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Fournier A, Fallet C, Sadeghipour F, Perrottet N. Assessing the applicability and appropriateness of ChatGPT in answering clinical pharmacy questions. Ann Pharm Fr 2024; 82:507-513. [PMID: 37992892 DOI: 10.1016/j.pharma.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/16/2023] [Accepted: 11/16/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVES Clinical pharmacists rely on different scientific references to ensure appropriate, safe, and cost-effective drug use. Tools based on artificial intelligence (AI) such as ChatGPT (Generative Pre-trained Transformer) could offer valuable support. The objective of this study was to assess ChatGPT's capacity to correctly respond to clinical pharmacy questions asked by healthcare professionals in our university hospital. MATERIAL AND METHODS ChatGPT's capacity to respond correctly to the last 100 consecutive questions recorded in our clinical pharmacy database was assessed. Questions were copied from our FileMaker Pro database and pasted into ChatGPT March 14 version online platform. The generated answers were then copied verbatim into an Excel file. Two blinded clinical pharmacists reviewed all the questions and the answers given by the software. In case of disagreements, a third blinded pharmacist intervened to decide. RESULTS Documentation-related issues (n=36) and drug administration mode (n=30) were preponderantly recorded. Among 69 applicable questions, the rate of correct answers varied from 30 to 57.1% depending on questions type with a global rate of 44.9%. Regarding inappropriate answers (n=38), 20 were incorrect, 18 gave no answers and 8 were incomplete with 8 answers belonging to 2 different categories. No better answers than the pharmacists were observed. CONCLUSIONS ChatGPT demonstrated a mitigated performance in answering clinical pharmacy questions. It should not replace human expertise as a high rate of inappropriate answers was highlighted. Future studies should focus on the optimization of ChatGPT for specific clinical pharmacy questions and explore the potential benefits and limitations of integrating this technology into clinical practice.
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Affiliation(s)
- A Fournier
- Service of Pharmacy, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - C Fallet
- Service of Pharmacy, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - F Sadeghipour
- Service of Pharmacy, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland; Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - N Perrottet
- Service of Pharmacy, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.
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Dib N, Samuel M, Levesque S, Zaidi A, Cohen S, Opotowsky AR, Mongeon FP, Mondésert B, Kay J, Ibrahim R, Hamilton RM, Fournier A, Jameson SM, Dore A, Cook SC, Cohen S, Chaix MA, Broberg CS, Aboulhosn J, Poirier N, Khairy P. Impact of Fontan Fenestration on Adverse Cardiovascular Outcomes: A Multicentre Study. Can J Cardiol 2024:S0828-282X(24)00079-5. [PMID: 38309467 DOI: 10.1016/j.cjca.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Fenestrating a Fontan baffle has been associated with improved perioperative outcomes in patients with univentricular hearts. However, longer-term potential adverse effects remain debated. We sought to assess the impact of a fenestrated Fontan baffle on adverse cardiovascular events including all-cause mortality, cardiac transplantation, atrial arrhythmias, and thromboemboli. METHODS A multicentre North American retrospective cohort study was conducted on patients with total cavopulmonary connection Fontan baffle, with and without fenestration. All components of the composite outcome were independently adjudicated. Potential static and time-varying confounders were taken into consideration, along with competing risks. RESULTS A total of 407 patients were followed for 10.4 (7.1-14.4) years; 70.0% had fenestration of their Fontan baffle. The fenestration spontaneously closed or was deliberately sealed in 79.9% of patients a median of 2.0 years after Fontan completion. In multivariable analysis in which a persistent fenestration was modelled as a time-dependent variable, an open fenestration did not confer a higher risk of the composite outcome (hazard ratio, 1.18; 95% confidence interval, 0.71-1.97; P = 0.521). In secondary analyses, an open fenestration was not significantly associated with components of the primary outcome: that is, mortality or transplantation, atrial arrhythmias, or thromboemboli. However, sensitivity analyses to assess the possible range of error resulting from imprecise dates for spontaneous fenestration closures could not rule out significant associations between an open fenestration and atrial arrhythmias or thromboemboli. CONCLUSIONS In this multicentre study, no significant association was identified between an open fenestration in the Fontan baffle and major adverse cardiovascular events.
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Affiliation(s)
- Nabil Dib
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Michelle Samuel
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Sylvie Levesque
- Montreal Health Innovations Coordinating Center, Montréal, Québec, Canada
| | - Ali Zaidi
- Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA
| | - Sarah Cohen
- Hôpital Marie-Lannelongue, Groupe Hospitalier Saint-Joseph, Le Plessis Robinson, Paris, France
| | - Alexander R Opotowsky
- Boston Adult Congenital Heart Service, Boston Children's Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; The Cincinnati Adult Congenital Heart Disease Program, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | | | - Blandine Mondésert
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Joseph Kay
- University of Colorado Denver, Aurora, Colorado, USA
| | - Reda Ibrahim
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Robert M Hamilton
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Anne Fournier
- Hôpital Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Susan M Jameson
- Stanford Adult Congenital Heart Program, Lucile Packard Children's Hospital Stanford and Stanford Health Care, Stanford University School of Medicine, Palo Alto, California, USA
| | - Annie Dore
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Stephen C Cook
- Indiana University Health Medical Center, Indianapolis, Indiana, USA
| | - Scott Cohen
- The Wisconsin Adult Congenital Heart (WAtCH) Program, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Marie-A Chaix
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | | | - Jamil Aboulhosn
- Ahmanson/UCLA Adult Congenital Heart Program, University of California, Los Angeles, California, USA
| | - Nancy Poirier
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Paul Khairy
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
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Nguyen L, Dawe-McCord C, Frost M, Arafeh M, Chambers K, Arafeh D, Pozniak K, Thomson D, Mosel J, Cardoso R, Galuppi B, Strohm S, Via-Dufresne Ley A, Cassidy C, McCauley D, Doucet S, Alazem H, Fournier A, Marelli A, Gorter JW. A commentary on the healthcare transition policy landscape for youth with disabilities or chronic health conditions, the need for an inclusive and equitable approach, and recommendations for change in Canada. Front Rehabil Sci 2023; 4:1305084. [PMID: 38192636 PMCID: PMC10773791 DOI: 10.3389/fresc.2023.1305084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 11/27/2023] [Indexed: 01/10/2024]
Abstract
There is a growing number of youth with healthcare needs such as disabilities or chronic health conditions who require lifelong care. In Canada, transfer to the adult healthcare system typically occurs at age 18 and is set by policy regardless of whether youth and their families are ready. When the transition to adult services is suboptimal, youth may experience detrimental gaps in healthcare resulting in increased visits to the emergency department and poor healthcare outcomes. Despite the critical need to support youth with disabilities and their families to transition to the adult healthcare system, there is limited legislation to ensure a successful transfer or to mandate transition preparation in Canada. This advocacy and policy planning work was conducted in partnership with the Patient and Family Advisory Council (PFAC) within the CHILD-BRIGHT READYorNot™ Brain-Based Disabilities (BBD) Project and the CHILD-BRIGHT Policy Hub. Together, we identified the need to synthesize and better understand existing policies about transition from pediatric to adult healthcare, and to recommend solutions to improve healthcare access and equity as Canadian youth with disabilities become adults. In this perspective paper, we will report on a dialogue with key informants and make recommendations for change in healthcare transition policies at the healthcare/community, provincial and/or territorial, and/or national levels.
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Affiliation(s)
- Linda Nguyen
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Claire Dawe-McCord
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Bachelor of Health Sciences Program, McMaster University, Hamilton, ON, Canada
- Patient and Family Advisory Council (young adult/patient partner), READYorNot™ Brain-Based Disabilities Project, CHILD-BRIGHT Network, Canada
| | - Michael Frost
- Patient and Family Advisory Council (young adult/patient partner), READYorNot™ Brain-Based Disabilities Project, CHILD-BRIGHT Network, Canada
| | - Musa Arafeh
- Patient and Family Advisory Council (young adult/patient partner), READYorNot™ Brain-Based Disabilities Project, CHILD-BRIGHT Network, Canada
| | - Kyle Chambers
- Patient and Family Advisory Council (young adult/patient partner), READYorNot™ Brain-Based Disabilities Project, CHILD-BRIGHT Network, Canada
| | - Dana Arafeh
- Patient and Family Advisory Council (young adult/patient partner), READYorNot™ Brain-Based Disabilities Project, CHILD-BRIGHT Network, Canada
| | - Kinga Pozniak
- Patient and Family Advisory Council (Parent/Family Partner), READYorNot™ Brain-Based Disabilities Project, CHILD-BRIGHT Network, Canada
| | - Donna Thomson
- Patient and Family Advisory Council (Parent/Family Partner), READYorNot™ Brain-Based Disabilities Project, CHILD-BRIGHT Network, Canada
| | - JoAnne Mosel
- Patient and Family Advisory Council (Parent/Family Partner), READYorNot™ Brain-Based Disabilities Project, CHILD-BRIGHT Network, Canada
| | | | - Barb Galuppi
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Sonya Strohm
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | | | - Caitlin Cassidy
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Dayle McCauley
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Shelley Doucet
- Nursing and Health Sciences, University of New Brunswick, Saint John, NB, Canada
| | - Hana Alazem
- Department of Pediatrics, Faculty of Medicine, University of Ottawa and Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Anne Fournier
- CHU Mère-Enfant, Sainte Justine Hospital, Montreal, QC, Canada
| | - Ariane Marelli
- Department of Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Jan Willem Gorter
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
- Centre of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, Netherlands
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Vô C, Dib N, Bartoletti S, Gonzalez CM, Mondésert B, Gagnon MH, Fournier A, Khairy P. Navigating Arrhythmias in Tetralogy of Fallot Throughout the Lifespan: A Case-based Review. CJC Pediatr Congenit Heart Dis 2023; 2:404-413. [PMID: 38161682 PMCID: PMC10755829 DOI: 10.1016/j.cjcpc.2023.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/12/2023] [Indexed: 01/03/2024]
Abstract
Arrhythmias are a common complication associated with tetralogy of Fallot (ToF), one of the most prevalent forms of congenital heart disease. As illustrated by this case-based review, various forms of arrhythmias can be encountered across the lifespan of patients with ToF, from infancy to older adulthood. These include atrioventricular block, junctional ectopic tachycardia, and atrial and ventricular arrhythmias. Arrhythmias have important implications on the health and quality of life of patients with ToF and require treatment by caregivers with dedicated expertise. The choice of pharmacologic and/or interventional therapies to alleviate symptoms, avoid complications, and mitigate risks depends in part on the type, severity, and frequency of the arrhythmia, as well as on the particularities of individual clinical scenarios. Preventing, monitoring for, and managing arrhythmias are an integral component of the care of patients with ToF throughout their lifespan that is critical to optimizing health outcomes.
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Affiliation(s)
- Christophe Vô
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montreal, Québec, Canada
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| | - Nabil Dib
- Division of Pediatric Cardiac Surgery, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montreal, Québec, Canada
| | - Stefano Bartoletti
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| | - Cecilia M. Gonzalez
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montreal, Québec, Canada
| | - Blandine Mondésert
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| | - Marie-Hélène Gagnon
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montreal, Québec, Canada
| | - Anne Fournier
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montreal, Québec, Canada
| | - Paul Khairy
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montreal, Québec, Canada
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
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Padley N, Moubayed D, Lanteigne A, Ouimet F, Clermont MJ, Fournier A, Racine E. Transition from Paediatric to adult health services: Aspirations and practices of human flourishing. Int J Qual Stud Health Well-being 2023; 18:2278904. [PMID: 37994797 PMCID: PMC11000676 DOI: 10.1080/17482631.2023.2278904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 10/31/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Transition from paediatric to adult care is challenging for youths with a chronic condition. Most transition programmes place high value in autonomy and independence. We undertook a qualitative study to: (1) identify the needs and aspirations of youths and (2) better understand the well-being and flourishing of youths. METHODS Semi-structured interviews were conducted with youths, parents of youths and healthcare professionals recruited from four clinics. Thematic analysis focused on: (1) perceptions of transition; (2) key aspects of human flourishing during transition; and (3) salient concerns with respect to the transition and dimensions of human flourishing. RESULTS 54 interviews were conducted. Perceptions of transition clustered around: (1) apprehension about adult care; (2) lack of clarity about the transition process; (3) emotional attachment to paediatric healthcare professionals; (4) the significance of the coinciding transition into adulthood. Fourteen salient concerns (e.g., Knowledge and information about the transition, Parental involvement in healthcare) were identified with corresponding recommendations. Salient concerns related to important dimensions of human flourishing (e.g., environmental mastery, autonomy). DISCUSSION AND CONCLUSION The flourishing of youths is affected by suboptimal transition practices. We discuss the implications of our findings for environmental mastery, contextual autonomy, and the holistic and humanistic aspects of transition.
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Affiliation(s)
- Nicole Padley
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - Dina Moubayed
- Département de pédiatrie (section médecine de l'adolescence), Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
- Département de médecine, Université de Montréal, Montréal, QC, Canada
| | - Amélie Lanteigne
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - François Ouimet
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - Marie-José Clermont
- Département de pédiatrie, CHU Sainte-Justine, Montréal, Québec, Canada
- Département de pédiatrie, Université de Montréal, Montréal, QC, Canada
| | - Anne Fournier
- Département de pédiatrie (section médecine de l'adolescence), Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
| | - Eric Racine
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
- Département de médecine, Université de Montréal, Montréal, QC, Canada
- Département de médecine sociale et préventive, École de santé publique de l’Université de Montréal, Montréal, QC, Canada
- Department of Medicine (Division of Experimental Medicine), McGill University, Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, 3801 Rue University, Montréal, QC, Canada
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Marshall M, Malik A, Shah M, Fish FA, Etheridge SP, Aziz PF, Russell MW, Tisma S, Pflaumer A, Sreeram N, Kubus P, Law IH, Kantoch MJ, Kertesz NJ, Strieper M, Erickson CC, Moore JP, Nakano SJ, Singh HR, Chang P, Cohen M, Fournier A, Ilina MV, Zimmermann F, Horndasch M, Li W, Batra AS, Liberman L, Hamilton R, Janson CM, Sanatani S, Zeltser I, McDaniel G, Blaufox AD, Garnreiter JM, Balaji S. Patterns of Electrocardiographic Abnormalities in Children with Hypertrophic Cardiomyopathy. Pediatr Cardiol 2023:10.1007/s00246-023-03252-4. [PMID: 37684488 DOI: 10.1007/s00246-023-03252-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/25/2023] [Indexed: 09/10/2023]
Abstract
Hypertrophic cardiomyopathy (HCM), a common cardiomyopathy in children, is an important cause of morbidity and mortality. Early recognition and appropriate management are important. An electrocardiogram (ECG) is often used as a screening tool in children to detect heart disease. The ECG patterns in children with HCM are not well described.ECGs collected from an international cohort of children, and adolescents (≤ 21 years) with HCM were reviewed. 482 ECGs met inclusion criteria. Age ranged from 1 day to 21 years, median 13 years. Of the 482 ECGs, 57 (12%) were normal. The most common abnormalities noted were left ventricular hypertrophy (LVH) in 108/482 (22%) and biventricular hypertrophy (BVH) in 116/482 (24%) Of the patients with LVH/BVH (n = 224), 135 (60%) also had a strain pattern (LVH in 83, BVH in 52). Isolated strain pattern (in the absence of criteria for hypertrophy) was seen in 43/482 (9%). Isolated pathologic Q waves were seen in 71/482 (15%). Pediatric HCM, 88% have an abnormal ECG. The most common ECG abnormalities were LVH or BVH with or without strain. Strain pattern without hypertrophy and a pathologic Q wave were present in a significant proportion (24%) of patients. Thus, a significant number of children with HCM have ECG abnormalities that are not typical for "hypertrophy". The presence of the ECG abnormalities described above in a child should prompt further examination with an echocardiogram to rule out HCM.
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Affiliation(s)
- Mayme Marshall
- Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Aneeq Malik
- University of Los Angeles Olive View, Los Angeles, CA, USA
| | - Maully Shah
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | - Peter F Aziz
- Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | | | | | - Andreas Pflaumer
- Royal Children's Hospital, University of Melbourne, Parkville, VIC, Australia
| | | | | | - Ian H Law
- University of Iowa, Iowa City, IA, USA
| | | | | | - Margaret Strieper
- Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | | | | | | | - Harinder R Singh
- Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, TX, USA
| | | | - Mitchell Cohen
- Inova LJ Murphy Children's Hospital, Falls Church, VA, USA
| | | | | | | | | | - Walter Li
- University of California, San Francisco, CA, USA
| | | | | | | | | | | | | | | | - Andrew D Blaufox
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | | | - Seshadri Balaji
- Oregon Health and Science University, 707 SW Gaines Street, Portland, OR, 97239, USA.
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Davies B, Allan KS, Carroll SL, Gibbs K, Roberts JD, MacIntyre C, Steinberg C, Tadros R, Dorian P, Healey JS, Gardner M, Laksman ZWM, Krahn AD, Fournier A, Seifer C, Lauck SB. Perceived self-efficacy and empowerment in patients at increased risk of sudden cardiac arrest. Front Cardiovasc Med 2023; 10:955060. [PMID: 37255708 PMCID: PMC10225561 DOI: 10.3389/fcvm.2023.955060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 03/10/2023] [Indexed: 06/01/2023] Open
Abstract
Background The role of multidisciplinary clinics for psychosocial care is increasingly recognized for those living with inherited cardiac conditions (ICC). In Canada, access to healthcare providers differ between clinics. Little is known about the relationship between access to specialty care and a patient's ability to cope with, and manage their condition. Methods We leveraged the Hearts in Rhythm Organization (HiRO) to conduct a cross-sectional, community-based survey of individuals with ICC and their family members. We aimed to describe access to services, and explore the relationships between participants' characteristics, cardiac history and self-reported health status and self-efficacy (GSE: General Self-Efficacy Scale) and empowerment (GCOS-24: Genetic Counseling Outcome Scale). Results We collected 235 responses from Canadian participants in 10 provinces and territories. Overall, 63% of participants reported involvement of a genetic counsellor in their care. Access to genetic testing was associated with greater empowerment [mean GCOS-24: 121.14 (SD = 20.53) vs. 105.68 (SD = 21.69); p = 0.004]. Uncertain genetic test results were associated with lower perceived self-efficacy (mean GSE: uncertain = 28.85 vs. positive = 33.16, negative = 34.13; p = 0.01). Low global mental health scores correlated with both lower perceived self-efficacy and empowerment scores, with only 11% of affected participants reporting involvement of psychology services in their care. Conclusion Differences in resource accessibility, clinical history and self-reported health status impact the perceived self-efficacy and empowerment of patients with ICC. Future research evaluating interventions to improve patient outcomes is recommended.
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Affiliation(s)
- Brianna Davies
- Centre for Cardiovascular Innovation, St. Paul’s and Vancouver General Hospitals, University of British Columbia, Vancouver, BC, Canada
| | - Katherine S. Allan
- Division of Cardiology, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Sandra L. Carroll
- School of Nursing, Faculty of Health Science, Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Karen Gibbs
- Centre for Cardiovascular Innovation, St. Paul’s and Vancouver General Hospitals, University of British Columbia, Vancouver, BC, Canada
| | - Jason D. Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department ofMedicine, Western University, London, ON, Canada
| | | | - Christian Steinberg
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Laval University, Quebec City, QC, Canada
| | - Rafik Tadros
- Department of Medicine, Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - Paul Dorian
- Division of Cardiology, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Jeff S. Healey
- School of Nursing, Faculty of Health Science, Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | | | - Zachary W. M. Laksman
- Centre for Cardiovascular Innovation, St. Paul’s and Vancouver General Hospitals, University of British Columbia, Vancouver, BC, Canada
| | - Andrew D. Krahn
- Centre for Cardiovascular Innovation, St. Paul’s and Vancouver General Hospitals, University of British Columbia, Vancouver, BC, Canada
| | - Anne Fournier
- Division of Pediatric Cardiology, CHU Sainte-Justine, Université de Montréal, Montreal,QC, Canada
| | - Colette Seifer
- Department of Internal Medicine, St Boniface Hospital, University of Manitoba, Winnipeg, MB, Canada
| | - Sandra B. Lauck
- Centre for Cardiovascular Innovation, St. Paul’s and Vancouver General Hospitals, University of British Columbia, Vancouver, BC, Canada
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8
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Rayani K, Davies B, Cheung M, Comber D, Roberts JD, Tadros R, Green MS, Healey JS, Simpson CS, Sanatani S, Steinberg C, MacIntyre C, Angaran P, Duff H, Hamilton R, Arbour L, Leather R, Seifer C, Fournier A, Atallah J, Kimber S, Makanjee B, Alqarawi W, Cadrin-Tourigny J, Joza J, Gardner M, Talajic M, Bagnall RD, Krahn AD, Laksman ZWM. Identification and in-silico characterization of splice-site variants from a large cardiogenetic national registry. Eur J Hum Genet 2023; 31:512-520. [PMID: 36138163 PMCID: PMC10172209 DOI: 10.1038/s41431-022-01193-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 08/23/2022] [Accepted: 09/08/2022] [Indexed: 11/08/2022] Open
Abstract
Splice-site variants in cardiac genes may predispose carriers to potentially lethal arrhythmias. To investigate, we screened 1315 probands and first-degree relatives enrolled in the Canadian Hearts in Rhythm Organization (HiRO) registry. 10% (134/1315) of patients in the HiRO registry carry variants within 10 base-pairs of the intron-exon boundary with 78% (104/134) otherwise genotype negative. These 134 probands were carriers of 57 unique variants. For each variant, American College of Medical Genetics and Genomics (ACMG) classification was revisited based on consensus between nine in silico tools. Due in part to the in silico algorithms, seven variants were reclassified from the original report, with the majority (6/7) downgraded. Our analyses predicted 53% (30/57) of variants to be likely/pathogenic. For the 57 variants, an average of 9 tools were able to score variants within splice sites, while 6.5 tools responded for variants outside these sites. With likely/pathogenic classification considered a positive outcome, the ACMG classification was used to calculate sensitivity/specificity of each tool. Among these, Combined Annotation Dependent Depletion (CADD) had good sensitivity (93%) and the highest response rate (131/134, 98%), dbscSNV was also sensitive (97%), and SpliceAI was the most specific (64%) tool. Splice variants remain an important consideration in gene elusive inherited arrhythmia syndromes. Screening for intronic variants, even when restricted to the ±10 positions as performed here may improve genetic testing yield. We compare 9 freely available in silico tools and provide recommendations regarding their predictive capabilities. Moreover, we highlight several novel cardiomyopathy-associated variants which merit further study.
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Affiliation(s)
- Kaveh Rayani
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Brianna Davies
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Matthew Cheung
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Drake Comber
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| | - Rafik Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute, Montreal, QC, Canada
- Department of Medicine, Universite de Montreal, Montreal, QC, Canada
| | - Martin S Green
- Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | | | | | | | - Christian Steinberg
- Institut Universitaire de Cardiologie et Pneumologie de Quebec, Laval University, Quebec City, QC, Canada
| | - Ciorsti MacIntyre
- Division of Cardiology, QEII Health Sciences Center, Halifax, NS, Canada
| | - Paul Angaran
- St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Henry Duff
- Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
| | - Robert Hamilton
- Division of Cardiology, The Hospital for Sick Children (SickKids), Toronto, ON, Canada
| | - Laura Arbour
- Division of Medical Genetics, Island Health, Victoria, BC, Canada
| | | | - Colette Seifer
- Section of Cardiology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Anne Fournier
- Division of Pediatric Cardiology, CHU Sainte-Justine, Universite de Montreal, Montreal, QC, Canada
| | - Joseph Atallah
- Division of Pediatric Cardiology, University of Alberta Stollery Children's Hospital, Edmonton, AB, Canada
| | - Shane Kimber
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Bhavanesh Makanjee
- Heart Health Institute, Scarborough Health Network, Scarborough, ON, Canada
| | - Wael Alqarawi
- Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Center, Montreal Heart Institute, Montreal, QC, Canada
- Department of Medicine, Universite de Montreal, Montreal, QC, Canada
| | - Jacqueline Joza
- Division of Cardiology, McGill University Health Centre, Montreal, QC, Canada
| | - Martin Gardner
- Division of Cardiology, QEII Health Sciences Center, Halifax, NS, Canada
| | - Mario Talajic
- Cardiovascular Genetics Center, Montreal Heart Institute, Montreal, QC, Canada
- Department of Medicine, Universite de Montreal, Montreal, QC, Canada
| | - Richard D Bagnall
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Andrew D Krahn
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Zachary W M Laksman
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Fournier A, Martinez A, Iglesias G. Impacts of climate change on wind energy potential in Australasia and South-East Asia following the Shared Socioeconomic Pathways. Sci Total Environ 2023; 882:163347. [PMID: 37084909 DOI: 10.1016/j.scitotenv.2023.163347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 05/03/2023]
Abstract
Wind energy is poised to play a major role in the energy transition. Fluctuations in global atmospheric circulation are expected as a result of climate change, and wind projections based on the most up-to-date scenarios of climate change, the Shared Socioeconomic Pathways (SSPs), anticipate significant changes in wind energy potential in many regions; so far, these changes have not been studied in Southeastern Asia and Australasia, a region with notable wind energy potential. This work investigates the evolution of wind power density and its temporal variability considering the latest scenarios of climate change, the SSPs. More specifically, two scenarios are considered, SSP2-4.5 and SSP5-8.5, corresponding to moderate and high emissions, respectively. As many as 18 global climate models are considered and compared against past-present data, and those that perform best are retained to build a large multi-model ensemble. The results show that projected changes in mean wind power density at the end of the 21st century are of little significance (typically below 5 %); nevertheless, this value can be far surpassed locally. In certain areas (e.g., Vietnam, Borneo) and seasons, remarkable changes in wind power density (exceeding 150 %) are anticipated. Typically, mean values and temporal variability changes are greater in the high-emissions scenario, however, seasonal variability is projected to be more pronounced in the moderate-emissions scenario. These effects of climate change on wind energy potential must be taken into account in the development of wind power in the region, for they will affect the energy production and, therefore, the economic viability of wind farms - not least in those areas where drastic changes are projected.
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Affiliation(s)
- A Fournier
- MINES-Paristech, Rue Claude Daunesse, Sophia Antipolis 06904, France
| | - A Martinez
- MaREI, Environmental Research Institute & School of Engineering, University College Cork, College Road, Cork, Ireland
| | - G Iglesias
- MaREI, Environmental Research Institute & School of Engineering, University College Cork, College Road, Cork, Ireland; University of Plymouth, School of Engineering, Computing & Mathematics, Marine Building, Drake Circus, Plymouth PL4 8AA, United Kingdom.
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10
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Khendek L, Molina V, Laverdure N, Abukasm K, Khullar S, Lachaud M, Dubois J, Dal Soglio D, Miro J, Fournier A, Paganelli M. A41 FONTAN ASSOCIATED LIVER DISEASE: THE ROLE OF TRANSIENT ELASTOGRAPHY IN CHILDREN AND ADOLESCENTS. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991091 DOI: 10.1093/jcag/gwac036.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Non-invasive assessment of Fontan Associated Liver Disease (FALD) is of interest, but studies have yielded inconsistent results about the correlation of severity of disease with laboratory values and imaging. Transient elastography (TE) is a non-invasive imaging modality used commonly for liver stiffness measurement (LSM) and in Fontan patients it is hypothesized to reflect not only liver fibrosis but also venous congestion. Purpose To better define the potential role of TE for non-invasive assessment of the severity of FALD. Method This was a retrospective study conducted on patients’ medical records at CHU Sainte-Justine Hospital. Patients less than 18 years of age with FALD who had at undergone at least one LSM by TE between 1998-2021 were included. The relationship between LSM and liver function tests, hepatic ultrasound findings (including a cirrhosis score), cardiac catheterization results and histological fibrosis scores were analyzed. The impact of interventions during cardiac catherization on LSM were also studied. Result(s) A total of 54 patients (36 boys and 18 girls) with FALD were studied. Median age at Fontan surgery was 4.6 years (IQR 4.0 ─ 5.4 years). Higher LSM values significantly correlated with longer time from Fontan, higher total and direct bilirubin and GGT levels, higher INR, longer APTT, lower Factor V, and lower absolute lymphocyte count. Greater LSM was also significantly associated with the presence of heterogenous parenchymal echogenicity, irregular liver contours and greater ultrasonographic cirrhosis scores. Higher TE values were significantly correlated with higher wedged hepatic venous pressure and Fontan pressure. After catherization interventions that addressed stenoses, there was a statistically significant reduction in mean LSM (24.9±3.63 kPa vs 15.8±4.6 kPa, p=0.005). After closure of significant pulmonary collaterals, mean LSM tended to increase, but this difference did not reach statistical significance (19.1±1.9 kPa vs 24.6±3.5 kPa, p=0.2). At liver biopsy, significant direct correlation was found between LSM and the grade of sinusoidal fibrosis and LSM. TE with values >20 kPa were found to have higher grades of sinusoidal fibrosis, while values <20kPa had higher grades of sinusoidal dilatation. Conclusion(s) This study showed that TE allows to identify patients with higher cholestatic parameters, more severe liver fibrosis at biopsy and sonographic signs suggestive of cirrhosis. Moreover, it confirmed that liver congestion significantly contributes to LSM values. Interestingly, catheter interventions addressing pulmonary stenoses led to the improvement of TE measurements, giving hope for the reduction of hepatic venous congestion in these patients, which might have an effect on their FALD. Finally, the LSM threshold of 20 kPa could be useful clinically as a value above which fibrosis is likely to be significant, while if below could indicate a greater contribution from hepatic congestion. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
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Affiliation(s)
- L Khendek
- Gastroenterology, Hepatology and Nutrition, Sainte-Justine University Hospital Center,University of Montreal
| | - V Molina
- University of Montreal,Cardiology
| | - N Laverdure
- Gastroenterology, Hepatology and Nutrition, Sainte-Justine University Hospital Center,University of Montreal
| | - K Abukasm
- Gastroenterology, Hepatology and Nutrition, Sainte-Justine University Hospital Center,University of Montreal
| | | | | | - J Dubois
- University of Montreal,Radiology, Sainte-Justine University Hospital Center, Montreal, Canada
| | | | - J Miro
- University of Montreal,Cardiology
| | | | - M Paganelli
- Gastroenterology, Hepatology and Nutrition, Sainte-Justine University Hospital Center,University of Montreal
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11
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Muller C, Ardouin L, Fournier A, Gaisne E, Leroy M, Bellemère P. Pyrocarbon interposition implant after lunate resection in Kienböck's disease: A case series. Hand Surg Rehabil 2023; 42:34-39. [PMID: 36336267 DOI: 10.1016/j.hansur.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/22/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022]
Abstract
In advanced stages of Kienböck's disease, the lunate is no longer conservable. One of the surgical options is to resect the lunate and replace it with a prosthesis. The procedure consisted in lunate resection and interposition of a free APSI® or Pi2® pyrocarbon implant through a dorsal approach. Follow-up was clinical and radiological on QuickDASH and PRWE scores. At a median follow-up of 3 years, 12 patients were reviewed, with a median age of 56 years. Flexion significantly decreased from 42° to 28° (p < 0.01). Extension and pronation-supination were conserved. Strength was 94% compared to the opposite side, with no significant difference from the preoperative measurement. Median QuickDASH and PRWE scores were 15.9 and 23.5 respectively and had significantly improved. One patient underwent scaphocapitate fusion because she was still in pain; the other patients were pain-free. No patients had to change jobs because of their wrist. Radiographically, there was no carpal collapse and carpal height was conserved. Radioscaphoid angle and ulnar translation were stable. There was 1 case of asymptomatic implant dislocation. Interposition of a pyrocarbon implant after lunate resection in advanced Kienböck's disease is a motion-conserving procedure that provides pain relief and functional recovery in the short and medium term. LEVEL OF EVIDENCE: IV.
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Affiliation(s)
- C Muller
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Émile Gallé, CHU Nancy, 49 Rue Hermite, 54000 Nancy, France.
| | - L Ardouin
- Institut de la Main Nantes Atlantique, Boulevard Charles-Gautier, Saint-Herblain, France
| | - A Fournier
- Institut de la Main Nantes Atlantique, Boulevard Charles-Gautier, Saint-Herblain, France
| | - E Gaisne
- Institut de la Main Nantes Atlantique, Boulevard Charles-Gautier, Saint-Herblain, France
| | - M Leroy
- Institut de la Main Nantes Atlantique, Boulevard Charles-Gautier, Saint-Herblain, France
| | - P Bellemère
- Institut de la Main Nantes Atlantique, Boulevard Charles-Gautier, Saint-Herblain, France
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12
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Janzen ML, Davies B, Laksman ZW, Roberts JD, Sanatani S, Steinberg C, Tadros R, Cadrin-Tourigny J, MacIntyre C, Atallah J, Fournier A, Green MS, Hamilton R, Khan HR, Kimber S, White S, Joza J, Makanjee B, Ilhan E, Lee D, Hansom S, Hadjis A, Arbour L, Leather R, Seifer C, Angaran P, Simpson CS, Healey JS, Gardner M, Talajic M, Krahn AD. Management of Inherited Arrhythmia Syndromes: a HiRO Consensus Handbook on Process of Care. CJC Open 2023; 5:268-284. [PMID: 37124966 PMCID: PMC10140751 DOI: 10.1016/j.cjco.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 02/14/2023] [Indexed: 02/27/2023] Open
Abstract
Inherited arrhythmia syndromes are rare genetic conditions that predispose seemingly healthy individuals to sudden cardiac arrest and death. The Hearts in Rhythm Organization is a multidisciplinary Canadian network of clinicians, researchers, patients, and families that aims to improve care for patients and families with inherited cardiac conditions, focused on those that confer predisposition to arrhythmia and sudden cardiac arrest and/or death. The field is rapidly evolving as research discoveries increase. A streamlined, practical guide for providers to diagnose and follow pediatric and adult patients with inherited cardiac conditions represents a useful tool to improve health system utilization, clinical management, and research related to these conditions. This review provides consensus care pathways for 7 conditions, including the 4 most common inherited cardiac conditions that confer predisposition to arrhythmia, with scenarios to guide investigation, diagnosis, risk stratification, and management. These conditions include Brugada syndrome, long QT syndrome, arrhythmogenic right ventricular cardiomyopathy and related arrhythmogenic cardiomyopathies, and catecholaminergic polymorphic ventricular tachycardia. In addition, an approach to investigating and managing sudden cardiac arrest, sudden unexpected death, and first-degree family members of affected individuals is provided. Referral to specialized cardiogenetic clinics should be considered in most cases. The intention of this review is to offer a framework for the process of care that is useful for both experts and nonexperts, and related allied disciplines such as hospital management, diagnostic services, coroners, and pathologists, in order to provide high-quality, multidisciplinary, standardized care.
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13
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Alami Laroussi N, Andelfinger G, Bigras JL, Boutin C, Brassard M, Dahdah N, Fournier A, Miró J, Raboisson MJ, van Doesburg N. Cé anvi baille ki baille (C'est l'envie de donner qui donne-It Is the Desire to Give That Gives). CJC Pediatr Congenit Heart Dis 2023; 2:1-2. [PMID: 37970102 PMCID: PMC10642114 DOI: 10.1016/j.cjcpc.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 11/16/2022] [Indexed: 11/17/2023]
Affiliation(s)
- Nassiba Alami Laroussi
- Division of Pediatric Cardiology, CHU Sainte-Justine, University of Montreal, Montreal, Québec, Canada
| | - Gregor Andelfinger
- Division of Pediatric Cardiology, CHU Sainte-Justine, University of Montreal, Montreal, Québec, Canada
| | - Jean-Luc Bigras
- Division of Pediatric Cardiology, CHU Sainte-Justine, University of Montreal, Montreal, Québec, Canada
| | - Christine Boutin
- Division of Pediatric Cardiology, CHU Sainte-Justine, University of Montreal, Montreal, Québec, Canada
| | - Myriam Brassard
- Division of Pediatric Cardiology, CHU Sainte-Justine, University of Montreal, Montreal, Québec, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, CHU Sainte-Justine, University of Montreal, Montreal, Québec, Canada
| | - Anne Fournier
- Division of Pediatric Cardiology, CHU Sainte-Justine, University of Montreal, Montreal, Québec, Canada
| | - Joaquim Miró
- Division of Pediatric Cardiology, CHU Sainte-Justine, University of Montreal, Montreal, Québec, Canada
| | - Marie-Josée Raboisson
- Division of Pediatric Cardiology, CHU Sainte-Justine, University of Montreal, Montreal, Québec, Canada
| | - Nicolaas van Doesburg
- Division of Pediatric Cardiology, CHU Sainte-Justine, University of Montreal, Montreal, Québec, Canada
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14
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Fournier A, Fines M, Verdon R. Neurosifilide. Neurologia 2022. [DOI: 10.1016/s1634-7072(22)47092-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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15
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Corben LA, Collins V, Milne S, Farmer J, Musheno A, Lynch D, Subramony S, Pandolfo M, Schulz JB, Lin K, Delatycki MB, Bidichandani SI, Boesch S, Cnop M, Corti M, Duquette A, Durr A, Eigentler A, Emmanuel A, Flynn JM, Foroush NC, Fournier A, França MC, Giunti P, Goh EW, Graf L, Hadjivassiliou M, Huckabee ML, Kearney MG, Koeppen AH, Lie Y, Lin KY, Lowit A, Mariotti C, Mathews K, McCormack SE, Montenegro L, Morlet T, Naeije G, Panicker JN, Parkinson MH, Patel A, Payne RM, Perlman S, Peverill RE, Pousset F, Puccio H, Rai M, Rance G, Reetz K, Rowland TJ, Sansom P, Savvatis K, Schalling ET, Schöls L, Smith B, Soragni E, Spencer C, Synofzik M, Szmulewicz DJ, Tai G, Tamaroff J, Treat L, Carpentier AV, Vogel AP, Walther SE, Weber DR, Weisbrod NJ, Wilmot G, Wilson RB, Yoon G, Zesiewicz T. Clinical management guidelines for Friedreich ataxia: best practice in rare diseases. Orphanet J Rare Dis 2022; 17:415. [PMID: 36371255 PMCID: PMC9652828 DOI: 10.1186/s13023-022-02568-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/30/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Individuals with Friedreich ataxia (FRDA) can find it difficult to access specialized clinical care. To facilitate best practice in delivering healthcare for FRDA, clinical management guidelines (CMGs) were developed in 2014. However, the lack of high-certainty evidence and the inadequacy of accepted metrics to measure health status continues to present challenges in FRDA and other rare diseases. To overcome these challenges, the Grading of Recommendations Assessment and Evaluation (GRADE) framework for rare diseases developed by the RARE-Bestpractices Working Group was adopted to update the clinical guidelines for FRDA. This approach incorporates additional strategies to the GRADE framework to support the strength of recommendations, such as review of literature in similar conditions, the systematic collection of expert opinion and patient perceptions, and use of natural history data. METHODS A panel representing international clinical experts, stakeholders and consumer groups provided oversight to guideline development within the GRADE framework. Invited expert authors generated the Patient, Intervention, Comparison, Outcome (PICO) questions to guide the literature search (2014 to June 2020). Evidence profiles in tandem with feedback from individuals living with FRDA, natural history registry data and expert clinical observations contributed to the final recommendations. Authors also developed best practice statements for clinical care points that were considered self-evident or were not amenable to the GRADE process. RESULTS Seventy clinical experts contributed to fifteen topic-specific chapters with clinical recommendations and/or best practice statements. New topics since 2014 include emergency medicine, digital and assistive technologies and a stand-alone section on mental health. Evidence was evaluated according to GRADE criteria and 130 new recommendations and 95 best practice statements were generated. DISCUSSION AND CONCLUSION Evidence-based CMGs are required to ensure the best clinical care for people with FRDA. Adopting the GRADE rare-disease framework enabled the development of higher quality CMGs for FRDA and allows individual topics to be updated as new evidence emerges. While the primary goal of these guidelines is better outcomes for people living with FRDA, the process of developing the guidelines may also help inform the development of clinical guidelines in other rare diseases.
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Affiliation(s)
- Louise A. Corben
- grid.1058.c0000 0000 9442 535XBruce Lefroy Centre for Genetic Health Research, Murdoch Children’s Research Institute, Parkville, VIC 3052 Australia ,grid.1008.90000 0001 2179 088XDepartment of Paediatrics, Melbourne University, Melbourne, VIC Australia ,grid.1002.30000 0004 1936 7857Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC Australia
| | - Veronica Collins
- grid.1058.c0000 0000 9442 535XBruce Lefroy Centre for Genetic Health Research, Murdoch Children’s Research Institute, Parkville, VIC 3052 Australia
| | - Sarah Milne
- grid.1058.c0000 0000 9442 535XBruce Lefroy Centre for Genetic Health Research, Murdoch Children’s Research Institute, Parkville, VIC 3052 Australia ,grid.1008.90000 0001 2179 088XDepartment of Paediatrics, Melbourne University, Melbourne, VIC Australia ,grid.419789.a0000 0000 9295 3933Monash Health, Clayton, VIC Australia ,grid.1002.30000 0004 1936 7857School of Primary and Allied Health Care, Monash University, Clayton, VIC Australia
| | - Jennifer Farmer
- grid.428632.9Friedreich’s Ataxia Research Alliance, Downingtown, PA USA
| | - Ann Musheno
- grid.428632.9Friedreich’s Ataxia Research Alliance, Downingtown, PA USA
| | - David Lynch
- grid.239552.a0000 0001 0680 8770Departments of Neurology and Pediatrics, Children’s Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA USA
| | - Sub Subramony
- grid.15276.370000 0004 1936 8091Fixel Center for Neurological Disorders, University of Florida College of Medicine, Gainesville, FL USA
| | - Massimo Pandolfo
- grid.14709.3b0000 0004 1936 8649McGill University, Montreal, QC Canada
| | - Jörg B. Schulz
- grid.412301.50000 0000 8653 1507Department of Neurology, University Hospital, Aachen, Germany ,grid.1957.a0000 0001 0728 696XJARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Kim Lin
- grid.239552.a0000 0001 0680 8770Department of Pediatrics, Children’s Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA USA
| | - Martin B. Delatycki
- grid.1058.c0000 0000 9442 535XBruce Lefroy Centre for Genetic Health Research, Murdoch Children’s Research Institute, Parkville, VIC 3052 Australia ,grid.1008.90000 0001 2179 088XDepartment of Paediatrics, Melbourne University, Melbourne, VIC Australia ,grid.507857.8Victorian Clinical Genetics Services, Parkville, VIC Australia
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16
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Basmaji S, Samuel M, Shohoudi A, Hamilton RM, Aboulhosn J, Broberg CS, Chaix MA, Cohen S, Cook S, Dore A, Fernandes SM, Fortier A, Fournier A, Guertin MC, Kay J, Mondésert B, Mongeon FP, Opotowsky AR, Proietti A, Ting J, Zaidi A, Khairy P. Time in Therapeutic Range With Vitamin K Antagonists in Congenital Heart Disease: A Multicentre Study. Can J Cardiol 2022; 38:1751-1758. [PMID: 35964887 DOI: 10.1016/j.cjca.2022.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Vitamin K antagonists (VKAs) are frequently prescribed to patients with congenital heart disease (CHD) for atrial arrhythmias or Fontan palliation, but there is a paucity of data regarding time spent in the therapeutic range (TTR). We sought to determine the TTR in patients with CHD and atrial arrhythmias or Fontan palliation prescribed VKAs and explore associations with thromboembolic and bleeding events. METHODS A multicentre North American cohort study was conducted on patients with CHD who received VKAs for sustained atrial arrhythmia or Fontan palliation. TTR was calculated using the Rosendaal linear interpolation method. Generalized estimating equations were used to explore factors associated with time outside the therapeutic range. RESULTS A total of 567 patients, aged 33 ± 17 years, 56% female, received VKAs for 11.5 ± 8.4 years for atrial arrhythmias (63.0%) or Fontan palliation (58.0%). CHD was simple, moderate, and complex in 10.8%, 20.3%, and 69.0%, respectively. Site investigators perceived good control over international normalized ratio (INR) levels in most patients (75.3%), with no or minor compliance or adherence issues (85.6%). The mean TTR was 41.9% (95% confidence interval [CI], 39.0%-44.8%). Forty-seven (8.3%) and 34 (6.0%) patients had thromboembolic and bleeding events, respectively. Thromboembolic events were associated with a higher proportion of time below the therapeutic range (31.3% vs 19.1%, P = 0.003) and bleeding complications with a higher proportion of time above the therapeutic range (32.5% vs 19.5%, P = 0.006). CONCLUSIONS Patients with CHD who receive VKAs spend < 42% of their time with INR levels in the therapeutic range, with repercussions regarding thromboembolic and bleeding complications.
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Affiliation(s)
- Samir Basmaji
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Michelle Samuel
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Azadeh Shohoudi
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Robert M Hamilton
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Marie-A Chaix
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Scott Cohen
- The Wisconsin Adult Congenital Heart (WAtCH) Program, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Stephen Cook
- Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Annie Dore
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | | | - Annik Fortier
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Anne Fournier
- Hôpital Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | | | - Joseph Kay
- University of Colorado Denver, Aurora, Colorado, USA
| | - Blandine Mondésert
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | | | - Alexander R Opotowsky
- Boston Adult Congenital Heart Service, Boston Children's Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anna Proietti
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Jennifer Ting
- Milton S. Hershey Medical Center, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Ali Zaidi
- Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA
| | - Paul Khairy
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
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17
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Dujeux C, Cottebrune T, Malherbe M, Michon J, Fournier A, Hulet C. Use of antibiotics in pyogenic flexor tenosynovitis. Hand Surg Rehabil 2022; 41:624-630. [PMID: 35933026 DOI: 10.1016/j.hansur.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/21/2022] [Accepted: 07/27/2022] [Indexed: 06/15/2023]
Abstract
Pyogenic flexor tenosynovitis is a frequent and serious condition. However, there is no consensus on the use of antibiotics. The objective of our study was to describe the treatment of this condition and to identify the surgical and medical management parameters to propose an effective and consensual postoperative antibiotic therapy protocol. We retrospectively reviewed pyogenic flexor tenosynovitis of the thumb or fingers treated between 01/01/2013 and 01/01/2018 at a teaching hospital. Inclusion criteria were confirmation of the clinical diagnosis intraoperatively and a minimum post-antibiotic follow-up of 6 months. Comorbidities, type of surgery, antibiotic therapy parameters, and treatment outcome were assessed. One hundred and thirteen patients were included. Fifty-four percent had comorbidities. The most frequent germ was staphylococcus, all patients received postoperative antibiotic therapy. Intravenous or intravenous followed by oral administration did not provide any benefit compared to an exclusively oral treatment (p = 0.46). The duration of postoperative antibiotic therapy (less than 7 days, between 7 and 14 days or more than 14 days) did not lead to any difference in healing rate (p = 0.67). However, treating for less than 7 days versus 7-14 days seemed to be associated with a higher risk of failure, although not statistically significant. Oral postoperative antibiotic therapy with amoxicillin + clavulanic acid for 7-14 days appears to be effective, allowing for outpatient management.
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Affiliation(s)
- C Dujeux
- Department of Orthopedic and Trauma Surgery, Caen University Hospital, Avenue de la côte de Nacre, 14000 Caen, France.
| | - T Cottebrune
- Department of Orthopedic and Trauma Surgery, Caen University Hospital, Avenue de la côte de Nacre, 14000 Caen, France
| | - M Malherbe
- Department of Orthopedic and Trauma Surgery, Caen University Hospital, Avenue de la côte de Nacre, 14000 Caen, France
| | - J Michon
- Department of Infectious Diseases, Caen University Hospital, Avenue de la côte de Nacre, 14000 Caen, France
| | - A Fournier
- Department of Infectious Diseases, Caen University Hospital, Avenue de la côte de Nacre, 14000 Caen, France
| | - C Hulet
- Department of Orthopedic and Trauma Surgery, Caen University Hospital, Avenue de la côte de Nacre, 14000 Caen, France
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18
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Yee LA, Han H, Davies B, Pearman CM, Laksman ZWM, Roberts JD, Steinberg C, Tadros R, Cadrin‐Tourigny J, Simpson CS, Gardner M, MacIntyre C, Arbour L, Leather R, Fournier A, Green MS, Kimber S, Angaran P, Sanatani S, Joza J, Khan H, Healey JS, Atallah J, Seifer C, Krahn AD. Sex Differences and Utility of Treadmill Testing in Long‐QT Syndrome. J Am Heart Assoc 2022; 11:e025108. [DOI: 10.1161/jaha.121.025108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Diagnosis of congenital long‐QT syndrome (LQTS) is complicated by phenotypic ambiguity, with a frequent normal‐to‐borderline resting QT interval. A 3‐step algorithm based on exercise response of the corrected QT interval (QTc) was previously developed to diagnose patients with LQTS and predict subtype. This study evaluated the 3‐step algorithm in a population that is more representative of the general population with LQTS with milder phenotypes and establishes sex‐specific cutoffs beyond the resting QTc.
Methods and Results
We identified 208 LQTS likely pathogenic or pathogenic
KCNQ1
or
KCNH2
variant carriers in the Canadian NLQTS (National Long‐QT Syndrome) Registry and 215 unaffected controls from the HiRO (Hearts in Rhythm Organization) Registry. Exercise treadmill tests were analyzed across the 5 stages of the Bruce protocol. The predictive value of exercise ECG characteristics was analyzed using receiver operating characteristic curve analysis to identify optimal cutoff values. A total of 78% of male carriers and 74% of female carriers had a resting QTc value in the normal‐to‐borderline range. The 4‐minute recovery QTc demonstrated the best predictive value for carrier status in both sexes, with better LQTS ascertainment in female patients (area under the curve, 0.90 versus 0.82), with greater sensitivity and specificity. The optimal cutoff value for the 4‐minute recovery period was 440 milliseconds for male patients and 450 milliseconds for female patients. The 1‐minute recovery QTc had the best predictive value in female patients for differentiating LQTS1 versus LQTS2 (area under the curve, 0.82), and the peak exercise QTc had a marginally better predictive value in male patients for subtype with (area under the curve, 0.71). The optimal cutoff value for the 1‐minute recovery period was 435 milliseconds for male patients and 455 milliseconds for femal patients.
Conclusions
The 3‐step QT exercise algorithm is a valid tool for the diagnosis of LQTS in a general population with more frequent ambiguity in phenotype. The algorithm is a simple and reliable method for the identification and prediction of the 2 major genotypes of LQTS.
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Affiliation(s)
- Lauren A. Yee
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, Department of Medicine University of British Columbia Vancouver British Columbia Canada
| | - Hui‐Chen Han
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, Department of Medicine University of British Columbia Vancouver British Columbia Canada
| | - Brianna Davies
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, Department of Medicine University of British Columbia Vancouver British Columbia Canada
| | - Charles M. Pearman
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, Department of Medicine University of British Columbia Vancouver British Columbia Canada
| | - Zachary W. M. Laksman
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, Department of Medicine University of British Columbia Vancouver British Columbia Canada
| | - Jason D. Roberts
- Population Health Research Institute, McMaster University, and Hamilton Health Sciences Hamilton Ontario Canada
| | - Christian Steinberg
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Laval University Quebec City Quebec Canada
| | - Rafik Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal Montreal Quebec Canada
| | - Julia Cadrin‐Tourigny
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal Montreal Quebec Canada
| | | | - Martin Gardner
- Queen Elizabeth II Health Sciences Center Halifax Nova Scotia Canada
| | - Ciorsti MacIntyre
- Queen Elizabeth II Health Sciences Center Halifax Nova Scotia Canada
| | - Laura Arbour
- Department of Medical Genetics University of British Columbia, and Island Health Victoria British Columbia Canada
| | | | - Anne Fournier
- Centre Hospitalier Universitaire Sainte‐Justine Montréal Quebec Canada
| | | | | | - Paul Angaran
- St. Michael’s Hospital, University of Toronto Toronto Ontario Canada
| | | | - Jacqueline Joza
- McGill University Health Sciences Center Montreal Quebec Canada
| | - Habib Khan
- London Health Sciences Center London Ontario Canada
| | | | | | | | - Andrew D. Krahn
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, Department of Medicine University of British Columbia Vancouver British Columbia Canada
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19
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Vô C, Fournier A, Miro J, Khairy P. Coronary sinus spasm with catheter entrapment and adjacent coronary artery compression during an ablation procedure in a child. HeartRhythm Case Rep 2022; 8:735-738. [PMID: 36618601 PMCID: PMC9811023 DOI: 10.1016/j.hrcr.2022.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Christophe Vô
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montreal, Canada
| | - Anne Fournier
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montreal, Canada
| | - Joaquim Miro
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montreal, Canada
| | - Paul Khairy
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montreal, Canada,Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada,Address reprint requests and correspondence: Dr Paul Khairy, Montreal Heart Institute, 5000 Belanger St E., Montreal, QC, Canada, H1T 1C8.
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20
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Moulson N, Connelly KA, Dorian P, Fournier A, Goodman JM, Grubic N, Isserow S, Johri AM, Philippon F, Pipe A, Poirier P, Quinn R, Taylor T, Thornton J, Wilkinson M, McKinney J. COVID-19, Inflammatory Heart Disease, and Vaccination in the Athlete and Highly Active Person: An Update and Further Considerations. Can J Cardiol 2022; 38:1580-1583. [PMID: 35643383 PMCID: PMC9132493 DOI: 10.1016/j.cjca.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/15/2022] [Accepted: 05/11/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Nathaniel Moulson
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kim A Connelly
- Division of Cardiology, Li Ka Shing Knowledge Institute of St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Paul Dorian
- Division of Cardiology, Li Ka Shing Knowledge Institute of St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Anne Fournier
- Centre Hospitalier Universitaire Sainte-Justine, University of Montréal, Montréal, Québec, Canada
| | - Jack M Goodman
- Division of Cardiology, Li Ka Shing Knowledge Institute of St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nicholas Grubic
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Saul Isserow
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amer M Johri
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - François Philippon
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec City, Québec, Canada
| | - Andrew Pipe
- University of Ottawa Heart Institute, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul Poirier
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec City, Québec, Canada
| | - Ryan Quinn
- Division of Cardiology, McMaster University, Hamilton, Ontario, Canada
| | - Taryn Taylor
- Department of Sports Medicine, Carleton Sport Medicine Clinic, Ottawa, Ontario, Canada
| | - Jane Thornton
- Department of Sports Medicine, Western University, London, Ontario, Canada
| | - Mike Wilkinson
- Department of Sports Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - James McKinney
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
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21
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Wei N, Lamba A, Franciosi S, Law IH, Ochoa LA, Johnsrude CL, Kwok SY, Tan TH, Dhillon SS, Fournier A, Seslar SP, Stephenson EA, Blaufox AD, Ortega MC, Bone JN, Sandhu A, Escudero CA, Sanatani S. Medical Management of Infants With Supraventricular Tachycardia: Results From a Registry and Review of the Literature. CJC Pediatr Congenit Heart Dis 2022; 1:11-22. [PMID: 37969556 PMCID: PMC10642123 DOI: 10.1016/j.cjcpc.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 09/30/2021] [Indexed: 11/17/2023]
Abstract
Background Several medication choices are available for acute and prophylactic treatment of refractory supraventricular tachycardia (SVT) in infants. There are almost no controlled trials, and medication choices are not necessarily evidence based. Our objective was to report the effectiveness of management strategies for infant SVT. Methods A registry of infants admitted to hospital with re-entrant SVT and no haemodynamically significant heart disease were prospectively followed at 11 international tertiary care centres. In addition, a systematic review of studies on infant re-entrant SVT in MEDLINE and EMBASE was conducted. Data on demographics, symptoms, acute and maintenance treatments, and outcomes were collected. Results A total of 2534 infants were included: n = 108 from the registry (median age, 9 days [0-324 days], 70.8% male) and n = 2426 from the literature review (median age, 14 days; 62.3% male). Propranolol was the most prevalent acute (61.4%) and maintenance treatment (53.8%) in the Registry, whereas digoxin was used sparingly (4.0% and 3.8%, respectively). Propranolol and digoxin were used frequently in the literature acutely (31% and 33.2%) and for maintenance (17.8% and 10.1%) (P < 0.001). No differences in acute or prophylactic effectiveness between medications were observed. Recurrence was higher in the Registry (25.0%) vs literature (13.4%) (P < 0.001), and 22 (0.9%) deaths were reported in the literature vs none in the Registry. Conclusion This was the largest cohort of infants with SVT analysed to date. Digoxin monotherapy use was rare amongst contemporary paediatric cardiologists. There was limited evidence to support one medication over another. Overall, recurrence and mortality rates on antiarrhythmic treatment were low.
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Affiliation(s)
- Nathan Wei
- BC Children's Hospital, Division of Cardiology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Avani Lamba
- BC Children's Hospital, Division of Cardiology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sonia Franciosi
- BC Children's Hospital, Division of Cardiology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ian H. Law
- Department of Pediatrics, Division of Pediatric Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Luis A. Ochoa
- Department of Pediatrics, Division of Pediatric Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Christopher L. Johnsrude
- Division of Pediatric Cardiology, Department of Pediatrics, University of Louisville, Louisville, Kentucky, USA
| | - Sit Yee Kwok
- Department of Pediatric Cardiology, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Teng Hong Tan
- Cardiology Service, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore
| | - Santokh S. Dhillon
- Division of Cardiology, Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anne Fournier
- Division of Pediatric Cardiology, Department of Pediatrics, CHU Ste Justine Hospital, Montreal, Québec, Canada
| | - Stephen P. Seslar
- Department of Pediatrics, Division of Cardiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Elizabeth A. Stephenson
- Labbatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Andrew D. Blaufox
- Department of Pediatrics, Division of Pediatric Cardiology, Cohen Children's Medical Center of New York, New Hyde Park, New York, USA
| | - Michel Cabrera Ortega
- Department of Arrhythmia and Cardiac Pacing, Cardiocentro Pediatrico William Soler, Havana, Cuba
| | - Jeffrey N. Bone
- Research Informatics, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Ash Sandhu
- Research Informatics, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Carolina A. Escudero
- Department of Pediatrics, Division of Pediatric Cardiology, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Shubhayan Sanatani
- BC Children's Hospital, Division of Cardiology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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22
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Grondin S, Davies B, Cadrin-Tourigny J, Steinberg C, Cheung CC, Jorda P, Healey JS, Green MS, Sanatani S, Alqarawi W, Angaran P, Arbour L, Antiperovitch P, Khan H, Leather R, Guerra PG, Rivard L, Simpson CS, Gardner M, MacIntyre C, Seifer C, Fournier A, Joza J, Gollob MH, Lettre G, Talajic M, Laksman ZW, Roberts JD, Krahn AD, Tadros R. OUP accepted manuscript. Eur Heart J 2022; 43:3071-3081. [PMID: 35352813 PMCID: PMC9392649 DOI: 10.1093/eurheartj/ehac145] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/25/2022] [Accepted: 03/07/2022] [Indexed: 12/04/2022] Open
Abstract
Aims Genetic testing is recommended in specific inherited heart diseases but its role remains unclear and it is not currently recommended in unexplained cardiac arrest (UCA). We sought to assess the yield and clinical utility of genetic testing in UCA using whole-exome sequencing (WES). Methods and results Survivors of UCA requiring external defibrillation were included from the Cardiac Arrest Survivor with Preserved Ejection fraction Registry. Whole-exome sequencing was performed, followed by assessment of rare variants in previously reported cardiovascular disease genes. A total of 228 UCA survivors (mean age at arrest 39 ± 13 years) were included. The majority were males (66%) and of European ancestry (81%). Following advanced clinical testing at baseline, the likely aetiology of cardiac arrest was determined in 21/228 (9%) cases. Whole-exome sequencing identified a pathogenic or likely pathogenic (P/LP) variant in 23/228 (10%) of UCA survivors overall, increasing the proportion of ‘explained’ cases from 9% only following phenotyping to 18% when combining phenotyping with WES. Notably, 13 (57%) of the 23 P/LP variants identified were located in genes associated with cardiomyopathy, in the absence of a diagnosis of cardiomyopathy at the time of arrest. Conclusions Genetic testing identifies a disease-causing variant in 10% of apparent UCA survivors. The majority of disease-causing variants was located in cardiomyopathy-associated genes, highlighting the arrhythmogenic potential of such variants in the absence of an overt cardiomyopathy diagnosis. The present study supports the use of genetic testing including assessment of arrhythmia and cardiomyopathy genes in survivors of UCA.
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Affiliation(s)
- Steffany Grondin
- Cardiovascular Genetics Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger, Montreal, QC, Canada H1T 1C8
| | - Brianna Davies
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger, Montreal, QC, Canada H1T 1C8
| | - Christian Steinberg
- Institut universitaire de cardiologie et pneumologie de Québec, Université Laval, Québec City, QC, Canada
| | - Christopher C Cheung
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Paloma Jorda
- Cardiovascular Genetics Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger, Montreal, QC, Canada H1T 1C8
| | - Jeffrey S Healey
- Population Health Research Institute, McMaster University, and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Martin S Green
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Shubhayan Sanatani
- Division of Pediatric Cardiology, British Columbia Children’s Hospital, Vancouver, BC, Canada
| | - Wael Alqarawi
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
- Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Paul Angaran
- Cardiac Arrhythmia Service, St Michael’s Hospital, Toronto, ON, Canada
| | - Laura Arbour
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Pavel Antiperovitch
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| | - Habib Khan
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| | - Richard Leather
- Division of Cardiology, Royal Jubilee Hospital, Victoria, BC, Canada
| | - Peter G Guerra
- Cardiovascular Genetics Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger, Montreal, QC, Canada H1T 1C8
| | - Lena Rivard
- Cardiovascular Genetics Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger, Montreal, QC, Canada H1T 1C8
| | | | - Martin Gardner
- Queen Elizabeth II Health Sciences Center, Halifax, NS, Canada
| | | | - Colette Seifer
- St Boniface Hospital, University of Manitoba, Winnipeg, MB, Canada
| | - Anne Fournier
- Ste-Justine Hospital, Université de Montréal, Montreal, QC, Canada
| | - Jacqueline Joza
- Department of Medicine, McGill University Health Center, Montreal, QC, Canada
| | - Michael H Gollob
- Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Guillaume Lettre
- Cardiovascular Genetics Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger, Montreal, QC, Canada H1T 1C8
| | - Mario Talajic
- Cardiovascular Genetics Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger, Montreal, QC, Canada H1T 1C8
| | - Zachary W Laksman
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jason D Roberts
- Population Health Research Institute, McMaster University, and Hamilton Health Sciences, Hamilton, ON, Canada
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| | - Andrew D Krahn
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Rafik Tadros
- Corresponding author. Tel: +1 514 376 3330, Fax: +1 514 593 2158, , Twitter: @rafik_tadros
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23
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Comber DA, Davies B, Roberts JD, Tadros R, Green MS, Healey JS, Simpson CS, Sanatani S, Steinberg C, MacIntyre C, Angaran P, Duff H, Hamilton R, Arbour L, Leather R, Seifer C, Fournier A, Atallah J, Kimber S, Makanjee B, Alqarawi W, Cadrin-Tourigny J, Joza J, Gibbs K, Robb L, Zahavich L, Gardner M, Talajic M, Virani A, Krahn AD, Lehman A, Laksman ZWM. Return of Results Policies for Genomic Research: Current Practices & The Hearts in Rhythm Organization Approach. Can J Cardiol 2021; 38:526-535. [PMID: 34715283 DOI: 10.1016/j.cjca.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 11/02/2022] Open
Abstract
Research teams developing biobanks and/or genomic databases must develop policies for the disclosure and reporting of potentially actionable genomic results to research participants. Currently, a broad range of approaches to the return of results exist, with some studies opting for non-disclosure of research results while others follow clinical guidelines for the return of potentially actionable findings from sequencing. In this review, we describe current practices and highlight decisions a research team must make when designing a return of results policy, from informed consent to disclosure practices and clinical validation options. The unique challenges of returning incidental findings in cardiac genes, including reduced penetrance and the lack of clinical screening standards for phenotype-negative individuals are discussed. Lastly, the National Hearts in Rhythm Organization (HiRO) Registry approach is described to provide a rationale for the selective return of field-specific variants to those participating in disease-specific research. Our goal is to provide researchers with a resource when developing a return of results policy tailored for their research program, based on unique factors related to study design, research team composition and availability of clinical resources.
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Affiliation(s)
- Drake A Comber
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Brianna Davies
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| | - Rafik Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute, and Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Martin S Green
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | | | | | | | - Christian Steinberg
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Laval University, Quebec City, QC, Canada
| | | | - Paul Angaran
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Henry Duff
- Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
| | - Robert Hamilton
- The Hospital for Sick Children (SickKids), Toronto, ON, Canada
| | - Laura Arbour
- Department of Medical Genetics, University of British Columbia and Island Health, Victoria, BC, Canada
| | | | - Colette Seifer
- Section of Cardiology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Anne Fournier
- Division of Pediatric Cardiology, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Joseph Atallah
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Shane Kimber
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Bhavanesh Makanjee
- Heart Health Institute, Scarborough Health Network, Scarborough, ON, Canada
| | - Wael Alqarawi
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Center, Montreal Heart Institute, and Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Jacqueline Joza
- Division of Cardiology, McGill University Health Centre, Montreal, QC, Canada
| | - Karen Gibbs
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Laura Robb
- Cardiovascular Genetics Center, Montreal Heart Institute, and Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Laura Zahavich
- The Hospital for Sick Children (SickKids), Toronto, ON, Canada
| | | | - Mario Talajic
- Cardiovascular Genetics Center, Montreal Heart Institute, and Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Alice Virani
- Department of Medical Genetics, The University of British, Columbia, Vancouver, British Columbia, Canada
| | - Andrew D Krahn
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anna Lehman
- Department of Medical Genetics, The University of British, Columbia, Vancouver, British Columbia, Canada
| | - Zachary W M Laksman
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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24
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Wei N, Lamba A, Franciosi S, Law I, Ochoa L, Johnsrude C, Kwok S, Tan T, Dhillon S, Fournier A, Seslar S, Stephenson E, Blaufox A, Cabrera Ortega M, Escudero C, Sanatani S. SUPRAVENTRICULAR TACHYCARDIA IN INFANTS: DOES MEDICATION CHOICE MATTER? Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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25
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Steinberg C, Davies B, Mellor G, Tadros R, Laksman ZW, Roberts JD, Green M, Alqarawi W, Angaran P, Healey J, Sanatani S, Leather R, Seifer C, Fournier A, Duff H, Gardner M, McIntyre C, Hamilton R, Simpson CS, Krahn AD. Short-coupled ventricular fibrillation represents a distinct phenotype among latent causes of unexplained cardiac arrest: a report from the CASPER registry. Eur Heart J 2021; 42:2827-2838. [PMID: 34010395 DOI: 10.1093/eurheartj/ehab275] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/14/2021] [Accepted: 04/27/2021] [Indexed: 12/25/2022] Open
Abstract
AIMS The term idiopathic ventricular fibrillation (IVF) describes survivors of unexplained cardiac arrest (UCA) without a specific diagnosis after clinical and genetic testing. Previous reports have described a subset of IVF individuals with ventricular arrhythmia initiated by short-coupled trigger premature ventricular contractions (PVCs) for which the term short-coupled ventricular fibrillation (SCVF) has been proposed. The aim of this article is to establish the phenotype and frequency of SCVF in a large cohort of UCA survivors. METHODS AND RESULTS We performed a multicentre study including consecutive UCA survivors from the CASPER registry. Short-coupled ventricular fibrillation was defined as otherwise unexplained ventricular fibrillation initiated by a trigger PVC with a coupling interval of <350 ms. Among 364 UCA survivors, 24/364 (6.6%) met diagnostic criteria for SCVF. The diagnosis of SCVF was obtained in 19/24 (79%) individuals by documented ventricular fibrillation during follow-up. Ventricular arrhythmia was initiated by a mean PVC coupling interval of 274 ± 32 ms. Electrical storm occurred in 21% of SCVF probands but not in any UCA proband (P < 0.001). The median time to recurrent ventricular arrhythmia in SCVF was 31 months. Recurrent ventricular fibrillation resulted in quinidine administration in 12/24 SCVF (50%) with excellent arrhythmia control. CONCLUSION Short-coupled ventricular fibrillation is a distinct primary arrhythmia syndrome accounting for at least 6.6% of UCA. As documentation of ventricular fibrillation onset is necessary for the diagnosis, most cases are diagnosed at the time of recurrent arrhythmia, thus the true prevalence of SCVF remains still unknown. Quinidine is effective in SCVF and should be considered as first-line treatment for patients with recurrent episodes.
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Affiliation(s)
- Christian Steinberg
- Cardiac Electrophysiology Service, Department of Cardiology and Cardiac Surgery, Institut universitaire de cardiologie et pneumologie de Québec, Laval University, 2725, Chemin Ste-Foy, Quebec, QC G1V 4G5, Canada
| | - Brianna Davies
- Heart Rhythm Services, Department of Medicine, St-Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Greg Mellor
- Cardiac Electrophysiology Service, Royal Papworth Hospital, Cambridge, UK
| | - Rafik Tadros
- Section of Cardiac Electrophysiology, Montreal Heart Institute, University of Montreal, Montreal, QC, Canada
| | - Zachary W Laksman
- Heart Rhythm Services, Department of Medicine, St-Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| | - Martin Green
- Cardiac Electrophysiology Service, Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | - Wael Alqarawi
- Cardiac Electrophysiology Service, Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | - Paul Angaran
- Cardiac Arrhythmia Service, St-Michael's Hospital, Toronto, ON, Canada
| | - Jeffrey Healey
- Arrhythmia Services Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | | | - Richard Leather
- Cardiac Electrophysiology Service, Royal Jubilee Hospital, Victoria, BC, Canada
| | - Colette Seifer
- St-Boniface Hospital, University of Manitoba, Winnipeg, MB, Canada
| | - Anne Fournier
- Division of Pediatric Cardiology, Department of Pediatrics, Centre Hospitalier Universitaire de Sainte-Justine, Montreal, QC, Canada
| | - Henry Duff
- Division of Cardiology, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
| | - Martin Gardner
- Cardiac Electrophysiology Service, QEII Health Sciences Center, Dalhousie University, Halifax, NS, Canada
| | - Ciorsti McIntyre
- Cardiac Electrophysiology Service, QEII Health Sciences Center, Dalhousie University, Halifax, NS, Canada
| | - Robert Hamilton
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | - Andrew D Krahn
- Heart Rhythm Services, Department of Medicine, St-Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
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MacDonald CJ, Madika AL, Lajous M, Canonico M, Fournier A, Boutron-Ruault MC. Association between cardiovascular risk-factors and venous thromboembolism in a large longitudinal study of French women. Thromb J 2021; 19:58. [PMID: 34419051 PMCID: PMC8380360 DOI: 10.1186/s12959-021-00310-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/05/2021] [Indexed: 11/14/2022] Open
Abstract
Background Previous studies have shown conflicting results regarding the influence of cardiovascular risk-factors on venous thromboembolism. This study aimed to determine if these risk-factors, i.e. physical activity, smoking, hypertension, dyslipidaemia, and diabetes, were associated with the risk of venous thromboembolism, and to determine if these associations were confounded by BMI. Methods We used data from the E3N cohort study, a French prospective population-based study initiated in 1990, consisting of 98,995 women born between 1925 and 1950. From the women in the study we included those who did not have prevalent arterial disease or venous thromboembolism at baseline; thus 91,707 women were included in the study. Venous thromboembolism cases were self-reported during follow-up, and verified via specific mailings to medical practitioners or via drug reimbursements for anti-thrombotic medications. Hypertension, diabetes and dyslipidaemia were self-reported validated against drug reimbursements or specific questionnaires. Physical activity, and smoking were based on self-reports. Cox-models, adjusted for BMI and other potential risk-factors were used to determine hazard ratios for incident venous thromboembolism. Results During 1,897,960 person-years (PY), 1, 649 first incident episodes of thrombosis were identified at an incidence rate of 0.9 per 1000 PY. This included 505 cases of pulmonary embolism and 1144 cases of deep vein thrombosis with no evidence of pulmonary embolism. Hypertension, dyslipidaemia, diabetes, smoking and physical activity were not associated with the overall risk of thrombosis after adjustment for BMI. Conclusions Traditional cardiovascular risk factors were not associated with the risk of venous thromboembolism after adjustment for BMI. Hypertension, dyslipidaemia and diabetes may not be risk-factors for venous thromboembolism. Supplementary Information The online version contains supplementary material available at 10.1186/s12959-021-00310-w.
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Affiliation(s)
- C J MacDonald
- INSERM (Institut National de la Santé et de la Recherche Médicale) U1018, Center for Research in Epidemiology and Population Health (CESP), Institut Gustave Roussy, Villejuif, France.,Université Paris-Saclay, Université Paris-Sud, Villejuif, France
| | - A L Madika
- INSERM (Institut National de la Santé et de la Recherche Médicale) U1018, Center for Research in Epidemiology and Population Health (CESP), Institut Gustave Roussy, Villejuif, France.,Université Paris-Saclay, Université Paris-Sud, Villejuif, France.,Université de Lille, CHU Lille, EA 2694 - Santé publique : épidémiologie et qualité des soins, F-59000, Lille, France
| | - M Lajous
- Center for Research on Population Health, INSP (Instituto Nacional de Salud Pública), Cuernavaca, Mexico.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - M Canonico
- INSERM (Institut National de la Santé et de la Recherche Médicale) U1018, Center for Research in Epidemiology and Population Health (CESP), Institut Gustave Roussy, Villejuif, France.,Université Paris-Saclay, Université Paris-Sud, Villejuif, France
| | - A Fournier
- INSERM (Institut National de la Santé et de la Recherche Médicale) U1018, Center for Research in Epidemiology and Population Health (CESP), Institut Gustave Roussy, Villejuif, France.,Université Paris-Saclay, Université Paris-Sud, Villejuif, France
| | - M C Boutron-Ruault
- INSERM (Institut National de la Santé et de la Recherche Médicale) U1018, Center for Research in Epidemiology and Population Health (CESP), Institut Gustave Roussy, Villejuif, France. .,Université Paris-Saclay, Université Paris-Sud, Villejuif, France.
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27
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Kallas D, Ghadiry-Tavi R, Roston TM, Franciosi S, Fischbach PS, Knight LM, Kannankeril PJ, Krahn AD, Kwok SY, LaPage MJ, Tisma-Dupanovic S, Atallah J, Kean AC, Etheridge SP, Hill AC, Law IH, Balaji S, Johnsrude CL, Backhoff D, Dhillon SS, Perry JC, Kubuš P, Kovach JR, Fournier A, Kamp AN, Kron J, Lau YR, Brugada GS, Hamilton RM, Sanatani S. B-PO05-167 ATRIAL TACHYARRHYTHMIAS IN CATECHOLAMINERGIC POLYMORPHIC VENTRICULAR TACHYCARDIA: A REPORT FROM THE INTERNATIONAL PEDIATRIC CPVT REGISTRY. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.1086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Lamba A, Roston TM, Franciosi S, Kallas D, Fischbach PS, Knight LM, Atallah J, Hill AC, Kannankeril PJ, Kwok SY, Backhoff D, LaPage MJ, Law IH, Balaji S, Dhillon SS, Krahn AD, Tisma-Dupanovic S, Etheridge SP, Johnsrude CL, Kamp AN, Kovach JR, Kubus P, Perry JC, Fournier A, Kean AC, Lau YR, Sanatani S. B-PO03-182 PRIMARY PREVENTION IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS IN CHILDREN WITH CATECHOLAMINERGIC POLYMORPHIC VENTRICULAR TACHYCARDIA: A PROSPECTIVE STUDY OF THE INTERNATIONAL PEDIATRIC CPVT REGISTRY. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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29
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Malik A, Marshall ME, Shah MJ, Fish FA, Etheridge SP, Aziz PF, Russell M, Tisma-Dupanovic S, Pflaumer A, Sreeram N, Kubuš P, Law IH, Kantoch M, Kertesz NJ, Strieper MJ, Erickson CC, Moore JP, Nakano S, Singh HR, Chang PM, Cohen MI, Fournier A, Ilina MV, Smith RT, Zimmermann F, Horndasch M, Li WL, Batra AS, Liberman L, Hamilton RM, Janson CM, Sanatani S, Zeltser I, McDaniel GM, Blaufox AD, Garnreiter JM, Balaji S. B-PO02-197 PATTERNS OF ELECTROCARDIOGRAPH ABNORMALITIES IN CHILDREN WITH HYPERTROPHIC CARDIOMYOPATHY. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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30
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Blum MR, Sallevelt BTGM, Spinewine A, O'Mahony D, Moutzouri E, Feller M, Baumgartner C, Roumet M, Jungo KT, Schwab N, Bretagne L, Beglinger S, Aubert CE, Wilting I, Thevelin S, Murphy K, Huibers CJA, Drenth-van Maanen AC, Boland B, Crowley E, Eichenberger A, Meulendijk M, Jennings E, Adam L, Roos MJ, Gleeson L, Shen Z, Marien S, Meinders AJ, Baretella O, Netzer S, de Montmollin M, Fournier A, Mouzon A, O'Mahony C, Aujesky D, Mavridis D, Byrne S, Jansen PAF, Schwenkglenks M, Spruit M, Dalleur O, Knol W, Trelle S, Rodondi N. Optimizing Therapy to Prevent Avoidable Hospital Admissions in Multimorbid Older Adults (OPERAM): cluster randomised controlled trial. BMJ 2021; 374:n1585. [PMID: 34257088 PMCID: PMC8276068 DOI: 10.1136/bmj.n1585] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To examine the effect of optimising drug treatment on drug related hospital admissions in older adults with multimorbidity and polypharmacy admitted to hospital. DESIGN Cluster randomised controlled trial. SETTING 110 clusters of inpatient wards within university based hospitals in four European countries (Switzerland, Netherlands, Belgium, and Republic of Ireland) defined by attending hospital doctors. PARTICIPANTS 2008 older adults (≥70 years) with multimorbidity (≥3 chronic conditions) and polypharmacy (≥5 drugs used long term). INTERVENTION Clinical staff clusters were randomised to usual care or a structured pharmacotherapy optimisation intervention performed at the individual level jointly by a doctor and a pharmacist, with the support of a clinical decision software system deploying the screening tool of older person's prescriptions and screening tool to alert to the right treatment (STOPP/START) criteria to identify potentially inappropriate prescribing. MAIN OUTCOME MEASURE Primary outcome was first drug related hospital admission within 12 months. RESULTS 2008 older adults (median nine drugs) were randomised and enrolled in 54 intervention clusters (963 participants) and 56 control clusters (1045 participants) receiving usual care. In the intervention arm, 86.1% of participants (n=789) had inappropriate prescribing, with a mean of 2.75 (SD 2.24) STOPP/START recommendations for each participant. 62.2% (n=491) had ≥1 recommendation successfully implemented at two months, predominantly discontinuation of potentially inappropriate drugs. In the intervention group, 211 participants (21.9%) experienced a first drug related hospital admission compared with 234 (22.4%) in the control group. In the intention-to-treat analysis censored for death as competing event (n=375, 18.7%), the hazard ratio for first drug related hospital admission was 0.95 (95% confidence interval 0.77 to 1.17). In the per protocol analysis, the hazard ratio for a drug related hospital admission was 0.91 (0.69 to 1.19). The hazard ratio for first fall was 0.96 (0.79 to 1.15; 237 v 263 first falls) and for death was 0.90 (0.71 to 1.13; 172 v 203 deaths). CONCLUSIONS Inappropriate prescribing was common in older adults with multimorbidity and polypharmacy admitted to hospital and was reduced through an intervention to optimise pharmacotherapy, but without effect on drug related hospital admissions. Additional efforts are needed to identify pharmacotherapy optimisation interventions that reduce inappropriate prescribing and improve patient outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT02986425.
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Affiliation(s)
- Manuel R Blum
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | | | - Anne Spinewine
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Belgium
- Department of Pharmacy, CHU UCL Namur, Yvoir, Belgium
| | - Denis O'Mahony
- School of Medicine, University College Cork, Cork, Republic of Ireland
| | - Elisavet Moutzouri
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Martin Feller
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Christine Baumgartner
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - Nathalie Schwab
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Lisa Bretagne
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Shanthi Beglinger
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Carole E Aubert
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Ingeborg Wilting
- Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Stefanie Thevelin
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Belgium
| | - Kevin Murphy
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Republic of Ireland
| | - Corlina J A Huibers
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - A Clara Drenth-van Maanen
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Benoit Boland
- Geriatric Medicine Division, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institute of Health and Society, Université Catholique de Louvain, Belgium
| | - Erin Crowley
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Republic of Ireland
| | - Anne Eichenberger
- Institute of Hospital Pharmacy, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michiel Meulendijk
- Department of Information and Computing Sciences, Utrecht University, Utrecht, Netherlands
| | - Emma Jennings
- School of Medicine, University College Cork, Cork, Republic of Ireland
| | - Luise Adam
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marvin J Roos
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Laura Gleeson
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Republic of Ireland
| | - Zhengru Shen
- Department of Information and Computing Sciences, Utrecht University, Utrecht, Netherlands
| | - Sophie Marien
- Geriatric Medicine Division, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institute of Health and Society, Université Catholique de Louvain, Belgium
| | - Arend-Jan Meinders
- Department of Internal Medicine and Intensive Care Unit, St Antonius Hospital, Nieuwegein and Utrecht, Netherlands
| | - Oliver Baretella
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Seraina Netzer
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Maria de Montmollin
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Anne Fournier
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Belgium
| | - Ariane Mouzon
- Department of Pharmacy, CHU UCL Namur, Yvoir, Belgium
| | - Cian O'Mahony
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Republic of Ireland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dimitris Mavridis
- Department of Primary School Education, University of Ioannina, Greece
| | - Stephen Byrne
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Republic of Ireland
| | - Paul A F Jansen
- Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Marco Spruit
- Department of Information and Computing Sciences, Utrecht University, Utrecht, Netherlands
- Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Olivia Dalleur
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Belgium
- Pharmacy, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Wilma Knol
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Sven Trelle
- CTU Bern, University of Bern, Bern, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
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Davies B, Bartels K, Hathaway J, Xu F, Roberts JD, Tadros R, Green MS, Healey JS, Simpson CS, Sanatani S, Steinberg C, Gardner M, Angaran P, Talajic M, Hamilton R, Arbour L, Seifer C, Fournier A, Joza J, Krahn AD, Lehman A, Laksman ZWM. Variant Reinterpretation in Survivors of Cardiac Arrest With Preserved Ejection Fraction (the Cardiac Arrest Survivors With Preserved Ejection Fraction Registry) by Clinicians and Clinical Commercial Laboratories. Circ Genom Precis Med 2021; 14:e003235. [PMID: 33960826 DOI: 10.1161/circgen.120.003235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Following an unexplained cardiac arrest, clinical genetic testing is increasingly becoming standard of care. Periodic review of variant classification is required, as reinterpretation can change the diagnosis, prognosis, and management of patients and their relatives. METHODS This study aimed to develop and validate a standardized algorithm to facilitate clinical application of the 2015 American College of Medical Genetics and Association for Molecular Pathology guidelines for the interpretation of genetic variants. The algorithm was applied to genetic results in the Cardiac Arrest Survivors With Preserved Ejection Fraction Registry, to assess the rate of variant reclassification over time. Variant classifications were then compared with the classifications of 2 commercial laboratories to determine the rate and identify sources of variant interpretation discordance. RESULTS Thirty-one percent of participants (40 of 131) had at least 1 genetic variant with a clinically significant reclassification over time. Variants of uncertain significance were more likely to be downgraded (73%) to benign than upgraded to pathogenic (27%; P=0.03). For the second part of the study, 50% (70 of 139) of variants had discrepant interpretations (excluding benign variants), provided by at least 1 team. CONCLUSIONS Periodic review of genetic variant classification is a key component of follow-up care given rapidly changing information in the field. There is potential for clinical care gaps with discrepant variant interpretations, based on the interpretation and application of current guidelines. The development of gene- and disease-specific guidelines and algorithms may provide an opportunity to further standardize variant interpretation reporting in the future. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00292032.
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Affiliation(s)
- Brianna Davies
- Division of Cardiology, Department of Medicine (B.D., K.B., A.D.K., Z.W.M.L.), The University of British Columbia, Vancouver, Canada
| | - Kirsten Bartels
- Division of Cardiology, Department of Medicine (B.D., K.B., A.D.K., Z.W.M.L.), The University of British Columbia, Vancouver, Canada
| | | | - Fang Xu
- Prevention Genetics, Marshfield, WI (F.X.)
| | - Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario (J.D.R.)
| | - Rafik Tadros
- Department of Medicine, Cardiovascular Genetics Center, Montreal Heart Institute, Canada (R.T., M.T.)
| | | | | | | | | | - Christian Steinberg
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Laval University (C. Steinberg)
| | | | - Paul Angaran
- St. Michael's Hospital, University of Toronto, Canada (P.A.)
| | - Mario Talajic
- Department of Medicine, Cardiovascular Genetics Center, Montreal Heart Institute, Canada (R.T., M.T.)
| | - Robert Hamilton
- hTe Hospital for Sick Children (SickKids), Toronto, Canada (R.H.)
| | - Laura Arbour
- Division of Medical Genetics, Island Health, Victoria, Canada (L.A.)
| | - Colette Seifer
- Section of Cardiology, Department of Internal Medicine, University of Manitoba, Winnipeg, Canada (C. Seifer)
| | - Anne Fournier
- Division of Pediatric Cardiology, CHU Sainte-Justine, Université de Montréal, QC (A.F.)
| | - Jacqueline Joza
- Division of Cardiology, McGill University Health Center, Montreal, Canada (J.J.)
| | - Andrew D Krahn
- Division of Cardiology, Department of Medicine (B.D., K.B., A.D.K., Z.W.M.L.), The University of British Columbia, Vancouver, Canada
| | - Anna Lehman
- Department of Medical Genetics (A.L.), The University of British Columbia, Vancouver, Canada
| | - Zachary W M Laksman
- Division of Cardiology, Department of Medicine (B.D., K.B., A.D.K., Z.W.M.L.), The University of British Columbia, Vancouver, Canada
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32
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Fornili M, Perduca V, Fournier A, Jérolon A, Boutron-Ruault MC, Maskarinec G, Severi G, Baglietto L. Association between menopausal hormone therapy, mammographic density and breast cancer risk: results from the E3N cohort study. Breast Cancer Res 2021; 23:47. [PMID: 33865453 PMCID: PMC8053286 DOI: 10.1186/s13058-021-01425-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 04/01/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Menopausal hormone therapy (MHT) is a risk factor for breast cancer (BC). Evidence suggests that its effect on BC risk could be partly mediated by mammographic density. The aim of this study was to investigate the relationship between MHT, mammographic density and BC risk using data from a prospective study. METHODS We used data from a case-control study nested within the French cohort E3N including 453 cases and 453 matched controls. Measures of mammographic density, history of MHT use during follow-up and information on potential confounders were available for all women. The association between MHT and mammographic density was evaluated by linear regression models. We applied mediation modelling techniques to estimate, under the hypothesis of a causal model, the proportion of the effect of MHT on BC risk mediated by percent mammographic density (PMD) for BC overall and by hormone receptor status. RESULTS Among MHT users, 4.2% used exclusively oestrogen alone compared with 68.3% who used exclusively oestrogens plus progestogens. Mammographic density was higher in current users (for a 60-year-old woman, mean PMD 33%; 95% CI 31 to 35%) than in past (29%; 27 to 31%) and never users (24%; 22 to 26%). No statistically significant association was observed between duration of MHT and mammographic density. In past MHT users, mammographic density was negatively associated with time since last use; values similar to those of never users were observed in women who had stopped MHT at least 8 years earlier. The odds ratio of BC for current versus never MHT users, adjusted for age, year of birth, menopausal status at baseline and BMI, was 1.67 (95% CI, 1.04 to 2.68). The proportion of effect mediated by PMD was 34% for any BC and became 48% when the correlation between BMI and PMD was accounted for. These effects were limited to hormone receptor-positive BC. CONCLUSIONS Our results suggest that, under a causal model, nearly half of the effect of MHT on hormone receptor-positive BC risk is mediated by mammographic density, which appears to be modified by MHT for up to 8 years after MHT termination.
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Affiliation(s)
- M Fornili
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - V Perduca
- Laboratoire MAP 5 (UMR CNRS 8145), Université de Paris, Paris, France
| | - A Fournier
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP UMR1018, 94805, Villejuif, France
| | - A Jérolon
- Laboratoire MAP 5 (UMR CNRS 8145), Université de Paris, Paris, France
| | - M C Boutron-Ruault
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP UMR1018, 94805, Villejuif, France
| | - G Maskarinec
- University of Hawaii Cancer Center, Honolulu, USA
| | - G Severi
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP UMR1018, 94805, Villejuif, France.
- Department of Statistics, Computer Science and Applications (DISIA), University of Florence, Florence, Italy.
| | - L Baglietto
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Elhani I, Audemard-Verger A, Fournier A, Gallou S, Chantepie S, Aouba A. Primo-infection à EBV avec méningo-encéphalite temporo-limbique efficacement traitée par corticothérapie. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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McKinney J, Connelly KA, Dorian P, Fournier A, Goodman JM, Grubic N, Isserow S, Moulson N, Philippon F, Pipe A, Poirier P, Taylor T, Thornton J, Wilkinson M, Johri AM. COVID-19-Myocarditis and Return to Play: Reflections and Recommendations From a Canadian Working Group. Can J Cardiol 2020; 37:1165-1174. [PMID: 33248208 PMCID: PMC7688421 DOI: 10.1016/j.cjca.2020.11.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/27/2020] [Accepted: 11/10/2020] [Indexed: 02/07/2023] Open
Abstract
The COVID-19–related pandemic has resulted in profound health, financial, and societal impacts. Organized sporting events, from recreational to the Olympic level, have been cancelled to both mitigate the spread of COVID-19 and protect athletes and highly active individuals from potential acute and long-term infection-associated harms. COVID-19 infection has been associated with increased cardiac morbidity and mortality. Myocarditis and late gadolinium enhancement as a result of COVID-19 infection have been confirmed. Correspondingly, myocarditis has been implicated in sudden cardiac death of athletes. A pragmatic approach is required to guide those who care for athletes and highly active persons with COVID-19 infection. Members of the Community and Athletic Cardiovascular Health Network (CATCHNet) and the writing group for the Canadian Cardiovascular Society/Canadian Heart Rhythm Society Joint Position Statement on the Cardiovascular Screening of Competitive Athletes recommend that highly active persons with suspected or confirmed COVID-19 infection refrain from exercise for 7 days after resolution of viral symptoms before gradual return to exercise. We do not recommend routine troponin testing, resting 12-lead electrocardiography, echocardiography, or cardiac magnetic resonance imaging before return to play. However, medical assessment including history and physical examination with consideration of resting electrocardiography and troponin can be considered in the athlete manifesting new active cardiac symptoms or a marked reduction in fitness. If concerning abnormalities are encountered at the initial medical assessment, then referral to a cardiologist who cares for athletes is recommended.
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Affiliation(s)
- James McKinney
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Kim A Connelly
- Division of Cardiology, Li Ka Shing Knowledge Institute of St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Paul Dorian
- Division of Cardiology, Li Ka Shing Knowledge Institute of St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Anne Fournier
- Centre Hospitalier Universitaire Sainte-Justine, University of Montréal, Montréal, Québec, Canada
| | - Jack M Goodman
- Division of Cardiology, Li Ka Shing Knowledge Institute of St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nicholas Grubic
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Saul Isserow
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathaniel Moulson
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - François Philippon
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada
| | - Andrew Pipe
- University of Ottawa Heart Institute, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada
| | - Taryn Taylor
- Department of Sports Medicine, Carleton Sport Medicine Clinic, Ottawa, Ontario, Canada
| | - Jane Thornton
- Department of Sports Medicine, Western University, London, Ontario, Canada
| | - Mike Wilkinson
- Department of Sports Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amer M Johri
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
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Azevedo Da Silva M, Fournier A, Boutron-Ruault MC, Balkau B, Bonnet F, Nabi H, Fagherazzi G. Increased risk of type 2 diabetes in antidepressant users: evidence from a 6-year longitudinal study in the E3N cohort. Diabet Med 2020; 37:1866-1873. [PMID: 32542873 DOI: 10.1111/dme.14345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2020] [Indexed: 12/16/2022]
Abstract
AIM To examine the association between antidepressant medication use and the risk of type 2 diabetes. METHODS Data were obtained from the E3N study (Étude Épidémiologique de Femmes de la Mutuelle Générale de l'Éducation Nationale), a French cohort study initiated in 1990, with questionnaire-based follow-up every 2 or 3 years. Exposure to antidepressants was obtained from drug reimbursement files available from 2004 onwards, and individually matched with questionnaire data. Cases of type 2 diabetes were identified from drug reimbursements. Cox proportional-hazard regression models were used, with drug exposure considered as a time-varying parameter. RESULTS Of the 63 999 women who were free of drug-treated type 2 diabetes at baseline in 2005, 1124 developed type 2 diabetes over the 6-year follow-up. Current use of antidepressants was associated with an increased risk of type 2 diabetes [hazard ratio 1.34 (95% CI 1.12, 1.61)] compared to non-users. When the different types of antidepressants were considered, women who currently used selective serotonin reuptake inhibitors, imipramine-type, 'other' or 'mixed' antidepressants had a 1.25-fold (95% CI 0.99, 1.57), 1.66-fold (95% CI 1.12, 2.46), 1.35-fold (95% CI 1.00, 1.84) and 1.82-fold (95% CI 0.85, 3.86) increase in risk of type 2 diabetes compared to non-users, respectively. CONCLUSION Our study suggests a positive association between antidepressant use and the risk of type 2 diabetes among women. If this association is confirmed, screening and surveillance of glucose levels should be considered in the context of antidepressant therapy. Further studies assessing the underlying mechanisms of this association are needed. (ClinicalTrials.gov identifier: NCT03285230).
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Affiliation(s)
- M Azevedo Da Silva
- Institute for Health and Social Policy, McGill University, Montreal, Quebec, Canada
- INSERM U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France
| | - A Fournier
- INSERM U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France
- University Paris-Saclay, University Paris-Sud, Villejuif, France
- Gustave Roussy Institute, Villejuif, France
| | - M-C Boutron-Ruault
- INSERM U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France
- University Paris-Saclay, University Paris-Sud, Villejuif, France
- Gustave Roussy Institute, Villejuif, France
| | - B Balkau
- INSERM U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France
- University Paris-Saclay, University Paris-Sud, Villejuif, France
- University Versailles-St Quentin, University Paris-Sud, Paris, France
| | - F Bonnet
- INSERM U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France
- University Paris-Saclay, University Paris-Sud, Villejuif, France
- Gustave Roussy Institute, Villejuif, France
- University Versailles-St Quentin, University Paris-Sud, Paris, France
- CHU Rennes, Rennes, France
| | - H Nabi
- INSERM U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France
- Département de Médecine Sociale et Préventive, Faculté de Médecine, Québec, QC, Canada
- Axe Oncologie, Centre de Recherche du CHU de Québec, Québec, QC, Canada
- Centre de Recherche sur le Cancer, Université Laval, Québec, QC, Canada
| | - G Fagherazzi
- INSERM U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France
- University Paris-Saclay, University Paris-Sud, Villejuif, France
- Gustave Roussy Institute, Villejuif, France
- Luxembourg Institute of Health, Department of Population Health, Strassen, Luxembourg
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Fournier A, Anrys P, Beuscart JB, Dalleur O, Henrard S, Foulon V, Spinewine A. Use and Deprescribing of Potentially Inappropriate Medications in Frail Nursing Home Residents. Drugs Aging 2020; 37:917-924. [PMID: 33047252 DOI: 10.1007/s40266-020-00805-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The STOPPFrail criteria were developed to assist physicians in deprescribing medications among frail patients approaching end of life. We aimed to measure the prevalence of potentially inappropriate medications (PIMs) and to describe changes over time, using STOPPFrail, in frail nursing home residents (NHRs) with limited life expectancy included in a medication review trial. METHODS We conducted a post-hoc analysis of the COME-ON study, a cluster-controlled trial that evaluated the effect of a complex intervention on appropriateness of prescribing in Belgian nursing homes. We identified NHRs eligible for the application of STOPPFrail based on functional status, comorbidities, level of care and survival. PIM use was measured at baseline and at 8 months. Changes over time were compared in the control group (CG) and intervention group (IG). RESULTS At baseline, 308 NHRs met the STOPPFrail eligibility criteria, of whom 196 (64.1%) had one or more PIM. At 8 months, among the 218 NHRs who were alive, there was an absolute reduction in the prevalence of PIMs of 9.1% in the CG (p < 0.05) and 10.2% in the IG (p < 0.05). We found large reductions for some medications (e.g. proton pump inhibitors) but no reduction for others (e.g. calcium). The percentage of NHRs with one or more PIM discontinued without a new PIM initiated was higher in the IG than the CG but the difference was not significant (35.1% vs 23.6%, p = 0.127). CONCLUSION Among frail NHRs with poor survival prognosis, a significant and encouraging decrease in PIM prevalence over time was observed, probably facilitated by medication reviews. The overall prevalence of PIMs remained high, however.
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Affiliation(s)
- Anne Fournier
- Louvain Drug Research Institute, Clinical Pharmacy Research Group, Université Catholique de Louvain, Avenue Mounier 72/B1.72.02, 1200 Woluwe-Saint-Lambert, Brussels, Belgium.,Cliniques Universitaires Saint-Luc, Pharmacy Department, Université Catholique de Louvain, Brussels, Belgium
| | - Pauline Anrys
- Louvain Drug Research Institute, Clinical Pharmacy Research Group, Université Catholique de Louvain, Avenue Mounier 72/B1.72.02, 1200 Woluwe-Saint-Lambert, Brussels, Belgium
| | - Jean-Baptiste Beuscart
- Univ. Lille, CHU Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, 59000, Lille, France
| | - Olivia Dalleur
- Louvain Drug Research Institute, Clinical Pharmacy Research Group, Université Catholique de Louvain, Avenue Mounier 72/B1.72.02, 1200 Woluwe-Saint-Lambert, Brussels, Belgium.,Cliniques Universitaires Saint-Luc, Pharmacy Department, Université Catholique de Louvain, Brussels, Belgium
| | - Séverine Henrard
- Louvain Drug Research Institute, Clinical Pharmacy Research Group, Université Catholique de Louvain, Avenue Mounier 72/B1.72.02, 1200 Woluwe-Saint-Lambert, Brussels, Belgium.,Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Anne Spinewine
- Louvain Drug Research Institute, Clinical Pharmacy Research Group, Université Catholique de Louvain, Avenue Mounier 72/B1.72.02, 1200 Woluwe-Saint-Lambert, Brussels, Belgium. .,CHU UCL Namur, Pharmacy Department, Université Catholique de Louvain, Yvoir, Belgium.
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Grubic N, Puskas J, Phelan D, Fournier A, Martin LJ, Johri AM. Shock to the Heart: Psychosocial Implications and Applications of Sudden Cardiac Death in the Young. Curr Cardiol Rep 2020; 22:168. [PMID: 33040200 PMCID: PMC7547819 DOI: 10.1007/s11886-020-01419-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Although rare, sudden cardiac death (SCD) in the young is a tragic event, having a dramatic impact upon all involved. The psychosocial burden associated with SCD can leave friends, families, and entire communities bereft. With only limited evidence to describe the volatile emotional reactions associated with a young SCD, there is an urgent need for care providers to better understand the psychological complexities and impacts faced by both at-risk individuals and those directly affected by these tragic events. RECENT FINDINGS Current knowledge of the psychosocial implications associated with SCD in the young has recently generated interest in the cardiovascular community, with the goal of addressing prevention strategies (screening), family bereavement, and the psychological impact of at-risk or surviving individuals. With the emergence of novel strategies aimed at reducing the public health impact of SCD in the young, further discussion regarding the psychosocial impact of SCD, encompassing prevention, survivorship, and the downstream communal effects of a young death is required. Support systems and intervention could assist in the management of the associated psychosocial burden, yet there is a lack of clinical guidelines to direct this form of care. There is an important need for multidisciplinary collaboration across subspecialties to provide support to grieving individuals and manage patient well-being throughout the screening process for SCD. This collaborative approach requires the integration of cardiovascular and psychological expertise where relevant.
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Affiliation(s)
- Nicholas Grubic
- Department of Public Health Sciences, Queen’s University, Kingston, Canada
- Department of Medicine, Queen’s University, Kingston, Canada
| | - Jake Puskas
- Department of Medicine, Queen’s University, Kingston, Canada
| | - Dermot Phelan
- Sanger Heart & Vascular Institute, Atrium Health, Charlotte, NC USA
| | - Anne Fournier
- Department of Pediatrics, University of Montréal, Montréal, Canada
| | - Luc J. Martin
- School of Kinesiology and Health Studies, Queen’s University, Kingston, Canada
| | - Amer M. Johri
- Department of Medicine, Queen’s University, Kingston, Canada
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Laksman Z, Davies B, Bartels K, Roberts J, Tadros R, Green M, Healey J, Simpson C, Sanatani S, Steinberg C, Gardner M, Angaran P, Talajic M, Arbour L, Seifer C, Fournier A, Joza J, Krahn A. VARIANT RE-INTERPRETATION IN SURVIVORS OF CARDIAC ARREST WITH PRESERVED EJECTION FRACTION (CASPER REGISTRY) BY CLINICIANS AND CLINICAL COMMERCIAL LABORATORIES. Can J Cardiol 2020. [DOI: 10.1016/j.cjca.2020.07.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Michon J, Baldolli A, Fournier A, Appia F, Leprieur A, Verdon R. Initiation d’un programme de vaccination et de rattrapage en collège en France à l’échelle d’une région : yes we can ! Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Michon J, Fournier A, Baldolli A, Appia F, Leprieur A, Verdon R. Perception de la vaccination et facteurs influençant la décision de vaccination lors d’une épidémie de rougeole dans une université française. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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41
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Baldolli A, Michon J, Fournier A, Verdon R. Étude PERCEVAC : perception et couverture vaccinale des étudiants en santé. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mauries C, Ranisavljevic N, Gallet R, Fournier A, Gala A, Ferrières-Hoa A, Brouillet S, Hamamah S. [Assessment of genital microbiota: An emerging approach in assisted reproductive techniques]. ACTA ACUST UNITED AC 2020; 49:185-192. [PMID: 32758671 DOI: 10.1016/j.gofs.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Indexed: 10/23/2022]
Abstract
The genital microbiota actively participates in women's reproductive health. Indeed, a genital dysbiosis (microbial imbalance associated with adverse effects on host health) can lead to vaginal infections (such as mycoses or bacterial vaginosis). Recent data reported that genital dysbiosis (e.g. vaginal or endometrial) was associated with fewer chances of live births in assisted reproductive technologies (ART), via decreased pregnancy rates and an increased risk of miscarriages. The presence or diversity of certain bacterial strains (in particular Gardenellavaginalis, Proteobacteria, Lactobacillusjensenii, Lactobacilluscrispatus or Atopobiumvaginae) within the genital microbiota seem to be associated with the outcomes of ART cycles, suggesting new approaches to improve ART results. In this review, we aim at presenting the state of art on the association between the female genital microbiota and ART success. The diagnostic and therapeutic approaches (i.e. probiotics, antibiotic therapy and transplantation of vaginal microbiota) in the management of patients with altered microbiota will also be discussed. The confirmation of these data in the coming years could significantly improve the management of infertile patients in ART with a more personalized approach partially based on the female genital microbiotic profile.
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Affiliation(s)
- C Mauries
- Département de biologie de la reproduction, CHU de Montpellier, université de Montpellier, 34000 Montpellier, France
| | - N Ranisavljevic
- Département de médecine de la reproduction, CHU de Montpellier, université de Montpellier, 34000 Montpellier, France
| | - R Gallet
- Inserm 1203, développement embryonnaire précoce humain et pluripotence, université de Montpellier, 34000 Montpellier, France
| | - A Fournier
- Département de biologie de la reproduction, CHU de Montpellier, université de Montpellier, 34000 Montpellier, France; Inserm 1203, développement embryonnaire précoce humain et pluripotence, université de Montpellier, 34000 Montpellier, France
| | - A Gala
- Département de biologie de la reproduction, CHU de Montpellier, université de Montpellier, 34000 Montpellier, France; Inserm 1203, développement embryonnaire précoce humain et pluripotence, université de Montpellier, 34000 Montpellier, France
| | - A Ferrières-Hoa
- Département de biologie de la reproduction, CHU de Montpellier, université de Montpellier, 34000 Montpellier, France; Inserm 1203, développement embryonnaire précoce humain et pluripotence, université de Montpellier, 34000 Montpellier, France
| | - S Brouillet
- Département de biologie de la reproduction, CHU de Montpellier, université de Montpellier, 34000 Montpellier, France; Inserm 1203, développement embryonnaire précoce humain et pluripotence, université de Montpellier, 34000 Montpellier, France; Centre clinique et biologique d'assistance médicale à la procréation, centre d'étude et de conservation des œufs et du sperme humains (CECOS), centre hospitalier universitaire de Grenoble, hôpital Couple-enfant, 38700 La Tronche, France.
| | - S Hamamah
- Département de biologie de la reproduction, CHU de Montpellier, université de Montpellier, 34000 Montpellier, France; Inserm 1203, développement embryonnaire précoce humain et pluripotence, université de Montpellier, 34000 Montpellier, France.
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Fourcot A, Feidt C, Bousquet-Mélou A, Ferran AA, Gourdine JL, Bructer M, Joaquim-Justo C, Rychen G, Fournier A. Modeling chlordecone toxicokinetics data in growing pigs using a nonlinear mixed-effects approach. Chemosphere 2020; 250:126151. [PMID: 32092563 DOI: 10.1016/j.chemosphere.2020.126151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/04/2020] [Accepted: 02/06/2020] [Indexed: 06/10/2023]
Abstract
The use of chlordecone (CLD), a chlorinated polycyclic pesticide used in the French West Indies banana fields between 1972 and 1993, resulted in a long-term pollution of agricultural areas. It has been observed that this persistent organic pollutant (POP) can transfer from contaminated soils to food chain. Indeed, CLD is considered almost fully absorbed after involuntary ingestion of contaminated soil by outdoor reared animals. The aim of this study was to model toxicokinetics (TKs) of CLD in growing pigs using both non-compartmental and nonlinear mixed-effects approaches (NLME). In this study, CLD dissolved in cremophor was intravenously administrated to 7 Creole growing pigs and 7 Large White growing pigs (1 mg kg-1 body weight). Blood samples were collected from time t = 0 to time t = 84 days. CLD concentrations in serum were measured by GCMS/MS. Data obtained were modeled using Monolix (2019R). Results demonstrated that a bicompartmental model best described CLD kinetics in serum. The influence of covariates (breed, initial weight and average daily gain) was simultaneously evaluated and showed that average daily gain is the main covariate explaining inter-individual TKs parameters variability. Body clearance was of 76.7 mL kg-1 d-1 and steady-state volume of distribution was of 6 L kg-1. This modeling approach constitutes the first application of NLME to study CLD TKs in farm animals and will be further used for rearing management practices in contaminated areas.
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Affiliation(s)
- A Fourcot
- Université de Lorraine, INRAE, USC 340, UR AFPA, 2 Avenue de la Forêt de Haye, TSA 40602, 54518, Vandœuvre-lès-Nancy, France
| | - C Feidt
- Université de Lorraine, INRAE, USC 340, UR AFPA, 2 Avenue de la Forêt de Haye, TSA 40602, 54518, Vandœuvre-lès-Nancy, France
| | - A Bousquet-Mélou
- INTHERES, Université de Toulouse, INRAE, ENVT, 31000, Toulouse, France
| | - A A Ferran
- INTHERES, Université de Toulouse, INRAE, ENVT, 31000, Toulouse, France
| | - J L Gourdine
- Unité de Recherches Zootechniques, INRAE, URZ UR143, Domaine Duclos, 97170, Petit-Bourg, France
| | - M Bructer
- Plateforme Tropicale d'Expérimentation sur l'Animal, INRAE, PTEA UE1294, 97170, Petit-Bourg, France
| | - C Joaquim-Justo
- Université de Liège, LEAE-CART, Freshwater and Oceanic Sciences Unit of Research (FOCUS), B6C, Allée du 6 Août, 11, 4000, Liège, Belgium
| | - G Rychen
- Université de Lorraine, INRAE, USC 340, UR AFPA, 2 Avenue de la Forêt de Haye, TSA 40602, 54518, Vandœuvre-lès-Nancy, France
| | - A Fournier
- Université de Lorraine, INRAE, USC 340, UR AFPA, 2 Avenue de la Forêt de Haye, TSA 40602, 54518, Vandœuvre-lès-Nancy, France.
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Moulson N, Bewick D, Selway T, Harris J, Suskin N, Oh P, Coutinho T, Singh G, Chow CM, Clarke B, Cowan S, Fordyce CB, Fournier A, Gin K, Gupta A, Hardiman S, Jackson S, Lamarche Y, Lau B, Légaré JF, Leong-Poi H, Mansour S, Marelli A, Quraishi AUR, Roifman I, Ruel M, Sapp J, Small G, Turgeon R, Wood DA, Zieroth S, Virani S, Krahn AD. Cardiac Rehabilitation During the COVID-19 Era: Guidance on Implementing Virtual Care. Can J Cardiol 2020; 36:1317-1321. [PMID: 32553606 PMCID: PMC7293761 DOI: 10.1016/j.cjca.2020.06.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/07/2020] [Accepted: 06/08/2020] [Indexed: 02/04/2023] Open
Abstract
Cardiac rehabilitation programs across Canada have suspended in-person services as a result of large-scale physical distancing recommendations designed to flatten the COVID-19 pandemic curve. Virtual cardiac rehabilitation (VCR) offers an alternate mechanism of care delivery, capable of providing similar patient outcomes and safety profiles compared with centre-based programs. To minimize care gaps, all centres should consider developing and implementing a VCR program. The process of this rapid implementation, however, can be daunting. Centres should initially focus on the collation, utilization, and repurposing of existing resources, equipment, and technology. Once established, programs should then focus on ensuring that quality indicators are met and care processes are protocolized. This should be followed by the development of sustainable VCR solutions to account for care gaps that existed before COVID-19, and to improve cardiac rehabilitation delivery, moving forward. This article reviews the potential challenges and obstacles of this process and aims to provide pragmatic guidance to aid clinicians and administrators during this challenging time.
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Affiliation(s)
- Nathaniel Moulson
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Bewick
- New Brunswick Heart Centre, Saint John, New Brunswick, Canada.
| | - Tracy Selway
- New Brunswick Heart Centre, Saint John, New Brunswick, Canada
| | - Jennifer Harris
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Paul Oh
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Thais Coutinho
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Gurmeet Singh
- Mazankowski Alberta Hearth Institute, Departments of Critical Care Medicine and Surgery, Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Chi-Ming Chow
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Brian Clarke
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Simone Cowan
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher B Fordyce
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne Fournier
- CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Kenneth Gin
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anil Gupta
- Trillium Health Partners, University of Toronto, Mississauga, Ontario, Canada
| | - Sean Hardiman
- Cardiac Services BC, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Simon Jackson
- QEII Health Sciences Center, Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Yoan Lamarche
- Department of Surgery, Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Benny Lau
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Howard Leong-Poi
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Samer Mansour
- Department of Medicine, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Ariane Marelli
- McGill University Health Center, Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Ata Ur Rehman Quraishi
- QEII Health Sciences Center, Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Idan Roifman
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Marc Ruel
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - John Sapp
- QEII Health Sciences Center, Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Gary Small
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Ricky Turgeon
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - David A Wood
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Sean Virani
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew D Krahn
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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45
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Virani A, Singh G, Bewick D, Chow CM, Clarke B, Cowan S, Fordyce CB, Fournier A, Gin K, Gupta A, Hardiman S, Jackson S, Lamarche Y, Lau B, Légaré JF, Leong-Poi H, Mansour S, Marelli A, Quraishi A, Roifman I, Ruel M, John Sapp, Small G, Turgeon R, Wood DA, Zieroth S, Virani S, Krahn AD. Guiding Cardiac Care During the COVID-19 Pandemic: How Ethics Shapes Our Health System Response. Can J Cardiol 2020; 36:1313-1316. [PMID: 32505633 PMCID: PMC7270812 DOI: 10.1016/j.cjca.2020.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/27/2020] [Accepted: 06/02/2020] [Indexed: 12/01/2022] Open
Abstract
The COVID-19 pandemic has raised ethical questions for the cardiovascular leader and practitioner. Attention has been redirected from a system that focuses on individual patient benefit toward one that focuses on protecting society as a whole. Challenging resource allocation questions highlight the need for a clearly articulated ethics framework that integrates principled decision making into how different cardiovascular care services are prioritized. A practical application of the principles of harm minimisation, fairness, proportionality, respect, reciprocity, flexibility, and procedural justice is provided, and a model for prioritisation of the restoration of cardiovascular services is outlined. The prioritisation model may be used to determine how and when cardiovascular services should be continued or restored. There should be a focus on an iterative and responsive approach to broader health care system needs, such as other disease groups and local outbreaks.
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Affiliation(s)
- Alice Virani
- Department of Medical Genetics, University of British Columbia, British Columbia, Canada.
| | - Gurmeet Singh
- Mazankowski Alberta Hearth Institute, Division of Cardiac Surgery, Departments of Critical Care Medicine and Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - David Bewick
- New Brunswick Heart Centre, Saint John, New Brunswick, Canada
| | - Chi-Ming Chow
- Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Brian Clarke
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Simone Cowan
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher B Fordyce
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne Fournier
- Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Kenneth Gin
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anil Gupta
- Trillium Health Partners, University of Toronto, Mississauga, Ontario, Canada
| | - Sean Hardiman
- Cardiac Services BC, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Simon Jackson
- QEII Health Sciences Center, Division of Cardiology, Dalhousie University Halifax, Halifax, Nova Scotia, Canada
| | - Yoan Lamarche
- Department of Surgery, Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Benny Lau
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Howard Leong-Poi
- Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Samer Mansour
- Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Ariane Marelli
- Department of Medicine, McGill University Health Center, McGill University, Montréal, Québec, Canada
| | - Ata Quraishi
- QEII Health Sciences Center, Division of Cardiology, Dalhousie University Halifax, Halifax, Nova Scotia, Canada
| | - Idan Roifman
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Marc Ruel
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - John Sapp
- QEII Health Sciences Center, Division of Cardiology, Dalhousie University Halifax, Halifax, Nova Scotia, Canada
| | - Gary Small
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Ricky Turgeon
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - David A Wood
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Sean Virani
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew D Krahn
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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46
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Turgeon RD, Zieroth S, Bewick D, Chow CM, Clarke B, Cowan S, Fordyce CB, Fournier A, Gin K, Gupta A, Hardiman S, Jackson S, Lau B, Leong-Poi H, Mansour S, Marelli A, Quraishi AR, Roifman I, Ruel M, Sapp J, Singh G, Small G, Virani S, Wood DA, Krahn A. Use of Renin-Angiotensin System Blockers During the COVID-19 Pandemic: Early Guidance and Evolving Evidence. Can J Cardiol 2020; 36:1180-1182. [PMID: 32502522 PMCID: PMC7265831 DOI: 10.1016/j.cjca.2020.05.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 05/24/2020] [Indexed: 12/04/2022] Open
Affiliation(s)
- Ricky D Turgeon
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
| | | | - David Bewick
- New Brunswick Heart Centre, Saint John, New Brunswick, Canada
| | - Chi-Ming Chow
- Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Brian Clarke
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Simone Cowan
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher B Fordyce
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne Fournier
- Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Kenneth Gin
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anil Gupta
- Trillium Health Partners, University of Toronto, Mississauga, Ontario, Canada
| | - Sean Hardiman
- Cardiac Services British Columbia, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Simon Jackson
- Queen Elizabeth II Health Sciences Center, Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Benny Lau
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Howard Leong-Poi
- Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Samer Mansour
- Department of Medicine, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Ariane Marelli
- McGill University Health Center, Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Ata Rehman Quraishi
- Queen Elizabeth II Health Sciences Center, Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Idan Roifman
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Marc Ruel
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - John Sapp
- Queen Elizabeth II Health Sciences Center, Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Gurmeet Singh
- Mazankowski Alberta Hearth Institute, Division of Cardiac Surgery, Departments of Critical Care Medicine and Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Gary Small
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Sean Virani
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - David A Wood
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Krahn
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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47
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Cunningham T, Roston TM, Franciosi S, Liu MC, Atallah J, Escudero CA, Udupa S, Roberts JD, Dhillon S, Dallaire F, Fournier A, Fatah M, Hamilton R, Sanatani S. Initially unexplained cardiac arrest in children and adolescents: A national experience from the Canadian Pediatric Heart Rhythm Network. Heart Rhythm 2020; 17:975-981. [DOI: 10.1016/j.hrthm.2020.01.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 01/29/2020] [Indexed: 02/01/2023]
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48
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Blais S, Meloche-Dumas L, Fournier A, Dallaire F, Dahdah N. Long-Term Risk Factors for Dilatation of the Proximal Aorta in a Large Cohort of Children With Bicuspid Aortic Valve. Circ Cardiovasc Imaging 2020; 13:e009675. [DOI: 10.1161/circimaging.119.009675] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Patients with bicuspid aortic valve (BAV) have a higher risk of developing aortic valve dysfunction and progressive proximal aorta dilatation, which can lead to aortic dissection. To this day, identification of children at risk of developing severe aortic dilatation during their pediatric follow-up is still challenging because most studies were restricted to adult subjects. The overarching goal of this study was to identify risk factors of aortic dilatation in children with BAV.
Methods:
We extracted clinical and echocardiographic data of all BAV subjects aged 0 to 20 years followed at Centre Hospitalier Universitaire Sainte-Justine between 1999 and 2016. We excluded subjects with concomitant heart defects and conditions affecting proximal aorta dimensions. Proximal aorta diameters (expressed as
Z
scores) were modeled in relation to age and potential predictive variables in a linear mixed model. The primary outcome was the rate of dilatation.
Results:
We included 761 subjects (3134 echocardiograms) in final analyses. The mean ascending aorta
Z
score progression rate for BAV patient with a normally functioning aortic valve was estimated at 0.05
Z
score unit per year. The strongest predictors of an increased dilatation rate were severe aortic stenosis, moderate and severe aortic regurgitation, and uncorrected coarctation of the aorta. Aortic valve leaflet fusion pattern and sex were not associated with progression rate.
Conclusions:
Children with a normally functioning BAV exhibited a very slow proximal aorta dilatation rate. Ascending aorta dilatation rate was significantly increased in patients with more than mild aortic valve dysfunction but was independent from BAV leaflet fusion type.
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Affiliation(s)
- Samuel Blais
- Department of Pediatrics, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Canada (S.B., F.D.)
| | - Léamarie Meloche-Dumas
- Department of General Surgery, Maisonneuve-Rosemont Hospital, Montreal, Canada (L.M.-D.)
| | - Anne Fournier
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Canada (A.F., N.D.)
| | - Frederic Dallaire
- Department of Pediatrics, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Canada (S.B., F.D.)
| | - Nagib Dahdah
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Canada (A.F., N.D.)
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49
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Wünnemann F, Ta-Shma A, Preuss C, Leclerc S, van Vliet PP, Oneglia A, Thibeault M, Nordquist E, Lincoln J, Scharfenberg F, Becker-Pauly C, Hofmann P, Hoff K, Audain E, Kramer HH, Makalowski W, Nir A, Gerety SS, Hurles M, Comes J, Fournier A, Osinska H, Robins J, Pucéat M, Elpeleg O, Hitz MP, Andelfinger G. Loss of ADAMTS19 causes progressive non-syndromic heart valve disease. Nat Genet 2019; 52:40-47. [PMID: 31844321 DOI: 10.1038/s41588-019-0536-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 10/23/2019] [Indexed: 01/24/2023]
Abstract
Valvular heart disease is observed in approximately 2% of the general population1. Although the initial observation is often localized (for example, to the aortic or mitral valve), disease manifestations are regularly observed in the other valves and patients frequently require surgery. Despite the high frequency of heart valve disease, only a handful of genes have so far been identified as the monogenic causes of disease2-7. Here we identify two consanguineous families, each with two affected family members presenting with progressive heart valve disease early in life. Whole-exome sequencing revealed homozygous, truncating nonsense alleles in ADAMTS19 in all four affected individuals. Homozygous knockout mice for Adamts19 show aortic valve dysfunction, recapitulating aspects of the human phenotype. Expression analysis using a lacZ reporter and single-cell RNA sequencing highlight Adamts19 as a novel marker for valvular interstitial cells; inference of gene regulatory networks in valvular interstitial cells positions Adamts19 in a highly discriminatory network driven by the transcription factor lymphoid enhancer-binding factor 1 downstream of the Wnt signaling pathway. Upregulation of endocardial Krüppel-like factor 2 in Adamts19 knockout mice precedes hemodynamic perturbation, showing that a tight balance in the Wnt-Adamts19-Klf2 axis is required for proper valve maturation and maintenance.
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Affiliation(s)
- Florian Wünnemann
- Cardiovascular Genetics, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine Research Centre, University of Montreal, Montreal, Quebec, Canada.,Institute of Bioinformatics, University of Münster, Münster, Germany
| | - Asaf Ta-Shma
- Department of Pediatric Cardiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Monique and Jacques Robo Department of Genetic Research, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Severine Leclerc
- Cardiovascular Genetics, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine Research Centre, University of Montreal, Montreal, Quebec, Canada
| | - Patrick Piet van Vliet
- Cardiovascular Genetics, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine Research Centre, University of Montreal, Montreal, Quebec, Canada.,LIA (International Associated Laboratory) Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada.,LIA (International Associated Laboratory) INSERM, Marseille, France
| | - Andrea Oneglia
- Cardiovascular Genetics, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine Research Centre, University of Montreal, Montreal, Quebec, Canada
| | - Maryse Thibeault
- Cardiovascular Genetics, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine Research Centre, University of Montreal, Montreal, Quebec, Canada
| | - Emily Nordquist
- Molecular, Cellular and Developmental Biology Graduate Program, The Ohio State University, Columbus, OH, USA.,Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Joy Lincoln
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Pediatric Cardiology, Herma Heart Institute, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Franka Scharfenberg
- Unit for Degradomics of the Protease Web, Institute of Biochemistry, University of Kiel, Kiel, Germany
| | - Christoph Becker-Pauly
- Unit for Degradomics of the Protease Web, Institute of Biochemistry, University of Kiel, Kiel, Germany
| | - Philipp Hofmann
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Kirstin Hoff
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany.,German Centre for Cardiovascular Research (DZHK), Kiel, Germany
| | - Enrique Audain
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany.,German Centre for Cardiovascular Research (DZHK), Kiel, Germany
| | - Hans-Heiner Kramer
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany.,German Centre for Cardiovascular Research (DZHK), Kiel, Germany
| | | | - Amiram Nir
- Department of Pediatric Cardiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | | | - Johanna Comes
- Cardiovascular Genetics, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine Research Centre, University of Montreal, Montreal, Quebec, Canada
| | - Anne Fournier
- Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Hanna Osinska
- Division of Molecular Cardiovascular Biology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Jeffrey Robins
- Division of Molecular Cardiovascular Biology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Michel Pucéat
- LIA (International Associated Laboratory) Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada.,LIA (International Associated Laboratory) INSERM, Marseille, France.,Université Aix-Marseille, INSERM U-1251, Marseille, France
| | | | - Orly Elpeleg
- Monique and Jacques Robo Department of Genetic Research, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Marc-Phillip Hitz
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany.,German Centre for Cardiovascular Research (DZHK), Kiel, Germany.,Wellcome Sanger Institute, Cambridge, UK.,Department of Human Genetics, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Gregor Andelfinger
- Cardiovascular Genetics, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine Research Centre, University of Montreal, Montreal, Quebec, Canada. .,Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada. .,Department of Biochemistry, University of Montreal, Montreal, Quebec, Canada.
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50
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Mackie AS, Fournier A, Swan L, Marelli AJ, Kovacs AH. Transition and Transfer From Pediatric to Adult Congenital Heart Disease Care in Canada: Call For Strategic Implementation. Can J Cardiol 2019; 35:1640-1651. [DOI: 10.1016/j.cjca.2019.08.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 07/26/2019] [Accepted: 08/01/2019] [Indexed: 01/17/2023] Open
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