Canadian Journal of Cardiology

INTRODUCTION: In patients with atrial fibrillation (AF) on vitamin K antagonist (VKA) therapy and therapeutical INR range the incidence of cardiac thromboembolism is not negligible and the subgroup carrying a mechanical prosthetic mitral valve (PMV) has the highest risk. We aimed to assess the long-term effects of left atrial appendage closure (LAAC) in AF patients carriers of mechanical PMV who experienced a failure of VKA therapy. METHODS: In this retrospective, multicenter study, patients underwent LAAC because of thrombotic events including TIA/stroke, systemic embolism and evidence of left atrial appendage thrombosis/sludge despite VKA therapy were enrolled...

Hypertrophic cardiomyopathy (HCM) is a relatively common hereditable cardiomyopathy that affects between 1:200 to 1:500 of the general population. The role of cardiovascular magnetic resonance (CMR) imaging in the management of HCM has expanded over the past two decades to become a key informant of risk in this patient population, delivering unique insights into tissue health and its influence on future outcomes. Numerous mature CMR-based techniques are clinically available for the interrogation of tissue health in patients with HCM, inclusive of contrast and non-contrast methods...

Contemporary goals of cardiac pacing have expanded beyond the primary need for reliable myocardial capture. Advances in implantation techniques have permitted novel pacing systems that aim to improve electrocardiographic measures, ventricular synchrony, left ventricular function, and objective clinical outcomes across a broader population of patients. Physiologic pacing strategies, including left bundle branch area pacing (LBBAP), have emerged as potentially beneficial therapies compared to conventional non-physiological pacing modalities, such as right ventricular (RV) pacing...

This paper discusses some of the recent advances in the use of noninvasive imaging applied to patients with hypertrophic cardiomyopathy. Echocardiography and cardiac CT are briefly discussed with respect to their power to detect apical aneurysmal disease. Echo phenotype-genotype correlations and the ability of echo to characterize myocardial work are reviewed. Positron emission tomography (PET) is reviewed in the context of ischaemia imaging and also the use of a new tracer which may allow for recognition of early activation of the fibrosis pathway...

Simulation-based medical education (SBME) has been proposed as a method to expose cardiology residents to common and uncommon clinical scenarios. This approach aims to develop the core clinical competencies required for practice amidst many constraints, such as reduced training hours, limited patient encounters, and increased healthcare complexity. SBME fits particularly well in the Canadian Competency-by-Design framework, where the emphasis is on measurable competencies and achievement of milestones. This survey-based study aims to outline the current uses of SBME in Canadian cardiology residency programs, explore opportunities for SBME to enhance current approaches and identify barriers to its integration into the curriculum...

In Canada and worldwide, the elderly population (i.e., individuals >65 years of age) is increasing disproportionately relative to the total population. This is expected to have a substantial impact on the healthcare system, as increased aged is associated with a greater incidence of chronic non-communicable diseases. Within the elderly population cardiovascular disease is a leading cause of death, therefore developing therapies which can prevent or slow disease progression in this demography is highly desirable...

Age is a major risk factor for the development of cardiovascular diseases in men and in women. However, not all people age at the same rate and those who are aging rapidly are considered frail, when compared to their fit counterparts. Frailty is an important clinical challenge because those who are frail are more likely to develop and die from illnesses, including cardiovascular diseases, than fit people of the same age. This increase in susceptibility to cardiovascular diseases in older individuals may occur as the cellular and molecular mechanisms involved in the aging process facilitate structural and functional damage in the heart...

BACKGROUND: The cardiovascular and renal benefits of renin-angiotensin aldosterone system (RAAS) blockade are not well-established in patients with advanced CKD. We conducted a systematic review and meta-analysis to identify potential risks and benefits from RAAS blockade in patients with CKD stage 4-5. METHODS: A Medline search from inception to November 2022 was conducted to identify randomized controlled trials (RCTs) in patients with CKD stage 4-5 (estimated GFR ≤ 30 mL/min/1...

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Hypertrophic cardiomyopathy (HCM) is a common myocardial disease defined by increased left ventricular wall thickness unexplained by loading conditions. HCM frequently is caused by pathogenic variants in sarcomeric protein genes, but several other syndromic, metabolic, infiltrative, and neuromuscular diseases can result in HCM phenocopies. This review summarizes the current understanding of these HCM mimics, highlighting their importance across the life course. The central role of a comprehensive, multiparametric diagnostic approach and the potential of precision medicine in tailoring treatment strategies are emphasized...

No abstract text is available yet for this article.

Canadian Cardiovascular Society/Canadian Heart Failure Society guidelines recommend optimizing patients with heart failure with reduced ejection fraction (HFrEF) on guideline directed medical therapy (GDMT) prior to implanting primary prevention implantable cardioverter defibrillators (ICDs). However, often GDMT is suboptimal at the time of ICD implantation, and is associated with reduced survival. Furthermore, with evidence for declining sudden cardiac death (SCD) rates in patients with cardiomyopathy, there is a need for better risk stratification to determine the indication for ICD...

BACKGROUND: Familial association of atrial fibrillation (AF) can involve single gene variants related to known arrhythmogenic mechanisms; however, genome-wide association studies often disclose complex genetic variants in familial and non-familial AF, making it difficult to relate to known pathogenetic mechanisms. METHODS: The finding of 4 siblings with AF led to studying 47 members of a family. Long-term Holter monitoring (298 hours average) ruled out silent AFWhole-exome sequencing was performed and variants shared by the index cases were filtered and prioritized according to current recommendations...

No abstract text is available yet for this article.

The term "RASopathies" designates a group of developmental syndromes that are caused by activating variants of the rat sarcoma virus protein (RAS)/mitogen-activated protein kinase (MAPK) cascade. The most prevalent clinical diagnosis is Noonan syndrome, and other, less prevalent conditions include Noonan syndrome with multiple lentigines, Costello syndrome, cardiofaciocutaneous syndrome, and others. Hypertrophic cardiomyopathy occurs in 10% of these patients and can be severe and life-threating. Recently, repurposing of medications inhibiting the RAS/MAPK on a compassionate use basis has emerged as a promising concept to improve the outcome of these patients...

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No abstract text is available yet for this article.

Long COVID has been defined by World Health Organization as "continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation". Cardiovascular disease is implicated as a risk factor, concomitant condition and consequence of Long COVID. As well as heterogeneity in definition, presentation and likely underlying pathophysiology of Long COVID, disparities by social determinants of health, extensively studied and described in cardiovascular disease, have been observed in three ways...

Atrial Fibrillation (AF), the most prevalent cardiac arrhythmia, poses a significant public health and economic burden. While socioeconomic factors like income and education have been implicated in AF incidence and outcomes, the potential sex-specific associations remained underexplored. This narrative review aimed to fill this gap by synthesizing existing literature on the sex-specific impact of socioeconomic factors on AF incidence, treatment and outcome. Among these socioeconomic factors, we identified income and education as the most frequently cited determinants...

No abstract text is available yet for this article.