedback informed revisions made between rounds.</div></div><div><h3>Results</h3><div>In round 1 (N = 21), all but one section of the infographic met the CVI threshold, and all FVI values exceeded 0.70. Feedback highlighted the need for explicit food examples, an improved layout, and reduced use of jargon. In round 2 (N = 28), CVI (0.86-1.0) and FVI (0.79-1.0, infographic; 0.89-1.0, video) improved. HCPs reported that the toolkit increased their knowledge, their confidence in recommending the Portfolio Diet and PortfolioDiet.app to patients, and their confidence in recommending the toolkit to other clinicians (FVI<sub>infographic</sub> = 0.89 to 1.0; FVI<sub>video</sub> = 0.89).</div></div><div><h3>Conclusions</h3><div>The toolkit demonstrated strong content and face validity. Repeated assessments and refinement guided by end-user feedback enhanced the toolkit, supporting HCPs in implementing the Portfolio Diet for CVD prevention and management in practice.</div></div><div><h3>Clinical Trial Registration</h3><div>NCT05915455.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 12","pages":"Pages 1662-1671"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145766166","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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