Clinical Presentation and Management of Patients Referred for Transthoracic Echocardiography in Canada's Arctic...

Indigenous populations in Canada experience disproportionately high cardiovascular risk, yet contemporary data on echocardiographic findings in the Arctic remain limited. This study evaluated indications, echocardiographic findings, and subsequent management of patients undergoing transthoracic echocardiography in Eastern Nunavut.

We conducted a retrospective analysis of all consecutive transthoracic echocardiograms performed between January 2020 and December 2023 in Iqaluit and surrounding remote communities. Demographic data, echocardiographic results, and management decisions were collected and compared between Indigenous and non-Indigenous patients. Significant abnormalities were defined as moderate or severe valvular heart disease (VHD), prosthetic valve dysfunction, left ventricular ejection fraction (LVEF) < 50%, regional wall-motion abnormalities (RWMA), systolic pulmonary artery pressure ≥ 40 mm Hg, or congenital heart disease.

Among 662 patients (mean age 55 ± 16 years; 47% women), 530 (80%) were Indigenous. Significant abnormalities were identified in 197 patients (30%). Moderate or severe VHD was present in 67 patients (10%), most commonly degenerative (31%), followed by functional (25%) and rheumatic (16%) etiologies. Reduced LVEF was seen in 16%, and RWMA was seen in 7%. Management included local follow-up (44%), transfer or hospital admission (16%), and tertiary-care referral (9%). Compared to non-Indigenous patients, Indigenous patients had higher unadjusted rates of significant abnormalities (33% vs 18%, P < 0.01), moderate or severe VHD (12% vs 5%, P = 0.04), and reduced LVEF or RWMA (21% vs 13%, P = 0.07).

Patients in Canada's Arctic, particularly Indigenous communities, carry a substantial burden of cardiac disease, including elevated rates of VHD and ventricular dysfunction. Improved prevention and access to cardiovascular care are essential to reduce these disparities.