Daily Cardiology Research Analysis
Analyzed 64 papers and selected 3 impactful papers.
Summary
Three impactful cardiology papers stood out today: a comprehensive meta-analysis refines diagnostic performance and software-related variability of the relative apical sparing pattern for cardiac amyloidosis; a nationally representative Canadian analysis shows post-pandemic increases in hypertension prevalence with worsening control; and a prospective cohort reveals sex differences in infective endocarditis management and adjusted survival. Together, these works advance diagnostic rigor, public health surveillance, and equitable care.
Research Themes
- Diagnostic accuracy and standardization in cardiac amyloidosis
- Population-level shifts in hypertension prevalence and control
- Sex-based differences in infective endocarditis management and outcomes
Selected Articles
1. Relative apical sparing of left ventricular longitudinal strain for the diagnosis of cardiac amyloidosis: a systematic review and meta-analysis.
Across 41 studies (n≈7,998), the RELAPS pattern showed good specificity (83.1%) but modest sensitivity (65.9%) for diagnosing cardiac amyloidosis. Diagnostic performance varied significantly by echocardiography software, with notably lower sensitivity using TomTec compared with GE EchoPAC, highlighting the need for standardized acquisition and predefined cut-offs.
Impact: This meta-analysis refines the diagnostic accuracy and software-dependent variability of a widely used echocardiographic marker for cardiac amyloidosis, directly informing clinical interpretation strategies.
Clinical Implications: RELAPS should be used as a supportive, not standalone, criterion for cardiac amyloidosis, with awareness of software-specific performance. Centers should standardize acquisition/analysis protocols and prespecify thresholds to reduce false negatives/positives and consider complementary diagnostics (e.g., bone scintigraphy, CMR, biomarkers).
Key Findings
- Pooled AUC-ROC 0.818 with sensitivity 65.9% and specificity 83.1% for RELAPS in cardiac amyloidosis.
- AL-CA and ATTR-CA showed comparable accuracy; AL-CA specificity reached 92.7%.
- Software significantly influenced performance: TomTec had much lower sensitivity vs GE EchoPAC despite similar specificity.
- Optimal thresholds varied; standardization and prespecified cut-offs are needed.
Methodological Strengths
- Comprehensive search across multiple databases with prespecified RELAPS definition
- Bivariate random-effects model, subgroup analyses by subtype/software, and meta-regression
Limitations
- Heterogeneity across studies and variable RELAPS thresholds
- Software-dependent variability may limit generalizability; potential publication bias not fully excluded
Future Directions: Establish consensus acquisition/analysis protocols and software-agnostic thresholds; prospective multicenter validation integrating RELAPS with multimodal diagnostics and machine learning-based decision support.
BACKGROUND: Cardiac amyloidosis (CA) is underdiagnosed due to non-specific clinical and echocardiographic features. This systematic review and meta-analysis evaluated the diagnostic accuracy of the left ventricular relative apical sparing (RELAPS) pattern on speckle-tracking echocardiography. METHODS: A literature search of PubMed, Scopus and Cochrane was conducted through August 2025. RELAPS was defined as the average apical longitudinal strain divided by the sum of average basal and average middle left ventricular longitudinal strains. Diagnostic accuracy was assessed using a bivariate random-effects model. Subgroup analyses by CA subtype and echocardiogram software, and meta-regression for clinical variables, were performed. Optimal cut-offs were determined by maximising the Youden index. Analyses were conducted in R V.4.4.1. RESULTS: Forty-one studies (3473 CA; 4525 comparators) were included. Pooled analysis yielded an area under the receiver operating characteristic curve (AUC-ROC) of 0.818, with sensitivity 65.9% (95% CIs 59.2% to 72.0%) and specificity 83.1% (CI 78.5% to 86.8%). The diagnostic oods ratio (DOR) was 9.54 (CI 7.41 to 12.10). In subtype analyses, immunoglobulin light chains (AL-CA) showed AUC-ROC 0.876, sensitivity 59.8% (CI 41.1% to 76.0%) and specificity 92.7% (CI 83.6% to 96.9%); transthyretin (ATTR-CA) showed AUC-ROC 0.822, sensitivity 63.8% (CI 51.2% to 74.8%) and specificity 84.4% (CI 76.7% to 89.9%), with no significant differences between subtypes (sensitivity p=0.760; specificity p=0.172). Three echocardiography software systems were evaluated. GE EchoPAC (26 studies) achieved an AUC-ROC of 0.822 (sensitivity 70.4% (CI 64.1% to 76.0%), specificity 81.2% (CI 75.7% to 85.7%)). Philips QLAB (four studies) performed comparably (AUC-ROC 0.904; sensitivity 67.6% (CI 31.2% to 90.6%), specificity 92.7% (CI 73.6% to 98.3%)). In contrast, TomTec (four studies) had an AUC-ROC of 0.806, but its sensitivity (31.1% (CI 9.4% to 66.3%)) was significantly lower than GE EchoPAC's (p<0.001), despite a similar specificity (93.6% (CI 78.8% to 98.3%)). CONCLUSION: RELAPS provides moderate diagnostic accuracy for identifying CA, with good specificity and modest sensitivity. Performance varies by analysis software and threshold, underscoring the need for standardised measurement and prespecified cut-offs.
2. CHANGES IN HYPERTENSION PREVALENCE AND CONTROL IN CANADA AFTER THE COVID-19 PANDEMIC: INSIGHTS FROM THE CANADIAN HEALTH MEASURES SURVEY CYCLE 7.
Hypertension prevalence in Canada rose to 27.7% in 2022–2024 (from 22.0% in 2018–2019), with the largest relative increases in adults aged 20–39. Treated-and-controlled hypertension declined by an absolute 13% (55.7% to 42.7%), with poorer control in adults <60 and in women.
Impact: This nationally representative analysis quantifies post-pandemic deterioration in hypertension epidemiology, identifying high-risk subgroups and actionable gaps in detection and control.
Clinical Implications: Health systems should intensify opportunistic screening (especially in adults <60 and women), simplify treatment intensification pathways, and expand home BP monitoring and team-based care to recover lost control rates.
Key Findings
- Hypertension prevalence increased to 27.7% (2022–2024) from 22.0% (2018–2019), p=0.03.
- Largest relative rise in ages 20–39: from 2.6% to 8.0% (207.7% relative increase, p=0.007).
- Treated-and-controlled hypertension fell by 13% absolute (55.7% to 42.7%, p=0.007).
- Control rates were lower in adults <60 years (35.5%) and in women (35.0%).
Methodological Strengths
- Nationally representative survey across seven cycles with standardized measurements
- Comparative analysis pre- vs post-pandemic with stratification by age and sex
Limitations
- Cross-sectional design limits causal inference regarding pandemic-related drivers
- Potential changes in measurement context or participation over cycles may influence estimates
Future Directions: Implement targeted interventions for younger adults and women, evaluate scalable care models (pharmacist-led, telehealth), and monitor recovery of control in subsequent CHMS cycles.
BACKGROUND: The impact of the COVID-19 pandemic on hypertension prevalence and control in Canada is unknown despite pandemic-associated changes in lifestyle behaviours, socioeconomic factors, and availability of medical care. METHODS: We compared data for non-pregnant adult participants from the 7 cycles of the nationally representative Canadian Health Measures Survey (CHMS) conducted between 2007-2009 and 2022-2024, including questionnaires and physical measurements. RESULTS: The prevalence of hypertension in CHMS adult participants remained relatively stable between 2007-2009 (20.3%, 95%CI 18.8%-21.8%) and 2018-2019 (22.0%, 95%CI 17.8%-27.0%), but increased to 27.7% (95%CI 24.8%-30.8%) in 2022-2024 (p=0.03 compared to 2018-2019). Prevalence was highest in men (31.8%, 95%CI 27.4%-36.5%) in 2022-2024. Although the absolute rates were lower, the relative increases in hypertension prevalence between 2018-2019 and 2022-2024 were greatest in younger adults: 207.7% in those aged 20-39 years (from 2.6% to 8.0%, p=0.007), 25.5% in those aged 40-59 years (from 20.0% to 25.1%, p=0.20), and 10.2% in those aged 60-79 years (from 50.9% to 56.1%, p=0.27). In 2022-2024, almost 3 out of 4 adults with hypertension were aware of their diagnosis and two-thirds were taking treatment but less than half were treated and controlled. This represented a 13% absolute decline in treated and controlled hypertension in 2022-2024 compared to 2018-2019 (42.7% [95%CI 36.9%-48.8%] versus 55.7% [95%CI 48.1%-63.1%], p=0.007). Control rates were lower in adults younger than 60 years (35.5%, 95%CI 25.8%-46.6%) and women (35.0%, 95%CI 26.6%-44.5%). CONCLUSIONS: Hypertension prevalence has increased and control has declined in Canada between 2018-2019 and 2022-2024, particularly in younger adults and women.
3. Sex differences in the diagnosis, management and outcomes of patients with infective endocarditis.
In a prospective cohort of 791 patients with definite/possible infective endocarditis, women had worse adjusted survival and were more likely to be denied surgery despite indications. After excluding patients in whom surgery was withheld, surgical treatment appeared more protective in women than in men.
Impact: The study identifies modifiable disparities in surgical decision-making and outcomes by sex in infective endocarditis, informing equity-focused quality improvement.
Clinical Implications: Multidisciplinary endocarditis teams should audit sex-based surgical decision patterns, ensure guideline-concordant surgery irrespective of sex, and monitor outcomes to mitigate avoidable mortality.
Key Findings
- Among 791 IE patients, women had worse adjusted survival compared with men.
- Women were more likely to have mitral valve IE, while men had more aortic valve IE and predisposing conditions.
- Surgery was withheld more often in women despite indications; excluding these, surgery appeared more protective in women.
Methodological Strengths
- Prospective inclusion of all team-discussed IE cases over nine years
- Adjusted survival analysis using Cox modeling accounting for baseline, IE type, and treatment
Limitations
- Single-center team-based cohort may limit generalizability
- Abstract lacks granular microbiology and surgical criteria details; residual confounding possible
Future Directions: Multicenter prospective registries with standardized surgical criteria and patient-centered outcomes to validate sex-specific differences and test interventions to reduce disparities.
BACKGROUND: Despite growing interest in male-female differences in cardiovascular disease, evidence in infective endocarditis (IE) is limited and contradictory. METHODS: This prospective study included all patients with definite or possible valvular IE discussed by the endocarditis team from 2016 to 2025. Baseline characteristics, diagnostics, treatment and outcomes were compared between sexes. A Cox model was conducted to assess survival adjusted for baseline characteristics, IE type and treatment. RESULTS: The cohort included 791 patients with definite or possible IE (72.8% males, 27.2% females). Age was not different (male: 67 (IQR 56-75), female: 71 (IQR 55-78) years, p=0.07). Females more often had hypertension (46.0% vs 35.2%, p=0.07) and mitral valve IE (45.6% vs 32.3%, p<0.001). Males had more predisposing conditions (71.5% vs 60.5%, p=0.004) and more aortic valve IE (71.0% vs 62.3%, p=0.02) and CONCLUSIONS: Differences were observed in baseline characteristics, IE type and survival. Females had worse overall adjusted survival, suggesting a less favourable overall prognosis. In terms of surgical decision-making, surgery was withheld more often in females despite surgical indication, and after excluding these patients, surgery appeared more protective in females than in males. These findings may reflect sex differences in surgical selection.