Forty-eight-hour Holter-monitoring (HM) is recommended to identify nonsustained ventricular tachycardia (NSVT) in patients with hypertrophic cardiomyopathy (HCM). This study aims to estimate the cumulative 48-hour risk of NSVT in HCM and assess arrhythmic disease progression during follow-up evaluation.
Methods
HCM patients were retrospectively identified from 2017 to 2020 and were evaluated from patient records. Patients with a minimum of 2 available HM periods were included.
Results
We identified 97 HCM patients, with a mean age of 47 ± 16 years, and 68% of whom were male. From the first to the latest HM period, the mean follow-up duration was 4.3 ± 2.5 years. The cumulative 48-hour risk of NSVT was 31% in the first HM period, compared to 37% in the latest period. No difference occurred in number of ventricular cycles or frequency of NSVT. Cox regressions analysis showed that no significant difference occurred in event rates of NSVT between the first and the latest HM periods (hazard ratio 1.27; 95% confidence interval [CI] 0.78-2.06; P = 0.33) and that age had no effect on the risk of NSVT (hazard ratio 1.01; 95% confidence interval 0.99-1.03; P = 0.15). In the latest HM period, atrial fibrillation was identified in 6% of patients, compared to none in the first HM period (P = 0.01). Premature ventricular contractions occurred more often in the first HM period (25, interquartile range 5, 170) compared to the latest HM period (50, interquartile range 14, 360, P = 0.01).
Conclusions
This study demonstrated a modest arrhythmic disease progression in HCM patients during a 4-year follow-up period, with a significant increase in premature ventricular contractions and atrial fibrillation, and a trend toward an increase in NSVT.
{"title":"Arrhythmic Disease Progression in Hypertrophic Cardiomyopathy During 4 Years of Follow-Up Evaluation","authors":"Louise Bjerregaard MD , Christoffer Harboe Nielsen MD , Steen Hvitfeldt Poulsen MD, DMSc , Torsten Bloch Rasmussen MD, PhD , Morten Kvistholm Jensen MD, PhD","doi":"10.1016/j.cjco.2025.07.006","DOIUrl":"10.1016/j.cjco.2025.07.006","url":null,"abstract":"<div><h3>Background</h3><div>Forty-eight-hour Holter-monitoring (HM) is recommended to identify nonsustained ventricular tachycardia (NSVT) in patients with hypertrophic cardiomyopathy (HCM). This study aims to estimate the cumulative 48-hour risk of NSVT in HCM and assess arrhythmic disease progression during follow-up evaluation.</div></div><div><h3>Methods</h3><div>HCM patients were retrospectively identified from 2017 to 2020 and were evaluated from patient records. Patients with a minimum of 2 available HM periods were included.</div></div><div><h3>Results</h3><div>We identified 97 HCM patients, with a mean age of 47 ± 16 years, and 68% of whom were male. From the first to the latest HM period, the mean follow-up duration was 4.3 ± 2.5 years. The cumulative 48-hour risk of NSVT was 31% in the first HM period, compared to 37% in the latest period. No difference occurred in number of ventricular cycles or frequency of NSVT. Cox regressions analysis showed that no significant difference occurred in event rates of NSVT between the first and the latest HM periods (hazard ratio 1.27; 95% confidence interval [CI] 0.78-2.06; <em>P</em> = 0.33) and that age had no effect on the risk of NSVT (hazard ratio 1.01; 95% confidence interval 0.99-1.03; <em>P</em> = 0.15). In the latest HM period, atrial fibrillation was identified in 6% of patients, compared to none in the first HM period (<em>P</em> = 0.01). Premature ventricular contractions occurred more often in the first HM period (25, interquartile range 5, 170) compared to the latest HM period (50, interquartile range 14, 360, <em>P</em> = 0.01).</div></div><div><h3>Conclusions</h3><div>This study demonstrated a modest arrhythmic disease progression in HCM patients during a 4-year follow-up period, with a significant increase in premature ventricular contractions and atrial fibrillation, and a trend toward an increase in NSVT.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 11","pages":"Pages 1434-1440"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145555053","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 : 2025-11-01DOI: 10.1016/j.cjco.2025.06.023
Lisa M. Mielniczuk MD , Eileen O’Meara MD , Christiane Wiefels MD , Li Chen MSc , Linda Garrard RN , James White MD , Robert A. deKemp PhD , Marcelo F. Di Carli MD , Eric Larose MD , David I. Paterson MD , Justin Ezekowitz MB , Riina M. Kandolin MD , Graham Wright PhD , Roxana Campisi MD , Mika K. Laine MD , Kim Connelly MBBS, PhD , Miroslaw Rajda MD , Joao V. Vitola MD , Serge Lepage MD , Juha Hartikainen MD , Rob S.B. Beanlands MD
Background
The role of advanced (cardiac magnetic resonance [CMR] or positron emission tomography [PET]) vs single-photon emission computerized tomography (SPECT) ischemia imaging to guide management remains unclear in patients with ischemic heart failure (IHF). The primary aim was to determine the effect of imaging modality on a composite cardiovascular endpoint and cardiac death in patients with IHF who require ischemia assessment.
Methods
Patients with IHF were randomized to advanced or SPECT imaging. A parallel registry also was performed. The primary endpoint was the composite of cardiac death, infarction, arrest, and cardiac rehospitalization. The key secondary endpoint was cardiac death.
Results
Patients in the randomized population (advanced imaging [PET or CMR; n = 64] or SPECT [n = 56]) had a cumulative incidence rate (CIR) for the primary endpoint of 33.1% and 33.0%, respectively (hazard ratio [HR] 0.94, 95% confidence interval [CI] 0.49, 1.80, P = 0.853). CIRs for cardiac death were 13.8% and 25.1%, respectively (HR 0.62, 95% CI 0.25, 1.80, P = 0.296).
In the parallel registry (n = 336 advanced; n = 216 SPECT), the primary endpoint CIRs were 31.2% and 35.3%, respectively (HR 0.81, 95% CI 0.56, 1.19, P = 0.284). CIRs for cardiac death were 11.0% and 16.6%, respectively (HR 0.53, 95% CI 0.27, 1.04, P = 0.066). Patients were followed for a median (interquartile range) of 24.1 (11.6, 27.5) months.
Pooled analysis from the randomized and registry populations revealed a significant benefit of advanced imaging for reduction of cardiac death (HR 0.56, 95% CI 0.33, 0.96, P = 0.04) with minimal heterogeneity (I2 = 0%).
Conclusion
Among IHF patients assessed for ischemia, advanced imaging (PET or CMR) was not associated with reduced composite cardiac events, compared to SPECT.
Clinical Trial Registration
NCT01288560.
在缺血性心力衰竭（IHF）患者中，高级心脏磁共振（CMR）或正电子发射断层扫描（PET）与单光子发射计算机断层扫描（SPECT）缺血成像在指导治疗中的作用尚不清楚。主要目的是确定成像方式对需要缺血评估的IHF患者复合心血管终点和心源性死亡的影响。方法将IHF患者随机分为高级或SPECT组。还执行了一个并行注册表。主要终点为心源性死亡、梗死、骤停和心脏再住院。主要的次要终点是心源性死亡。结果随机分组患者（高级影像学[PET或CMR； n = 64]或SPECT [n = 56]）主要终点的累积发病率（CIR）分别为33.1%和33.0%（风险比[HR] 0.94, 95%可信区间[CI] 0.49, 1.80, P = 0.853）。心源性死亡的CIRs分别为13.8%和25.1% （HR 0.62, 95% CI 0.25, 1.80, P = 0.296）。在平行注册中（n = 336例晚期，n = 216例SPECT），主要终点CIRs分别为31.2%和35.3% （HR 0.81, 95% CI 0.56, 1.19, P = 0.284）。心源性死亡的CIRs分别为11.0%和16.6% （HR 0.53, 95% CI 0.27, 1.04, P = 0.066）。患者随访的中位数（四分位数范围）为24.1（11.6,27.5）个月。来自随机和登记人群的汇总分析显示，先进成像对降低心脏性死亡有显著益处（HR 0.56, 95% CI 0.33, 0.96, P = 0.04），异质性最小（I2 = 0%）。结论在评估为缺血的IHF患者中，与SPECT相比，晚期成像（PET或CMR）与减少复合心脏事件无关。临床试验注册编号：nct01288560。
{"title":"The Alternative Imaging Modalities in Ischemic Heart Failure (AIMI-HF) Trial—IMAGE HF Project 1A","authors":"Lisa M. Mielniczuk MD , Eileen O’Meara MD , Christiane Wiefels MD , Li Chen MSc , Linda Garrard RN , James White MD , Robert A. deKemp PhD , Marcelo F. Di Carli MD , Eric Larose MD , David I. Paterson MD , Justin Ezekowitz MB , Riina M. Kandolin MD , Graham Wright PhD , Roxana Campisi MD , Mika K. Laine MD , Kim Connelly MBBS, PhD , Miroslaw Rajda MD , Joao V. Vitola MD , Serge Lepage MD , Juha Hartikainen MD , Rob S.B. Beanlands MD","doi":"10.1016/j.cjco.2025.06.023","DOIUrl":"10.1016/j.cjco.2025.06.023","url":null,"abstract":"<div><h3>Background</h3><div>The role of advanced (cardiac magnetic resonance [CMR] or positron emission tomography [PET]) vs single-photon emission computerized tomography (SPECT) ischemia imaging to guide management remains unclear in patients with ischemic heart failure (IHF). The primary aim was to determine the effect of imaging modality on a composite cardiovascular endpoint and cardiac death in patients with IHF who require ischemia assessment.</div></div><div><h3>Methods</h3><div>Patients with IHF were randomized to advanced or SPECT imaging. A parallel registry also was performed. The primary endpoint was the composite of cardiac death, infarction, arrest, and cardiac rehospitalization. The key secondary endpoint was cardiac death.</div></div><div><h3>Results</h3><div>Patients in the randomized population (advanced imaging [PET or CMR; n = 64] or SPECT [n = 56]) had a cumulative incidence rate (CIR) for the primary endpoint of 33.1% and 33.0%, respectively (hazard ratio [HR] 0.94, 95% confidence interval [CI] 0.49, 1.80, <em>P</em> = 0.853). CIRs for cardiac death were 13.8% and 25.1%, respectively (HR 0.62, 95% CI 0.25, 1.80, <em>P</em> = 0.296).</div><div>In the parallel registry (n = 336 advanced; n = 216 SPECT), the primary endpoint CIRs were 31.2% and 35.3%, respectively (HR 0.81, 95% CI 0.56, 1.19, <em>P</em> = 0.284). CIRs for cardiac death were 11.0% and 16.6%, respectively (HR 0.53, 95% CI 0.27, 1.04, <em>P</em> = 0.066). Patients were followed for a median (interquartile range) of 24.1 (11.6, 27.5) months.</div><div>Pooled analysis from the randomized and registry populations revealed a significant benefit of advanced imaging for reduction of cardiac death (HR 0.56, 95% CI 0.33, 0.96, <em>P</em> = 0.04) with minimal heterogeneity (I<sup>2</sup> = 0%).</div></div><div><h3>Conclusion</h3><div>Among IHF patients assessed for ischemia, advanced imaging (PET or CMR) was not associated with reduced composite cardiac events, compared to SPECT.</div></div><div><h3>Clinical Trial Registration</h3><div>NCT01288560.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 11","pages":"Pages 1423-1433"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145555052","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}
Optimized 4-pillar guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) has significantly altered clinical practice, with a coinciding decrease in sudden cardiac death. The continued role for implantable cardioverter-defibrillators (ICDs) in primary prevention of sudden death has recently been debated in the context of residual arrhythmic risk. This survey explored contemporary attitudes toward primary prevention ICD use in ischemic and nonischemic cardiomyopathy.
Methods
An international, REDCap-based survey targeting clinicians involved in HFrEF management assessed the impact of GDMT on ICD decision-making, clinical thresholds used for implantation, and willingness to participate in randomized controlled trials.
Results
Of 210 registered responses, 140 (66.7%) could be analyzed. Most respondents were electrophysiologists (77.1%) working in academic centers (70.7%) in North America (87.1%). Fewer ICD implantations were reported after the introduction of 4-pillar GDMT, with a larger reduction in nonischemic cardiomyopathy (P = 0.003). Clinical thresholds based on left ventricular ejection fraction and New York Heart Association class were common, whereas age, renal function, and late gadolinium enhancement cut-offs were used less frequently. Willingness to randomize patients into ICD vs no-ICD trials was moderate for ischemic cardiomyopathy (38.8% for all patients, 31.8% for select patients). In nonischemic cardiomyopathy, willingness was higher, with 51.2% willing to randomize all patients and only 9.3% declining. Free-text responses emphasized individualized decision-making and the growing role of imaging and genetics.
Conclusions
In the era of optimized GDMT, practice patterns regarding primary prevention ICD implantation are increasingly heterogeneous. These findings underscore the need for nuanced shared decision-making and well-designed randomized controlled studies to guide future practice.
{"title":"Contemporary Use of Implantable Cardioverter-Defibrillators in the Era of 4-Pillar Heart Failure Therapy---an International Survey","authors":"Bert Vandenberk MD, PhD , Roopinder K. Sandhu MD, MPH , Justin Ezekowitz MBBCh, MSc , Derek S. Chew MD, MSc","doi":"10.1016/j.cjco.2025.06.016","DOIUrl":"10.1016/j.cjco.2025.06.016","url":null,"abstract":"<div><h3>Background</h3><div>Optimized 4-pillar guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) has significantly altered clinical practice, with a coinciding decrease in sudden cardiac death. The continued role for implantable cardioverter-defibrillators (ICDs) in primary prevention of sudden death has recently been debated in the context of residual arrhythmic risk. This survey explored contemporary attitudes toward primary prevention ICD use in ischemic and nonischemic cardiomyopathy.</div></div><div><h3>Methods</h3><div>An international, REDCap-based survey targeting clinicians involved in HFrEF management assessed the impact of GDMT on ICD decision-making, clinical thresholds used for implantation, and willingness to participate in randomized controlled trials.</div></div><div><h3>Results</h3><div>Of 210 registered responses, 140 (66.7%) could be analyzed. Most respondents were electrophysiologists (77.1%) working in academic centers (70.7%) in North America (87.1%). Fewer ICD implantations were reported after the introduction of 4-pillar GDMT, with a larger reduction in nonischemic cardiomyopathy (<em>P</em> = 0.003). Clinical thresholds based on left ventricular ejection fraction and New York Heart Association class were common, whereas age, renal function, and late gadolinium enhancement cut-offs were used less frequently. Willingness to randomize patients into ICD vs no-ICD trials was moderate for ischemic cardiomyopathy (38.8% for all patients, 31.8% for select patients). In nonischemic cardiomyopathy, willingness was higher, with 51.2% willing to randomize all patients and only 9.3% declining. Free-text responses emphasized individualized decision-making and the growing role of imaging and genetics.</div></div><div><h3>Conclusions</h3><div>In the era of optimized GDMT, practice patterns regarding primary prevention ICD implantation are increasingly heterogeneous. These findings underscore the need for nuanced shared decision-making and well-designed randomized controlled studies to guide future practice.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 11","pages":"Pages 1454-1460"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145555055","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 : 2025-11-01DOI: 10.1016/j.cjco.2025.07.005
Evan J. Wiens MD, MSc, FRCPC , Kristal L. Kawa MN, NP , Silvia J. Leon MD, MSc , Reid Whitlock MSc , Setor Kunutsor BSc, MD, MPhil, PhD , Navdeep Tangri MD, PhD , Ashish H. Shah MBBS, MD, MD-Research, FRCP
Background
Although delays in treatment are known to worsen outcomes in ST-elevation myocardial infarction, their effect in non-ST-elevation myocardial infarction (NSTEMI) is less clear. Care quality and timely revascularization should be comparable across presentation sites to optimize patient outcomes.
Methods
Using the Manitoba Centre for Health Policy data, we retrospectively analyzed adult NSTEMI patients who underwent cardiac catheterization and revascularization from January 2001 to March 2021. Patients were grouped by initial presentation site—rural hospital, urban noncardiac hospital, or specialized cardiac centre. We assessed in-hospital, 1-year, and long-term outcomes.
Results
Of 30,817 NSTEMI patients, 19,482 underwent catheterization, and 12,567 received revascularization. Distribution by site was as follows: 44% at cardiac centres, 28.5% at urban noncardiac hospitals, and 27.5% at rural hospitals. Urban noncardiac hospital patients experienced significantly higher cardiovascular mortality in-hospital (hazard ratio [HR] 1.64; 95% confidence interval [CI] 1.09-2.47), at 1 year (HR 1.30; 95% CI 1.11-1.53), and over an average 6.65-year follow-up period (HR 1.15; 95% CI 1.07-1.24). Rural hospital patients showed a lower mortality incidence, potentially due to selection bias if critically ill patients did not survive the transfer. Both rural and urban noncardiac cohorts had elevated rates of major adverse cardiovascular events at all follow-up intervals. Time to catheterization was notably delayed for nonspecialized sites (cardiac centre, 0.83 ± 1.90 vs urban noncardiac 3.20 ± 3.05 vs rural, 3.09 ± 2.56 days; P < 0.001).
Conclusions
NSTEMI patients presenting to rural and urban nonspecialized hospitals experience worse short- and long-term outcomes, including increased incidence of major adverse cardiovascular events and mortality. These findings highlight the need for strategies to reduce disparities in access to specialized cardiac care.
{"title":"Outcomes of Non-ST Elevation Myocardial Infarction Patients by Presentation Site: Rural, Urban Community, or Specialized Cardiac Hospital","authors":"Evan J. Wiens MD, MSc, FRCPC , Kristal L. Kawa MN, NP , Silvia J. Leon MD, MSc , Reid Whitlock MSc , Setor Kunutsor BSc, MD, MPhil, PhD , Navdeep Tangri MD, PhD , Ashish H. Shah MBBS, MD, MD-Research, FRCP","doi":"10.1016/j.cjco.2025.07.005","DOIUrl":"10.1016/j.cjco.2025.07.005","url":null,"abstract":"<div><h3>Background</h3><div>Although delays in treatment are known to worsen outcomes in ST-elevation myocardial infarction, their effect in non-ST-elevation myocardial infarction (NSTEMI) is less clear. Care quality and timely revascularization should be comparable across presentation sites to optimize patient outcomes.</div></div><div><h3>Methods</h3><div>Using the Manitoba Centre for Health Policy data, we retrospectively analyzed adult NSTEMI patients who underwent cardiac catheterization and revascularization from January 2001 to March 2021. Patients were grouped by initial presentation site—rural hospital, urban noncardiac hospital, or specialized cardiac centre. We assessed in-hospital, 1-year, and long-term outcomes.</div></div><div><h3>Results</h3><div>Of 30,817 NSTEMI patients, 19,482 underwent catheterization, and 12,567 received revascularization. Distribution by site was as follows: 44% at cardiac centres, 28.5% at urban noncardiac hospitals, and 27.5% at rural hospitals. Urban noncardiac hospital patients experienced significantly higher cardiovascular mortality in-hospital (hazard ratio [HR] 1.64; 95% confidence interval [CI] 1.09-2.47), at 1 year (HR 1.30; 95% CI 1.11-1.53), and over an average 6.65-year follow-up period (HR 1.15; 95% CI 1.07-1.24). Rural hospital patients showed a lower mortality incidence, potentially due to selection bias if critically ill patients did not survive the transfer. Both rural and urban noncardiac cohorts had elevated rates of major adverse cardiovascular events at all follow-up intervals. Time to catheterization was notably delayed for nonspecialized sites (cardiac centre, 0.83 ± 1.90 vs urban noncardiac 3.20 ± 3.05 vs rural, 3.09 ± 2.56 days; <em>P</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>NSTEMI patients presenting to rural and urban nonspecialized hospitals experience worse short- and long-term outcomes, including increased incidence of major adverse cardiovascular events and mortality. These findings highlight the need for strategies to reduce disparities in access to specialized cardiac care.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 11","pages":"Pages 1466-1473"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145555415","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 : 2025-11-01DOI: 10.1016/j.cjco.2025.06.021
Alisha Labinaz BSc , Ren Jie Robert Yao MD , Farshad Hosseini MD , Ricky D. Turgeon BSc (Pharm), ACPR, PharmD , Miles Marchand MD , Liam Brunham MD, PhD, FRCPC, FACP , Nathaniel M. Hawkins MD, MBChB, MPH , Graham Wong MD, MPH, FRCPC, FACC, FCCS, FAHA , G.B. John Mancini MD, FRCPC, FACP, FACC , Christopher B. Fordyce MD, MHS, MSc, FRCPC
Following an acute coronary syndrome (ACS), patients remain at a residual increased risk of adverse cardiovascular events. As such, secondary prevention strategies, including dyslipidemia management, are key in the delivery of post-ACS care. Multiple randomized controlled trials have highlighted the benefit of lipid-lowering therapies in reducing low-density lipoprotein cholesterol levels, an independent predictor of adverse cardiovascular events post-ACS. However, registries have demonstrated that post-ACS, a significant proportion of patients are not achieving guideline-recommended low-density lipoprotein target levels, and intensification of lipid-lowering therapies continues to be underutilized. This review assesses strategies in which post-ACS lipid management can be improved, in particular by standardizing follow-up care through dedicated post-ACS clinics.
{"title":"Implementing Dyslipidemia Guidelines into Clinical Practice Following an Acute Coronary Syndrome: Challenges and Opportunities for Improvement","authors":"Alisha Labinaz BSc , Ren Jie Robert Yao MD , Farshad Hosseini MD , Ricky D. Turgeon BSc (Pharm), ACPR, PharmD , Miles Marchand MD , Liam Brunham MD, PhD, FRCPC, FACP , Nathaniel M. Hawkins MD, MBChB, MPH , Graham Wong MD, MPH, FRCPC, FACC, FCCS, FAHA , G.B. John Mancini MD, FRCPC, FACP, FACC , Christopher B. Fordyce MD, MHS, MSc, FRCPC","doi":"10.1016/j.cjco.2025.06.021","DOIUrl":"10.1016/j.cjco.2025.06.021","url":null,"abstract":"<div><div>Following an acute coronary syndrome (ACS), patients remain at a residual increased risk of adverse cardiovascular events. As such, secondary prevention strategies, including dyslipidemia management, are key in the delivery of post-ACS care. Multiple randomized controlled trials have highlighted the benefit of lipid-lowering therapies in reducing low-density lipoprotein cholesterol levels, an independent predictor of adverse cardiovascular events post-ACS. However, registries have demonstrated that post-ACS, a significant proportion of patients are not achieving guideline-recommended low-density lipoprotein target levels, and intensification of lipid-lowering therapies continues to be underutilized. This review assesses strategies in which post-ACS lipid management can be improved, in particular by standardizing follow-up care through dedicated post-ACS clinics.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 11","pages":"Pages 1482-1494"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145555417","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}
Populations with lower socioeconomic position (SEP) are at increased risk of developing cardiovascular disease (CVD). Movement behaviours, including physical activity, sedentary behaviour, and sleep, contribute to socioeconomic gradients in CVD risk, as low-SEP populations are less likely to meet evidence-informed recommendations for these behaviours. Adolescence represents a sensitive period for establishing lifelong health behaviours, with CVD risk beginning to accumulate before adulthood. This study will model the potential effect of adolescent movement behaviour interventions on socioeconomic inequalities in adult CVD risk. We will conduct a population-based cohort study of adolescents from the Add Health study, recruited in 1994-1995 from the US and followed into adulthood. Unhealthy movement behaviours, including a low level of moderate-to-vigorous physical activity, a high level of recreational screen time, and short sleep duration, will be operationalized based on the 24-hour Movement Guidelines and measured twice during adolescence (ages 12-24 years). Parental educational attainment and family financial hardship will be used to capture SEP in adolescence. The outcome will be the 30-year risk of CVD, assessed in adulthood (ages 33-41 years) using a validated risk score that incorporates objectively measured biomarkers, demographic information, and self-reported health indicators. We will perform causal decompositions to quantify the change of socioeconomic inequalities in adult CVD risk under 2 interventional scenarios: (i) elimination (unhealthy movement behaviours are eliminated in the whole population of adolescents); and (ii) equalization (the distributions of unhealthy movement behaviours for low-SEP adolescents are equalized to those of high-SEP adolescents). This study will provide insights into how modifying adolescent movement behaviours may contribute to reducing socioeconomic inequalities in CVD risk.
{"title":"Reducing Socioeconomic Inequalities in Adult Cardiovascular Disease Risk by Targeting Unhealthy Movement Behaviours During Adolescence: A Protocol","authors":"Nicholas Grubic MSc , Katerina Maximova PhD , Arnaud Chiolero MD, PhD , Arjumand Siddiqi ScD , Sarah Carsley PhD , Brice Batomen PhD , Kathleen Mullan Harris PhD , Cristian Carmeli PhD","doi":"10.1016/j.cjco.2025.08.002","DOIUrl":"10.1016/j.cjco.2025.08.002","url":null,"abstract":"<div><div>Populations with lower socioeconomic position (SEP) are at increased risk of developing cardiovascular disease (CVD). Movement behaviours, including physical activity, sedentary behaviour, and sleep, contribute to socioeconomic gradients in CVD risk, as low-SEP populations are less likely to meet evidence-informed recommendations for these behaviours. Adolescence represents a sensitive period for establishing lifelong health behaviours, with CVD risk beginning to accumulate before adulthood. This study will model the potential effect of adolescent movement behaviour interventions on socioeconomic inequalities in adult CVD risk. We will conduct a population-based cohort study of adolescents from the Add Health study, recruited in 1994-1995 from the US and followed into adulthood. Unhealthy movement behaviours, including a low level of moderate-to-vigorous physical activity, a high level of recreational screen time, and short sleep duration, will be operationalized based on the 24-hour Movement Guidelines and measured twice during adolescence (ages 12-24 years). Parental educational attainment and family financial hardship will be used to capture SEP in adolescence. The outcome will be the 30-year risk of CVD, assessed in adulthood (ages 33-41 years) using a validated risk score that incorporates objectively measured biomarkers, demographic information, and self-reported health indicators. We will perform causal decompositions to quantify the change of socioeconomic inequalities in adult CVD risk under 2 interventional scenarios: (i) elimination (unhealthy movement behaviours are eliminated in the whole population of adolescents); and (ii) equalization (the distributions of unhealthy movement behaviours for low-SEP adolescents are equalized to those of high-SEP adolescents). This study will provide insights into how modifying adolescent movement behaviours may contribute to reducing socioeconomic inequalities in CVD risk.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 11","pages":"Pages 1495-1506"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145555418","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 : 2025-11-01DOI: 10.1016/j.cjco.2025.07.015
Sophia Wolfermann , Timo Schmitz MD , Philip Raake MD , Bernhard Kuch MD , Jakob Linseisen PhD , Christa Meisinger MD, MPH
Background
Our aim in this study was to identify the frequencies of typical and atypical acute myocardial infarction (AMI) symptoms over the past 35 years as well as age and sex differences.
Methods
In this study we used data from the population-based Augsburg Myocardial Infarction Registry. All patients (N = 23,905) 25-74 years of age and hospitalized with AMIs occurring between 1985 and 2019 were included in this analysis. During their hospital stay, patients were interviewed about their symptoms at the acute event and information from patient records was used. Multivariable adjusted logistic regression analyses were conducted to investigate the trends of AMI symptoms over time.
Results
On comparing the time interval 1985-1995 vs 2006-2019, there was a decrease in frequencies (P < 0.001 for all) for symptoms of typical chest pain (83.5% vs 80.0%), pain in the left shoulder/arm/hand (52.1% vs 44.9%), pain between the shoulder blades (23.8% vs 19.5%), nausea/vomiting (36.0% vs 30.1%), and fear of death/feeling of annihilation (30.7% vs 14.7%), whereas shortness of breath increased significantly over time (43.8% vs 48.4%, P < 0.001). Multivariable logistic regression analysis confirmed the decrease of frequency of AMI symptoms over the past decades. The only exception was occurrence of shortness of breath, where a significantly independent increase was observed when comparing 1985-1995 and 2006-2019 (odds ratio 1.22, 95% confidence interval 1.13-1.32). Atypical symptoms occurred more frequently in older patients and women.
Conclusions
Although there has been a decrease in the frequency of most AMI symptoms over almost 4 decades, AMIs are still commonly accompanied by typical chest pain. In particular, AMI must be considered if shortness of breath is present.
{"title":"Frequencies and Trends of Myocardial Infarction Symptoms From the Years 1985-2019: A Register-based, Real-world Analysis","authors":"Sophia Wolfermann , Timo Schmitz MD , Philip Raake MD , Bernhard Kuch MD , Jakob Linseisen PhD , Christa Meisinger MD, MPH","doi":"10.1016/j.cjco.2025.07.015","DOIUrl":"10.1016/j.cjco.2025.07.015","url":null,"abstract":"<div><h3>Background</h3><div>Our aim in this study was to identify the frequencies of typical and atypical acute myocardial infarction (AMI) symptoms over the past 35 years as well as age and sex differences.</div></div><div><h3>Methods</h3><div>In this study we used data from the population-based Augsburg Myocardial Infarction Registry. All patients (N = 23,905) 25-74 years of age and hospitalized with AMIs occurring between 1985 and 2019 were included in this analysis. During their hospital stay, patients were interviewed about their symptoms at the acute event and information from patient records was used. Multivariable adjusted logistic regression analyses were conducted to investigate the trends of AMI symptoms over time.</div></div><div><h3>Results</h3><div>On comparing the time interval 1985-1995 vs 2006-2019, there was a decrease in frequencies (<em>P</em> < 0.001 for all) for symptoms of typical chest pain (83.5% vs 80.0%), pain in the left shoulder/arm/hand (52.1% vs 44.9%), pain between the shoulder blades (23.8% vs 19.5%), nausea/vomiting (36.0% vs 30.1%), and fear of death/feeling of annihilation (30.7% vs 14.7%), whereas shortness of breath increased significantly over time (43.8% vs 48.4%, <em>P</em> < 0.001). Multivariable logistic regression analysis confirmed the decrease of frequency of AMI symptoms over the past decades. The only exception was occurrence of shortness of breath, where a significantly independent increase was observed when comparing 1985-1995 and 2006-2019 (odds ratio 1.22, 95% confidence interval 1.13-1.32). Atypical symptoms occurred more frequently in older patients and women.</div></div><div><h3>Conclusions</h3><div>Although there has been a decrease in the frequency of most AMI symptoms over almost 4 decades, AMIs are still commonly accompanied by typical chest pain. In particular, AMI must be considered if shortness of breath is present.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 11","pages":"Pages 1474-1481"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145555416","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 : 2025-10-01DOI: 10.1016/j.cjco.2025.06.014
Peng Jin MD , Lan Su MD , Tiantian Chen MD , Shenglong Zheng MD , Zhongping Yang PhD , Hao Zhou MD , Xiao Chen MD , Shengjie Wu MD , Lu Lin MD , Xi Zhou MD , Xue Xia MD , Weijian Huang MD
Background
Right atrial appendage pacing (RAAp) may increase the risk of atrial fibrillation (AF), compared to right atrial septal pacing (RASp). However, the implantation of atrial septal stylet-driven leads (SDLs) for RASp can present procedural challenges and limit its clinical application. We evaluated the long-term safety and feasibility of using lumenless leads (LLLs) with the delivery sheath for RASp and SDLs for RAAp, and compared AF events between the RASp and RAAp in patients with sick sinus syndrome.
Methods
A total of 329 patients with sick sinus syndrome who underwent pacemaker implantation were divided into 2 groups, based on the site of atrial lead placement: the RASp group (n = 162) with LLLs, and the RAAp group (n = 167) with SDLs. Implantation success rate, procedural time, P-wave characteristics, pacing parameters, complications, and AF episodes were compared between the 2 groups.
Results
The success rates were similar for the RASp and RAAp groups (98.8% vs 97.6%, P > 0.05). The lead implantation time was significantly shorter in the RASp group (2.5 ± 1.9 minutes vs 10.3 ± 2.9 minutes, P < 0.05). During a mean follow-up of 36.4 ± 20.5 months, the pacing parameters remained stable without serious complications. Additionally, the RASp group had a significantly reduced incidence of AF episodes (6.7% vs 14.0%, P < 0.05) and new-onset AF (1.8% vs 4.6%, P < 0.05).
Conclusions
The long-term safety and feasibility of RASp with LLLs were comparable to those of RAAp patients with SDLs. The RASp reduced the incidence of postoperative AF episodes and new-onset AF. The RASp by delivery sheath implantation is a safe and effective method.
背景：与右房间隔起搏（RASp）相比，右心房附件起搏（RAAp）可能增加心房颤动（AF）的风险。然而，房间隔样式驱动导联（SDLs）的植入对RASp的治疗存在操作上的挑战，并限制了其临床应用。我们评估了RASp和RAAp使用无腔导联（LLLs）和SDLs的长期安全性和可行性，并比较了RASp和RAAp在病窦综合征患者中的AF事件。方法将329例病窦综合征患者行心脏起搏器植入术，根据心房导联放置位置分为两组：RASp组（n = 162）合并lll， RAAp组（n = 167）合并sdl。比较两组植入率、手术时间、p波特征、起搏参数、并发症及房颤发作情况。结果RASp组和RAAp组的成功率相似（98.8% vs 97.6%, P > 0.05）。RASp组导联种植时间明显缩短（2.5±1.9 min vs 10.3±2.9 min, P < 0.05）。在平均36.4±20.5个月的随访中，起搏参数保持稳定，无严重并发症。此外，RASp组AF发作发生率（6.7% vs 14.0%, P < 0.05）和新发AF发生率（1.8% vs 4.6%, P < 0.05）均显著降低。结论RAAp合并LLLs的长期安全性和可行性与RAAp合并SDLs的长期安全性和可行性相当。RASp可降低房颤术后发作和新发房颤的发生率，通过分娩鞘植入RASp是一种安全有效的方法。
{"title":"Long-Term Safety and Feasibility of Right Atrial Septal Pacing with Lumenless Leads in Patients with Sick Sinus Syndrome","authors":"Peng Jin MD , Lan Su MD , Tiantian Chen MD , Shenglong Zheng MD , Zhongping Yang PhD , Hao Zhou MD , Xiao Chen MD , Shengjie Wu MD , Lu Lin MD , Xi Zhou MD , Xue Xia MD , Weijian Huang MD","doi":"10.1016/j.cjco.2025.06.014","DOIUrl":"10.1016/j.cjco.2025.06.014","url":null,"abstract":"<div><h3>Background</h3><div>Right atrial appendage pacing (RAAp) may increase the risk of atrial fibrillation (AF), compared to right atrial septal pacing (RASp). However, the implantation of atrial septal stylet-driven leads (SDLs) for RASp can present procedural challenges and limit its clinical application. We evaluated the long-term safety and feasibility of using lumenless leads (LLLs) with the delivery sheath for RASp and SDLs for RAAp, and compared AF events between the RASp and RAAp in patients with sick sinus syndrome.</div></div><div><h3>Methods</h3><div>A total of 329 patients with sick sinus syndrome who underwent pacemaker implantation were divided into 2 groups, based on the site of atrial lead placement: the RASp group (n = 162) with LLLs, and the RAAp group (n = 167) with SDLs. Implantation success rate, procedural time, P-wave characteristics, pacing parameters, complications, and AF episodes were compared between the 2 groups.</div></div><div><h3>Results</h3><div>The success rates were similar for the RASp and RAAp groups (98.8% vs 97.6%, <em>P</em> > 0.05). The lead implantation time was significantly shorter in the RASp group (2.5 ± 1.9 minutes vs 10.3 ± 2.9 minutes, <em>P</em> < 0.05). During a mean follow-up of 36.4 ± 20.5 months, the pacing parameters remained stable without serious complications. Additionally, the RASp group had a significantly reduced incidence of AF episodes (6.7% vs 14.0%, <em>P</em> < 0.05) and new-onset AF (1.8% vs 4.6%, <em>P</em> < 0.05).</div></div><div><h3>Conclusions</h3><div>The long-term safety and feasibility of RASp with LLLs were comparable to those of RAAp patients with SDLs. The RASp reduced the incidence of postoperative AF episodes and new-onset AF. The RASp by delivery sheath implantation is a safe and effective method.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 10","pages":"Pages 1345-1353"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334550","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}
Aortic valve replacement (AVR) for chronic aortic regurgitation (AR) in the presence of reduced left ventricular ejection fraction (LVEF) is associated with greater surgical risk. Long-term outcomes remain poorly described in contemporary cohorts.
Methods
Between 2004 and 2019, 122 patients underwent AVR for chronic severe AR with LVEF < 50%. Patients with severely reduced LVEF (< 35%; n = 37) were compared with those with mild to moderately reduced LVEF (35%-50%; n = 85).
Results
Preoperative and intraoperative characteristics were similar in both groups. Operative mortality for the entire cohort was 1.6% (n = 2) and similar across the LVEF spectrum. Postoperatively, optimal medical therapy was achieved in most patients and > 25% of patients with LVEF < 35% benefited from cardiac resynchronization therapy. At latest follow-up, mean LVEF was 42 ± 12% in the severely reduced LVEF group (vs baseline 28 ± 5%; P < 0.001) and 51 ± 9% in the mild to moderately reduced LVEF group (vs baseline 46 ± 4%; P < 0.001). Freedom from cardiovascular death at 10 years was 87.2% in the severe group and 94.7% in the mild to moderate group (P = 0.10). Freedom from heart failure hospitalization at 10 years was higher in the mild to moderate group (96.3%) than in the severe group (88.3%; P = 0.009).
Conclusions
In this contemporary cohort of patients who underwent AVR for chronic severe AR, patients with severely reduced LVEF treated with optimal medical therapy had operative mortality and freedom from cardiovascular death similar to patients with mild to moderately reduced LVEF. Favourable left ventricular remodelling was observed in both groups. Hospitalization for heart failure was < 15% in both groups at 10-year follow-up.
{"title":"Effect of Contemporary Optimal Medical Therapy on Patients With Reduced Ejection Fraction Who Have Undergone Surgery for Severe Chronic Aortic Regurgitation","authors":"Marie-Christine Blais MD , Alexandre Cinq-Mars MD , Émile Voisine MD , Roxanne St-Louis MD , Charline Pujos MD , Montse Massot MD , Jean-Benoît Veillette MD , Florence Bernier MD , David Belzile MD , Pierre Yves Turgeon MD , Alexander Beaulieu-Shearer MD , Mathieu Bernier MD , Francois Dagenais MD , Mario Sénéchal MD","doi":"10.1016/j.cjco.2025.06.017","DOIUrl":"10.1016/j.cjco.2025.06.017","url":null,"abstract":"<div><h3>Background</h3><div>Aortic valve replacement (AVR) for chronic aortic regurgitation (AR) in the presence of reduced left ventricular ejection fraction (LVEF) is associated with greater surgical risk. Long-term outcomes remain poorly described in contemporary cohorts.</div></div><div><h3>Methods</h3><div>Between 2004 and 2019, 122 patients underwent AVR for chronic severe AR with LVEF < 50%. Patients with severely reduced LVEF (< 35%; n = 37) were compared with those with mild to moderately reduced LVEF (35%-50%; n = 85).</div></div><div><h3>Results</h3><div>Preoperative and intraoperative characteristics were similar in both groups. Operative mortality for the entire cohort was 1.6% (n = 2) and similar across the LVEF spectrum. Postoperatively, optimal medical therapy was achieved in most patients and > 25% of patients with LVEF < 35% benefited from cardiac resynchronization therapy. At latest follow-up, mean LVEF was 42 ± 12% in the severely reduced LVEF group (vs baseline 28 ± 5%; <em>P</em> < 0.001) and 51 ± 9% in the mild to moderately reduced LVEF group (vs baseline 46 ± 4%; <em>P</em> < 0.001). Freedom from cardiovascular death at 10 years was 87.2% in the severe group and 94.7% in the mild to moderate group (<em>P</em> = 0.10). Freedom from heart failure hospitalization at 10 years was higher in the mild to moderate group (96.3%) than in the severe group (88.3%; <em>P</em> = 0.009).</div></div><div><h3>Conclusions</h3><div>In this contemporary cohort of patients who underwent AVR for chronic severe AR, patients with severely reduced LVEF treated with optimal medical therapy had operative mortality and freedom from cardiovascular death similar to patients with mild to moderately reduced LVEF. Favourable left ventricular remodelling was observed in both groups. Hospitalization for heart failure was < 15% in both groups at 10-year follow-up.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 10","pages":"Pages 1413-1422"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334590","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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