CJC Open最新文献

英文中文

High Prevalence of Atrial Fibrillation Found in the Capital of Greenland When Using Continuous Electrocardiogram Monitoring: A Cross-Sectional Study 格陵兰首府使用连续心电图监测发现心房颤动发病率高：一项横断面研究

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open

Pub Date : 2024-07-01 DOI: 10.1016/j.cjco.2024.03.011

Nadja Albertsen MD, MSA , Mads Mose Jensen MD , Kunuk Lauge Koch Hansen , Michael Lynge Pedersen MD, MedScD , Stig Andersen MD, PhD , Christina Brock MSc, PhD , Sam Riahi MD, PhD

Background

Atrial fibrillation (AF) increases the risk of conditions such as ischemic stroke, dementia, and heart failure, and early detection is crucial. In Greenland, ischemic strokes are common, and the prevalences of AF risk factors are increasing. Studies based on 30-second electrocardiograms (ECGs) and diagnosis codes so far have indicated either a low prevalence of AF or a prevalence comparable to that in other Western countries, such as Denmark. However, using short, single-point ECGs may underestimate the true prevalence, as especially paroxysmal AF can be missed. With this study, we aim to estimate the prevalence of AF using 3-5–day continuous Holter recordings among people in Nuuk, the capital of Greenland.

Methods

In this cross-sectional study, we estimated the prevalence of AF among the population aged ≥ 50 years in Greenland’s capital, Nuuk. We used an ePatch to record continuous ECGs for 3-5 days, and questionnaires to assess demographic data, comorbidities, medication, symptoms, and risk factors for AF.

Results

Of 226 participants (62% women), 21 (33% women) had either self-reported AF, AF on the recording, or both, equivalent to a prevalence of 9.3% (confidence interval [CI] 5.8-13.9). The age-stratified prevalence was 7.2% (CI 2.7-15.1) among those aged 50-59 years; 8.8% (CI 4.1-16.1) among those aged 60-69 years; and 18.2% (CI 7.0-35.5) among those aged ≥ 70 years.

Conclusions

This study provides a novel insight into AF prevalence in Nuuk, emphasizing the potential underestimation in previous studies. Continuous ECG monitoring revealed a higher prevalence, especially among the younger age groups, urging a reevaluation of diagnostic practices in this unique population.

背景心房颤动（房颤）会增加缺血性中风、痴呆症和心力衰竭等疾病的风险，因此早期发现至关重要。在格陵兰岛，缺血性中风很常见，房颤风险因素的发病率也在上升。迄今为止，基于 30 秒心电图和诊断代码的研究表明，心房颤动的发病率较低，或与丹麦等其他西方国家的发病率相当。然而，使用短时间的单点心电图可能会低估真实的患病率，因为尤其是阵发性房颤可能会被漏诊。在这项研究中，我们旨在使用 3-5 天的连续 Holter 记录来估算格陵兰首府努克的房颤患病率。方法在这项横断面研究中，我们估算了格陵兰首府努克年龄≥ 50 岁人群的房颤患病率。我们使用电子血压计连续记录了 3-5 天的心电图，并通过问卷调查评估了人口统计学数据、合并症、药物治疗、症状和心房颤动的风险因素。结果在 226 名参与者（62% 为女性）中，21 人（33% 为女性）自述有心房颤动，或在记录中发现有心房颤动，或两者皆有，患病率为 9.3%（置信区间 [CI] 5.8-13.9）。按年龄划分，50-59 岁人群的患病率为 7.2%（置信区间 [CI] 2.7-15.1）；60-69 岁人群的患病率为 8.8%（置信区间 [CI] 4.1-16.1）；≥ 70 岁人群的患病率为 18.2%（置信区间 [CI] 7.0-35.5）。连续心电图监测显示房颤的发病率较高，尤其是在年轻群体中，因此需要对这一特殊人群的诊断方法进行重新评估。

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引用次数: 0

Takotsubo Cardiomyopathy After Oxaliplatin Chemotherapy Exposure: A Case Report 奥沙利铂化疗后的塔克苏波心肌病：病例报告

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open

Pub Date : 2024-07-01 DOI: 10.1016/j.cjco.2024.07.005

Shafaz Veettil, Omar Khan, Daniel P. Durocher

引用次数: 0

Intracardiac echocardiography-guided transseptal puncture invisible by transesophageal echocardiography after secundum atrial septal defect closure 心内超声心动图引导下经食管超声心动图隐形经房间隔缺损封堵术后的穿刺术

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open

Pub Date : 2024-07-01 DOI: 10.1016/j.cjco.2024.07.002

Y. Kasai, T. Kitai, R. Horita, D. Hachinohe, Junji Morita, Ryo Otake, Hidemasa Shitan, Yumetsugu Munakata, Jungo Kasai, Tsutomu Fujita

引用次数: 0

Competency-based cardiology training: A simple approach to improve supervisor completion of Entrustable Professional Activities 基于能力的心脏病学培训：改进督导人员完成委托专业活动的简单方法

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open

Pub Date : 2024-07-01 DOI: 10.1016/j.cjco.2024.07.007

W. Faiella, Sandila Navjot, Sarah Ramer

引用次数: 0

Distinguishing Primary Prevention From Secondary Prevention Implantable Cardioverter Defibrillators Using Administrative Health and Cardiac Device Registry Data 利用行政健康和心脏设备登记数据区分一级和二级预防植入式心律转复除颤器

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open

Pub Date : 2024-07-01 DOI: 10.1016/j.cjco.2024.02.003

Isaac Robinson , Daniel Daly-Grafstein MSc , Mayesha Khan MA , Andrew D. Krahn MD , Nathaniel M. Hawkins MD , Jeffrey R. Brubacher MD , John A. Staples MD, MPH

Background

Administrative health data and cardiac device registries can be used to empirically evaluate outcomes and costs after implantable cardioverter defibrillator (ICD) implantation. These datasets often have incomplete information on the indication for implantation (primary vs secondary prevention of sudden cardiac death).

Methods

We used 16 years of population-based cardiac device registry and administrative health data from British Columbia, Canada, to derive and internally validate statistical models that predict the likely indication for ICD implantation. We used chart review data as the reference standard for ICD indication in the Cardiac Device Registry database (CDR; 2004-2012 [Cardiac Services BC]) and nonmissing indication as the reference standard in the Heart Information System registry database (HEARTis; 2013-2019 [Cardiac Services BC]). We created 3 logistic regression prediction models in each database: one using only registry data, one using only administrative data, and one using both registry and administrative data. We assessed the predictive performance of each model using standard metrics after optimism correction with 200 bootstrap resamples.

Results

Models that used registry data alone demonstrated excellent predictive performance (sensitivity ≥ 89%; specificity ≥ 87%). Models that used only administrative data performed well (sensitivity ≥ 84%; specificity ≥ 70%). Models that used both registry and administrative data showed modest gains over those that used registry data alone (sensitivity ≥ 90%; specificity ≥ 89%).

Conclusions

Administrative health data and cardiac device registry data can distinguish secondary prevention ICDs from primary prevention ICDs with acceptable sensitivity and specificity. Imputation of missing ICD indication might make these data resources more useful for research and health system monitoring.

背景行政健康数据和心脏设备登记可用于对植入式心律转复除颤器（ICD）植入后的疗效和成本进行经验性评估。我们利用加拿大不列颠哥伦比亚省 16 年的基于人口的心脏设备登记和行政健康数据，推导并在内部验证了预测 ICD 植入可能适应症的统计模型。我们使用病历审查数据作为心脏设备登记数据库（CDR；2004-2012 年 [Cardiac Services BC]）中 ICD 适应症的参考标准，并使用心脏信息系统登记数据库（HEARTis；2013-2019 年 [Cardiac Services BC]）中的非遗漏适应症作为参考标准。我们在每个数据库中创建了 3 个逻辑回归预测模型：一个仅使用登记数据，一个仅使用管理数据，一个同时使用登记数据和管理数据。结果仅使用登记处数据的模型表现出卓越的预测性能（灵敏度≥ 89%；特异性≥ 87%）。仅使用行政数据的模型表现良好（灵敏度≥ 84%；特异度≥ 70%）。结论行政健康数据和心脏设备登记数据能以可接受的灵敏度和特异性区分二级预防 ICD 和一级预防 ICD。对缺失的 ICD 适应症进行估算可能会使这些数据资源在研究和卫生系统监测方面更加有用。

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引用次数: 0

Exploring Patient Viewpoints to Optimize Implementation of a Biological Therapy for Atrial Fibrillation Prevention 探索患者观点，优化心房颤动预防生物疗法的实施

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open

Pub Date : 2024-07-01 DOI: 10.1016/j.cjco.2024.04.003

Chloé Smith MD , Manoj M. Lalu MD, PhD , Darryl R. Davis MD

Background

Embracing patient viewpoints can enhance the translation of novel therapeutics to clinical settings. This study evaluated the acceptability of using extracellular vesicles (EVs) as a biological therapy for preventing postoperative atrial fibrillation (AF), through engagement with patients, providing insights into their attitudes and information needs.

Methods

Patients participated in prerecorded presentations, virtual focus groups, and surveys to assess their perspectives on EV therapy and determine the factors influencing their acceptance of the intervention.

Results

Participants with postoperative AF experienced prolonged intensive care unit and hospital stays, compared to those of patients with normal heart rhythm. Prior to the presentation, a number of participants were unfamiliar with postoperative AF and biological therapies. However, postpresentation and post–focus group activities resulted in enhanced understanding of the research, with high levels of comprehension reported by all participants. The level of acceptance of EV therapy tended to increase, with a majority expressing willingness to participate in clinical trials and accept the therapy. The focus groups identified and addressed common questions regarding the potential risks and side effects of EVs, their source, dosing, utility for patients with preexisting AF, and the risk of human immunodeficiency virus (HIV) contraction or allergic reactions.

Conclusions

The study highlights the importance of providing education, involving the patient's circle of care, and addressing patient concerns, to promote acceptance of therapies such as EV therapy for postoperative AF.

Clinical Trial Registration

NCT05032495.

背景了解患者的观点可以促进新型疗法向临床转化。本研究通过让患者参与评估使用细胞外囊泡（EVs）作为生物疗法预防术后房颤（AF）的可接受性，从而深入了解他们的态度和信息需求。结果与心律正常的患者相比，术后房颤患者在重症监护室和医院的住院时间更长。在演讲之前，许多与会者对术后房颤和生物疗法并不熟悉。然而，演讲后和焦点小组活动后，与会者对研究有了更深入的了解，所有与会者都表示理解程度很高。参与者对 EV 疗法的接受程度趋于提高，大多数人表示愿意参加临床试验并接受该疗法。焦点小组确定并解决了有关 EV 潜在风险和副作用、其来源、剂量、对已有房颤的患者的效用以及感染人类免疫缺陷病毒 (HIV) 或过敏反应的风险等常见问题。

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引用次数: 0

ASSESSMENT OF COAGULATION FACTORS IN PATIENTS WITH SEVERE RHEUMATIC MITRAL STENOSIS IN SINUS RHYTHM WITH LEFT ATRIAL APPENDAGE INACTIVITY 评估窦性心律伴有左心房阑尾不活动的严重风湿性二尖瓣狭窄患者的凝血因子

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open

Pub Date : 2024-07-01 DOI: 10.1016/j.cjco.2024.07.004

S. Mukhopadhyay, N. Chauhan, Ghazi Muheeb, J. Yusuf, V. Mehta, Bhawna Mahajan, Sanjeev Kathuria, R. Agrawal

引用次数: 0

Lymphopenia in the Adult Population With Fontan Physiology: A Potential New Marker for Disease Assessment 成人 Fontan 群体中的淋巴细胞减少症：疾病评估的潜在新标记物

Q3 Medicine

CJC Open

Pub Date : 2024-06-01 DOI: 10.1016/j.cjco.2024.01.012

Anna L. Scandinaro MD , Michael D. McCann MD, MBA , Anisa Chaudhry MD , Allen Kunselman MA , Elisa A. Bradley MD , William R. Davidson Jr. MD

Background

Patients with complex congenital heart disease and Fontan palliation frequently develop extracardiac disease, including hematologic abnormalities, such as lymphopenia. However, the clinical implications of this finding are poorly understood and are therefore the topic of this investigation.

Methods

Patients with Fontan physiology in our centre (1999-2018) were evaluated for the presence and impact of lymphopenia. The cohort was divided into a group with lymphopenia (L) (2 consecutive absolute lymphocyte counts ≤ 1∗10³ K/ μL) and a group who had never had lymphopenia (NL). Clinical characteristics and hospital admissions (762 patient-years) were evaluated.

Results

In 62 adult patients with Fontan physiology (aged 34 ± 9 years; 32 women [52%]), the patients who developed lymphopenia earliest did so 8 years after Fontan completion, with up to 60% of patients developing lymphopenia by 30 years. Lymphopenia was found to be associated with portal hypertension (varices, ascites, splenomegaly, and thrombocytopenia [VAST] score)—NL: 0 (0-2) vs L: 2 (0-4), P < 0.0001). A total of 76 heart failure and 81 arrhythmia-associated admissions occurred per 1000 patient-years. At 40 years post-Fontan, the probability of a heart failure admission was higher in the L group (L: 51 [86%] vs NL: 8 [14%], P < 0.01).

Conclusions

Adult patients with Fontan physiology and lymphopenia demonstrated portal hypertension and lymphatic dysfunction more commonly, perhaps suggesting that this may be a marker of Fontan congestion and early Fontan failure. Further investigation into the relationship between lymphopenia, clinical outcomes, and Fontan function is needed.

背景复杂先天性心脏病和Fontan姑息治疗患者经常会出现心外疾病，包括血液学异常，如淋巴细胞减少症。方法对本中心的丰坦生理学患者（1999-2018 年）进行了淋巴细胞减少症存在及其影响的评估。研究对象分为淋巴细胞减少症（L）组（连续两次淋巴细胞绝对计数≤1∗103 K/μL）和从未出现淋巴细胞减少症（NL）组。结果在 62 名患有丰坦生理学的成年患者（年龄为 34 ± 9 岁；32 名女性 [52%]）中，最早出现淋巴细胞减少症的患者是在丰坦手术完成后 8 年出现的，多达 60% 的患者在 30 年前出现淋巴细胞减少症。淋巴细胞减少症与门静脉高压有关（静脉曲张、腹水、脾肿大和血小板减少[VAST]评分）--NL：0 (0-2) vs L：2 (0-4)，P < 0.0001）。每 1000 患者年中，共有 76 例心力衰竭和 81 例心律失常相关入院。结论成人丰坦生理学和淋巴细胞减少症患者更常表现为门脉高压和淋巴功能障碍，这可能是丰坦充血和早期丰坦衰竭的标志。需要进一步研究淋巴细胞减少症、临床结果和Fontan功能之间的关系。

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引用次数: 0

Prescription Trends of Thiazide Diuretics in a Canadian Primary Care Population From 2015 to 2021 2015-2021 年加拿大初级保健人群中噻嗪类利尿剂的处方趋势

Q3 Medicine

CJC Open

Pub Date : 2024-06-01 DOI: 10.1016/j.cjco.2024.03.001

Catherine Ji MD, MSc , Jemisha Apajee MPhil , Ellen Stephenson PhD , Karen Tu MD, Msc

Background

Hypertension Canada 2017 guidelines favoured the use of thiazide (TZ)-like diuretics, such as CLTD (chlorthalidone) and indapamide (IND) over hydrochlorothiazide (HCTZ). Health Canada warned in 2019 that HCTZ may be associated with increased risk of skin cancer. Our study looked at the changes in TZ prescriptions from 2015 to 2021 in Ontario, Canada.

Methods

A retrospective cohort study was conducted of adults with hypertension, using electronic medical record data from the University of Toronto Practice-Based Research Network database covering mostly the Greater Toronto area. Outcomes included the proportion of patients who received a prescription of HCTZ, CLTD, or IND each month. Interrupted time-series analysis was used to evaluate the change in outcomes after publication of the 2017 guidelines and 2019 safety warning. Prescription trends were stratified by prescribing physicians’ sex and year of medical school graduation.

Results

A total of 100,428 patients with hypertension were included in the cohort, with 31,700 patients who received at least one TZ prescription from 343 family physicians. We found a declining trend in HCTZ prescriptions over time, accompanied by an increase in IND and CLTD prescriptions, with statistically significant but transient changes in prescription rates after publication of the 2017 guidelines and the 2019 safety warning for all 3 medications. Female physician and early-career physician prescription rates changed faster than that of their counterparts immediately after the Health Canada safety warning was issued.

Conclusions

TZ diuretic prescription patterns have changed in recent years, but Hypertension Canada’s 2017 guidelines and the 2019 Health Canada safety warning did not have a sustained significant impact on the change in prescription rates of HCTZ, IND, and CLTD.

背景加拿大2017年高血压指南倾向于使用噻嗪类（TZ）利尿剂，如CLTD（氯沙利酮）和吲哒帕胺（IND），而不是氢氯噻嗪（HCTZ）。加拿大卫生部在2019年警告说，HCTZ可能与皮肤癌风险增加有关。我们的研究调查了加拿大安大略省从2015年到2021年TZ处方的变化情况。研究方法利用多伦多大学基于实践的研究网络数据库（主要覆盖大多伦多地区）中的电子病历数据，对成人高血压患者进行了一项回顾性队列研究。研究结果包括每月获得 HCTZ、CLTD 或 IND 处方的患者比例。采用间断时间序列分析来评估 2017 年指南和 2019 年安全警告发布后的结果变化。根据处方医生的性别和医学院毕业年份对处方趋势进行了分层。结果共有 100,428 名高血压患者被纳入队列，其中 31,700 名患者从 343 名家庭医生处获得了至少一张 TZ 处方。我们发现，随着时间的推移，HCTZ处方量呈下降趋势，同时IND和CLTD处方量有所增加，在2017年指南发布和2019年所有3种药物的安全警告发布后，处方率发生了统计学意义上的显著变化，但这种变化是短暂的。在加拿大卫生部安全警告发布后，女性医生和早期职业医生的处方率变化比她们的同行更快。结论近年来，TZ 利尿剂处方模式发生了变化，但加拿大高血压协会 2017 年指南和 2019 年加拿大卫生部安全警告并未对 HCTZ、IND 和 CLTD 处方率的变化产生持续的重大影响。

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引用次数: 0

Progression of Left Ventricular Aneurysm to Pseudoaneurysm on Serial Imaging 连续成像显示左心室动脉瘤向假性动脉瘤发展

Q3 Medicine

CJC Open

Pub Date : 2024-06-01 DOI: 10.1016/j.cjco.2024.04.002

Yoshito Kadoya MD, PhD , Alexander Dick MD , Hassan Mir MD , Luc Beauchesne MD , D. Ian Paterson MD

引用次数: 0

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