Canadian Journal of Cardiology最新文献

We aimed to describe methodological variations in systematic reviews (SRs) that estimated clinical outcomes with different anticoagulant strategies for pregnant individuals with mechanical heart valves (MHVs), and to provide most reliable risk estimates. We identified eligible SRs through a search involving eight databases and critically appraised (a) study quality using A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2) (b) search strategies using Peer Review of Electronic Search Strategies (PRESS) guidelines and operationalized criteria of SR searches, and (c) meta-analytic approaches using a self-designed checklist. We determined most reliable estimates for clinical outcomes using an algorithm considering AMSTAR-2 scores, quality of search strategy and recency of publication. Of the 12 eligible SRs, most (9/12) were of critically low quality based on AMSTAR-2. Of the 4 that published search strategies, 3 were of low quality based on PRESS guidelines. Meta-analytic approaches varied widely. The most reliable risk estimates with VKAs were 0.9% [95% Confidence Interval (CI 0.1-1.6%)] for maternal mortality, 2.7% (1.4-4.0%) for thromboembolism, 35.5% (19.8-51.2%) for fetal loss and 2.0% (0.3-3.7%) for congenital anomalies. These risks with sequential therapy were 2.0% (0.8-3.1%), 5.8% (3.8-7.7%), 20.1% (14.4-25.7%) and 1.4% (0.3-2.5%), and with LMWH, they were 2.9% (0.2-5.7), 8.7% (3.9-13.4), 8.0% (2.0-13.9) and 0.0% (0.0-0.0) respectively. SRs on anticoagulation for pregnant individuals with MHVs demonstrate considerable heterogeneity in terms of study quality, search strategies, and meta-analytical approaches. The provided risk estimates could inform shared decision-making and clinical practice guidelines.

Assisted reproductive technology (ART) includes medical interventions used primarily to address infertility. With increasing accessibility to ART worldwide, more women are now able to achieve pregnancy, including those with cardiovascular disease (CVD). Unfortunately, little is known about the use of ART in women with pre-existing CVD, with no large-scale studies to date investigating the impact of ART on pregnancy outcomes in this vulnerable patient population. We discuss what is established in the literature and areas for future research to assist cardiologists in managing women with CVD seeking ART to achieve pregnancy.

The field of gene therapy has experienced significant advancement in the last decade. Originally restricted to experimental biology, gene therapy is now an established clinical modality with demonstrated efficacy in addressing a range of diseases, particularly rare monogenic disorders, hematologic conditions, and oncologic applications. Nevertheless, the cardiovascular system presents both substantial challenges and notable opportunities for innovation in gene therapy. Cardiovascular disease continues to be the leading cause of mortality worldwide. Although advancements have been made in pharmacological treatments, medical devices, and lifestyle modifications, current interventions do not fundamentally address the molecular mechanisms underlying most cardiac diseases. Gene therapy offers distinct potential to modify disease processes at the molecular and cellular level, providing prospects for durable or potentially curative solutions in heart failure, cardiomyopathies, arrhythmias, and vascular pathologies.

The societal burden and prognostic relevance of coronary microvascular and vasomotor dysfunction are well established, but there are currently limited therapies proven to improve clinical outcomes of these patients. This may be explained by the heterogeneity of the population and the complexity of the underlying pathophysiology. In this first companion paper, we revisit clinical conditions and patient groups at risk for coronary microvascular and vasomotor dysfunction, identify non-invasive tests of peripheral and coronary vascular function that may be helpful for baseline assessment and long-term follow-up, define the metrics of disease burden that might determine the need for invasive assessment and serve as outcome measures. We use these observations to define the baseline and follow-up variables that will be included in the Canadian Coronary Physiology Registry. When integrated with invasive metrics derived from a standardized invasive coronary function testing protocol, it will ultimately facilitate the design and conduct of future clinical outcomes trials in Canada.