Canadian Journal of Cardiology最新文献

Background: In this we study aimed to develop and validate a dynamic prediction model for acute kidney injury (AKI) in heart failure (HF) patients.

Methods: Using data from 7636 HF patients in the Medical Information Mart for Intensive Care IV (MIMIC-IV) version 3.1 database, we constructed a long short-term memory model with dynamic focal loss to handle class imbalance. We designed 2 prediction perspectives: for short-term prediction w used different data collection windows (6-72 hours) to dynamically predict the risk of AKI occurrence within subsequent specific time windows (12-72 hours); for long-term prediction we used data from specific time points after admission (12-72 hours) to predict the occurrence of AKI during the entire hospitalization.

Results: The model showed robust performance across all prediction tasks (area under the receiver operating characteristic curve range, 0.80-0.94). Analysis of prediction lead time showed that the model could provide early warnings: the median lead times for predicting AKI occurrence within 12, 24, 48, and 72 hours were 9.57, 12.89, 18.77, and 27.25 hours, respectively. Feature importance analysis revealed that urine output, Sequential Organ Failure Assessment (SOFA) score, and systolic blood pressure played dominant roles in short-term prediction, whereas troponin T and history of cardiovascular surgery were more important in long-term prediction.

Conclusions: The long short-term memory-based model proposed in this study captures dynamic physiological changes in HF patients and provides dynamic risk assessments for AKI with sufficient lead time.

Background: Atrial fibrillation (AF) is prevalent in older adults and has been associated with functional decline beyond its cardiovascular complications. However, the interplay between AF, multimorbidity, and functional decline remains poorly understood. In this study we investigated the effect of AF and multimorbidity on longitudinal transitions in functional status among older adults, considering initial self-sufficiency levels.

Methods: This longitudinal analysis included 3083 community-dwelling individuals aged 65 years or older from the Progetto Veneto Anziani (Pro.V.A.) study. Functional status was classified into 3 states-independent, moderately impaired, and severely impaired in activities of daily living-and modelled through continuous-time multistate models. Independent variables included AF, multimorbidity, and covariates such as age, sex, education, living arrangements, smoking status, body mass index, Mini-Mental State Examination and Geriatric Depression Scale scores.

Results: Over a median follow-up of 4.4 years (standard deviation, 0.5), 33.5% of independent individuals experienced functional decline, 13% died, and only 12.2% improved after moderate impairment. AF was significantly associated with transition from independence to severe functional impairment (hazard ratio [HR], 4.12; 95% confidence interval [CI], 1.83-9.24), although this estimate is on the basis of a small number of events and should be interpreted with caution, from moderate to severe impairment (HR, 1.75; 95% CI, 1.01-3.1), and with mortality in moderately impaired individuals (HR, 1.66; 95% CI, 1.16-2.38). Multimorbidity showed no association with worsening transitions but was associated with mortality among independent individuals (HR, 1.15; 95% CI, 1.07-1.24).

Conclusions: AF is a marker of greater risk of severe functional decline in older adults, whereas multimorbidity primarily increases mortality. Routine functional assessments and person-centred interventions are essential to preserve autonomy and prevent disability in older adults with AF.

The objective of diagnostic investigations should be to confirm or refute the presence of abnormal coronary function and to identify patients who might benefit from specific therapeutic interventions. In the field of coronary microvascular and vasomotor dysfunction, progress toward this goal is hampered if diagnostic pathways differ among sites, the meaning of the results are unclear, or the potential benefits of current therapies are not well established. In this second companion paper, we define the metrics that can be derived from the invasive assessment of the coronary function assessed in the Canadian Coronary Physiology Registry, discuss the theoretical and practical value and limitations of singular vs multiple combined metrics, and propose a flexible interpretative framework. We also provide early phenomapping analysis of the noninvasive data, which both confirm the complexity and demonstrate the power of machine learning to unravel this problem. The combination of the multiple invasive metrics with the comprehensive clinical assessment will determine the phenotypic and pathophysiological relevance of these metrics that will guide further research efforts.

Lipoprotein(a) [Lp(a)] is a genetically determined and independent risk factor for atherosclerotic cardiovascular disease, including acute coronary syndrome, peripheral arterial disease, and stroke, as well as calcific aortic stenosis. Despite its high prevalence, affecting an estimated 20% of Canadians, Lp(a) remains under-recognized and undermeasured in clinical practice. This report provides guidance on the assessment and management of Lp(a) in primary and secondary prevention in the Canadian context. It outlines when and how to measure Lp(a), with a recommendation for universal, one-time testing in adulthood. The report summarizes the pathophysiologic role of Lp(a) in promoting atherosclerosis, thrombosis, and aortic stenosis, and highlights significant ethnic variability in Lp(a) levels and associated risk. It also addresses the limitations of existing cardiovascular risk calculators that omit Lp(a) and discusses the potential role of emerging imaging and treatment strategies, including novel Lp(a)-lowering therapies. Special attention is given to clinical interpretation of Lp(a) values, the role of cascade screening in families, and recommendations for preventive interventions, with an emphasis on current approaches for managing patients with elevated Lp(a) level while awaiting the availability of targeted therapies. The goal of this report is to support clinicians in identifying at-risk individuals earlier and guiding appropriate risk reduction strategies in primary and secondary prevention settings.