Canadian Journal of Cardiology最新文献

英文中文

Epidemiology and Risk Factors for Constrictive Pericarditis in a Statewide Australian Cohort of Patients With Pericardial Disease 澳大利亚全州心包疾病患者中缩窄性心包炎的流行病学和危险因素

IF 5.3 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Canadian Journal of Cardiology

Pub Date : 2026-01-01 DOI: 10.1016/j.cjca.2025.09.031

Timothy N. Kwan MD, Gemma Kwan MD, David Brieger MBBS, PhD, Vincent Chow MBBS, PhD, Leonard Kritharides MBBS, PhD, Austin Chin Chwan Ng MMed, MBBS

Background

Constrictive pericarditis is a rare but serious complication of pericardial disease, with limited longitudinal studies assessing its risk factors. In this study we evaluated the epidemiology and predictors of constrictive pericarditis in a large population-based cohort.

Methods

We conducted a retrospective cohort study of all hospitalized patients with pericardial disease from 2004 to 2021 using the Australian New South Wales Admitted Patient Data Collection database. Multivariable logistic regression identified risk factors for constrictive pericarditis at index admission with pericardial disease, whereas time-dependent Cox regression and the Fine-Gray method were used to assess risk factors during follow-up.

Results

Among 45,445 patients with pericardial disease, 763 (1.7%) developed constrictive pericarditis (median age 64.3 years; 63.4% men). The median time from cardiac surgery to diagnosis of constriction was 6 months and from autoimmune disease diagnosis it was 2 years. Of these patients, 530 (1.2%) had constriction at index presentation of pericardial disease and 233 (0.5%) developed constriction during follow-up. Constriction at index presentation was associated with older age, malignancy (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.2-1.8), tuberculosis (OR 3.9, 95% CI 1.4-8.9), liver disease (OR 1.7, 95% CI 1.3-2.2), and heart failure (OR 2.7 95% CI 2.2-3.3). Constriction identified during follow-up was more common after hospitalization for heart failure (hazard ratio [HR] 5.3, 95% CI 3.4-8.2), nonconstrictive recurrent pericardial disease requiring hospitalization (HR 3.7, 95% CI 2.3-6.2), or pericardiocentesis (HR 3.6, 95% CI 2.7-4.8).

Conclusions

In this large, contemporary cohort, constrictive pericarditis was rare but occurred more commonly after a diagnosis of tuberculosis, malignancy, liver disease, heart failure, recurrent pericardial disease, and pericardiocentesis. These findings highlight the importance of long-term vigilance when considering constriction in at-risk populations.

背景：缩窄性心包炎是一种罕见但严重的心包疾病并发症，目前评估危险因素的纵向研究有限。我们在一个大型人群队列中评估了缩窄性心包炎的流行病学和预测因素。方法：我们使用澳大利亚新南威尔士州住院患者数据收集数据库，对2004-2021年所有心包疾病住院患者进行了回顾性队列研究。多变量logistic回归确定了入院时伴有心包疾病的缩窄性心包炎的危险因素，而时间依赖性Cox回归和Fine and Gray方法评估了随访期间的危险因素。结果：45445例心包疾病患者中，763例（1.7%）发生缩窄性心包炎（中位年龄64.3岁，男性63.4%）。从心脏手术到诊断为收缩的中位时间为6个月，从自身免疫性疾病诊断为2年。其中530例（1.2%）在心包疾病表现时出现收缩，233例（0.5%）在随访期间出现收缩。指数呈现时的收缩与年龄较大、恶性肿瘤（优势比[OR]=1.5, 95%可信区间[CI]=1.2-1.8）、结核病（OR=3.9, 95%CI=1.4-8.9）、肝脏疾病（OR=1.7, 95%CI=1.3-2.2）和心力衰竭（OR=2.7, 95%CI=2.2-3.3）相关。随访中发现的收缩更常见于因心力衰竭住院（风险比[HR]=5.3, 95%CI=3.4-8.2）、需要住院治疗的非收缩性心包疾病复发（HR=3.7, 95%CI=2.3-6.2）或心包穿刺（HR=3.6, 95%CI=2.7-4.8）。结论：在这个大型当代队列中，缩窄性心包炎很少见，但在诊断为结核、恶性肿瘤、肝病、心力衰竭、复发性心包炎和心包穿刺后更常见。这些发现强调了在考虑高危人群收缩时长期保持警惕的重要性。

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引用次数: 0

Pericardial Delivery of Stem Cells: An Emerging Frontier in Myocardial Regeneration for Ischemic Heart Disease 心包干细胞输送：缺血性心脏病心肌再生的新前沿。

IF 5.3 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Canadian Journal of Cardiology

Pub Date : 2026-01-01 DOI: 10.1016/j.cjca.2025.10.012

Aliya Izumi BSc , Terrence M. Yau MD, MSc , Paul W.M. Fedak MD, PhD , Ali Fatehi Hassanabad MD, MSc, PhD

Cardiac regenerative therapies have seen limited clinical translation due to persistent challenges in stem cell viability, retention, and demonstration of efficacy. The pericardial space, however, has emerged as a dynamic reservoir of bioactive substances capable of modulating cellular processes within the myocardium. Pericardial delivery of stem cells offers a promising solution to modern translational roadblocks by leveraging the pericardial space for its proximity to the heart, protective compartmentalization, and favorable biochemical milieu. Preclinical studies using cardiospheres, cardiosphere-derived cells, and mesenchymal stem cells have demonstrated significant improvements in cardiac function, infarct size reduction, and vascular regeneration after myocardial infarction. Additionally, epicardial hydrogels and percutaneous pericardial injections have been shown to reduce local immune responses and enable broader therapeutic distribution compared with intramyocardial and intracoronary approaches. As a potential cardiac surgical adjuvant therapy, pericardial delivery of stem cells represents an exciting frontier in cardiac regeneration, warranting further research to define its role in clinical practice.

由于干细胞活力、保留和疗效证明方面的持续挑战，心脏再生疗法的临床转化有限。然而，心包空间已成为能够调节心肌细胞过程的生物活性物质的动态储存库。通过利用心包空间靠近心脏、保护性区隔化和有利的生化环境，心包干细胞的输送为现代转译障碍提供了一个有希望的解决方案。使用心球、心球源性细胞和间充质干细胞的临床前研究表明，在心肌梗死后心功能、梗死面积缩小和血管再生方面有显著改善。此外，与心肌内和冠状动脉内入路相比，心外膜水凝胶和经皮心外膜注射已被证明可减少局部免疫反应，使治疗分布更广。作为一种潜在的心脏外科辅助治疗方法，心包干细胞移植是心脏再生研究的一个令人兴奋的前沿，需要进一步的研究来确定其在临床实践中的作用。

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引用次数: 0

Superior Vena Cava Syndrome in a Dialysis Patient After Re-do Bentall Hemi-Arch With Division of the Innominate Vein: A Case Report Redo-Bentall半弓伴无名静脉分裂后透析患者上腔静脉综合征1例报告。

IF 5.3 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Canadian Journal of Cardiology

Pub Date : 2026-01-01 DOI: 10.1016/j.cjca.2025.09.050

Keir A. Forgie MD, PhD , Prapti Patel MD , Matthew Cwinn MD, MSc , Michael C. Moon MD

引用次数: 0

Current Challenges in Cardiac Device Management: Guidance for Practicing Clinicians: A Canadian Journal of Cardiology White Paper 当前在心脏设备管理的挑战：指导执业临床医生：加拿大心脏病学杂志白皮书

IF 5.3 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Canadian Journal of Cardiology

Pub Date : 2026-01-01 DOI: 10.1016/j.cjca.2025.05.020

Jacqueline Joza MD, MSc (co-chair) , Francois Philippon MD , Derek S. Chew MD, MSc , Jaimie Manlucu MD , Blandine Mondésert MD , Mouhannad M. Sadek MD , Jason D. Roberts MD, MAS , Christian Steinberg MD , Ratika Parkash MD, MS , Matthew T. Bennett MD , Isabelle Greiss MD , Nathaniel M. Hawkins MBChB, MD, MPH , Felix Ayala-Paredes MD, PhD , Vidal Essebag MD, PhD , Clarence Khoo MD , Katherine Kulyk DHA , Evan Lockwood MD , Andrew Mardell BSc , Carlos A. Morillo MD , Emily Murtagh BSc , Jason G. Andrade MD (co-chair)

Cardiac implantable electronic devices (CIED) are medical devices that play a significant role in the management of heart disease by regulating cardiac rate and rhythm. CIEDs encompass pacemakers, implantable cardioverter defibrillators, cardiac resynchronisation devices (CRT), and implantable cardiac monitors. While robust evidence supports the use of these devices, there are several areas where technical developments have outpaced robust clinical trials, including: the role of primary prevention implantable cardioverter-defibrillators in the era of contemporary heart failure (HF) therapy, risk stratification in hypertrophic and dilated cardiomyopathies, the use of conduction system pacing, the impact of tricuspid regurgitation in the presence of a CIED, the role of CIEDs in structural valve interventions (such as percutaneous tricuspid valve interventions and transcatheter aortic valve implantation), and role of leadless CIED systems. Here, we critically appraise the literature associated with these evidence gaps, provide expert review and assessment based on the current evidence, and attempt to foster dialogue among key stakeholders, including clinicians, researchers, industry leaders, and policymakers, in order to generate the evidence needed to refine clinical decision-making and improve patient outcomes.

心脏植入式电子设备（CIED）是通过调节心率和节律在心脏病管理中发挥重要作用的医疗设备。cied包括起搏器、植入式心律转复除颤器、心脏再同步装置（CRT）和植入式心脏监护仪。虽然强有力的证据支持使用这些装置，但在一些领域，技术发展已经超过了强有力的临床试验，包括：在当代心力衰竭（HF）治疗时代，一级预防植入式心律转复除颤器的作用，肥厚和扩张型心肌病的风险分层，传导系统起搏的使用，CIED存在时三尖瓣反流的影响，CIED在结构性瓣膜干预（如经皮三尖瓣干预和经导管主动脉瓣植入）中的作用，以及无导线CIED系统的作用。在这里，我们批判性地评估与这些证据差距相关的文献，根据现有证据提供专家审查和评估，并试图促进关键利益相关者（包括临床医生、研究人员、行业领导者和政策制定者）之间的对话，以产生完善临床决策和改善患者预后所需的证据。

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引用次数: 0

Taking the Pulse: a Retrospective, Population-based Analysis of Alberta’s Privatization of Cardiac Testing 采取的脉搏：回顾，以人口为基础的分析阿尔伯塔的私有化心脏测试。

IF 5.3 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Canadian Journal of Cardiology

Pub Date : 2026-01-01 DOI: 10.1016/j.cjca.2025.08.347

Robert M. Mayall PhD , Braden J. Manns MD, MSc , Derek S. Chew MD, MSc , Flora Au MA , Amity E. Quinn PhD

Background

Many provinces are considering an expanded role for for-profit diagnostic imaging facilities. We describe trends over time in the use of cardiac imaging studies, a subset of diagnostic imaging, in the for-profit and publicly operated facilities in Alberta. Alberta has allowed testing in private facilities since the 1970s, with formalized guidelines released in 1998.

Methods

We performed a retrospective, population-based analysis using administrative data from Alberta, Canada between 1995 and 2020 to describe the annual rates of cardiac diagnostic tests for both inpatient and outpatient settings, and trends in invasive cardiac treatments like angioplasty and coronary artery bypass grafting.

Results

A 3.95-fold increase in the rate of outpatient cardiac imaging per 100,000 Albertans was observed between 1998 and 2020, driven by an increase in testing at private, for-profit facilities. The rate of invasive cardiac treatments did not increase substantially over this same period. This has resulted in a net cost to Alberta of over $694 million (in 2020 dollars) in additional spending above predicted levels since 1998.

Conclusions

After the implementation of imaging guidelines, a sustained and substantial increase in cardiac imaging facilities and rates was observed, including in Albertans classified as low risk for cardiac disease. A similar increase was not observed among cardiac treatment procedures, which would be anticipated if increased testing was due to changes in underlying population risk.

背景：许多省份正在考虑扩大营利性诊断成像设施的作用。我们描述了在艾伯塔省营利性和公共运营设施中使用心脏成像研究（诊断成像的一个子集）的趋势。阿尔伯塔省自20世纪70年代以来就允许在私人机构进行测试，并于1998年发布了正式的指导方针。方法：我们对加拿大艾伯塔省1995-2020年间的行政数据进行了回顾性、基于人群的分析，以描述住院和门诊的年度心脏诊断测试率，以及血管成形术和冠状动脉旁路移植术等有创心脏治疗的趋势。结果：1998年至2020年期间，每10万阿尔伯塔人的门诊心脏成像率增加了3.95倍，这是由私营营利性机构的检测增加所驱动的。在同一时期，有创心脏治疗的比率并没有显著增加。这导致阿尔伯塔省自1998年以来的额外支出净成本超过6.94亿美元（以2020年的美元计算），高于预测水平。结论：在实施成像指南后，观察到心脏成像设施和比率持续大幅增加，包括在艾伯塔省被列为心脏病低风险的人群中。在心脏治疗过程中没有观察到类似的增加，如果增加的检测是由于潜在人群风险的变化，这是可以预料的。

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引用次数: 0

The LIRA Method for Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valve 经导管二尖瓣主动脉瓣置换术的LIRA方法。

IF 5.3 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Canadian Journal of Cardiology

Pub Date : 2026-01-01 DOI: 10.1016/j.cjca.2025.08.352

Barbara Bellini MD , Matteo Montorfano MD

引用次数: 0

The Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive Guidelines for the Selection, Implantation, and Management of Patients With Cardiac Implantable Electronic Devices 加拿大心血管学会/加拿大心律学会心脏植入式电子设备患者的选择、植入和管理综合指南

IF 5.3 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Canadian Journal of Cardiology

Pub Date : 2026-01-01 DOI: 10.1016/j.cjca.2025.08.363

Jason G. Andrade MD (co-chair) , Jacqueline Joza MD, MSc (co-chair) , Derek S. Chew MD MSc (CCS Methodologist) , Felix Ayala-Paredes MD, PhD , Matthew T. Bennett MD , Vidal Essebag MD, PhD , Isabelle Greiss MD , Nathaniel M. Hawkins MBChB, MD, MPH , Clarence Khoo MD , Katherine Kulyk DHA , Evan Lockwood MD , Jaimie Manlucu MD , Andrew Mardell BSc , Blandine Mondésert MD , Carlos A. Morillo MD , Emily Murtagh BSc , Ratika Parkash MD, MS , Francois Philippon MD , Satish R. Raj MD, MSCI , Calum Redpath MBChB, PhD , Raymond Yee MD

The Canadian Cardiovascular Society/Canadian Heart Rhythm Society cardiac implantable electronic device (CIED) guidelines program was developed to aid clinicians in the management of patients with a CIED, as well as to provide direction to policy makers and health care systems regarding issues related to CIEDs. There has never before been a comprehensive Canadian Cardiovascular Society/Canadian Heart Rhythm Society guideline to address the management of patients with CIEDs. This guideline is intended to be used by practicing clinicians across all disciplines who care for patients with CIEDs. We used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system to grade recommendation strength and the quality of evidence. Areas of focus include bradycardia, syncope, cardiac resynchronization therapy, and conduction system pacing, sudden death prevention, and defibrillator therapy, the role of leadless devices, perioperative considerations and complications, lead extraction, postimplant CIED management, and competency and training standards. Extensive use is made of tables and figures to synthesize important material and present key concepts. This document should be an important aid for knowledge translation and a valuable reference tool to help improve the clinical management of patients who are assessed for possible CIED implantation or to improve decision-making for those who already have CIEDs.

加拿大心血管学会/加拿大心律学会心脏植入式电子设备（CIED）指南计划的制定是为了帮助临床医生管理CIED患者，并为政策制定者和医疗保健系统提供有关CIED问题的指导。加拿大心血管学会/加拿大心律学会从未有过一个全面的指南来解决cied患者的管理问题。本指南旨在供所有学科的临床医生使用，他们关心cied患者。我们使用推荐、评估、发展和评估分级（GRADE）系统对推荐强度和证据质量进行分级。重点领域包括心动过缓、晕厥、心脏再同步化治疗、传导系统起搏、猝死预防和除颤器治疗、无铅装置的作用、围手术期注意事项和并发症、铅拔出、植入后CIED管理、能力和培训标准。广泛使用表格和图形来综合重要材料和提出关键概念。本文献应成为知识翻译的重要辅助工具和有价值的参考工具，以帮助改善评估可能植入CIED的患者的临床管理或改善已经患有CIED的患者的决策。

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