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Ducas RA, Mao T, Beauchesne L, Silversides C, Dore A, Ganame J, Alonso-Gonzalez R, Keir M, Muhll IV, Grewal J, Williams A, Dehghani P, Siu S, Johri A, Bedard E, Therrien J, Hayami D, Kells C, Marelli A. Adult Congenital Heart Disease Care in Canada: Has Quality of Care Improved in the Last Decade? Can J Cardiol 2024; 40:138-147. [PMID: 37924967 DOI: 10.1016/j.cjca.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/12/2023] [Accepted: 08/04/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Patients with adult congenital heart disease (ACHD) are at increased risk of comorbidity and death compared with the age-matched population. Specialized care is shown to improve survival. The purpose of this study was to analyze current measures of quality of care in Canada compared with those published by our group in 2012. METHODS A survey focusing on structure and process measures of care quality in 2020 was sent to 15 ACHD centres registered with the Canadian Adult Congenital Heart Network. For each domain of quality, comparisons were made with those published in 2012. RESULTS In Canada, 36,708 patients with ACHD received specialized care between 2019 and 2020. Ninety-five cardiologists were affiliated with ACHD centres. The median number of patients per ACHD clinic was 2000 (interquartile range [IQR]: 1050, 2875). Compared with the 2012 results, this represents a 68% increase in patients with ACHD but only a 19% increase in ACHD cardiologists. Compared with 2012, all procedural volumes increased with cardiac surgeries, increasing by 12% and percutaneous intervention by 22%. Wait time for nonurgent consults and interventions all exceeded national recommendations by an average of 7 months and had increased compared with 2012 by an additional 2 months. Variability in resources were noted across provincial regions. CONCLUSIONS Over the past 10 years, ACHD care gaps have persisted, and personnel and infrastructure have not kept pace with estimates of ACHD population growth. Strategies are needed to improve and reduce disparity in ACHD care relative to training, staffing, and access to improved care for Canadians with ACHD.
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Affiliation(s)
- Robin A Ducas
- Department of Internal Medicine, Section of Cardiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Tony Mao
- Department of Internal Medicine, Section of Cardiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Luc Beauchesne
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Candice Silversides
- University Health Network, Peter Munk Cardiac Centre, Toronto Adult Congenital Heart Disease Program, University of Toronto, Toronto, Ontario, Canada
| | - Annie Dore
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | | | - Rafael Alonso-Gonzalez
- University Health Network, Peter Munk Cardiac Centre, Toronto Adult Congenital Heart Disease Program, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Jasmine Grewal
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne Williams
- Memorial University, St John's, Newfoundland, Canada
| | - Payam Dehghani
- Prairie Vascular Research Inc, Adult Congenital Heart Disease, Regina, Saskatchewan, Canada
| | - Samuel Siu
- Western University, London, Ontario, Canada
| | - Amer Johri
- Queen's University, Kingston, Ontario, Canada
| | - Elisabeth Bedard
- Quebec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Judith Therrien
- Jewish General Hospital, McGill Adult Unit for Congenital Heart Disease (MAUDE Unit), McGill University, Montréal, Québec, Canada
| | - Doug Hayami
- Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Ariane Marelli
- Jewish General Hospital, McGill Adult Unit for Congenital Heart Disease (MAUDE Unit), McGill University, Montréal, Québec, Canada
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Mao RT, Beauchesne L, Marelli A, Silversides C, Dore A, Ganame J, Keir M, Alonso-Gonzalez R, Vonder Muhll I, Grewal J, Williams A, Dehghani P, Siu S, Johri A, Bedard E, Therrien J, Hayami D, Kells C, Ducas RA. The Impact of the COVID-19 Pandemic Restrictions on the Provision of Adult Congenital Heart Disease Care Across Canada: A National Survey. CJC Pediatr Congenit Heart Dis 2023; 2:247-252. [PMID: 37970218 PMCID: PMC10642110 DOI: 10.1016/j.cjcpc.2023.09.002] [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] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/05/2023] [Indexed: 11/17/2023]
Abstract
Background The COVID-19 pandemic significantly impacted health care access across Canada with the reduction in in-person evaluations. The aim of the study was to examine the effects of the COVID-19 pandemic on access to health care services among the Canadian population with adult congenital heart disease (ACHD). Methods All Canadian adult congenital heart affiliated centres were contacted and asked to collect data on outpatient clinic and procedural volumes for the 2019 and 2020 calendar years. A survey was sent detailing questions on clinic and procedural volumes and wait times before and after pandemic restrictions. Descriptive statistics were used with the Student t-test to compare groups. Results In 2019, there were 19,326 ACHD clinic visits across Canada and only 296 (1.5%) virtual clinic visits. However, during the first year of the pandemic, there were 20,532 clinic visits and 11,412 (56%) virtual visits (P < 0.0001). There were no differences in procedural volumes (electrophysiology, cardiac surgery, and percutaneous intervention) between 2019 and 2020. The mean estimated wait times (months) before the pandemic vs the pandemic were as follows: nonurgent consult 5.4 ± 2.6 vs 6.6 ± 4.2 (P = 0.65), ACHD surgery 6.0 ± 3.5 vs 7.0 ± 4.6 (P = 0.47), electrophysiology procedures 6.3 ± 3.3 vs 5.7 ± 3.3 (P = 0.72), and percutaneous intervention 4.6 ± 3.9 vs 4.4 ± 2.3 (P = 0.74). Conclusions During the pandemic and restrictions of social distancing, the use of virtual clinic visits helped to maintain continuity in ACHD clinical care, with 56% of ACHD visits being virtual. The procedural volumes and wait times for consultation and percutaneous and surgical interventions were not delayed.
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Affiliation(s)
| | - Luc Beauchesne
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Ariane Marelli
- McGill Adult Unit for Congenital Heart Disease (MAUDE unit), Montreal, Québec, Canada
| | - Candice Silversides
- University Health Network, Peter Munk Cardiac Centre, Toronto Adult Congenital Heart Disease Program, University of Toronto, Toronto, Ontario, Canada
| | - Annie Dore
- Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| | | | | | - Rafael Alonso-Gonzalez
- University Health Network, Peter Munk Cardiac Centre, Toronto Adult Congenital Heart Disease Program, University of Toronto, Toronto, Ontario, Canada
| | | | - Jasmine Grewal
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne Williams
- Memorial University, St. John’s, Newfoundland, Canada
| | - Payam Dehghani
- Prairie Vascular Research Inc, Regina, Saskatchewan, Canada
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Samuel Siu
- Western University, London, Ontario, Canada
| | - Amer Johri
- Queen’s University, Kingston, Ontario, Canada
| | - Elisabeth Bedard
- Quebec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Judith Therrien
- McGill Adult Unit for Congenital Heart Disease (MAUDE unit), Montreal, Québec, Canada
| | - Doug Hayami
- Dalhousie University, Halifax, Nova Scotia, Canada
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Pirzada A, Hayami D. Stress Echocardiography in the Diagnosis of Coronary Microvascular Ischemia: The Forgotten Old Faithful Tool? Can J Cardiol 2022; 38:1763-1765. [PMID: 35870691 DOI: 10.1016/j.cjca.2022.07.009] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/10/2022] [Accepted: 07/14/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Ashar Pirzada
- Division of Cardiology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Doug Hayami
- Division of Cardiology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Mao R, Beauchesne L, Marelli A, Silversides C, Dore A, Ganame J, Keir M, Alonso-Gonzalez R, Muhll IV, Grewal J, Williams A, Dehghani P, Siu S, Johri A, Bedard E, Therrien J, Kells C, Hayami D, Ducas R. ADULT CONGENITAL HEART DISEASE HEALTH SERVICES IN CANADA-WHERE HAVE WE COME IN THE PAST 15 YEARS. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.051] [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: 11/17/2022] Open
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Mao R, Beauchesne L, Marelli A, Silversides C, Dore A, Ganame J, Keir M, Alonso-Gonzalez R, Muhll IV, Grewal J, Williams A, Dehghani P, Siu S, Johri A, Bedard E, Therrien J, Kells C, Hayami D, Ducas R. THE IMPACT OF THE COVID-19 PANDEMIC RESTRICTIONS ON THE PROVISION OF ACHD CARE ACROSS CANADA. Can J Cardiol 2022. [PMCID: PMC9595437 DOI: 10.1016/j.cjca.2022.08.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Eze-Nliam C, Schiller NB, Hayami D, Ghahghaie F, Bibby D, Fang Q, Marcus GM, Åström Aneq M. Endurance exercise in seniors: Tonic, toxin or neither? Clin Physiol Funct Imaging 2020; 40:320-327. [PMID: 32364658 DOI: 10.1111/cpf.12638] [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: 10/30/2019] [Revised: 04/08/2020] [Accepted: 04/27/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cardiac adaptation to sustained exercise in the athletes is established. However, exercise-associated effect on the cardiac function of the elderly has to be elucidated. The aim of this study was to analyse left (LV) and right ventricular (RV) characteristics at different levels of chronic exercise in the senior heart. MATERIALS AND METHODS We studied 178 participants in the World Senior Games (mean age 68 ± 8 years, 86 were men; 48%). Three groups were defined based on the type and intensity of sports: low-, moderate- and high-intensity level. Exclusion criteria were coronary artery disease, atrial fibrillation, valvular heart disease or uncontrolled hypertension. LV and RV size and function were evaluated with an echocardiogram. RESULTS LV trans-mitral inflow deceleration time decreased in parallel to the intensity of chronic exercise: 242 ± 54 ms in low-, 221 ± 52 ms in moderate- and 215 ± 58 ms in high-intensity level, p = .03. Left atrial volume index (LAVI) was larger in high-intensity group, p = .001. The LAVI remained significantly larger when adjusting for age, gender, heart rate, hypertension and diabetes (p = .002). LV and RV sizes were larger in the high-intensity group. LV ejection fraction and RV systolic function evaluated by tissue Doppler velocity, atrioventricular plane displacement and strain did not differ between groups. CONCLUSION Left ventricular diastolic filling is not only preserved, but may also be enhanced in long-term, top-level senior athletes. Moreover, LV and RV systolic function remain unchanged at different levels of exercise. This supports the beneficial effects of endurance exercise participation in senior hearts.
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Affiliation(s)
- Chete Eze-Nliam
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Nelson B Schiller
- Division of Cardiology, University of California, San Francisco, CA, USA
| | - Doug Hayami
- Division of Cardiology, Queen Elizabeth II Health Sciences Center, Halifax Infirmary Site, Halifax, NS, Canada
| | - Farzin Ghahghaie
- Division of Cardiology, University of California, San Francisco, CA, USA
| | - Dwight Bibby
- Division of Cardiology, University of California, San Francisco, CA, USA
| | - Qizhi Fang
- Division of Cardiology, University of California, San Francisco, CA, USA
| | - Gregory M Marcus
- Division of Cardiology, University of California, San Francisco, CA, USA
| | - Meriam Åström Aneq
- Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Sosner P, Gayda M, Dupuy O, Garzon M, Lemasson C, Gremeaux V, Lalongé J, Gonzales M, Hayami D, Juneau M, Nigam A, Bosquet L. Ambulatory blood pressure reduction following 2 weeks of high-intensity interval training performed on ergo-cycle in water or dry land condition. Archives of Cardiovascular Diseases Supplements 2017. [DOI: 10.1016/s1878-6480(17)30309-9] [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: 11/24/2022]
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Thorin-Trescases N, Hayami D, Yu C, Luo X, Nguyen A, Larouche JF, Lalongé J, Henri C, Arsenault A, Gayda M, Juneau M, Lambert J, Thorin E, Nigam A. Exercise Lowers Plasma Angiopoietin-Like 2 in Men with Post-Acute Coronary Syndrome. PLoS One 2016; 11:e0164598. [PMID: 27736966 PMCID: PMC5063321 DOI: 10.1371/journal.pone.0164598] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 09/27/2016] [Indexed: 12/11/2022] Open
Abstract
Pro-inflammatory angiopoietin-like 2 (angptl2) promotes endothelial dysfunction in mice and circulating angptl2 is higher in patients with cardiovascular diseases. We previously reported that a single bout of physical exercise was able to reduce angptl2 levels in coronary patients. We hypothesized that chronic exercise would reduce angptl2 in patients with post-acute coronary syndrome (ACS) and endothelial dysfunction. Post-ACS patients (n = 40, 10 women) were enrolled in a 3-month exercise-based prevention program. Plasma angptl2, hs-CRP, and endothelial function assessed by scintigraphic forearm blood flow, were measured before and at the end of the study. Exercise increased VO2peak by 10% (p<0.05), but did not significantly affect endothelial function, in both men and women. In contrast, exercise reduced angptl2 levels only in men (-26±7%, p<0.05), but unexpectedly not in women (+30±16%), despite similar initial levels in both groups. Exercise reduced hs-CRP levels in men but not in women. In men, levels of angptl2, but not of hs-CRP, reached at the end of the training program were negatively correlated with VO2peak (r = -0.462, p = 0.012) and with endothelial function (r = -0.419, p = 0.033) measured at baseline: better initial cardiopulmonary fitness and endothelial function correlated with lower angptl2 levels after exercise. Pre-exercise angptl2 levels were lower if left ventricular ejection time was long (p<0.05) and the drop in angptl2 induced by exercise was greater if the cardiac output was high (p<0.05). In conclusion, in post-ACS men, angptl2 levels are sensitive to chronic exercise training. Low circulating angptl2 reached after training may reflect good endothelial and cardiopulmonary functions.
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Affiliation(s)
| | - Doug Hayami
- Montreal Heart Institute, Research Center, University of Montreal, Montreal, Quebec, Canada
- Cardiac Rehabilitation and Prevention Center (EPIC) of the Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - Carol Yu
- Montreal Heart Institute, Research Center, University of Montreal, Montreal, Quebec, Canada
- Departments of Pharmacology and Surgery, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Xiaoyan Luo
- Montreal Heart Institute, Research Center, University of Montreal, Montreal, Quebec, Canada
| | - Albert Nguyen
- Montreal Heart Institute, Research Center, University of Montreal, Montreal, Quebec, Canada
- Departments of Pharmacology and Surgery, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Jean-François Larouche
- Montreal Heart Institute, Research Center, University of Montreal, Montreal, Quebec, Canada
- Cardiac Rehabilitation and Prevention Center (EPIC) of the Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - Julie Lalongé
- Cardiac Rehabilitation and Prevention Center (EPIC) of the Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - Christine Henri
- Montreal Heart Institute, Research Center, University of Montreal, Montreal, Quebec, Canada
| | - André Arsenault
- Montreal Heart Institute, Research Center, University of Montreal, Montreal, Quebec, Canada
- Montreal Behavioral Medicine Centre, Montreal, Quebec, Canada
| | - Mathieu Gayda
- Montreal Heart Institute, Research Center, University of Montreal, Montreal, Quebec, Canada
- Cardiac Rehabilitation and Prevention Center (EPIC) of the Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - Martin Juneau
- Montreal Heart Institute, Research Center, University of Montreal, Montreal, Quebec, Canada
- Cardiac Rehabilitation and Prevention Center (EPIC) of the Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - Jean Lambert
- Montreal Heart Institute, Research Center, University of Montreal, Montreal, Quebec, Canada
- School of Public Health, University of Montreal, Montreal, Quebec, Canada
| | - Eric Thorin
- Montreal Heart Institute, Research Center, University of Montreal, Montreal, Quebec, Canada
- Departments of Pharmacology and Surgery, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
- * E-mail:
| | - Anil Nigam
- Montreal Heart Institute, Research Center, University of Montreal, Montreal, Quebec, Canada
- Cardiac Rehabilitation and Prevention Center (EPIC) of the Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
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Affiliation(s)
- Xavier Freixa
- Department of Interventional Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
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Nguyen A, Mamarbachi M, Turcot V, Lessard S, Yu C, Luo X, Lalongé J, Hayami D, Gayda M, Juneau M, Thorin-Trescases N, Lettre G, Nigam A, Thorin E. Lower Methylation of the ANGPTL2 Gene in Leukocytes from Post-Acute Coronary Syndrome Patients. PLoS One 2016; 11:e0153920. [PMID: 27101308 PMCID: PMC4839636 DOI: 10.1371/journal.pone.0153920] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 04/06/2016] [Indexed: 02/08/2023] Open
Abstract
DNA methylation is believed to regulate gene expression during adulthood in response to the constant changes in environment. The methylome is therefore proposed to be a biomarker of health through age. ANGPTL2 is a circulating pro-inflammatory protein that increases with age and prematurely in patients with coronary artery diseases; integrating the methylation pattern of the promoter may help differentiate age- vs. disease-related change in its expression. We believe that in a pro-inflammatory environment, ANGPTL2 is differentially methylated, regulating ANGPTL2 expression. To test this hypothesis we investigated the changes in promoter methylation of ANGPTL2 gene in leukocytes from patients suffering from post-acute coronary syndrome (ACS). DNA was extracted from circulating leukocytes of post-ACS patients with cardiovascular risk factors and from healthy young and age-matched controls. Methylation sites (CpGs) found in the ANGPTL2 gene were targeted for specific DNA methylation quantification. The functionality of ANGPTL2 methylation was assessed by an in vitro luciferase assay. In post-ACS patients, C-reactive protein and ANGPTL2 circulating levels increased significantly when compared to healthy controls. Decreased methylation of specific CpGs were found in the promoter of ANGPTL2 and allowed to discriminate age vs. disease associated methylation. In vitro DNA methylation of specific CpG lead to inhibition of ANGPTL2 promoter activity. Reduced leukocyte DNA methylation in the promoter region of ANGPTL2 is associated with the pro-inflammatory environment that characterizes patients with post-ACS differently from age-matched healthy controls. Methylation of different CpGs in ANGPTL2 gene may prove to be a reliable biomarker of coronary disease.
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Affiliation(s)
- Albert Nguyen
- Montreal Heart Institute, Research Center, Université de Montréal, Montreal, Quebec, Canada
- Department of Pharmacology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Maya Mamarbachi
- Montreal Heart Institute, Research Center, Université de Montréal, Montreal, Quebec, Canada
| | - Valérie Turcot
- Montreal Heart Institute, Research Center, Université de Montréal, Montreal, Quebec, Canada
| | - Samuel Lessard
- Montreal Heart Institute, Research Center, Université de Montréal, Montreal, Quebec, Canada
| | - Carol Yu
- Montreal Heart Institute, Research Center, Université de Montréal, Montreal, Quebec, Canada
- Department of Pharmacology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Xiaoyan Luo
- Montreal Heart Institute, Research Center, Université de Montréal, Montreal, Quebec, Canada
| | - Julie Lalongé
- Montreal Heart Institute, Research Center, Université de Montréal, Montreal, Quebec, Canada
- Cardiac Rehabilitation and Prevention Center (EPIC) of the Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Doug Hayami
- Montreal Heart Institute, Research Center, Université de Montréal, Montreal, Quebec, Canada
- Cardiac Rehabilitation and Prevention Center (EPIC) of the Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Mathieu Gayda
- Montreal Heart Institute, Research Center, Université de Montréal, Montreal, Quebec, Canada
- Cardiac Rehabilitation and Prevention Center (EPIC) of the Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Martin Juneau
- Montreal Heart Institute, Research Center, Université de Montréal, Montreal, Quebec, Canada
- Cardiac Rehabilitation and Prevention Center (EPIC) of the Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | | | - Guillaume Lettre
- Montreal Heart Institute, Research Center, Université de Montréal, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Anil Nigam
- Montreal Heart Institute, Research Center, Université de Montréal, Montreal, Quebec, Canada
- Cardiac Rehabilitation and Prevention Center (EPIC) of the Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- * E-mail: (AN); (ET)
| | - Eric Thorin
- Montreal Heart Institute, Research Center, Université de Montréal, Montreal, Quebec, Canada
- Department of Surgery, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- * E-mail: (AN); (ET)
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Hayami D, Gayda M, Larouche J, Lapierre G, Juneau M, Nigam A. RANDOMIZED CONTROLLED TRIAL OF HIGH INTENSITY INTERVAL TRAINING VS MODERATE INTENSITY CONTINUOUS EXERCISE TRAINING IN PATIENTS POST ACUTE CORONARY. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.559] [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: 10/24/2022] Open
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Hayami D, Garceau P, Ducharme A, Bonan R, Basmadjian A, L'Allier P, Asgar A. Transcatheter Mitral Leaflet Repair for High Risk Patients With Mitral Regurgitation: Follow Up Echocardiographic Outcomes. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.532] [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: 10/26/2022] Open
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Hayami D, Jackson S, Thompson K. 792 Acute Coronary Syndrome in Patients With Normal or Non-Obstructive Coronary Artery Disease: Patient Characteristics and Long-Term Outcomes. Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.713] [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: 10/27/2022] Open
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Kagan R, Hayami D, Joseph L, St Pierre Y, Clarke AE. The predictive value of a positive prick skin test to peanut in atopic, peanut-naïve children. Ann Allergy Asthma Immunol 2003; 90:640-5. [PMID: 12839323 DOI: 10.1016/s1081-1206(10)61869-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although allergy testing before food ingestion is generally not recommended, many peanut-naive children undergo prick skin tests (PSTs) to peanut because of atopy. Children with positive PSTs are generally advised to avoid peanuts either indefinitely or until a definitive diagnosis is made through challenge. OBJECTIVE To describe peanut challenges in atopic, peanut-naive children with PST to peanuts > or = 3 mm and the PST properties in this population. METHODS Between 1994 and 2001, 47 patients were identified who had a positive peanut PST, no previous peanut ingestion, and had undergone a peanut challenge. RESULTS Forty-nine percent of the challenges were positive. The mean of the largest wheal diameter (95% confidence interval [CI]) of the PST in children having a negative and positive challenge was 6.3 mm (CI, 5.3 to 7.3) and 10.3 mm (CI, 8.9 to 11.8), respectively. At a PST cutoff of > or = 5 mm, the sensitivity and negative predictive value (95% CI) was 100% (85.2 to 100) and 100% (29.2 to 100), whereas the specificity and positive predictive value (95% CI) was 12.5% (2.7 to 32.4) and 52.3% (36.7 to 67.5), respectively. CONCLUSIONS We show that 49% of atopic, peanut-naïve children sensitized to peanut developed allergic symptoms during oral provocation with peanut. Although the sensitivity of the PST at > or = 5 mm for the detection of peanut allergy in this study was 100%, our small sample size limits the applicability of this value. Further investigation is needed to determine whether children with wheal diameters of 3 or 4 mm, perhaps coupled with low peanut-specific IgE, could undergo less resource-intensive, accelerated challenges.
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Affiliation(s)
- Rhoda Kagan
- Division of Allergy/Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Québec, Canada.
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