Low-extremity peripheral artery disease (LE-PAD) is often associated with coronary artery disease (CAD). Development of biomarkers is needed to identify those among LE-PAD patients who have associated CAD. The pharmacologic profile of adenosine A2A receptors (A2AR; expression, cyclic adenosine monophosphate [cAMP] production, half maximal effective concentration [EC50]) evaluated on peripheral blood mononuclear cells is useful because these parameters are modified during myocardial ischemia. A total of 127 patients were included; 75 with CAD had a positive flow-fraction-reserve (FFR) but no intermittent claudication. Among those with LE-PAD, 27 had a positive FFR, and 25 had a negative FFR. The A2AR expression and EC50 were lower in patients with a positive FFR vs a negative FFR. Obstructive CAD might be detected by measuring the adenosine A2AR profile.
{"title":"Pharmacologic Profile of A2A Adenosine Receptors: Identifying Patients with Intermittent Claudication and Associated Myocardial Ischemia","authors":"Pierre Deharo MD, PhD , Julien Fromonot MD, PhD , Soumeya Aliouane PhD , Marion Marlinge MD, PhD , Bouchra Talbi MD , Nathalie Kipson BHsc , Tristan Werquin PhD , Julia Dodivers MD , Thomas Cuisset MD, PhD , Marine Gaudry MD, PhD , Régis Guieu MD, PhD , Franck Paganelli MD, PhD","doi":"10.1016/j.cjco.2025.06.024","DOIUrl":"10.1016/j.cjco.2025.06.024","url":null,"abstract":"<div><div>Low-extremity peripheral artery disease (LE-PAD) is often associated with coronary artery disease (CAD). Development of biomarkers is needed to identify those among LE-PAD patients who have associated CAD. The pharmacologic profile of adenosine A<sub>2A</sub> receptors (A<sub>2A</sub>R; expression, cyclic adenosine monophosphate [cAMP] production, half maximal effective concentration [EC<sub>50</sub>]) evaluated on peripheral blood mononuclear cells is useful because these parameters are modified during myocardial ischemia. A total of 127 patients were included; 75 with CAD had a positive flow-fraction-reserve (FFR) but no intermittent claudication. Among those with LE-PAD, 27 had a positive FFR, and 25 had a negative FFR. The A<sub>2A</sub>R expression and EC<sub>50</sub> were lower in patients with a positive FFR vs a negative FFR. Obstructive CAD might be detected by measuring the adenosine A<sub>2A</sub>R profile.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 10","pages":"Pages 1410-1412"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334553","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.2025.05.021
Christopher De Luca MHSc , Hardik Bhatt MD , Arnav Gupta MD , Ashkan Yahyavi MD , Behrooz Banivaheb MD , Daniel Rayner MSc , Kim Anderson MD , Shelley Zieroth MD , Sean A. Virani MD , Farid Foroutan PhD , Natasha Aleksova MD, MSc
Background
The recommendations for mineralocorticoid receptor antagonists (MRAs) in patients with heart failure with nonreduced ejection fraction (HFnrEF), defined as heart failure with left ventricular ejection fraction > 40%, are not clear. This systematic review and meta-analysis aims to evaluate the effect of MRAs on patient-important outcomes in HFnrEF.
Methods
We searched MEDLINE, Embase, Cochrane Database/Register from inception to September 6, 2024, for all randomized controlled trials comparing MRAs to placebo/standard of care in HFnrEF. Fixed and random effects models pooled estimates for mortality (all-cause and cardiovascular), HF hospitalization (HFH), functional capacity, health-related quality of life, and adverse outcomes. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach informed certainty-of-evidence assessments.
Results
Eight RCTs reported on 10,313 patients with HFnrEF. Compared to placebo or standard of care, MRAs result in a reduction in HFH (risk ratio [RR] 0.83, 95% confidence interval [CI] 0.76-0.91; risk difference [RD] 29 fewer per 1000, 95% CI 31 fewer to 15 fewer; high certainty). Moderate-certainty evidence suggests that MRAs probably result in a slight reduction in all-cause mortality (RR 0.93, 95% CI 0.85-1.02; RD 11 fewer per 1000, 95% CI 23 fewer to 3 more) and cardiovascular mortality (RR 0.92, 95% CI 0.81-1.05; RD 7 fewer per 1000, 95% CI 16 fewer to 5 more). MRA use is associated with more hyperkalemia and worsening renal function, with no difference in withdrawal of the drug due to adverse events. compared to placebo.
Conclusions
Among patients with HFnrEF, MRAs reduce HFH. Although MRAs increase the risk of hyperkalemia and worsening renal function, this does not lead to higher rates of drug discontinuation.
背景：矿质皮质激素受体拮抗剂（MRAs）用于非降低射血分数（HFnrEF）心衰患者（定义为左心室射血分数为40%的心衰）的推荐使用尚不明确。本系统综述和荟萃分析旨在评估mra对HFnrEF患者重要结局的影响。方法：我们检索MEDLINE、Embase、Cochrane数据库/Register，从成立到2024年9月6日，检索所有比较mra与安慰剂/标准治疗在HFnrEF中的随机对照试验。固定效应和随机效应模型汇总了死亡率（全因和心血管）、心衰住院（HFH）、功能能力、健康相关生活质量和不良结局的估计。建议分级评估、发展和评价（GRADE）方法为证据确定性评估提供了依据。结果8项随机对照试验共报道10313例HFnrEF患者。与安慰剂或标准护理相比，MRAs导致HFH降低（风险比[RR] 0.83, 95%置信区间[CI] 0.76-0.91；风险差[RD]每1000人减少29,95% CI减少31至15；高确定性）。中等确定性证据表明，MRAs可能导致全因死亡率（RR 0.93, 95% CI 0.85-1.02； RD减少11 / 1000,95% CI 23减少至3 / 1000）和心血管死亡率（RR 0.92, 95% CI 0.81-1.05； RD减少7 / 1000,95% CI 16减少至5 / 1000）略有降低。MRA的使用与更多的高钾血症和肾功能恶化有关，由于不良事件而停药的情况没有差异。与安慰剂相比。结论在HFnrEF患者中，MRAs降低HFH。尽管mra增加了高钾血症和肾功能恶化的风险，但这并不会导致更高的停药率。
{"title":"The Effect of Mineralocorticoid Receptor Antagonists on Heart Failure with Nonreduced Ejection Fraction: A Systematic Review and Meta-Analysis","authors":"Christopher De Luca MHSc , Hardik Bhatt MD , Arnav Gupta MD , Ashkan Yahyavi MD , Behrooz Banivaheb MD , Daniel Rayner MSc , Kim Anderson MD , Shelley Zieroth MD , Sean A. Virani MD , Farid Foroutan PhD , Natasha Aleksova MD, MSc","doi":"10.1016/j.cjco.2025.05.021","DOIUrl":"10.1016/j.cjco.2025.05.021","url":null,"abstract":"<div><h3>Background</h3><div>The recommendations for mineralocorticoid receptor antagonists (MRAs) in patients with heart failure with nonreduced ejection fraction (HFnrEF), defined as heart failure with left ventricular ejection fraction > 40%, are not clear. This systematic review and meta-analysis aims to evaluate the effect of MRAs on patient-important outcomes in HFnrEF.</div></div><div><h3>Methods</h3><div>We searched MEDLINE, Embase, Cochrane Database/Register from inception to September 6, 2024, for all randomized controlled trials comparing MRAs to placebo/standard of care in HFnrEF. Fixed and random effects models pooled estimates for mortality (all-cause and cardiovascular), HF hospitalization (HFH), functional capacity, health-related quality of life, and adverse outcomes. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach informed certainty-of-evidence assessments.</div></div><div><h3>Results</h3><div>Eight RCTs reported on 10,313 patients with HFnrEF. Compared to placebo or standard of care, MRAs result in a reduction in HFH (risk ratio [RR] 0.83, 95% confidence interval [CI] 0.76-0.91; risk difference [RD] 29 fewer per 1000, 95% CI 31 fewer to 15 fewer; high certainty). Moderate-certainty evidence suggests that MRAs probably result in a slight reduction in all-cause mortality (RR 0.93, 95% CI 0.85-1.02; RD 11 fewer per 1000, 95% CI 23 fewer to 3 more) and cardiovascular mortality (RR 0.92, 95% CI 0.81-1.05; RD 7 fewer per 1000, 95% CI 16 fewer to 5 more). MRA use is associated with more hyperkalemia and worsening renal function, with no difference in withdrawal of the drug due to adverse events. compared to placebo.</div></div><div><h3>Conclusions</h3><div>Among patients with HFnrEF, MRAs reduce HFH. Although MRAs increase the risk of hyperkalemia and worsening renal function, this does not lead to higher rates of drug discontinuation.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 10","pages":"Pages 1332-1344"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334591","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.2025.07.013
Daniel Boctor MD , Samuel B. Brusca MD , Gurpreet Dhaliwal MD , Matthew D. Ponzini MS, MPH , Noelle Boctor MD , Connor G. O’Brien MD
Background
Heart failure is one of the leading causes of hospital admissions in North America. Although guidelines support the continuation of beta blockers on admission, hemodynamic considerations and mechanistic reasoning may prompt beta blocker discontinuation even in the absence of contraindications. Resident physicians often face this dilemma and are an important group in which to evaluate this decision-making.
Methods
Internal medicine residents at two institutions were presented with two scenarios: 1) whether to continue outpatient metoprolol succinate for a patient without evidence of shock admitted with acute decompensated heart failure (ADHF) and 2) beta blocker selection during a patient’s index presentation with heart failure.
Results
142 of 287 (49.5%) residents responded to the survey. In scenario 1, 61% of residents discontinued metoprolol succinate on admission. The top three concerns about continuing metoprolol were precipitating cardiogenic shock, discomfort with the vital signs range, and attending physician disagreement. In scenario 2, 74% of participants initiated metoprolol succinate, 25% chose carvedilol, and only 1 participant chose bisoprolol.
Conclusions
Drivers of inpatient beta blocker discontinuation should be considered by internal medicine training programs and heart failure guideline writers when opportunities arise to enact practice changes that align with evidence.
{"title":"Factors Influencing Internal Medicine Resident Beta-Blocker Discontinuation in Acute Decompensated Heart Failure","authors":"Daniel Boctor MD , Samuel B. Brusca MD , Gurpreet Dhaliwal MD , Matthew D. Ponzini MS, MPH , Noelle Boctor MD , Connor G. O’Brien MD","doi":"10.1016/j.cjco.2025.07.013","DOIUrl":"10.1016/j.cjco.2025.07.013","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure is one of the leading causes of hospital admissions in North America. Although guidelines support the continuation of beta blockers on admission, hemodynamic considerations and mechanistic reasoning may prompt beta blocker discontinuation even in the absence of contraindications. Resident physicians often face this dilemma and are an important group in which to evaluate this decision-making.</div></div><div><h3>Methods</h3><div>Internal medicine residents at two institutions were presented with two scenarios: 1) whether to continue outpatient metoprolol succinate for a patient without evidence of shock admitted with acute decompensated heart failure (ADHF) and 2) beta blocker selection during a patient’s index presentation with heart failure.</div></div><div><h3>Results</h3><div>142 of 287 (49.5%) residents responded to the survey. In scenario 1, 61% of residents discontinued metoprolol succinate on admission. The top three concerns about continuing metoprolol were precipitating cardiogenic shock, discomfort with the vital signs range, and attending physician disagreement. In scenario 2, 74% of participants initiated metoprolol succinate, 25% chose carvedilol, and only 1 participant chose bisoprolol.</div></div><div><h3>Conclusions</h3><div>Drivers of inpatient beta blocker discontinuation should be considered by internal medicine training programs and heart failure guideline writers when opportunities arise to enact practice changes that align with evidence.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 10","pages":"Pages 1314-1323"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335043","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.2025.07.002
Katherine Kelemen–Dagg RN , Sandra Wong RN , Haley Emmerson RN , Ruth Coulton RN , Ryan Milne BSc , Roja Gauda MSc , Ademola Opapeju RDCS , Douaa Swar RDCS , Aimee Large RDCS , Samantha Kolupanowicz RDCS , Megan Kirkpatrick RDCS , Kaleki Hill RDCS , Kerri-Anne Mullen PhD , Christele Ferry MD , Kednapa Thavorn PhD, MPharm, BPharm , Gary Small MD , Vincent Chan MD, PhD , Donna Justus , Kelsey Oldland , Kate Macdonald BA , David Messika-Zeitoun MD, PhD
Background
There is a critical need to implement new strategies to combat cardiovascular (CV) disease and more specifically valvular heart disease (VHD). We hypothesize that a community-based, outreach, mobile screening program offering convenient screening for VHD using handheld cardiac ultrasound is feasible. and capable of facilitating early diagnosis and referral in a substantial proportion of patients. We aimed to present our experience and results from the first 18 months of implementation of the program.
Methods
We included individuals aged ≥ 65 years with no known CV disease, residing in Ottawa and its surrounding region (within Canada). We took the opportunity to combine CV risk factor assessment with VHD screening. Potential abnormal findings were triaged according to a predefined algorithm, including an automatic referral process.
Results
We screened 1817 participants (aged 75 ± 7 years; 70% female) during 109 clinics held at 57 different locations between May 2023 and October 2024. VHD abnormalities were observed in 125 participants (7%), and nonvalvular echocardiographic abnormalities were observed in 163 participants (9%). Taking advantage of VHD screening, we identified elevated blood pressure, cholesterol level, or hemoglobin A1C level in 505 participants (28%), with 77% of these cases being newly diagnosed/untreated. Participants with VHD were referred to our valve centre; others were advised to contact their primary care provider or a walk-in clinic for appropriate follow-up care.
Conclusions
In this innovative prevention initiative, we demonstrate the feasibility of an outreach mobile screening program, revealing relatively high rates of VHD, nonvalvular abnormalities, and uncontrolled risk factors. These findings highlight the program's potential to substantially enhance population health outcomes.
{"title":"The Ottawa Mobile Screening Program—Concept and First 18 Months of Experience with a Community-Based Outreach Cardiovascular Prevention Program","authors":"Katherine Kelemen–Dagg RN , Sandra Wong RN , Haley Emmerson RN , Ruth Coulton RN , Ryan Milne BSc , Roja Gauda MSc , Ademola Opapeju RDCS , Douaa Swar RDCS , Aimee Large RDCS , Samantha Kolupanowicz RDCS , Megan Kirkpatrick RDCS , Kaleki Hill RDCS , Kerri-Anne Mullen PhD , Christele Ferry MD , Kednapa Thavorn PhD, MPharm, BPharm , Gary Small MD , Vincent Chan MD, PhD , Donna Justus , Kelsey Oldland , Kate Macdonald BA , David Messika-Zeitoun MD, PhD","doi":"10.1016/j.cjco.2025.07.002","DOIUrl":"10.1016/j.cjco.2025.07.002","url":null,"abstract":"<div><h3>Background</h3><div>There is a critical need to implement new strategies to combat cardiovascular (CV) disease and more specifically valvular heart disease (VHD). We hypothesize that a community-based, outreach, mobile screening program offering convenient screening for VHD using handheld cardiac ultrasound is feasible. and capable of facilitating early diagnosis and referral in a substantial proportion of patients. We aimed to present our experience and results from the first 18 months of implementation of the program.</div></div><div><h3>Methods</h3><div>We included individuals aged ≥ 65 years with no known CV disease, residing in Ottawa and its surrounding region (within Canada). We took the opportunity to combine CV risk factor assessment with VHD screening. Potential abnormal findings were triaged according to a predefined algorithm, including an automatic referral process.</div></div><div><h3>Results</h3><div>We screened 1817 participants (aged 75 ± 7 years; 70% female) during 109 clinics held at 57 different locations between May 2023 and October 2024. VHD abnormalities were observed in 125 participants (7%), and nonvalvular echocardiographic abnormalities were observed in 163 participants (9%). Taking advantage of VHD screening, we identified elevated blood pressure, cholesterol level, or hemoglobin A1C level in 505 participants (28%), with 77% of these cases being newly diagnosed/untreated. Participants with VHD were referred to our valve centre; others were advised to contact their primary care provider or a walk-in clinic for appropriate follow-up care.</div></div><div><h3>Conclusions</h3><div>In this innovative prevention initiative, we demonstrate the feasibility of an outreach mobile screening program, revealing relatively high rates of VHD, nonvalvular abnormalities, and uncontrolled risk factors. These findings highlight the program's potential to substantially enhance population health outcomes.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 10","pages":"Pages 1366-1374"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334584","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.2025.09.004
Phelopater Sedrak MD , Vera Dounaevskaia MD , G.B. John Mancini MD , Shelley Zieroth MD , Robert S. McKelvie MD, PhD , Wynne Chiu MSN, RN, CCN(C) , David Bewick MD , Anique Ducharme MD, MSc , Samer Mansour MD , Serge Lepage MD , Glen J. Pearson PharmD, FCSHP, FCCS , Robert C. Welsh MD , Jacob A. Udell MD, MPH , Kim A. Connelly MBBS, PhD
Vaccination is a crucial preventative strategy, particularly in individuals with cardiovascular (CV) disease (CVD). People living with CVD are at increased risk of morbidity and mortality from vaccine-preventable infections such as influenza, severe acute respiratory syndrome-corona virus 2 (SARS-CoV-2), respiratory syncytial virus (RSV), varicella zoster virus (VZV), and pneumococcal disease. These infections also have been associated with downstream CV complications, including ischemic events and myocarditis. Randomized controlled trials have demonstrated that influenza vaccination reduces major adverse CV events and all-cause mortality, especially in people with CVD. The same has been observed in registry analyses during the SARS-CoV-2 pandemic. Pooling of data from observational and cohort studies also has shown significant benefit of vaccination against RSV, VZV, and pneumococcal disease in older populations and those with CV comorbidities. Despite recommendations from national public health guidelines and immunization programs, vaccination uptake in patients with CVD remains suboptimal. This low uptake is influenced by lack of vaccine information, access issues, and mistrust in the healthcare system, all summarized in the term “vaccine hesitancy.” Vaccination promotion should focus on addressing these gaps in communication and access barriers at the provider, community, and public health levels. Healthcare providers including cardiologists are reminded, through this review, of the importance of emphasizing vaccination recommendations during clinical encounters. Addressing patient misconceptions and providing patient decision aids strongly improves acceptance rates. Continued efforts at the community and public health levels should address barriers to access and advance surveillance methods to target improved clinical outcomes for groups at risk.
{"title":"Vaccination in Patients with Cardiovascular Disease: A Case-Based Approach and Contemporary Review","authors":"Phelopater Sedrak MD , Vera Dounaevskaia MD , G.B. John Mancini MD , Shelley Zieroth MD , Robert S. McKelvie MD, PhD , Wynne Chiu MSN, RN, CCN(C) , David Bewick MD , Anique Ducharme MD, MSc , Samer Mansour MD , Serge Lepage MD , Glen J. Pearson PharmD, FCSHP, FCCS , Robert C. Welsh MD , Jacob A. Udell MD, MPH , Kim A. Connelly MBBS, PhD","doi":"10.1016/j.cjco.2025.09.004","DOIUrl":"10.1016/j.cjco.2025.09.004","url":null,"abstract":"<div><div>Vaccination is a crucial preventative strategy, particularly in individuals with cardiovascular (CV) disease (CVD). People living with CVD are at increased risk of morbidity and mortality from vaccine-preventable infections such as influenza, severe acute respiratory syndrome-corona virus 2 (SARS-CoV-2), respiratory syncytial virus (RSV), varicella zoster virus (VZV), and pneumococcal disease. These infections also have been associated with downstream CV complications, including ischemic events and myocarditis. Randomized controlled trials have demonstrated that influenza vaccination reduces major adverse CV events and all-cause mortality, especially in people with CVD. The same has been observed in registry analyses during the SARS-CoV-2 pandemic. Pooling of data from observational and cohort studies also has shown significant benefit of vaccination against RSV, VZV, and pneumococcal disease in older populations and those with CV comorbidities. Despite recommendations from national public health guidelines and immunization programs, vaccination uptake in patients with CVD remains suboptimal. This low uptake is influenced by lack of vaccine information, access issues, and mistrust in the healthcare system, all summarized in the term “vaccine hesitancy.” Vaccination promotion should focus on addressing these gaps in communication and access barriers at the provider, community, and public health levels. Healthcare providers including cardiologists are reminded, through this review, of the importance of emphasizing vaccination recommendations during clinical encounters. Addressing patient misconceptions and providing patient decision aids strongly improves acceptance rates. Continued efforts at the community and public health levels should address barriers to access and advance surveillance methods to target improved clinical outcomes for groups at risk.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 10","pages":"Pages 1375-1388"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334585","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.2025.07.003
Keitaro Akita MD, PhD , Ryota Sato MD, PhD , Atsushi Anzai MD, PhD , Rahul Sakhuja MD, MPP, MSC , Michael A. Fifer MD , Yuichi J. Shimada MD, MPH , Yuichiro Maekawa MD, PhD
Background
Alcohol septal ablation (ASA) is an established intervention for patients with drug-refractory obstructive hypertrophic cardiomyopathy. Whereas some patients require ASA with multiple target septal branches due to a residual pressure gradient, the prognostic effect of multiple-branch ablation remains unclear. Thus, we aimed to investigate the association of multiple-branch ablation with cardiovascular (CV) events after ASA.
Methods
This multicentre trans-Pacific study enrolled patients who underwent ASA at 4 institutions in the US and Japan. Patients were categorized into single- and multiple-branch ablation groups. CV events, defined as a composite of CV death, repeated septal reduction therapy, and heart failure hospitalization, were compared in 2 groups within 1 year after ASA was performed. To address potential confounding, inverse probability of treatment weighting (IPTW) was performed, based on the propensity scores for multiple-branch ablation. Odds ratios (ORs) were examined for CV events before and after the IPTW was performed.
Results
This study enrolled 151 patients who underwent ASA (single-branch, n = 66; multiple-branch, n = 85). The multiple-branch ablation group had higher peak gradients, which became comparable after ASA was performed. CV events were significantly lower in the multiple-branch ablation group, both before the IPTW (OR 0.33, 95% confidence interval [CI] 0.10-0.96, P = 0.049) and after the IPTW (OR 0.27, 95% CI 0.10-0.68, P = 0.01) was performed. The effect of the reduced incidence was primarily due to a decrease in heart failure hospitalization.
Conclusions
This study demonstrated that ASA with multiple target branches may be an effective treatment option for reducing CV events in morphologically and hemodynamically eligible patients with obstructive hypertrophic cardiomyopathy.
背景：酒精室间隔消融术（ASA）是药物难治性梗阻性肥厚性心肌病患者的一种既定干预措施。然而，由于残余压力梯度，一些患者需要多目标间隔分支的ASA，多分支消融的预后影响尚不清楚。因此，我们的目的是研究ASA后多分支消融与心血管事件的关系。方法：这项跨太平洋的多中心研究纳入了在美国和日本的4家机构接受ASA治疗的患者。患者分为单支和多支消融组。心血管事件，定义为心血管死亡、重复间隔缩小治疗和心力衰竭住院的复合，比较两组在ASA后1年内的心血管事件。为了解决潜在的混淆，基于多分支消融的倾向评分，进行了治疗加权逆概率（IPTW）。在IPTW前后检查CV事件的比值比（ORs）。结果本研究纳入151例接受ASA治疗的患者（单支，66例；多支，85例）。多支消融组有更高的峰值梯度，ASA后具有可比性。在IPTW术前（OR 0.33, 95%可信区间[CI] 0.10-0.96, P = 0.049）和IPTW术后（OR 0.27, 95% CI 0.10-0.68, P = 0.01），多支消融组的CV事件均显著降低。降低发病率的影响主要是由于心力衰竭住院治疗的减少。结论：本研究表明，在形态学和血流动力学符合条件的阻塞性肥厚性心肌病患者中，多靶点分支ASA可能是减少心血管事件的有效治疗选择。
{"title":"Multiple-Branch Alcohol Septal Ablation Is Associated with Reduced Cardiovascular Events: Insights from a Trans-Pacific Multicentre Registry","authors":"Keitaro Akita MD, PhD , Ryota Sato MD, PhD , Atsushi Anzai MD, PhD , Rahul Sakhuja MD, MPP, MSC , Michael A. Fifer MD , Yuichi J. Shimada MD, MPH , Yuichiro Maekawa MD, PhD","doi":"10.1016/j.cjco.2025.07.003","DOIUrl":"10.1016/j.cjco.2025.07.003","url":null,"abstract":"<div><h3>Background</h3><div>Alcohol septal ablation (ASA) is an established intervention for patients with drug-refractory obstructive hypertrophic cardiomyopathy. Whereas some patients require ASA with multiple target septal branches due to a residual pressure gradient, the prognostic effect of multiple-branch ablation remains unclear. Thus, we aimed to investigate the association of multiple-branch ablation with cardiovascular (CV) events after ASA.</div></div><div><h3>Methods</h3><div>This multicentre trans-Pacific study enrolled patients who underwent ASA at 4 institutions in the US and Japan. Patients were categorized into single- and multiple-branch ablation groups. CV events, defined as a composite of CV death, repeated septal reduction therapy, and heart failure hospitalization, were compared in 2 groups within 1 year after ASA was performed. To address potential confounding, inverse probability of treatment weighting (IPTW) was performed, based on the propensity scores for multiple-branch ablation. Odds ratios (ORs) were examined for CV events before and after the IPTW was performed.</div></div><div><h3>Results</h3><div>This study enrolled 151 patients who underwent ASA (single-branch, n = 66; multiple-branch, n = 85). The multiple-branch ablation group had higher peak gradients, which became comparable after ASA was performed. CV events were significantly lower in the multiple-branch ablation group, both before the IPTW (OR 0.33, 95% confidence interval [CI] 0.10-0.96, <em>P</em> = 0.049) and after the IPTW (OR 0.27, 95% CI 0.10-0.68, <em>P</em> = 0.01) was performed. The effect of the reduced incidence was primarily due to a decrease in heart failure hospitalization.</div></div><div><h3>Conclusions</h3><div>This study demonstrated that ASA with multiple target branches may be an effective treatment option for reducing CV events in morphologically and hemodynamically eligible patients with obstructive hypertrophic cardiomyopathy.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 10","pages":"Pages 1324-1331"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335048","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.2025.07.004
Vatsal Singh MBBS , George D. Veenhuyzen MD , Satish R. Raj MD, MSCI
{"title":"Pacemaker Failure to Capture Caused by a Pneumothorax","authors":"Vatsal Singh MBBS , George D. Veenhuyzen MD , Satish R. Raj MD, MSCI","doi":"10.1016/j.cjco.2025.07.004","DOIUrl":"10.1016/j.cjco.2025.07.004","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 10","pages":"Pages 1354-1356"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334551","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.2025.06.012
Jocelyn Chai MD , Matthew Cheung MD , Jeffrey Yim MD , Lu Kun Chen MD , Ahmad Didi MD , Shane J.T. Balthazaar PhD, RDCS , Darwin Yeung MD , Daniel Worsley MD , Margot K. Davis MD, MSc
Background
Transthyretin cardiac amyloidosis (ATTR-CM) is an underdiagnosed infiltrative cardiomyopathy. Diagnosis is based on Technetium-99m-pyrophosphate-bone-scintigraphy scans (Tc-99m-PYP) with grades 2 to 3 classified as positive. The clinical significance of grade 1 (classified equivocal by American Society of Nuclear Cardiology) is unclear. We aimed to describe the differences in clinical/imaging characteristics among those with equivocal vs positive Tc-99m-PYP and to describe outcomes of further investigations.
Methods
We performed a retrospective study of patients who underwent Tc-99m-PYP at 2 institutions between January 2017 and November 2022. Baseline demographics, laboratory, and imaging data were collected.
Results
A total of 502 Tc-99m-PYP were performed with single-photon emission computed tomography (SPECT) 3 hours post-tracer injection: 347 (69%) negative, 46 (9%) equivocal, and 109 (22%) positive. In the latter 2 groups, the median age was 78 (interquartile range [IQR]: 72-84) years, and 38 (25%) were female. Average follow-up was 19.7 ± 14.6 months. No patients with equivocal scans were diagnosed with ATTR-CM. Equivocal scans had lower intraventricular septal diameters (11 mm [IQR: 10-11] vs 15 mm [IQR: 12-17]), larger left ventricular end-diastolic dimension (50 mm [IQR: 44-56] vs 43 mm [IQR: 40-50]), and more negative global longitudinal strain (–18.7 [IQR: –22.2 to –18.7] vs –13.8 [IQR: –17.9 to –10.9] %). Only 12 (26%) patients with equivocal scans underwent further imaging or biopsy. Of 2 patients with monoclonal gammopathy, 1 had AL-amyloidosis.
Conclusions
Our patients with equivocal grade 1 scans were not diagnosed with ATTR-CM. They exhibited distinct imaging compared to positive scans. Our findings suggest that ATTR-CM phenotype and equivocal scans may represent early ATTR-CM (ie, false negative) or false positives and should undergo further workup. Further research is needed to determine the significance of equivocal studies.
甲状腺素型心脏淀粉样变性（atr - cm）是一种未确诊的浸润性心肌病。诊断基于锝-99m焦磷酸盐骨显像扫描（Tc-99m-PYP）， 2至3级为阳性。1级的临床意义尚不清楚（美国核心脏病学会的分类是模棱两可的）。我们的目的是描述Tc-99m-PYP不明确与阳性患者临床/影像学特征的差异，并描述进一步研究的结果。方法：我们对2017年1月至2022年11月期间在2家机构接受Tc-99m-PYP治疗的患者进行了回顾性研究。收集基线人口统计学、实验室和影像学数据。结果502例Tc-99m-PYP患者在注射示踪剂3 h后进行单光子发射计算机断层扫描（SPECT），其中347例（69%）阴性，46例（9%）模糊，109例（22%）阳性。后两组患者年龄中位数为78岁（四分位数间距[IQR]: 72-84），女性38例（25%）。平均随访19.7±14.6个月。没有模棱两可的患者被诊断为atr - cm。模棱两可扫描显示室间隔直径较低（11 mm [IQR: 10-11] vs 15 mm [IQR: 12-17]），左心室舒张末期尺寸较大（50 mm [IQR: 44-56] vs 43 mm [IQR: 40-50]），整体纵向应力负（-18.7 [IQR: -22.2至-18.7]vs -13.8 [IQR: -17.9至-10.9]%）。只有12例（26%）扫描结果不明确的患者接受了进一步的成像或活检。2例单克隆γ病患者中，1例有al -淀粉样变性。结论有模棱两可的1级扫描的sour患者未被诊断为atr - cm。与阳性扫描相比，它们表现出明显的成像。我们的研究结果表明，atr - cm表型和模棱两可的扫描可能代表早期atr - cm（即假阴性）或假阳性，应该进行进一步的检查。需要进一步的研究来确定模棱两可研究的意义。
{"title":"Equivocal vs Positive Technetium-99m-Pyrophosphate Scintigraphy for Transthyretin Amyloid Cardiomyopathy: Comparing Outcomes, Demographics, and Imaging","authors":"Jocelyn Chai MD , Matthew Cheung MD , Jeffrey Yim MD , Lu Kun Chen MD , Ahmad Didi MD , Shane J.T. Balthazaar PhD, RDCS , Darwin Yeung MD , Daniel Worsley MD , Margot K. Davis MD, MSc","doi":"10.1016/j.cjco.2025.06.012","DOIUrl":"10.1016/j.cjco.2025.06.012","url":null,"abstract":"<div><h3>Background</h3><div>Transthyretin cardiac amyloidosis (ATTR-CM) is an underdiagnosed infiltrative cardiomyopathy. Diagnosis is based on Technetium-99m-pyrophosphate-bone-scintigraphy scans (Tc-99m-PYP) with grades 2 to 3 classified as positive. The clinical significance of grade 1 (classified equivocal by American Society of Nuclear Cardiology) is unclear. We aimed to describe the differences in clinical/imaging characteristics among those with equivocal vs positive Tc-99m-PYP and to describe outcomes of further investigations.</div></div><div><h3>Methods</h3><div>We performed a retrospective study of patients who underwent Tc-99m-PYP at 2 institutions between January 2017 and November 2022. Baseline demographics, laboratory, and imaging data were collected.</div></div><div><h3>Results</h3><div>A total of 502 Tc-99m-PYP were performed with single-photon emission computed tomography (SPECT) 3 hours post-tracer injection: 347 (69%) negative, 46 (9%) equivocal, and 109 (22%) positive. In the latter 2 groups, the median age was 78 (interquartile range [IQR]: 72-84) years, and 38 (25%) were female. Average follow-up was 19.7 ± 14.6 months. No patients with equivocal scans were diagnosed with ATTR-CM. Equivocal scans had lower intraventricular septal diameters (11 mm [IQR: 10-11] vs 15 mm [IQR: 12-17]), larger left ventricular end-diastolic dimension (50 mm [IQR: 44-56] vs 43 mm [IQR: 40-50]), and more negative global longitudinal strain (–18.7 [IQR: –22.2 to –18.7] vs –13.8 [IQR: –17.9 to –10.9] %). Only 12 (26%) patients with equivocal scans underwent further imaging or biopsy. Of 2 patients with monoclonal gammopathy, 1 had AL-amyloidosis.</div></div><div><h3>Conclusions</h3><div>Our patients with equivocal grade 1 scans were not diagnosed with ATTR-CM. They exhibited distinct imaging compared to positive scans. Our findings suggest that ATTR-CM phenotype and equivocal scans may represent early ATTR-CM (ie, false negative) or false positives and should undergo further workup. Further research is needed to determine the significance of equivocal studies.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 10","pages":"Pages 1282-1289"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335045","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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