Pub Date : 2026-02-01DOI: 10.1016/j.cjca.2025.11.008
Lauren K. Truby MD, MS, FACC , Gaurav Sharma PhD , William D. Watson BSc(Hons), DPhil, MBBChir , Philip F. Halloran MD, PhD , Tafsia Hussain MSc , Katelynn S. Madill-Thomsen PhD , Gabriel Esmailian MD , Nicole Fung BSc , Eliot Peyster MD, MS , Yasbanoo Moayedi MD , Vivek Rao MD, PhD , Darren Freed MD, PhD , Dawn E. Bowles PhD , Matthias Peltz MD , Filio Billia MD, PhD, FACC
Heart transplantation remains the gold standard treatment for end-stage heart failure. Yet, challenges such as ischemia-reperfusion injury, primary graft dysfunction, allograft rejection, and cardiac allograft vasculopathy continue to affect long-term patient outcomes. In this contemporary review, we explore the applications of basic science in enhancing heart transplantation practices. We describe the molecular mechanisms of ischemic-reperfusion injuty, emphasizing the role of reactive oxygen species and mitochondrial dysfunction, which contribute to graft viability and post-transplant dysfunction. We also examine the evolution of preservation strategies, highlighting advancements from static cold storage to dynamic machine perfusion techniques, including hypothermic and normothermic systems that provide metabolic support and improve graft function. The potential of emerging biomarkers, such as circulating cell-free DNA and innovative diagnostic tools like the Molecular Microscope Diagnostic System, are discussed as vital tools for monitoring graft health and predicting rejection. By leveraging these advancements, the field of heart transplantation can address current challenges, improve patient outcomes, and enhance quality of life for transplant recipients. The importance of continued collaboration between researchers and clinicians in translating scientific discoveries into effective clinical applications cannot be overstated.
{"title":"From the Bench to the Bedside and Back: Contemporary Applications of Basic Science to Innovations in Heart Transplantation","authors":"Lauren K. Truby MD, MS, FACC , Gaurav Sharma PhD , William D. Watson BSc(Hons), DPhil, MBBChir , Philip F. Halloran MD, PhD , Tafsia Hussain MSc , Katelynn S. Madill-Thomsen PhD , Gabriel Esmailian MD , Nicole Fung BSc , Eliot Peyster MD, MS , Yasbanoo Moayedi MD , Vivek Rao MD, PhD , Darren Freed MD, PhD , Dawn E. Bowles PhD , Matthias Peltz MD , Filio Billia MD, PhD, FACC","doi":"10.1016/j.cjca.2025.11.008","DOIUrl":"10.1016/j.cjca.2025.11.008","url":null,"abstract":"<div><div>Heart transplantation remains the gold standard treatment for end-stage heart failure. Yet, challenges such as ischemia-reperfusion injury, primary graft dysfunction, allograft rejection, and cardiac allograft vasculopathy continue to affect long-term patient outcomes. In this contemporary review, we explore the applications of basic science in enhancing heart transplantation practices. We describe the molecular mechanisms of ischemic-reperfusion injuty, emphasizing the role of reactive oxygen species and mitochondrial dysfunction, which contribute to graft viability and post-transplant dysfunction. We also examine the evolution of preservation strategies, highlighting advancements from static cold storage to dynamic machine perfusion techniques, including hypothermic and normothermic systems that provide metabolic support and improve graft function. The potential of emerging biomarkers, such as circulating cell-free DNA and innovative diagnostic tools like the Molecular Microscope Diagnostic System, are discussed as vital tools for monitoring graft health and predicting rejection. By leveraging these advancements, the field of heart transplantation can address current challenges, improve patient outcomes, and enhance quality of life for transplant recipients. The importance of continued collaboration between researchers and clinicians in translating scientific discoveries into effective clinical applications cannot be overstated.</div></div>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"42 2","pages":"Pages 233-254"},"PeriodicalIF":5.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145511766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.cjca.2025.10.043
Alyssa Power MD, Anne I. Dipchand MD
Heart transplantation is the standard of care for children with end-stage heart disease refractory to medical and surgical interventions. It is performed across the age spectrum, from neonates to adolescents. Children awaiting transplant represent a critically ill group with high waitlist mortality, and an increasing percentage of children await transplant on ventricular assist device support. Post-transplant survival has improved significantly over the past three decades, but ongoing challenges exist to maximize long-term graft function, patient longevity, and quality of life. This review highlights some key challenges in the field of paediatric heart transplantation, including a discussion of unique features at both ends of the age continuum (infants and adolescents), ABO-incompatible transplant, limitations in rejection surveillance, the importance of long-term psychosocial support, patients with single ventricle physiology, genetic diagnoses, consideration of age and size in donor selection, live vaccination, and partial heart transplantation.
{"title":"Unique Challenges in Paediatric Heart Transplantation","authors":"Alyssa Power MD, Anne I. Dipchand MD","doi":"10.1016/j.cjca.2025.10.043","DOIUrl":"10.1016/j.cjca.2025.10.043","url":null,"abstract":"<div><div>Heart transplantation is the standard of care for children with end-stage heart disease refractory to medical and surgical interventions. It is performed across the age spectrum, from neonates to adolescents. Children awaiting transplant represent a critically ill group with high waitlist mortality, and an increasing percentage of children await transplant on ventricular assist device support. Post-transplant survival has improved significantly over the past three decades, but ongoing challenges exist to maximize long-term graft function, patient longevity, and quality of life. This review highlights some key challenges in the field of paediatric heart transplantation, including a discussion of unique features at both ends of the age continuum (infants and adolescents), ABO-incompatible transplant, limitations in rejection surveillance, the importance of long-term psychosocial support, patients with single ventricle physiology, genetic diagnoses, consideration of age and size in donor selection, live vaccination, and partial heart transplantation.</div></div>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"42 2","pages":"Pages 368-380"},"PeriodicalIF":5.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145630538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.cjca.2025.10.031
Nitish K. Dhingra MD , Farid Foroutan PhD , Lauren K. Truby MD, MS , Joan Guzman-Bofarull MD , Eduard Rodenas-Alesina MD, MSc , Roxana Moayedifar MD, PhD , Marisa Signorile MSc , Erik Henricksen PharmD , Marta Farrero MD, PhD , Laura Hastenteufel MD , Mercedes Rivas-Lasarte MD, PhD , Sharon Chih MD, PhD , Heather J. Ross MD, MHSc , Kiran K. Khush MD, MAS , Yasbanoo Moayedi MD, MHSc , International PGD Consortium Core Group
Primary graft dysfunction (PGD) occurs in nearly 8%-10% of heart transplant recipients, and is the most consequential early complication with an associated reduction in 1-year survival from 95% to 75%. The biological mechanisms underpinning PGD are the subject of ongoing investigations, and thus recognizing, preventing, and treating PGD remain elusive goals. The present expert review summarizes salient developments in the prediction and management of PGD. The International Society for Heart & Lung Transplantation (ISHLT) consensus definition and its severity was developed more than a decade ago. Since then, a significant volume of literature has attempted to elucidate risk factors for PGD at the donor, recipient, and procedural level. Importantly, updated international consensus guidelines, currently in press, have revisited and modernized the definitions and grading of PGD to reflect contemporary practice. Although previously validated prediction tools have performed poorly in contemporary data sets, more updated and clinically relevant models have been developed by leveraging multinational data and machine learning algorithms. Translational research has identified several donor and recipient biomarkers that promise to revolutionize current prediction paradigms. With respect to the prevention of PGD, novel preservation systems have yielded encouraging early data for expanding the potential donor pool while reducing risk of PGD, but vigorous assessment through randomized trials is still lacking. Finally, although the mainstay of PGD management remains the use of vasoactive medications and mechanical circulatory support, there have been recent publications on pharmacological and nonpharmacological treatments for PGD that might reduce the clinical effects of this deadly complication. Although there remains a significant need to reduce the burden of PGD after heart transplantation, evolving literature suggests that with enough validated data, PGD might be a predictable phenomenon, the burden of which can be mitigated by targeted interventions at discrete time points. Performance of multicentre, prospective, and when possible randomized trials will be crucial to ensuring that future clinical practice is guided by robust evidence.
{"title":"When Bad Things Happen to Good Hearts: Prediction and Management of Primary Graft Dysfunction","authors":"Nitish K. Dhingra MD , Farid Foroutan PhD , Lauren K. Truby MD, MS , Joan Guzman-Bofarull MD , Eduard Rodenas-Alesina MD, MSc , Roxana Moayedifar MD, PhD , Marisa Signorile MSc , Erik Henricksen PharmD , Marta Farrero MD, PhD , Laura Hastenteufel MD , Mercedes Rivas-Lasarte MD, PhD , Sharon Chih MD, PhD , Heather J. Ross MD, MHSc , Kiran K. Khush MD, MAS , Yasbanoo Moayedi MD, MHSc , International PGD Consortium Core Group","doi":"10.1016/j.cjca.2025.10.031","DOIUrl":"10.1016/j.cjca.2025.10.031","url":null,"abstract":"<div><div>Primary graft dysfunction (PGD) occurs in nearly 8%-10% of heart transplant recipients, and is the most consequential early complication with an associated reduction in 1-year survival from 95% to 75%. The biological mechanisms underpinning PGD are the subject of ongoing investigations, and thus recognizing, preventing, and treating PGD remain elusive goals. The present expert review summarizes salient developments in the prediction and management of PGD. The International Society for Heart & Lung Transplantation (ISHLT) consensus definition and its severity was developed more than a decade ago. Since then, a significant volume of literature has attempted to elucidate risk factors for PGD at the donor, recipient, and procedural level. Importantly, updated international consensus guidelines, currently in press, have revisited and modernized the definitions and grading of PGD to reflect contemporary practice. Although previously validated prediction tools have performed poorly in contemporary data sets, more updated and clinically relevant models have been developed by leveraging multinational data and machine learning algorithms. Translational research has identified several donor and recipient biomarkers that promise to revolutionize current prediction paradigms. With respect to the prevention of PGD, novel preservation systems have yielded encouraging early data for expanding the potential donor pool while reducing risk of PGD, but vigorous assessment through randomized trials is still lacking. Finally, although the mainstay of PGD management remains the use of vasoactive medications and mechanical circulatory support, there have been recent publications on pharmacological and nonpharmacological treatments for PGD that might reduce the clinical effects of this deadly complication. Although there remains a significant need to reduce the burden of PGD after heart transplantation, evolving literature suggests that with enough validated data, PGD might be a predictable phenomenon, the burden of which can be mitigated by targeted interventions at discrete time points. Performance of multicentre, prospective, and when possible randomized trials will be crucial to ensuring that future clinical practice is guided by robust evidence.</div></div>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"42 2","pages":"Pages 324-334"},"PeriodicalIF":5.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145430478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/S0828-282X(26)00015-2
{"title":"Information for Readers","authors":"","doi":"10.1016/S0828-282X(26)00015-2","DOIUrl":"10.1016/S0828-282X(26)00015-2","url":null,"abstract":"","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"42 2","pages":"Page A6"},"PeriodicalIF":5.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146102490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.cjca.2025.08.336
Ahmed Younis MBBCh , Sara ElZalabany MBBCh , William R. Miranda MD , Heidi M. Connolly MD , Joseph A. Dearani MD , Mauricio T. Villavicencio MD , Alexander C. Egbe MD, MPH
Background
The purpose of this study was to describe outcomes after heart transplantation in adults with congenital heart disease (CHD) based on the experience from a high-volume transplant centre.
Method
We undertook a retrospective cohort study of adults with CHD who underwent heart transplantation at Mayo Clinic, Rochester, Minnesota (2003-2024).
Results
Of 89 patients (median age 40 years [interquartile range 9-66 years], 52% male) who underwent heart transplantation, 67 (75%) had biventricular physiology and 22 (25%) had Fontan physiology. Fifty (56%) and 39 (44%) received single organ vs multi-organ transplants, respectively. The proportion of patients with Fontan palliation undergoing heart transplantation was higher in the late era (after December 31, 2013): 31% (21/67) vs 5% (1/22); P = 0.005. The 30-day, 1-year, and 5-year survival rates were 97% (95% CI 97%-99%), 91% (95% CI 87%-95%), and 87% (95% CI 82%-92%), respectively, and these rates were higher than the estimates from national registries. Patients with Fontan physiology had lower post-transplantation survival compared with those with biventricular physiology, but Fontan physiology was not an independent predictor of mortality. The predictors of post-transplantation mortality were longer cardiopulmonary bypass time, mechanical ventilation duration, and postoperative mechanical circulatory support.
Conclusions
We observed a higher post-transplantation survival compared with historical estimates. Post-transplantation mortality was related to operative and postoperative factors, and not to CHD physiology. There was a high proportion of patients requiring multi-organ transplantation, and a rising proportion of patients with Fontan physiology who underwent transplantation in the later part of the study. These findings highlight important demographic changes, the importance of institutional expertise, and the need for improvements in risk stratification and referral patterns to align with these changes.
背景：本研究的目的是根据一个大容量移植中心的经验，描述患有先天性心脏病（CHD）的成人心脏移植后的结果。方法：回顾性队列研究在梅奥诊所接受心脏移植的成年冠心病患者（2003-2024年）。结果：89例接受心脏移植的患者（40岁[9；66]，男性占52%）中，双心室生理67例（75%），Fontan生理22例（25%）。50例（56%）和39例（44%）分别接受单器官移植和多器官移植。晚期（2023年12月31日之后）Fontan palliation患者接受心脏移植的比例更高，为31% [21 /67]vs . 5% [1/22], p=0.005。30天、1年和5年生存率分别为97% （95% CI 97, 99）、91% （95% CI 87, 95）和87% (95% CI 82, 92)，这些比率高于国家登记的估计值。与双心室生理相比，Fontan生理的患者移植后生存率较低，但Fontan生理并不是死亡率的独立预测因子。较长的体外循环时间、机械通气时间和术后机械循环支持是移植后死亡率的预测因子。结论：与历史估计相比，我们观察到移植后生存率更高。移植后死亡率与手术和术后因素有关，与冠心病生理无关。需要多器官移植的患者比例很高，并且在研究后期，Fontan生理学患者接受移植的比例不断上升。这些发现强调了重要的人口变化，机构专业知识的重要性，以及改善风险分层和转诊模式以适应这些变化的必要性。
{"title":"Outcomes After Heart Transplantation in Adults With Congenital Heart Disease—A Single-Center Experience","authors":"Ahmed Younis MBBCh , Sara ElZalabany MBBCh , William R. Miranda MD , Heidi M. Connolly MD , Joseph A. Dearani MD , Mauricio T. Villavicencio MD , Alexander C. Egbe MD, MPH","doi":"10.1016/j.cjca.2025.08.336","DOIUrl":"10.1016/j.cjca.2025.08.336","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study was to describe outcomes after heart transplantation in adults with congenital heart disease (CHD) based on the experience from a high-volume transplant centre.</div></div><div><h3>Method</h3><div>We undertook a retrospective cohort study of adults with CHD who underwent heart transplantation at Mayo Clinic, Rochester, Minnesota (2003-2024).</div></div><div><h3>Results</h3><div>Of 89 patients (median age 40 years [interquartile range 9-66 years], 52% male) who underwent heart transplantation, 67 (75%) had biventricular physiology and 22 (25%) had Fontan physiology. Fifty (56%) and 39 (44%) received single organ vs multi-organ transplants, respectively. The proportion of patients with Fontan palliation undergoing heart transplantation was higher in the late era (after December 31, 2013): 31% (21/67) vs 5% (1/22); <em>P</em> = 0.005. The 30-day, 1-year, and 5-year survival rates were 97% (95% CI 97%-99%), 91% (95% CI 87%-95%), and 87% (95% CI 82%-92%), respectively, and these rates were higher than the estimates from national registries. Patients with Fontan physiology had lower post-transplantation survival compared with those with biventricular physiology, but Fontan physiology was not an independent predictor of mortality. The predictors of post-transplantation mortality were longer cardiopulmonary bypass time, mechanical ventilation duration, and postoperative mechanical circulatory support.</div></div><div><h3>Conclusions</h3><div>We observed a higher post-transplantation survival compared with historical estimates. Post-transplantation mortality was related to operative and postoperative factors, and not to CHD physiology. There was a high proportion of patients requiring multi-organ transplantation, and a rising proportion of patients with Fontan physiology who underwent transplantation in the later part of the study. These findings highlight important demographic changes, the importance of institutional expertise, and the need for improvements in risk stratification and referral patterns to align with these changes.</div></div>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"42 2","pages":"Pages 394-402"},"PeriodicalIF":5.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.cjca.2025.12.005
Divisha Sharma MD , Jonathan M. Hand MD
The worldwide shortage of donor hearts necessitates transplant programs reassess organs once declined due to infection-related concerns. Donor-derived infections (DDIs) are rare, complicating fewer than 0.2 % of solid-organ transplants, whereas wait-list mortality for advanced heart failure reaches 10–15 % annually. This review synthesizes modern epidemiology, transmission rates, and management for major pathogen groups, integrating guideline updates, Disease Transmission Advisory Committee (DTAC) ten-year surveillance, and recent CDC investigations. With transparent risk communication, recipient screening, and targeted prophylaxis or pre-emptive therapy, many donors with infections can be safely utilized, while others may pose risks that preclude acceptance. Infection transmission fears, uncertainty, and inconsistent protocols likely contribute to variations in center-to-center donor utilization. The objective of this review is, therefore, practical: to delineate which infections are acceptable with mitigation, quantify true transmission probability, and offer an evidence-based playbook for clinicians.
{"title":"Safe Use of Heart Donors With Infection and Strategies for Donor-derived Infection Mitigation","authors":"Divisha Sharma MD , Jonathan M. Hand MD","doi":"10.1016/j.cjca.2025.12.005","DOIUrl":"10.1016/j.cjca.2025.12.005","url":null,"abstract":"<div><div>The worldwide shortage of donor hearts necessitates transplant programs reassess organs once declined due to infection-related concerns. Donor-derived infections (DDIs) are rare, complicating fewer than 0.2 % of solid-organ transplants, whereas wait-list mortality for advanced heart failure reaches 10–15 % annually. This review synthesizes modern epidemiology, transmission rates, and management for major pathogen groups, integrating guideline updates, Disease Transmission Advisory Committee (DTAC) ten-year surveillance, and recent CDC investigations. With transparent risk communication, recipient screening, and targeted prophylaxis or pre-emptive therapy, many donors with infections can be safely utilized, while others may pose risks that preclude acceptance. Infection transmission fears, uncertainty, and inconsistent protocols likely contribute to variations in center-to-center donor utilization. The objective of this review is, therefore, practical: to delineate which infections are acceptable with mitigation, quantify true transmission probability, and offer an evidence-based playbook for clinicians.</div></div>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"42 2","pages":"Pages 286-296"},"PeriodicalIF":5.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145751553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Post-transplant rejection surveillance remains a cornerstone of heart transplant care. Although endomyocardial biopsy (EMB) has long been the gold standard for detecting rejection, its invasive nature, interobserver variability in histologic interpretation, and limitations in distinguishing between acute cellular rejection (ACR) and antibody-mediated rejection have prompted interest in noninvasive techniques. Traditional biomarkers—such as troponin, C-reactive protein, brain natriuretic peptide, and donor-specific antibodies—offer supplementary assessments of graft function but lack the specificity and sensitivity required to be stand-alone markers. In contrast, commercially available molecular diagnostics and gene expression profiling tests have emerged as promising noninvasive biomarkers that reduce reliance on EMB while maintaining and improving diagnostic accuracy. These biomarkers enable longitudinal, noninvasive monitoring and may detect rejection earlier, enhancing overall care for transplant recipients. Complementary cardiac imaging modalities, including advanced echocardiography techniques, cardiac magnetic resonance, and positron emission tomography, further enhance graft assessment by providing detailed, structural, functional, and metabolic information. Despite these advancements, challenges remain in fully integrating these noninvasive approaches into the standardized care pathway of heart transplant patients. In addition, emerging biomarkers, such as microRNAs, transcriptomic signatures, proteomic patterns, and metabolomic profiles, are under active investigation and hold the potential to further transform the landscape of rejection surveillance. This article reviews the current standards in heart transplant rejection monitoring, highlights the promise of emerging molecular and imaging technologies, and explores the potential of multimodal strategies to personalize and improve long-term transplant outcomes.
{"title":"Biomarker-Based Surveillance in Heart Transplant Rejection","authors":"Katrina Etts BS , Balaphanidhar Mogga MD , Abhishek Jaiswal MD","doi":"10.1016/j.cjca.2025.08.345","DOIUrl":"10.1016/j.cjca.2025.08.345","url":null,"abstract":"<div><div>Post-transplant rejection surveillance remains a cornerstone of heart transplant care. Although endomyocardial biopsy (EMB) has long been the gold standard for detecting rejection, its invasive nature, interobserver variability in histologic interpretation, and limitations in distinguishing between acute cellular rejection (ACR) and antibody-mediated rejection have prompted interest in noninvasive techniques. Traditional biomarkers—such as troponin, C-reactive protein, brain natriuretic peptide, and donor-specific antibodies—offer supplementary assessments of graft function but lack the specificity and sensitivity required to be stand-alone markers. In contrast, commercially available molecular diagnostics and gene expression profiling tests have emerged as promising noninvasive biomarkers that reduce reliance on EMB while maintaining and improving diagnostic accuracy. These biomarkers enable longitudinal, noninvasive monitoring and may detect rejection earlier, enhancing overall care for transplant recipients. Complementary cardiac imaging modalities, including advanced echocardiography techniques, cardiac magnetic resonance, and positron emission tomography, further enhance graft assessment by providing detailed, structural, functional, and metabolic information. Despite these advancements, challenges remain in fully integrating these noninvasive approaches into the standardized care pathway of heart transplant patients. In addition, emerging biomarkers, such as microRNAs, transcriptomic signatures, proteomic patterns, and metabolomic profiles, are under active investigation and hold the potential to further transform the landscape of rejection surveillance. This article reviews the current standards in heart transplant rejection monitoring, highlights the promise of emerging molecular and imaging technologies, and explores the potential of multimodal strategies to personalize and improve long-term transplant outcomes.</div></div>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"42 2","pages":"Pages 310-323"},"PeriodicalIF":5.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-31DOI: 10.1016/j.cjca.2026.01.046
Shreya Sharma, Michelle Keir, Maude Peretz-Larochelle, Matthew Sibbald, Sarah Blissett
Cardiovascular complications during pregnancy are increasing. However, many are preventable with increased provider education. To address these gaps, we developed four virtual, asynchronous Cardio-Obstetrics modules. This proof-of-concept study evaluated trainee satisfaction, content knowledge, collaborative skills, and perceived interactivity. Thirty-four trainees from three Canadian programs participated. Trainees showed improvement in content knowledge and collaborative skills, rated simulated dialogue as the design element with highest interactivity, and indicated preferences for collaboration prompts. These findings support the use of asynchronous virtual modules in Cardiology, with potential to enhance provider knowledge in caring for pregnant patients with heart disease.
{"title":"Enhancing Provider Knowledge in Cardio-Obstetrics Through Virtual Modules.","authors":"Shreya Sharma, Michelle Keir, Maude Peretz-Larochelle, Matthew Sibbald, Sarah Blissett","doi":"10.1016/j.cjca.2026.01.046","DOIUrl":"https://doi.org/10.1016/j.cjca.2026.01.046","url":null,"abstract":"<p><p>Cardiovascular complications during pregnancy are increasing. However, many are preventable with increased provider education. To address these gaps, we developed four virtual, asynchronous Cardio-Obstetrics modules. This proof-of-concept study evaluated trainee satisfaction, content knowledge, collaborative skills, and perceived interactivity. Thirty-four trainees from three Canadian programs participated. Trainees showed improvement in content knowledge and collaborative skills, rated simulated dialogue as the design element with highest interactivity, and indicated preferences for collaboration prompts. These findings support the use of asynchronous virtual modules in Cardiology, with potential to enhance provider knowledge in caring for pregnant patients with heart disease.</p>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146103961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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