Featured Publications

As a learning organization committed to enhancing the health of current and future generations through research, the CVC relentlessly pursues the generation, translation, and dissemination of new knowledge addressing unmet clinical needs. This section highlights important publications produced by the CVC faculty and our body of research in recent months.

View CVC’s full publication archive here.

The Effects of Acute Atmospheric Pressure Changes on the Occurrence of ST-Elevation Myocardial Infarction: A Case-Crossover Study.

Hong Y, Graham MM, Rosychuk RJ, Southern D, McMurtry MS.
Can J Cardiol. 2019;35:753-760.

Few studies have explored the influence of short-term exposure to atmospheric pressure changes on the abrupt onset of ST-elevation myocardial infarction (STEMI). In this study, the authors sought to evaluate the association between acute atmospheric pressure changes and the occurrence of STEMI.

Using data obtained from the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH), the inpatient Discharge Abstract Database (DAD), and Environment Canada, the authors used a case-crossover study design to explore the effects of acute atmospheric pressure changes on the onset of STEMI.

The authors conclude that there is no evidence of a statistically significant association between acute air pressure changes and the onset of STEMI in a lag time of 1-6 days, whereas acute air pressure decrease is associated with higher odds of a STEMI event 7 days after exposure. Weather advisories might be issued when atmospheric pressure decrease occurs.

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Frequency, Predictors, and Prognosis of Ejection Fraction Improvement in Heart Failure: An Echocardiogram-Based Registry Study.

Ghimire A, Fine N, Ezekowitz JA, Howlett J, Youngson E, McAlister FA.
Eur Heart J. 2019;40:2110-2117.

There is emerging interest in identifying the natural history and prognosis for heart failure (HF) patients exhibiting improvements in their left ventricular ejection fraction (LVEF) with treatment (HFrecEF). Cohort-studies and secondary analyses of randomized trials suggest that 10–20% of HF patients with LVEF <40% demonstrate improvement in LVEF. However, currently published studies on HFrecEF are subject to selection bias as they included only randomized trial participants or patients from selected specialty referral practices.

The authors designed this retrospective cohort study to examine a broader spectrum of HF patients to establish the prevalence, predictors, and prognosis of patients with HFrecEF in contemporary clinical practice.

The research concludes that although HFrecEF is more common in women, those without ischaemic heart disease, and those with narrower QRS complexes at baseline, more work is needed to find other markers that accurately identify those HFrEF patients most likely to exhibit EF improvement and flag those destined to have persistent HFrEF who may benefit from even more aggressive application of proven efficacious therapies.

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Changes in the Prevalence of Overweight, Obesity, and Severe Obesity Between 2010 and 2017 in Preschoolers: A Population-Based Study.

Ball GDC, Savu A, Kaul P.
Pediatr Obes. 2019;14: e12561.

The prevalence of overweight and obesity in children remains high, but recent reports suggest that excess weight has either plateaued or decreased in recent years. Most pediatric studies have focused on the prevalence of overweight and obesity exclusively, yet health risks often increase with increasing levels of body fatness, leading to growing interest in studying severe obesity in children

In this study, the authors examine changes in the prevalence of overweight, obesity, and severe obesity from 2010 to 2017 in a population of preschoolers (4‐ to 6‐year‐olds) from Alberta, Canada and determine the influence of maternal and family‐level factors on excess weight.

Their analyses revealed reductions in overweight and obesity as well as stabilization of severe obesity in a population of Canadian preschoolers. The moderating effects of household income and breast feeding practices on some, but not all, categories of excess weight underscore the importance of continued monitoring of young children's growth and development over time, especially those with severe obesity. These findings also highlight the imperative to develop, implement, and evaluate population‐level initiatives designed to support the health and well‐being of all young children and their families, especially those with lower household incomes.

Dr. Padma Kaul also spoke further about this study in a recent article featured in Folio.

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Will Cardiac Intensive Care Unit Admissions Warrant Appropriate Use Criteria in the Future?

van Diepen S, Katz JN, Morrow DA.
Circulation. 2019;140:267-269.

The coronary care unit was developed in the pre-reperfusion era as an acute myocardial infarction monitoring unit wherein nurses, armed with defibrillators and empowered to act independently, were credited with reducing post-infarction arrhythmic deaths. Contemporary tertiary coronary care units have since evolved. This care transformation has led many institutions to rename and rebrand their coronary care unit as the cardiac intensive care unit (CICU).

Although multiple studies have highlighted both the shift and variations in admission practices, very few data are available to inform healthcare providers on the appropriate use of the contemporary CICU. The key to reaffirming the clinical and economic values of the modern CICU will be to identify which groups of cardiovascular patients are likely to derive the greatest benefit from the services and expertise it provides.

The authors conclude that the future development and implementation of evidence-based criteria to reduce variations in CICU admission practices has the potential to reduce healthcare costs and to ease strain on critical care capacity without an undue influence on patient-centered outcomes. As the patient population evolves, it is incumbent on all clinicians to adapt their clinical practice patterns to ensure that patient care needs are aligned with finite and costly acute care resources.

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Parental Atrial Fibrillation and Stroke or Atrial Fibrillation in Young Adults.

McAlister FA, Yan L, Roos LL, Lix LM.
Stroke. 2019;50:2322-2328.

About 1 in 4 ischemic strokes or transient ischemic attacks (TIAs) are considered cryptogenic in origin. However, many of these events may be associated with undiagnosed atrial fibrillation (AF).

Currently, no studies have examined whether parental history of AF is associated with an increased risk of stroke or TIA in their offspring during young adulthood irrespective of whether the offspring also have documented AF. As such, the authors sought to test whether parental history of AF is associated with incident stroke or TIA in offspring during young adulthood, independent of documented AF or other stroke risk factors in the offspring.

The authors found that parental AF is associated with a higher frequency of AF, stroke/TIA, and other cardiovascular risk factors in offspring in early adulthood. They believe these findings suggest that young adults with a history of parental AF should be counseled about cardiovascular health and primary prevention maneuvers.

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An Update on the Development and Feasibility Assessment of Canadian Quality Indicators for Atrial Fibrillation and Atrial Flutter.

Sandhu RK, Wilton SB, Cruz J, Aztema CL, MacFarlane K, McKelvie R, Lambert L, Rush K, Zimmerman R, Oakes G, Deyell M, Wyse DG, Cox JL, Skanes A.
CJC Open. 2019;1: 198-205

This retrospective administrative data study examines health outcomes and evaluates quality indicators in diverse Canadian populations. The authors provide an update on the Canadian Cardiovascular Society Atrial Fibrillation/Atrial Flutter (AF/AFL) quality indicator (QI) working group. The working group reconvened in 2017 to review the relevance of previously proposed QIs, identify opportunities to develop new QIs, and propose an initial strategy for measuring and reporting. This first step could provide a better initial understanding of the quality of AF/AFL care in Canada, but important gaps in the meaningful measurement of QIs remain.

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Effects of Alirocumab on Cardiovascular Events After Coronary Bypass Surgery.

Goodman SG, Aylward PE, Szarek M, Chumburidze V, Bhatt DL, Bittner VA, Diaz R, Edelberg JM, Hanotin C, Harrington RA, Jukema JW, Kedev S, Letierce A, Moryusef A, Pordy R, Ramos López GA, Roe MT, Viigimaa M, White HD, Zeiher AM, Steg PG, Schwartz GG; ODYSSEY OUTCOMES Committees and Investigators.
J Am Coll Cardiol. 2019;74:1177-1186.

Patients with acute coronary syndrome (ACS) and history of coronary artery bypass grafting (CABG) are at high risk for recurrent cardiovascular events and death. This study sought to determine the clinical benefit of adding alirocumab to statins in ACS patients with prior CABG in a pre-specified analysis of ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab).

Among patients with recent ACS and elevated atherogenic lipoproteins despite intensive statin therapy, alirocumab was associated with large absolute reductions in MACE and death in those with CABG preceding the ACS event.

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Outcomes Among Clopidogrel, Prasugrel, and Ticagrelor in ST-Elevation Myocardial Infarction Patients Who Underwent Primary Percutaneous Coronary Intervention From the TOTAL Trial.

Welsh RC, Sidhu RS, Cairns JA, Lavi S, Kedev S, Moreno R, Cantor WJ, Stankovic G, Meeks B, Yuan F, Džavík V, Jolly SS.
Can J Cardiol. 2019;35:1377-1385.

There is currently a relative paucity of clear evidence to guide the optimal P2Y12 inhibitor selection in ST-elevation myocardial infarction (STEMI) patients who receive primary percutaneous coronary intervention (PPCI). Adequate comparisons between clopidogrel, ticagrelor and parasugrel are limited by the available data.

Data from the Thrombectomy With PCI Versus PCI Alone in Patients With STEMI Undergoing Primary PCI (TOTAL) trial provided an opportunity to analyze one of the largest contemporary cohorts of STEMI-PPCI patients. Accordingly, this observational analysis was undertaken to evaluate the effect of P2Y12 inhibitor choice on 1-year efficacy and safety outcomes from these trial data.

In this post hoc analysis of STEMI patients who underwent primary PCI from the TOTAL trial, ticagrelor was associated with better efficacy compared with clopidogrel and prasugrel. Neither ticagrelor nor prasugrel were associated with and increased risk of major bleeding or stroke compared with clopidogrel. Although the authors attempted to adjust for baseline differences, an appropriately powered randomized trial is needed to confirm these findings.

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