bluuebunny/crossref_metadata_2025 huggingface dataset:
RETRACTED: The importance of agricultural clusters for the development of rural regions
Authors: Yekimov Sergey , Kontsevaya Stanislava , Poltorak Anastasiya S. , Sharin Oleksandr , Verkhovod Iryna , Kuris Yurii
Published: June 2024

See the retraction notice E3S Web of Conferences 538, 00001 (2024), https://doi.org/10.1051/e3sconf/202453800001
RETRACTED: The diversity of the higher algae of Lake Kumsulton
Authors: Pardayev Sh. , Shamsiyev N.A. , Toshev H.M. , Sanoyeva Kh.O. , Rakhmonov N.R. , Tuymurodova Sh.Sh.
Published: June 2024

See the retraction notice E3S Web of Conferences 538, 00001 (2024), https://doi.org/10.1051/e3sconf/202453800001
RETRACTED: Study and analysis of existing polymer binders used in the production of wood chip materials
Authors: Jalilov Sherali , Rubidinov Shokhrukh , Gayratov Jasurbek
Published: June 2024

See the retraction notice E3S Web of Conferences 538, 00001 (2024), https://doi.org/10.1051/e3sconf/202453800001
RETRACTED: Providing thermal exchange when designing special clothing
Authors: Mirtalipova N. , Kamilova Kh. , Vakhidova U.
Published: June 2024

See the retraction notice E3S Web of Conferences 538, 00001 (2024), https://doi.org/10.1051/e3sconf/202453800001
RETRACTED: Optoelectronic device for measuring the humidity of silkworth cocoons
Authors: Kuldashov Golibzhon , Daliyev Baxtiyorjon , Komilov Abdullajon , Tillaboev Mukhiddinjon , Khalilov Muhammadmusa
Published: June 2024

See the retraction notice E3S Web of Conferences 538, 00001 (2024), https://doi.org/10.1051/e3sconf/202453800001
RETRACTED: Inheritance of morpho economic traits in f1-f2 descendants of cotton
Authors: Norov Bekzod , Amanturdiyev Alisher , Kuchkorov Orip , Raimberdiev Kholygit , Mirakhmedov Mirvakhob , Khamrokulov Isfandiyar
Published: June 2024

See the retraction notice E3S Web of Conferences 538, 00001 (2024), https://doi.org/10.1051/e3sconf/202453800001
RETRACTED: Improving the quality of education based on the system of continuing education
Authors: Firsova Nadezda , Bezkorovaina Olha , Oleksenko Roman , Chernenko Oleksandr , Tsukanova Nataliia , Dubinka Mykola , Ihnatiev Vitalii , Anatolii Mykhailov
Published: June 2024

See the retraction notice E3S Web of Conferences 538, 00001 (2024), https://doi.org/10.1051/e3sconf/202453800001
RETRACTED: The influence of arts education on love of the natural environment
Authors: Komarovska Oksana , Vlasova Valeria , Pet'ko Lyudmila , Voloshenko Anna , Holinska Tetiana , Prodius Oksana
Published: June 2024

See the retraction notice E3S Web of Conferences 538, 00001 (2024), https://doi.org/10.1051/e3sconf/202453800001
RETRACTED: A systematic approach to the use of digital art in the training of design and tourism specialists
Authors: Kuzminets Mykola , Dubovenko Yurii , Ivanchyk Svitlana , Bondarenko Vladislava
Published: June 2024

See the retraction notice E3S Web of Conferences 538, 00001 (2024), https://doi.org/10.1051/e3sconf/202453800001
RETRACTED: The philosophy of progress
Authors: Asgarov Shahlar , Hajıyeva Rena
Published: June 2024

See the retraction notice E3S Web of Conferences 538, 00001 (2024), https://doi.org/10.1051/e3sconf/202453800001
RETRACTED: A balanced view of digital transformation in environmental education
Authors: Kurpayanidi Konstantin , Khamdamova Shokhida , Ergashev Dilmurod , Nishonov Usmonkhon , Kholmatova Dilorom , Khoshimov Akhrorjon
Published: June 2024

See the retraction notice E3S Web of Conferences 538, 00001 (2024), https://doi.org/10.1051/e3sconf/202453800001
RETRACTED: Pedagogical and psychological analysis of the works of Sadriddin Aini, the Bukhara savant
Authors: Ahmadov Olimjon , Elova Dilnoza
Published: June 2024

See the retraction notice E3S Web of Conferences 538, 00001 (2024), https://doi.org/10.1051/e3sconf/202453800001
RETRACTED: The influence of "One Thousand Nights" on Uzbek folklore
Authors: Astanova Gulnara , Mirzoyeva Yulduz
Published: June 2024

See the retraction notice E3S Web of Conferences 538, 00001 (2024), https://doi.org/10.1051/e3sconf/202453800001
RETRACTED: The teachings of Hurufism and Nasimi’s poetic skills
Authors: Amonova Zilola , Rajabova Marifat , Safarova Hilola , Shirinova Mekhrigiyo , Akhrorova Zufnunabegim
Published: June 2024

See the retraction notice E3S Web of Conferences 538, 00001 (2024), https://doi.org/10.1051/e3sconf/202453800001
RETRACTED: Experimental testing of the effectiveness of the Turan struggle in higher education
Authors: Arslonov Qaxramon , Ibragimov Mironshox , Koraboev Fazliddin , Abitova Jasmin
Published: June 2024

See the retraction notice E3S Web of Conferences 538, 00001 (2024), https://doi.org/10.1051/e3sconf/202453800001
RETRACTED: Some actual problems related to Uzbek toponymy
Authors: Safarova Maftuna , Khairullayeva Marjona
Published: June 2024

See the retraction notice E3S Web of Conferences 538, 00001 (2024), https://doi.org/10.1051/e3sconf/202453800001
RETRACTED: Assessment of the effectiveness of the physical education process in preschool educational organizations
Authors: Qo’ldoshev Rustambek , Jumayeva Habiba , Husenova Aziza , Xaitov Lazizbek , Gudzina Victoria , Sanoyev G‘aybullo
Published: June 2024

See the retraction notice E3S Web of Conferences 538, 00001 (2024), https://doi.org/10.1051/e3sconf/202453800001
RETRACTED: Organizing an environment for cooperation of students in the educational process (for ensuring the development of the new Uzbekistan society)
Authors: Safarova Rohat , Khasanova Gulnoz
Published: June 2024

See the retraction notice E3S Web of Conferences 538, 00001 (2024), https://doi.org/10.1051/e3sconf/202453800001
Exploring the impact of fabrication parameters in organic solar cells with PM6:Y6 using machine learning
Authors: Zhao Xiaojie , Lei Min , Wang Kuo , Peng Xinyu , Li Zhennan , Zhou Haixin , Peng Zhiyan , Chen Ziye , Deng Jiahao , Zhang Kang , Huang Di , Liang Jiaojiao
Published: June 2024

The preparation parameters of PM6:Y6 non-fullerene organic solar cells (OSCs) have significant influence on the power conversion efficiency (PCE). Herein, machine learning (ML) models are applied for analyzing the quantitative effects of the PCE on PM6:Y6 non-fullerene OSCs from the perspective of fabrication parameters. Random Forest (RF) model has the best evaluation performance and is considered as the best model among the six different algorithms. The Pearson correlation coefficient, coefficient of determination, root mean square error, mean absolute error, and mean absolute percentage error of the test set in the RF model are 0.836, 0.668, 0.695, 0.538, and 0.035, respectively. In addition, the most important preparation parameters for PCE are the effective area of OSCs, type of solvent and solvent additives, spin-coating speed, total concentration, annealing temperature, annealing time from SHAP analysis. The optimized PCE can be obtained in PM6:Y6 non-fullerene OSCs when the effective area is between 4 and 6 mm2, the spin-coating speed is 3000 rpm, and the total concentration is 18 mg ml−1, respectively. The contour map further reflects that the optimal annealing temperature are 80 or 105 °C, and the corresponding annealing time are 5 or 9 min, respectively. Based on the above preparation conditions, we verified through the experimental design that the optimal PCE is 16.91%, and the relative error with the ML prediction is only 1.24%. Our research provides low time and cost guidance on preparation parameter matching for the development of high-performance the PM6:Y6 non-fullerene OSCs.
Doubly warped product manifolds: Investigations through the projective curvature tensor and relativistic applications
Authors: Syied Abdallah Abdelhameed , Chand De Uday , Turki Nasser Bin , Kumar Rajesh
Published: June 2024

This paper introduces a description of a doubly warped product manifold, taking into account certain conditions related to the projective curvature tensor. We demonstrate that the factor manifolds of a projectively flat (symmetric) doubly warped product manifold possess constant sectional curvature. In the flatness scenario, a doubly warped product manifold reduces to a singly warped product manifold. We establish that the factor manifolds of a doubly warped product manifold with harmonic projective curvature tensor are Einstein manifolds and exhibit harmonic projective curvature tensor. In Sec. VI, we provide evidence that a projectively flat (symmetric) generalized Robertson–Walker space-time is both a perfect fluid and static.
A remark on the set of exactly approximable vectors in the simultaneous case
Authors: Fregoli Reynold
Published: June 2024

We compute the Hausdorff dimension of the set of

ψ
\psi

-exactly approximable vectors, in the simultaneous case, in dimension strictly larger than

2
2

and for approximating functions

ψ
\psi

with order at infinity less than or equal to

−
2

-2

. Our method relies on the analogous result in dimension

1
1

, proved by Yann Bugeaud and Carlos Moreira, and a version of Jarník’s theorem on fibres.
Introduction to solids
Authors: Nitzan Abraham
Published: June 2024

This chapter reviews essential concept of solid-state physics. (1) Lattice periodicity. (2) Lattice vibrations (normal modes of harmonic systems, simple harmonic crystal in one dimension, density of modes, phonons in higher dimensions and the heat capacity of solids). (3) Electronic structure of solids (the free electron theory of metals: energetics and motion, electronic structure of periodic solids: Bloch theory, the one-dimensional tight binding model, the nearly free particle model, intermediate summary: Free electrons versus non-interacting electrons in a periodic potential, dynamical implications of the electronic band structure of solids, semiconductors). (4) The work function. (5). Surface potential and screening (general considerations, the Thomas–Fermi theory of screening by metallic electrons, semiconductor interfaces, interfacial potential distributions).
Time-correlation functions
Authors: Nitzan Abraham
Published: June 2024

This chapter discusses classical and quantum correlation functions and the use of harmonic representations of thermal environments. (1) Time correlation functions in stationary systems. (2) Simple examples (the diffusion coefficient, golden rule rates). (3) Classical time correlation functions. (4) Quantum time-correlation functions. (5) Harmonic reservoir (classical bath, the spectral density, quantum bath, instantaneous normal modes).
Vibrational energy relaxation
Authors: Abraham Nitzan
Published: June 2024

This chapter describe the applications of quantum and classical relaxation theory to vibrational relaxation of molecules interacting with their thermal environments. (1) A model Hamiltonian for a molecule undergoing vibrational relaxation process. (2) Evaluation of vibrational relaxation rates for different model interactions (the bilinear interaction model, nonlinear interaction models, the independent binary collision (IBC) model, multi-phonon theory of vibrational relaxation). (3) Effect of supporting modes. (4) Numerical simulations of vibrational relaxation.
Solvation dynamics
Authors: Nitzan Abraham
Published: June 2024

This chapter analyses the important role of solvation and solvation dynamics in the determination of the course of chemical processes in condensed phases. (1) Dielectric solvation. (2) Continuum dielectric model of solvation—dielectric relaxation and the Debye model. (3) Linear response theory of solvation. (4) Quantum solvation.
Double product reserve is associated with waist circumference but not body mass index in overweight or obese individuals
Authors: Yigit S , Akinci B , Eksi B , Calikoglu F , Satman I
Published: June 2024

Background

Obesity is an independent risk factor for cardiovascular disease (CVD). Excessive accumulation of adipose tissue in the myocardium leads to structural and functional changes. Body mass index (BMI) is a parameter used to classify overweight and obesity, but it does not distinguish fat-free mass from fat mass and cannot be used to assess body fat distribution. Recent research suggests that abdominal obesity, as measured by waist circumference, is a risk factor for CVD independent of BMI.

Purpose

In this study, we aimed to investigate the relationship between double product (DP) reserve as a marker of cardiac workload and body composition in overweight and obese individuals.

Methods

One hundred and forty-one overweight or obese individuals aged 35-65 years (F:105, M:36, mean age=51.48±7.41/years) were included. Body composition (BMI, (mean±SD=35.61±23.31 kg/m2), waist circumference, body fat percentage, waist/hip ratio) was measured. DP was calculated according to the 6-minute walk test (6MWT), which is a submaximal exercise test to estimate myocardial work. It was calculated by multiplying heart rate (HR) by systolic blood pressure (SBP) at rest and after completion of the 6 MWT. DP reserve was calculated as the difference before and after 6MWT.

Results

DP reserve was not significantly different according to obesity classification (p=0.210, eta-squared=0.032, 95% CI=0.00-0.09) (Table1). DP reserve showed a weakly correlation with waist circumference (r=0.188, p=0.026). No significant relationship was observed between DP reserve and BMI, waist-to-hip ratio and body fat percentage (p>0.05).

Conclusion

The results of this study showed that cardiac workload estimated with DP reserve was associated with abdominal obesity but not with other body composition parameters. This finding can be interpreted as increased cardiac stress after submaximal exercise in subjects with increased waist circumference regardless of BMI or body fat percentage in overweight or obese subjects.
Health behaviors and adherence levels of patients with hypertension and type 2 diabetes
Authors: Swiatoniowska-Lonc N
Published: June 2024

Introduction

Diabetes (DM) and hypertension (HA) are one of the most commonly diagnosed chronic diseases. Both conditions are treated with pharmacotherapy but also with lifestyle changes and maintenance of health-promoting behaviors. Failure to adhere to therapeutic recommendations can result in a lack of control of these diseases and an increase in acute and chronic complications.

The aim of this study was to assess the degree of compliance with therapeutic recommendations of patients with HA.

Material and methods

The study included 117 patients with HA. The Adherence to Refills and Medications Scale (ARMS) and the Health Behavior Inventory (IZZ) were used.

Results

The mean level of overall adherence was (17.1±5.2). The group of patients with high adherence scored better in health behavior in the domains: IZZ-sum scores (p<0.001), proper eating habits (p<0.001), preventive behaviors (p<0.001) and health practices (p=0.028). No differences were found for the domain of positive mental attitude (p=0.353). Predictors having a negative effect on adherence and the results of the preventive behavior and health practices domains of the IZZ questionnaire were the absence of comorbidities (r=-0.233, p=0.004) and hyperglycemic episodes (r=-0.180, p=0.027).

Conclusions

Patients adhering to pharmacological recommendations have higher adherence to non-pharmacological recommendations. Patients adhering to both pharmacological and non-pharmacological recommendations achieve better control of diabetes compensation. Independent predictors negatively affecting adherence are the absence of comorbidities and episodes of hyperglycemia.
Efficacy and safety of direct oral anticoagulants versus warfarin in obese patients: a systematic review and meta-analysis of 31 studies
Authors: Karakasis P , Ktenopoulos N , Pamporis K , Sagris M
Published: June 2024

Background

Based on current guidelines and consensus documents, the use of direct oral anticoagulants (DOACs) in obese patients (body mass index [BMI] >30 kg/m2) is not advised, with warfarin being the indicated anticoagulant in this population.

Purpose

The present systematic review (SR) and meta-analysis (MA) aimed to synthesize the existing evidence on the efficacy and safety of DOACs versus warfarin in obese patients with non-valvular atrial fibrillation (AF) or venous thromboembolism (VTE). The primary efficacy outcomes were the composite endpoint of all cause-mortality, stroke, systemic embolism (SE) and myocardial infarction (MI), as well as all-cause mortality. The primary safety outcome was major bleeding.

Methods

A systematic search was performed in MEDLINE, SCOPUS and Cochrane databases from inception to October 3, 2023. Double independent study selection, data extraction and quality assessment was performed. Data were pooled and risk ratios (RR) and 95% confidence intervals (CI) were calculated using random-effects MA.

Results

Totally, 31 studies with 613,968 participants were analyzed. The use of DOACs was significantly associated with reductions in the composite outcome (RR=0.80, 95% CI [0.65, 0.98], I2=95%), hemorrhagic stroke (RR=0.58, 95% CI [0.38, 0.88], I2=92%), major bleeding (RR=0.80, 95% CI [0.67, 0.97], I2=94%), gastrointestinal bleeding (RR=0.59, 95% CI [0.49, 0.72], I2=88%) and intracranial bleeding (RR=0.45, 95% CI [0.34, 0.60], I2=44%) compared to warfarin. Non-significant benefit of DOACs was observed in all-cause mortality (RR=0.78, 95% CI [0.49, 1.23], I2=97%), MI (RR=0.82, 95% CI [0.51, 1.32], I2=88%), the composite of stroke or SE (RR=0.90, 95% CI [0.71, 1.15], I2=94%), ischemic stroke (RR=0.94, 95% CI [0.72, 1.22], I2=93%), SE (RR=0.81, 95% CI [0.63, 1.05], I2=26%), VTE (RR=0.80, 95% CI [0.61, 1.03], I2=89%) and minor bleeding (RR=0.88, 95% CI [0.71, 1.09], I2=77%) compared to warfarin. The subgroup analysis indicated no effect modification based on the indication for anticoagulation or the study design.

Conclusion(s)

The DOACs were associated with significant reductions in clinically relevant efficacy and safety outcomes in obese patients with non-valvular AF or VTE compared to warfarin. Our findings suggest that their use could possibly be safely extended in this patient subgroup.
Diabetic ketoacidosis in patients with type 2 diabetes mellitus receiving sodium-glucose co-transporter-2 inhibitors: The Hong Kong Diabetes Study
Authors: Jing F , Law Q P S , Rafiee H , Chou O H I , Wong W T , Leung B K H , Pui H H H , Wai A K C , Yip C , Liu T , Cheung B M Y , Tse G , Zhou J
Published: June 2024

Background

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have been associated with increased risks of diabetic ketoacidosis in some studies, but not others. Also, few studies have analysed the characteristics of DKA cases nor have they developed risk models to predict DKA.

Methods

This was a population-based cohort study of patients with type 2 diabetes mellitus (T2DM) who were prescribed a SGLT2i between 1st January 2015 and 31st December 2020, with follow-up until 2022.

Results

A total of 28,814 patients (59.54% male, mean age 57.9±11.3 years old) were included. Over 159,000 person-years, 494 patients suffered from DKA and 855 patients died. Multivariable Cox regression identified seven significant predictors of incident DKA: need for financial aid, prior DKA, insulin use, acarbose use, time-weighted mean of HbA1c, fasting glucose and coefficient of variation for fasting glucose. The same predictors remained significant after excluding patients with prior DKA before SGLT2I use. Altogether, it was possible develop a multivariable score-based system, with weightings for risk stratification of incident DKA.

Conclusions

Significant predictors of DKA of SGLT2I use were identified with development of a score-based system for risk stratification. This enables clinicians to identify high-risk patients early and monitor them more closely. Multivariable Cox regression  Risk score for DKA prediction
Statin adherence in coronary outpatients: a novel direct method compared with pharmacy registry data
Authors: Pivoriunas J , Engebretsen I , Vethe N T , Kristiansen O , Dammen T , Fagerland M W , Husebye E , Munkhaugen J , Sverre E
Published: June 2024

Introduction

An optimal method to assess adherence to statin therapy is needed. We have developed a novel test analysing atorvastatin, simvastatin and their metabolites in blood, to identify reduced adherence (≥2 consecutively omitted doses). The association between statin adherence measured in blood and long-term adherence is yet to be defined.

Purpose

To compare statin adherence measured by a single blood test with pharmacy registry data.

Methods

In a cross-sectional study including 451 patients using either atorvastatin or simvastatin, a spot blood sample was collected 2-35 (median 18) months after a coronary heart disease event. Participants were unaware of the forthcoming statin analyses. Reduced adherence to atorvastatin and simvastatin was determined by drug concentration measurements using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Study data was linked to the pharmacy registry. Indirect adherence was defined by a statin treatment gap exceeding 90 days; i. the three months period prior to the blood test, and ii. from six months before until six months after the blood test. We accounted for overlapping prescriptions of statins.

Results

Mean age was 61 (SD 9) years, and 19% were women. Thirty-nine (9%) out of 412 patients had reduced adherence to statins, determined by the direct method. The non-adherent patients had higher LDL-cholesterol levels, higher rates of multiple coronary events, lower participation rates at cardiac rehabilitation, and were more often smokers compared with the adherent patients (Table 1). Among patients classified as adherent by the blood test, only one (0.2%) had a treatment gap exceeding 90 days during the preceding three months (Table 2). Correspondingly, of 39 patients with reduced adherence by the blood test, 11 (28%) had treatment gaps exceeding 90 days. The negative agreement between the methods was 97% and the positive agreement 43%. Among patients classified as adherent by the blood test, 21 (5%) had treatment gaps exceeding 90 days from six months before until six months after the blood test. Correspondingly, of 39 patients with reduced adherence by the blood test, 15 (39%) had at least one treatment gap exceeding 90 days. The negative agreement between measurements was 95% and the positive agreement 40%.

Conclusions

Of 412 coronary outpatients classified adherent by the statin blood test, registry data only identified one patient (0.2%) with a treatment gap exceeding 90 days. The novel blood test emerges as a promising tool to identify patients adherent to statins, and thus may improve lipid management in clinical practice.
Impact of a myocardial infarction emergency management network on population 28-day myocardial infarction case-fatality trends 2008-2019
Authors: Camps-Vilaro A , Tizon-Marcos H , Degano I R , Subirana I , Cainzos-Achirica M , Puig T , Mauri J , Lidon R M , Arbelo E , Marrugat J
Published: June 2024

Introduction

The implementation of emergency care networks (Codi IAM, in our case) has reduced time to treatment of ST-elevation acute myocardial infarction (AMI).

Purpose

We analyzed the hypothesis that the implementation of the Codi IAM should translate into a reduction in population AMI 28-day case-fatality, as more sudden death patients are expected to be reached earlier and appropriately reperfusioned.

Methods

We linked the databases of the Codi IAM registry, the Catalan hospital discharge data and the mortality registry. More than 97,000 AMI patients aged 35-84 years hospitalized or dead between 2008 and 2019 were included. The trends in pre-hospital, in-hospital, and overall 28-day standardized case-fatality 2008-2010, prior to the implementation of the Codi IAM network and in the implementation period (2011-2019) are compared. The Annual Percentage Change (APC) and Spline trends were calculated.

Results

The incidence of AMI decreased after 2011 (p=0.001). In that period, the mean patients’ age decreased from 70 to 67 years, p<0.001, and the percentage of women from 29,2% to 25.7%, p<0.001). Patient comorbidity increased: hypertension (38.8% to 49.9%, p<0.001), diabetes (23.9% to 31.9%, p<0.001) and history of cardiovascular disease (26.5% to 28.5%, p<0.001). Overall 28-day AMI case-fatality decreased significantly after 2010 (p<0.001): mainly due to a significant decrease in pre-hospital case-fatality after that year (p<0.001) (Table 1). Conversely in-hospital case-fatality significantly decreased until 2011 (p<0.001) and remained steady thereafter (p=0,12) (Figure 1).

Conclusions

The observed AMI 28-day pre-hospital case-fatality decreasing trends paralleling the implementation of the emergency network Codi IAM in Catalonia strongly suggest that Codi IAM successfully transferred out-of-hospital otherwise sudden death patients, to treating hospitals, with barely any change in in-hospital case-fatality.
Prognostic value of computational pressure-flow dynamics derived fractional flow reserve among non-ST-elevation myocardial infarction and unstable angina patients
Authors: Sze H , Leung K L C , Yiu K H
Published: June 2024

Computational pressure-flow dynamics derived fractional flow reserve (caFFR) is a novel index to assess the severity of coronary artery stenoses without requirement of invasive pressure wire and hyperaemic stimulus in fractional flow reserve (FFR) measurement. Non-ST-elevation myocardial infarction (NSTEMI) and unstable angina (UA) is the most and second most common acute coronary syndrome, respectively. However, whether selective PCI guided by caFFR in addition to angiography can provide further clinical benefit is unclear for patients presenting with NSTEMI and UA. The aim of this study is to investigate the prognostic value of caFFR among NSTEMI and UA patients.

A total of 1449 vessels in 483 patients that presented with NSTEMI or UA (mean age=67.0±12.3, 67.9% male) were retrospectively analysed for caFFR. Patients had undergone PCI according to the angiographic and clinical data available at the time. Vessels were said to be adherent to caFFR if ischemic vessels, defined by caFFR≤0.8 had been treated with PCI and non-ischemic vessels, defined by caFFR>0.8 had not been treated by PCI. Otherwise, they were considered non-adherent to caFFR. The primary endpoint was the vessel-oriented composite endpoint (VOCE), defined as vessel-related cardiovascular mortality, vessel-related myocardial infarction (MI) and unplanned revascularisation at median 4.4 years follow-up. Survival curves were constructed using Kaplan-Meier estimates and differences between groups were tested using the log-rank test. Cox proportional hazards model was used to evaluate the association between adherence to caFFR and the risk of VOCE, with parameters with P<0.1 upon univariate analysis entered into multivariable Cox model.

Among the 1449 vessels, caFFR was analysable in 1020 (70.4%) vessels, with 802 (78.6%) vessels that received treatment adherent to caFFR and 218 (21.4%) vessels that received treatment non-adherent to caFFR. Adherent vessels had significantly lower incidence rates of VOCE (11.2% vs 18.3%; P=0.005) and MI (2.0% vs 9.2%, P<0.001) compared to non-adherent vessels. This was primarily driven by reductions in the incidence of VOCE (18.0% vs 28.9%; P=0.026) and MI (2.4% vs 15.7%; P<0.001) in ischemic vessels that underwent PCI compared to ischemic vessels that did not undergo PCI. After multivariate adjustment, adherent vessels had a significantly lower risk than non-adherent vessels in terms of VOCE (HR 0.59; 95%[Cl] 0.41-0.86; P=0.006) and vessel-related MI (HR 0.22; 95%Cl 0.11-0.42; P<0.001).

In patients presenting with NSTEMI or UA, revascularization that was adherent to caFFR guidelines was associated with a significant reduction in VOCE. The findings support the potential use of caFFR in treatment guidance of NSTEMI and UA patients. Kaplan-Meier plots for VOCE  Kaplan-Meier plots for vessel-related MI
Assessing the impact of air pollution on major adverse cardiovascular events. Insights from the EP-PARTICLES Cohort Study in Eastern Poland
Authors: Kuzma L , Kurasz A , Swieczkowski M , Gajewska-Bachorzewska H , Tomaszuk-Kazberuk A , Dobrzycki S , Lip G H
Published: June 2024

Introduction

Exposure to air pollution (AP) is a modifiable risk factor for cardiovascular diseases (CVD).

Objective

To analyze the short-term and long-term health effects of AP on the occurrence of major adverse cardiovascular events (MACE).

Methods

A spatio-temporal analysis was conducted on the EP-PARTICLES cohort during the years 2011-2020 (N=80,077,671 patients-years), residents of Eastern Poland. The MACE endpoint included the occurrence of STEMI, NSTEMI, or CVD mortality. The sources of medical data were NFZ (National Health Fund) and GUS (Central Statistical Office). The analysis utilized data from the GEM-AQ air quality modeling system and panel-time methods. Analyses were conducted at the municipality level (LAU -2) for an increase of interquartile range in AP concentrations. In the second stage we pooled municipality-specific estimates with a random-effects meta-analysis. To estimate the overall shape of the associations between air pollutant concentrations and MACE at the national level, we plotted meta concentration–response curves.

Results

Between 2011-20, there were 139,697 cases of ACS (45.2% STEMI); 831,246 deaths (including 45.4% CVD N=377,344), with a median age of 79 [67–86], and 50.5% male. WHO air pollution concentration standards were exceeded annually with a decreasing trend in concentrations (Kendall's tau -0.778, P<0.001). The main triggers for MACE were PM2.5 (RR LAG0-1 1.04 95%CI 1.028-1.053) and BaP (RR LAG0-1 1.021 95%CI 1.01-1.032). An increase of up to 10% in MACE related to the monthly increase in concentration was noted: PM2.5 (RR LAG0-30 1.098 95%CI 1.043-1.154), BaP (RR LAG0-30 1.033 95%CI 1.026-1.041). The percentage of hospitalizations that can be linked to air pollution is 20% for STEMI (N=12,500), after 13% of CVD deaths (N=47,474) and NSTEMI (N=10,200), which translates into 71,440 lost years of life (YLL) over the analyzed decade. These effects were 5% higher in the female group vs. male and 9% in the group <65 vs. >65 years of age (p<0.001).

Conclusions

Particulate matter and BaP are significant factors associated with the occurrence of MACE, with young women being the most at-risk group. Exposure to air pollution should be included in CVD prevention models. The losses associated with premature mortality and living with illness indicate an urgent need for systemic changes in public health.
Differences in blood pressure and heart rate variability between individuals with and without coronary artery calcification during prolonged high-intensity endurance exercise
Authors: Svane J , Wiktorski T , Eftestol T C , Orn S
Published: June 2024

Background

Physical exercise is associated with increased life duration and improved life quality. Paradoxically, high exercise intensity is also associated with increased coronary artery calcification (CAC) and a small but significant increased risk of myocardial infarction and cardiac death during high-intensity exercise. This study compares cardiovascular hemodynamic measures and heart rate variability (HRV), which may impact cardiac function, during prolonged high-intensity exercise in individuals with and without CAC.

Methods

A total of 56 healthy, middle-aged (51.0 [43.0-58.0] years [median, (Q1-Q3)]) individuals (41 men/15 women) participating in a 91-km (251.2 [217.2-271.6] minutes) leisure sport mountain bike race were included in this study. Computer tomography coronary angiography after the race demonstrated CAC in 25 participants (20 men/5 women), defining them as CAC+. The other participants without CAC were defined as CAC-. The study subjects were assessed using hemodynamic measures and HRV at the top of the hardest hill (THH) towards the end of the race.

Results

Comparing hemodynamic measures after THH demonstrated that CAC+ individuals had significantly higher systolic blood pressure (235.0 [225.0-245.0] mmHg vs 220.0 [192.5-237.5] mmHg, p=0.008), higher diastolic blood pressure (DBP) (105.0 [95.0-110.0] mmHg vs 95.0 [85.0-110.0] mmHg, p=0.006), higher pulse pressure (130.0 [125.0-140.0] mmHg vs 123.0 [110.0-130.0] mmHg, p=0.039), higher mean rate pressure product (33882 [30872-35053] bpm×mmHg vs 31028 [27392-33047] bpm×mmHg, p=0.028), and larger increase in DBP from baseline (20.0 [20.0-30.0] mmHg vs 10.0 [0.0-20.0] mmHg, p=0.001), compared with CAC- individuals. The CAC+ individuals had a significant reduction in the low frequency (LF) component of HRV (6.3 [2.4-11.5] ms² vs 12.4 [6.8-20.2] ms², p=0.044). In multivariate analysis, LF was an independent predictor of presence of CAC even after adjusting for established risk factors of atherosclerosis.

Conclusion

Individuals with calcified plaques had significant alterations in hemodynamic measures and LF following prolonged high-intensity exercise compared to individuals without CAC. LF was an independent predictor of presence of CAC suggesting a potentially pathological autonomic response to high intensity exercise in individuals with CAC.
Young patients with acute myocardial infarction: early screening is warranted
Authors: Lagoas Pohle C , Silva Ferreira J , Antunes Coelho R , Quintal J , Bernardes P , Esteves A F , Sa C , Seixo F
Published: June 2024

Background

Acute Myocardial Infarction (AMI) remains a significant cause of morbidity and mortality in young individuals, although relatively under-studied, with no consensus on a cutoff value for this definition.

Purpose

The purpose of this study was to compare the cardiovascular risk factors and characteristics of acute coronary events in a population of younger versus older AMI patients.

Methods

A retrospective analysis of consecutive AMI patients admitted to the Cardiology Department from November 2021 to October 2022 was conducted.

The population was evaluated according to basal characteristics. We divided the population in two groups: young AMI patients (YAMI) (defined as ≤50 years) and older AMI patients (defined as >50 years), which were compared according to demographic and index-hospitalization variables, co-morbidities, analytical and echocardiographic data and adverse events.

Results

A total of 390 patients (71.3% males) with a mean age of 66.6 ± 12.3 years were included.

The characteristics of the two groups are described in Table 1.

The YAMI group (n=38) had a median age of 46.0 years (IQR 43-48) and 86.8% were male. In this group of patients, 42.1% had a known diagnosis of hypertension, 39.5% had dyslipidemia, 39.5% had type 2 diabetes, 26.3% were obese and 76.3% were smokers. ST-elevation myocardial infarction (STEMI) presentation occurred in 68.4% and multivessel disease was observed in 31.6% of the YAMI group.

Patients in the YAMI group were predominantly male (p = 0.026), smokers (p < 0.001) and with a family history (FH) of AMI (p = 0.007). STEMI was more likely in the YAMI group (p = 0.007), which had higher LDL-cholesterol (p = 0.007) and total cholesterol levels (p = 0.003), but lower glycosylated hemoglobin values (p = 0.005).

Conclusion

This study emphasizes that YAMI patients in this population exhibit greater metabolic dysregulation, evidenced by higher LDL, and total cholesterol levels, highlighting the importance of early screening and intervention in younger patients with cardiovascular risk factors (namely smokers) and with a family history of AMI.
Cardiac rehabilitation versus percutaneous coronary intervention for stable angina pectoris: effects on major adverse cardiovascular events and associated healthcare costs
Authors: De Koning I , Heutinck J M , Vromen T , Bakker E A , Maessen M F H , Smolders J , Eijsvogels T M H , Grutters J P C , Kemps H M C , Thijssen D H J
Published: June 2024

Background

Stable angina pectoris is commonly treated with percutaneous coronary intervention (PCI), but cardiac rehabilitation (CR) may represent a potential alternative effective treatment.

Purpose

The purpose of the study was to compare the effects of CR versus PCI on major adverse cardiovascular events (MACE), new revascularisations (PCI and coronary artery bypass grafting), chest pain and associated healthcare costs over a period of 24-months in patients with stable angina pectoris.

Methods

We performed a retrospective cohort study using a database from a Dutch health insurance company. Patients diagnosed with stable angina pectoris between January 2013 and July 2018 who received a treatment of PCI only or CR only were included. To create comparable groups, propensity score matching based on age, sex, respiratory diseases, dementia, diabetes and use of cardiovascular medication was used. Post-treatment MACE (ischemic events, acute heart failure and mortality), new revascularizations (PCI and coronary artery bypass grafting) and chest pain were recorded during 24-month follow-up, whilst we also calculated healthcare costs associated to cardiovascular events and stable angina pectoris treatment.

Results

Of 4,724 eligible patients, 1,682 patients were matched and included in the analysis. Following propensity score matching, the CR (n=841) and PCI (n=841) group did not differ regarding patient characteristics. We found significantly fewer MACE following CR (n=239 (28.4%)) compared to PCI (n=367 (43.7%), p<0.001) within 24-month follow-up (hazard ratio 0.54; 95% confidence interval, 0.46-0.64). Following CR, significantly fewer PCIs and coronary artery bypass grafts were performed than following PCI (PCI: hazard ratio 0.71, 95% confidence interval: 0.79-1.01; CABG: hazard ratio 0.18, 95% confidence interval: 0.04-0.81 ). Prevalence of chest pain did not significantly differ between both groups. Healthcare costs, including treatment and cardiovascular events during follow-up, were significantly higher in PCI (€7386; 95% confidence interval, €7067-€7704) compared to CR (€4468; 95% confidence interval, €4221-€4715, p<0.001).

Conclusion

We found that CR in patients with stable angina pectoris was associated with significantly fewer MACE and lower healthcare costs compared to PCI during a 24-month follow-up. These findings indicate that in a selection of patients with stable angina pectoris, CR might be a cost-effective alternative to PCI.
Unlocking the mystery. Exploring the relationship between PFO anatomical features and the right to left shunt size
Authors: Kalesi A E , Karakosta M , Maritsa D , Ntiloudi D , Gardikioti V , Archontikis A , Karaminas N , Ntalekou K , Plaitis A , Arnas N , Kasinos N , Destounis A , Zachos P , Patsourakos N , Theodosis - Georgilas A
Published: June 2024

Introduction

The contributory role of a patent foramen ovale (PFO) in stroke pathogenesis remains a subject of debate. This study endeavors to elucidate a potential association between the anatomical characteristics of PFOs and the size of right-to-left (R-L) shunt.

Material and methods

This retrospective investigation was performed in a tertiary center and included individuals aged 18 to 65 who presented with cryptogenic stroke between January 2018 and June 2023, and in whom a transesophageal echocardiogram was conducted as part of the comprehensive assessment for stroke etiology, revealing the presence of a PFO.

PFO dimensions, including length (overlap between septum primum and septum secundum), maximum atrial septal displacement (towards both the left and right atrium), and height (maximal separation between septum primum and septum secundum), were measured. Additionally, the size of the right-to-left shunt (classified as small or moderate with <30 bubbles and large with >30 bubbles) was assessed.

Statistical analysis was performed using non-parametric tests (Mann-Whitney test), and the predetermined level of statistical significance was set at p < 0.05.

Results

Among the 250 patients subjected to transesophageal echocardiography, 76 individuals (58 males) were identified with a PFO, accounting for 30.4% of the cohort. The median age of patients with PFO was 52 years (range 20-65 years). Of these 76 patients, 44 (57.9%) exhibited a large PFO, while 32 (42.1%) had a small or moderate shunt. In those with a small-moderate shunt, the mean values for PFO length, maximal atrial septal displacement, and PFO height were 10.8±4.7, 10.3±4.2, and 3.8±1.2, respectively. In the sub-group of patients with large R-L shunt, the mean values for PFO length, maximal atrial septal displacement and PFO height were 11.8±4.1, 10.5±3.6, and 4.8±1.5, respectively. In the subset of patients exhibiting large shunts, the measured PFO height values were statistically significantly higher compared to the other subgroup (p=0.001) (figure 1). While PFO length and maximal atrial septal displacement values in the large shunt subgroup were numerically greater, no statistically significant differences were observed between the two groups (figure 2).

Conclusions

The PFO height seems promising as a potential predictor for the size of the right-to-left shunt. Nonetheless, comprehensive epidemiological studies are warranted to further explore the correlation between PFO characteristics and infarct size.
Differences in left atrial functionality between individuals with ischemic stroke and healthy controls: a comparative analysis
Authors: Kalesi A E , Karakosta M , Maritsa D , Ntiloudi D , Vasiliadou A , Tzinieris T , Kalivi A , Konstantara A , Zampelis D , Skantzikas P , Kapsokoli C , Theodosis - Georgilas A , Destounis A , Patsourakos N , Kasinos N
Published: June 2024

Introduction

Recent findings highlight the critical involvement of atrial cardiomyopathy in the pathophysiology of embolic strokes of unidentified source (ESUS). Newer echocardiographic indices, such as the left atrium (LA) peak reservoir strain (LARS), present promising tools for evaluating left atrial (LA) function and gaining insights into the role of atrial myopathy in this specific patient population. The objective of this study was to compare left atrial strain values between patients with ischemic stroke and healthy individuals.

Material/methods

This retrospective study was conducted at a tertiary center and included individuals aged 18 to 65 with stroke and no prior history of atrial fibrillation or carotid artery disease who underwent a transesophageal echocardiogram between January 2018 and June 2023.

Fifty patients were excluded due to insufficient data. Gender and age-matched healthy individuals were also enrolled. The left atrial strain was quantified using the speckle-tracking method in the apical four-chamber view.

Statistical analysis was performed using non-parametric tests (Mann-Whitney test), and the predetermined level of statistical significance was set at p < 0.05.

Results

A total of 197 patients with stroke were included in the study, comprising 128 men (65.1%) and 83 healthy individuals, of which 52 were men (62.7%). Among the stroke patients, 64 individuals (32.5%) were identified to have a patent foramen ovale (PFO). The median age for both sub-groups of stroke patients (with and without PFO) was 52 years (range 20-65 years), while the healthy individuals had a median age of 49 years (range 19-63 years).

The left atrial strain (LARS) values exhibited a statistically significant difference (p=0.032) between the healthy individuals’ group (mean rank 156.5) and the stroke patients group (mean rank 133.8), with higher values observed in the healthy cohort (Figure 1). Within the stroke patient group, those with PFO had significantly elevated LARS values (mean rank 117.25) compared to those without PFO (mean rank 91.63), demonstrating a notable difference with a p-value of 0.003 (Figure 2).

Conclusions

Our study reveals a noteworthy distinction in left atrial strain (LARS) values between stroke patients and healthy individuals, with stroke patients demonstrating significantly lower LARS values. Additionally, within the stroke group, individuals with a patent foramen ovale (PFO) present higher LARS values compared to those without PFO.
Accuracy of nine artificial intelligence chatbots in replying in accordance with the 2023 ESH guidelines for the management of arterial hypertension
Authors: Ioannidis A , Tsounis D , Bouras G , Pantelas N , Pechlevanis A , Gkavoudi K , Stravodimou N , Sidera C , Markidou E , Kafkia T
Published: June 2024

Background/Introduction

The emergence of artificial intelligence (AI) models has created new opportunities in the medical field. The potential of AI chatbots to deliver timely, reliable medical information is one of its promising features.

Purpose

Our goal was to assess how well online AI chatbots could respond in accordance with the 2023 ESH Guidelines for the management of arterial hypertension.

Methods

We structured 20 questions covering issues that have been included in the recommendations of the 2023 ESH Guidelines. Fifteen questions required simple answers (e.g. What is the systolic blood pressure threshold for initiation of drug therapy in patients ≥80 years? Should we use cuffless blood pressure devices for the evaluation of hypertension in clinical practice?). The questions were fed to nine free online chatbots. The responses were recorded and evaluated by three experienced cardiologists with special interest in hypertension. To assess consistency, each question was asked three times, though only the first response was included in the accuracy analysis. All questions were preceded by "According to the 2023 ESH Guidelines for the management of arterial hypertension". A response was considered "accurate" if it included all essential information, "inaccurate" if it was not in accordance with the guidelines, and "incomplete" if any essential information was missing.

Results

In total there were 180 responses recorded. A total of 82 (45.6%) responses were deemed accurate, ranging from only 4 out of 20 (20% for deepai.org) to 16 out of 20 (80% for Google-PaLM) (see Figure). Eighty (44.4%) of the responses were judged as inaccurate and 18 (10%) as incomplete. Only one question got accurate responses from all nine chatbots and there were three questions with accurate replies from only one chatbot (different chatbot for each question). Moreover, 293 out of the 360 regenerated responses were consistent with the initial answer (81.1%). No chatbot would have replied accurately to every question even if the regenerated responses were to be considered.

Conclusion(s)

The study resulted in a variation in the accuracy of the responses generated by nine popular online AI chatbots when asked about issues covered in the recommendations of the 2023 ESH Guidelines on arterial hypertension. While the use of chat-based AI in medicine is still in its early stages and current models are not intended for medical use, the potential for such technology is significant. The debate is still ongoing about what level of accuracy is thought to be acceptable.