bluuebunny/crossref_metadata_2025 huggingface dataset:
Optimal landmark for chest compression during cardiopulmonary resuscitation derived from a chest computed tomography in arms-down position
Authors: Usawasuraiin P , Wittayachamnankul B , Euathrongchit J , Phinyo P , Tangsuwanaruk T
Published: February 2022

Funding Acknowledgements

Type of funding sources: Private hospital(s). Main funding source(s): The Faculty of Medicine, Chiang Mai University Fund

Background

Recently evidence, compression at the maximal left ventricular diameter on sternum (LVmax) maximises cardiac output, stroke volume and rate of return of spontaneous circulation. However, there is insufficient evidence for the specific landmark on the chest for high-quality chest compression. Although cardiac arrest patients are usually in the arms-down position, previous studies used chest computed tomography (CCT) of the patient with arms-up position. It might alter the left ventricular position.

Purpose

This study aimed to identify the landmark of LVmax and to propose the new hand placement to optimise the chest compression by using CCT in arms-down position.

Methods

A retrospective, cross-sectional study conducted at a university-based, tertiary care hospital between September 2016 and November 2020. We included adult patients who underwent CCT in arms-down position. We measured healthcare providers’ hand heel width and the cardiothoracic parameters in CCT to establish a new optimal landmark of chest compression. We defined the sternal notch as a reference point and measured the distance from the sternal notch to LVmax (DLVmax), to the lower half of sternum (DLH), and to the point of maximal force of hand which placed the palmar margin of the reference hand at the xiphisternal junction (lower end of the sternum).

Results

A total of 39 patients were enrolled to measure the cardiothoracic parameters. There were 22 male (56.4%) and the median age was 67 years. DLVmax was neither different in inspiratory-hold nor expiratory-hold (mean ± standard deviation: 12.1 ± 1.9 cm and 12.9 ± 2.7 cm, p = 0.386). LVmax was located lower than the lower half of the sternum (Figure 1); the median of DLVmax and DLH were 12.6 cm (interquartile range: 10.6, 13.5 cm) and 10.0 cm (9.5, 11.0 cm), respectively (p <0.001). We found that the distance from the sternal notch to the point of maximal force of the left hand which the ulnar border located at the xiphisternal junction (DLU) was not significantly different from DLVmax (Figure 2); the median of DLVmax and DLU were 12.6 cm (10.6, 13.5 cm) and 11.3 cm (10.6, 12.5 cm), respectively (p 0.076).

Conclusions

The maximal left ventricular diameter on sternum (DLVmax) in the arms-down position was located lower than the lower half of the sternum (lower than the standard guideline recommendation). We propose that the new hand placement for chest compression is placing the left hand down and the hand’s border located at the xiphisternal junction while approach at left side of the patient. Abstract Figure.  Abstract Figure.
Intravenous epoprostenol therapy in the treatment of pulmonary arterial hypertension: the Singapore experience
Authors: Choo J , Yap J , Ismail AIDILA , Lim C L , Sumathy P , Ruan W , Sewa D W , Phua G C , Hong C , Low A H L , Lim S T , Tan J L
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Pulmonary arterial hypertension (PAH) is a progressive disease with significant morbidity and mortality. While intravenous (IV) Epoprostenol, a prostacyclin analogue, has been shown to improve exercise tolerance, symptoms, hemodynamics and survival, there are challenges with initiation and maintenance of this IV therapy.

Purpose

We aim to describe our local experience of the use of IV Epoprostenol in the treatment of PAH patients in Singapore, highlighting various issues and challenges.

Methods

From 2016, patients at a tertiary cardiac institution diagnosed with Group 1 PAH and remaining in intermediate to high risk class with progressive symptoms (despite being on maximum tolerable doses of PhosphoDiEsterase-5 inhibitors and Endothelin-1 receptor antagonists) were assessed and counselled for initiation of Epoprostenol therapy. With a fixed set of local protocols, comprehensive assessment and support of a multi-disciplinary team including physicians, specialist nurses and pharmacists, suitable patients were started on this treatment.

Results

A total of 12 patients (11 female, mean age 42.8 +/- 11.0 years) were included. The average New York Heart Association class of the patients initiated on Epoprostenol was II-III. The pulmonary artery pressures and pulmonary vascular resistance on right heart catheterization prior to initiation was 52.5 (IQR 47.0-54.0) mmHg and 12.6 (IQR 10.0-14.2) Woods respectively. The duration from diagnosis to time of initiating Epoprostenol was 89 (IQR 62-140) months. Epoprostenol was generally well tolerated. The most common side effect experienced was diarrhea (5/12 patients) followed by headache and musculoskeletal complains (3/12 patients each). Of the 12 patients, 6 passed away after 12 (IQR 10-16) months of Epoprostenol therapy. Of the remaining 6, PAH was diagnosed 110 (IQR 104-136) months ago and Epoprostenol therapy has been continued for 17 (IQR 14-27) months. Of those who survived, right ventricle size and PA pressures on echocardiography remained relatively stable as compared to those who passed on. 2 patients had line related infections requiring a line change 1 and 2 times respectively.

Conclusion

While not without its challenges, the establishment of concrete protocols with the support of a multidisciplinary team allows for the introduction of IV Epoprostenol as an additional potential line of effective therapy for PAH patients in Singapore.
The Clinical Experience of Macitentan in pulmonary hypertension in Indian cohort: 12-months follow-up
Authors: Jariwala PANKAJ , Jadhav KARTIK
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

AIM AND OBJECTIVE

Macitentan, an endothelin receptor antagonist, has been shown to be effective and safe in the treatment of pulmonary arterial hypertension (PAH) in multiple randomized clinical trials, including SERAPHIN, focusing on morbidity and mortality reduction. The goal of this study was to show the clinical and echocardiographic improvement with macitentan in Indian patients with PAH.

METHODS

We conducted a retrospective study of 20 patients with various etiologies of PAH who received macitentan treatment in a single institution between June 2018 and June 2019. Of the total cases, 55% of the patients took conventional PAH therapies. We assessed the World Health Organization functional class (WHO-FC), 6-minute walking distance (6MWD), N-terminal prohormone brain natriuretic peptide level (NT-pro-BNP), and echocardiographic data such as tricuspid annular plane systolic excursion (TAPSE), systolic pulmonary artery pressure (sPAP), and the presence of pericardial effusion at baseline and 12-month follow-up.

RESULTS

The study involved 20 PAH patients, 70 % of whom were female. The majority (50%) were in WHO FC II, while 35% were in FC III, and 15% were in FC IV. At the start of the macitentan therapy, the average age was 43.4 years. After 12-months of macitentan medication, 85% of patients showed significant improvement in their FC, 6-minute walking distance test (p < 0.0001; Fig.-1), and plasma levels of NT-pro BNP were significantly reduced (p < 0.0001). Echocardiographic parameters such as TAPSE and sPAP have also improved (p < 0.0001).

CONCLUSION

Our findings indicate that macitentan has been well-tolerated and beneficial in Indian patients with PAH, and further future research is required to verify these results. Abstract Figure.
Direct oral anticoagulant vs low molecular weight heparin for the treatment of venous thromboembolism associated with malignancy: a meta- analysis
Authors: Lastimosa H
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Venous thromboembolism (VTE) is a major cause of morbidity and mortality in cancer patients and treatment of cancer associated thromboembolism is challenging. Low molecular weight heparin (LMWH) has been the standard of care treatment for cancer-associated VTE yet the use of direct oral anticoagulant (DOACs) has been promising.

Purpose

To determine the efficacy and safety between direct oral anticoagulants compared to low molecular weight heparin in recurrent VTE prevention cancer associated thromboembolism.

Method

Randomized controlled trials (RCT) comparing DOACs with LMWH for treatment of VTE in cancer patients.

Results

Four randomized controlled trials were selected which included a total of 2,894 participants enrolled in 4 randomized controlled trials, with a mean follow-up of 6-12 months. As a pooled aggregate, oral anticoagulant is beneficial over dalteparin in the prevention of recurrent VTE. (RR 0.75; 95% CI, 0.59-0.95; I2 59%). The safety of oral anticoagulant compared to dalteparin, there was statistically no significant difference in the major bleeding risk. (RR 1.35; 95% CI, 0.93-1.94; I2 28%). Sub-group analysis of clinically relevant non major bleeding however favors the dalteparin over oral anticoagulant. (RR 1.59; 95% CI, 1.23-2.05; I2 41%).

Conclusion

In this meta-analysis, the efficacy of direct oral anticoagulant in terms of recurrent VTE prevention for patients with cancer is favorable or at least similar to that of dalteparin. Though safety profile has no significant difference in terms of major bleeding between the two groups, oral anticoagulants has a higher risk of clinically non-major bleeding. Abstract Figure. Forest plot for recurrent VTE  Abstract Figure. Forest plot for major bleeding
Three year clinical outcomes of fractional flow reserve guided coronary revascularization using a monorail pressure sensor microcatheter
Authors: Bhavnani C D , Koh K T , Oon Y Y , Pang I X , Tan C T , Chen L S , Shu F E P , Ho K H , Cham Y L , Ling H S , Said A , Thien L K , Chung B K , Fong A Y Y , Ong T K
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Fractional flow reserve (FFR) has a Class 1A recommendation for guiding coronary revascularization in stable coronary artery disease. Deferral of revascularization for coronary stenosis of FFR >0.80 has shown favorable long-term outcomes, yet the adoption in real-world practice is limited. To date, there is no study on FFR guided PCI in the Malaysian population.

Objective

(1) To explore the 3-year clinical outcome of FFR guided coronary revascularization.

(2) To compare the clinical outcome of FFR guided deferral of coronary revascularization versus FFR guided revascularization. The primary outcome was a composite of all cause mortality, non fatal myocardial infarction (MI) and ischemia driven target vessel revascularization (TVR)

Results

Thirty-five patients were lost to follow up leaving 78 patients (95 vessels) for final analysis. The mean age was 59.3 ± 9.4 years old. 69 (88.5%) patients were male, 24 (30.7%) had diabetes mellitus, 58 (74.3%) had dyslipidemia, 61 (78.2%) had hypertension and 45 (57.7%) were smokers. The mean LVEF was 56.7 ± 14.7%. FFR to the LAD artery was performed in 64 (82%) patients. Based on the FFR value of 0.80, 47 (60.2%) patients had FFR guided deferral of coronary revascularization and 31 (39.7%) patients had FFR guided revascularization.

At 3 years, 11 (14.1%) patients met the primary outcome, mainly driven by all-cause mortality (11.5%). The primary outcome was met in 14.9% of FFR guided deferral versus 12.9% of FFR guided revascularization (p = 0.828). All-cause mortality was 12.7% in patients with FFR guided deferral compared to 9.7% in patients with FFR guided revascularization at 3 years (p = 0.712). 

Cox proportional hazards model did not demonstrate any independent predictors associated with the primary outcome or all cause mortality. 

Conclusion

FFR guided deferral of revascularization was safe and had comparable long-term clinical outcomes to FFR guided PCI. To our knowledge, this is the first study on long-term clinical outcome on FFR guided revascularization in Malaysia. Abstract Figure. Kaplan-Meier curve primary end point  Abstract Figure. Kaplan-Meier curve all cause mortality
Standardized LocSSIPs improves risk prevention for in-patient angioplasty in tertiary care hospital
Authors: Kyaw K
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

acute cardiovascular care

Introduction

There are no established ESC/NICE guidelines for acceptable Safety Checklists in invasive coronary angiogram. A lack of Quality Assurance Checklists that is indicated by WHO guidelines for coronary angiogram can lead to potentially serious or life-threatening implications such as acute pulmonary and venous thromboembolism, stent thrombosis due to delays in anti-platelet therapy and thromboprophylaxis.

Purpose

A LocSSIPS audit was conducted to investigate poor compliances of Patient Safety Checklists that are indicated per WHO guidelines. Further objectives were to understand the reasons for poor compliance and to formulate local guidelines to standardize checklists for angioplasty.

Methods

A total of 50 patients were assessed for poor compliance in safety checklists from 1st April 2021 to 16thJuly 2021.Out of these 30 received coronary angioplasty (study population for the audit). Poor compliance counted from the day evidence to implants was recorded in local Safety checklist elements. Compliance was assessed in different steps as compliances in anti-platelet therapy, Venous Thrombo-prophylaxis and female aged 11-55 years taken pregnancy test prior radiation exposure and implant verification. An acceptable audit standard was devised as 100% of compliance in Safety Checklists for all patients undergoing angioplasty.

Results

 It was found that only 20 out of 30 patients (67%) achieved the audit standard of FULL compliance. In 10 of the 30 patients, who did not meet the audit standard, the main reasons are lack of VTE prophylaxis, anti-platelets drugs, and implant sterility. A standardized safety checklist was hence devised to improve upon quality of angioplasty. This involved designating the on-call cardiology registrar to flag up the Venous Thrombo- prophylaxis and anti-platelet therapy checks for patients undergoing invasive coronary angiogram.  An electronic LocSSIPs checklist was also devised with alerts to Interventional cardiologists and the procedure booking team. A multi-professional team discussion of raising poor compliance is held in the monthly Clinical Governance meeting as a quality control measure with creation of an Ongoing annual re-audit following implementation of recommendation.

Conclusion

The incorporation of audit recommendations in local cardiology guidelines has led to significant improvement in patient quality of care and potential reduction in risk of serious outcomes due to poor compliance in safety checklists for invasive coronary angiogram. Abstract Figure. Overall Score Percentage Data Analysis  Abstract Figure. Average Percentage Score Data analysis
Initial clinical experience with a new sheathless guiding catheter designed for direct insertion
Authors: Borrie A , Fairley S , Harding S A
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Radial access for percutaneous coronary intervention (PCI) is growing rapidly as this approach has been shown to improve patient comfort and reduce complications. Use of a sheathless guiding catheter for transradial PCI has the potential reduce trauma to the radial artery and to further expand the type of cases where this approach can be utilised. The new Sheathless Hyperion system allows direct insertion of the Sheathless Hyperion guiding catheter using a 20 G needle or IV cannula, a 0.25" Silverway wire and a custom dilator.

Purpose

We report the first clinical experience with the new Sheathless Hyperion guiding catheter designed for direct insertion.

Methods

We prospectively evaluated outcomes in consecutive patients who underwent PCI using the Sheathless Hyperion catheter at our institution between June 2020 and March 2021.  All procedures were performed via radial access. There were no exclusion criteria.

Results

Eighty one patients were included with 99 lesion being treated using 85 Sheathless Hyperion catheters. Mean age 67.7 ± 11.8 years, 77.8% male, 22.2% diabetic and 38.8% had acute coronary syndromes. The Sheathless Hyperion was inserted directly into the radial artery in 46 (54.1%) cases with 100% success rate and inserted following initial sheath insertion for the remaining 39 (45.9%). Of the Sheathless Hyperion catheters used 30 (35.3%) were 6F in 55 (64.7%) were 7F. The Sheathless Hyperion was passed into the ascending aorta successfully in all cases. The target coronary artery was successfully engaged in 85 (98.8%). In one case the coronary could not be engaged because of excessive brachiocephalic tortuosity and conversion to femoral access occurred. In 4 cases the Sheathless Hyperion catheter had to be exchanged for one with a small curve. The majority of lesions were complex: 18.2% CTO, 39.4% heavily calcified, 44.4% long lesions and 31.3% bifurcation lesions. Adjunctive devices included rotational atherectomy (12.1%), intravascular lithotripsy 14.1%, IVUS (56.6%) and OCT (28.3%). Angiographic success was achieved in 100%. Peri-procedural non-ST-elevation myocardial infarctions defined by the 4th Universal definition occurred in 3 (3.7%) patients. No patient meet the SCAI criteria for periprocedural MI. There was no in-hospital target vessel revascularisation or death. Radial artery occlusion was infrequent occurring in one patient.  No major haematomas or vascular complications occurred.

Conclusion

First clinical experience with the Sheathless Hyperion demonstrates that direct insertion is safe and effective and that it allows complex interventions to be undertaken transradially with a high success rate.
Early impact of COVID-19 pandemic on heart transplant volumes in Asia and Oceania: results from the Global Observatory on Donation and Transplantation (GODT)
Authors: Manla Y , Bader N , Bajwa G , Gobolos L , Alsindi F , Hamour I , Ghalib H , Al Badarin F
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Massive demand for healthcare services worldwide following the emergence of coronavirus disease 2019 (COVID-19) has limited the availability of healthcare resources needed for certain high-complexity procedures, including orthotopic heart transplantation (OHT). Whereas the negative impact of COVID-19 pandemic on several elective procedures has been well-documented, data on regional changes in OHT volumes after COVID-19 are limited. Therefore, we aimed to quantify the impact of COVID-19 pandemic on OHT volumes in Asia and Oceania.

Methods

Using data from the Global Observatory on Donation and Transplantation (GODT), the world"s most comprehensive source of data on organ donation and transplantation, we recorded the number of OHT procedures performed in years 2019 (pre-COVID-19 era) and 2020 (COVID-19 era). The analysis was limited to countries with reported OHT data within Asia and Oceania (Australia, China, India, Iran, Israel, Japan, New Zealand, Russian Federation, Saudi Arabia, Thailand, Turkey, and the United Arab Emirates). OHT rates were reported for each country per million population (PMP), and change in the COVID-19 era was reported as percentage of the pre-COVID-19 rates. The association of total COVID-19 cases with relative reduction in OHT was evaluated using linear regression.

Results

Across the Asia/Oceania region, number of OHT in COVID-19 era (median 0.64 procedures PMP, IQR 0.28, 2.15) was significantly lower compared with the pre-COVID-19 era (median 1.18 procedures PMP, IQR 0.49, 2.50), with a median change of -0.29 (IQR -0.70, -0.08; P = 0.04). The impact of COVID-19 on OHT was most pronounced in Turkey, United Arab Emirates, and India, where OHT volumes decreased by 75.4%, 60.8%, and 53%, respectively. Country-level reduction in OHT volumes was not associated with total number of COVID-19 cases during the year 2020 in that country (r = 0.31; P-value = 0.3).

Conclusion

The number of heart transplants during the early phase of COVID-19 pandemic significantly decreased in ­­­most countries of the Asia/Oceania region. Furthermore, the change in OHT volumes did not correlate with the total number of recorded COVID-19 cases, suggesting the pandemic’s impact on OHT numbers extended beyond limiting availability of resources. Identifying factors leading to OHT deferral during COVID-19 pandemic will advance our understanding of the pandemic’s true impact on the care of advanced heart failure patients in the region. Abstract Figure.
Can cord blood lipid and lipoprotein levels inform LDL targets?
Authors: Tan J W C , Yeo K K , Phua S K , Lee J J B , Koh N S Y , Aw T C
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

  Current ESC dyslipidemia guidelines recommend lowering LDL targets to 1.4mmol/L (55mg/dL) for very high risk individuals. Lipid levels of newborns may provide insights into physiologic levels at the time of birth. There is limited data on cord blood lipids/lipoprotein levels in Asian populations. This study aims to describe cord blood lipid levels in a multi-ethnic Asian population.

Methods

  We analyzed 563 (F = 275) anonymized residual cord serum samples for the measurement of cholesterol, triglycerides, dLDL and HDL on the Cobas c702 autoanalyzer and cLDL after exclusion of outliers (Tukey). Following tests for Gaussian distribution (Shapiro-Wilk) all data were log transformed. Gender differences were assessed by Mann-Whitney U test. dLDL was compared with cLDL (Passing-Bablok regression, Wilcoxon’s test, Bland-Altman plot). Statistical calculations were performed using MedCalc v20 (MedCalc software, Ostend, Belgium).

Results

There was no gender difference for cord cholesterol (p = 0.1781) and cLDL (p = 0.6186) and their values were: cholesterol (range:0.78-3.09mmol/L; mean:1.486; reference interval:0.92-2.42) and cLDL (range:0.19-1.85mmol/L; mean:0.60 ; reference interval:0.27-1.21). dLDL was higher in females (p = 0.0388) (range:0.17-1.84mmol/L; median:0.54; IQR:0.37,0.71; reference interval:0.22-1.26; 99th percentile 1.42) compared to males (range:0.16-1.19mmol/L; median:0.49; IQR:0.36,0.62; reference interval:0.21-0.98; 99th percentile 1.13). Cord dLDL values were significantly lower (p < 0.001) than cLDL; the difference (Bland-Altman) between dLDL and cLDL ranged from -0.2062-0.0141 mmol/L (mean -0.0960). Passing-Bablok regression analysis showed cLDL = 1.0465dLDL + 0.0695 with a correlation coefficient (Spearman) of 0.963 (p < 0.0001). Female triglycerides were lower (p < 0.0001) [range:0.11-0.82mmol/L; median:0.24; IQR:0.19,0.31; reference interval:0.11-0.64] than males [range:0.11-0.85mmol/L; median:0.28; IQR:0.21,0.38; reference interval:0.13-0.66]. HDL was higher in females [range:0.40-1.62mmol/L; median:0.75; IQR:0.62,0.93; reference interval:0.44-1.34] than males [range:0.33-1.29mmol/L; median:0.69; IQR:0.58,0.86; reference interval:0.43-1.16] (p = 0.005).

Conclusion

  Contemporary cord blood lipid/lipoprotein values have been derived for our local multi-ethnic Asian population. Directly measured LDL, shows ESC guideline LDL targets are not lower than cord dLDL levels at the 99th percentile. However cLDL overestimates cord dLDL in this cohort of subjects.
Effectiveness of a home-based cardiovascular disease prevention program during the COVID-19 pandemic
Authors: Chockalingam P , Natarajan V , Sekar T , Rajaram A , Yusuf M M , Gunasekaran S , Nayar P G , Chockalingam V
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Home-based cardiovascular disease (CVD) primary prevention (HBPP) and cardiac rehabilitation (HBCR) programs which occupied a small proportion of the overall Preventive Cardiology work in the past have become mainstream during the COVID-19 pandemic.

Purpose

This study aims to analyse the effectiveness of a home-based CVD prevention program implemented during the pandemic in India.

Methods

A retrospective study was conducted on pre-pandemic and pandemic enrolees. Health behaviour, CVD risk factors, physical and mental component score (PCS, MCS) from SF-12 questionnaire, body mass index (BMI), 6-minute walk distance (6MWD), and clinical and biochemical parameters were assessed. A multidisciplinary team consisting of Physician, Physiotherapist, Dietician and Counselling Psychologist provided the program using tele-health platforms.

Results

Of the 66 subjects (55 ± 13 years, 73% male), 17 (26%) enrolled pre-pandemic and 49 (74%) enrolled during-pandemic, 28 (42%) were HBPP and 38 (58%) were HBCR participants. Majority of the subjects (n = 51, 77%), with significantly more HBCR than HBPP participants, harboured 4 or more risk factors (p = 0.04). In the 60 (91%) program completers, BMI, 6MWD, PCS and MCS had improved significantly. SBP, DBP, LVEF, HbA1c, total cholesterol and LDL had improved significantly in affected subjects. Completely home-based participants (n = 44, 67%) who never had any in-person contact with the team during the program also showed significant improvement. No adverse events were reported.

Conclusion

Comprehensive home-based CVD prevention programs are effective in improving anthropometric, clinical, biochemical and psychosocial parameters, are a safe alternative to conventional programs and could potentially become the standard-of-care in the post-pandemic era. Abstract Figure. Outcomes in program participants  Abstract Figure. Management of ACS in participants
Referral rates and patient characteristics of the inpatient cardiac rehabilitation program of a philippine tertiary cardiovascular referral center
Authors: Agustin R D , Samson A L , Dela Cruz A , Pipo M M , Punzalan F E
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

International guidelines recommend effective cardiac rehabilitation programs to decrease mortality and morbidity and improve health-related quality of life. However, cardiac rehabilitation remains underutilized with low referral rates. Data on referral rates and factors affecting referral are lacking in our setting.

Purpose

We evaluated the utilization of inpatient cardiac rehabilitation in our general hospital in terms of referral rates of patients with Class I indications for cardiac rehabilitation, time to referral, treadmill exercise test (TET) participation rate, and characteristics of patients referred and not referred.

Methods

We conducted this retrospective descriptive cross-sectional study by reviewing the medical records of eligible patients admitted between January 1 to December 31,2018. Patient characteristics, indications for cardiac rehabilitation, referral rates, time to referral, and TET participation rates were determined.

Results

We included 759 patients with a mean age of 57.5 years; majority were male (59.9%), married (66.8%), hypertensive (58.4%) and diabetic (32%). The overall referral rate is 17.7%. The highest indication-specific referral rates were for CABG(70%), STEMI(32%), PCI(32%), and PAD(32%). The lowest referral rates were seen in patients with NSTEMI(18%) and HF (16%). The mean time to referral was 6 days. The TET participation rate was 1.3%.

Conclusion

Cardiac rehabilitation remains underutilized despite evidence-based recommendations. Intensified efforts are needed to enroll all patients with Class I indications for inpatient cardiac rehabilitation, increase referral rates, improve the existing program, and optimize the management of our cardiovascular patients.
Correlation between fasting heart rate and fasting plasma glucose level in rural Indians
Authors: Inamdar Aniket
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Diabetes mellitus is associated with abnormal autonomic function. Diabetes and impaired fasting glucose are associated with increased mortality, particularly from cardiovascular causes. Several factors, including fast heart rate, have been identified to be associated with an increased likelihood of having diabetes. Heart rate is a crude index of the autonomic nervous system tone, reflecting a balance of sympathetic and parasympathetic inputs, and correlates with muscle sympathetic nerve activity and noradrenaline serum levels . Examining its potential role in diabetes risk could improve our understanding of the pathogenesis of diabetes.

Purpose

Aim of our study was to establish correlation between fasting heart rate and fasting blood glucose level.

Methods

509 patients between age group 25 years to 75 years were studied. Resting heart rate was recorded on finger pulse oximeter before taking fasting blood sample. Morning blood samples were obtained by venipuncture after an overnight fast of at least 8 hours and blood glucose estimation done by the hexokinase method. Diabetes mellitus was defined in accordance with American Diabetes Association and World Health Organization guidelines. Pearson"s correlation test was used for statistical analysis.

Results

 We found that resting heart rate was significantly higher in patients with higher fasting blood glucose levels compared with patients with normal glucose levels. This difference was statistically significant with p = 0.002 (r:0.137).

Conclusions

 Our study strongly supports faster resting heart rate as an independent risk factor for incident diabetes and impaired fasting glucose. Meta-analysis of seven published studies confirmed the positive association between resting heart rate and diabetes risks. A resting heart rate is generally considered as a surrogate marker for autonomic activity, and increased sympathetic nerve system activity is associated with both acute and chronic insulin resistance. Sympathetic activation has been associated with many diabetes-related risk factors, including reduced insulin sensitivity, high BP, obesity, subclinical inflammation and the metabolic syndrome. Our findings suggest that this area of investigation may be relevant for future studies.
Awareness and cognitive status of older patients with chronic cardiorenal syndrome in terms of patient-centered approach
Authors: Efremova E , Shutov A M
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

A patient-centered approach is the basis for older patients with cardiovascular comorbidity. Collaborative decision making is especially important for older patients with chronic kidney disease (СKD).

The aim of the study was to study the possibilities and difficulties of a patient-centered approach in older patients with chronic cardiorenal syndrome.

Material and methods. 214 older patients with stable cardiovascular disease (106 males, mean age was 69.5 ± 7.6 years) were studied. CKD was diagnosed and classified according to the KDIGO guidelines (2012). Charlson comorbidity index (CCI) was estimated. Cognitive status was assessed using the Mini-Mental State Examination (MMSE) and the Clinical Dementia Rating scale (CDR). Assessment of socio-demographic characteristics and awareness of patients was determined by questionnaires and interviews. Follow-up period was 12 months.

Results. CKD was observed in 144 (67.3%) patients with stable cardiovascular disease. A third of older patients with CKD (48; 33.3%) were informed about impaired renal function (n = 144), and only 23 (16%) older patients with CKD, along with observation by a therapist, consulted a nephrologist . Only half of older patients with cardiovascular pathology, regardless of the presence of CKD, know their cholesterol level and their cardiovascular risk. In 70 (48.6%) older patients with stable cardiovascular pathology and CKD, pre-dementia cognitive impairment was observed, in 28 (19.4%) - mild dementia. A third of older patients with cardiovascular pathology and CKD (47; 32.6%) still have questions about their health. 112 (77.8%) patients would like to be able to remotely communicate with medical personnel in case of health issues. At the same time, only 37 (25.7%) patients with CKD are ready to attend full-time schools for patients.

Conclusion. Cognitive impairments and low awareness of older patients with chronic cardiorenal syndrome complicate the implementation of a patient-centered approach.
Measuring the arterial phase of the right coronary artery in the patients suspected of coronary artery disease: a dual study by dynamic angiography and deep learning program
Authors: Truyen T , Vu L , Pham D , Do Q , Huynh T , Ho D , Nguyen T
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background. In the diagnosis of coronary artery disease (CAD), coronary angiography (CA) plays a crucial role in determining the location and severity of the stenosis, the anatomical aspect of a lesion. It does not accurately reflect the flow dynamics in the coronary artery. This study aimed to evaluate the coronary flow abnormalities based on our new angiographic technique and Deep Learning (DL) program in patients suspected of CAD.

Methods. We randomly selected patients who were admitted with suspected CAD. All patients underwent our new technique of CA. After the index coronary artery was filled completely with contrast, we stopped the injection. At that time, the blood in white color flew in. The flow characteristics, the shape of the tip, borders, and direction could be clearly observed above a black background of the contrast. In this study, we measured the arterial phase (AP) from the beginning when the blood moved in until the end when all contrasts in black color washed out of the distal vasculature. In the DL protocol, the U-Net model combined with Dense-Net-121 and a binary image classification model are used to predict the beginning and ending frame. To obtain the best image for the DL program, we analyzed only the flow of the right coronary artery (RCA).

Results. 81 patients were enrolled. In patients with normal coronary angiography, the mean AP was 1.86s (27.4 +/- 5.4 frames). In patients with one significant lesion, the mean AP value was 2.35s (35.3 +/- 7.7 frames). The mean difference of the AP between the two groups was 0.49s (95% confidence interval: 0.295 to 0.694). This difference is statistically significant. Our DL has the mean root square error in predicting the AP was 0.34s.

Conclusion. In patients with CAD, the prolonged arterial phase could be accurately estimated using the DL program, reflecting the slow circulation of highly oxygenated blood. It could be used as a marker of coronary perfusion in future studies.
Sex Differences in the Risk of Dementia in Older Veterans
Authors: Eastman Jennifer , Bahorik Amber , Kornblith Erica , Xia Feng , Yaffe Kristine
Published: February 2022

Background

Studies have demonstrated women to have a higher prevalence of dementia compared to men. However, sex differences in dementia incidence are controversial with conflicting reports showing women with higher, lower, or similar incidence. Source of difference may be due to clinical setting and lack of consideration of competing risk of death. We examined dementia incidence in a sample of the national Veteran population to determine differences by sex.

Methods

We examined data from the Veterans Health Administration (VHA), the largest integrated health care system in the United States. We studied 947 797 Veterans aged ≥55 years (mean age: 69.9 ± 8.4, 3% female) evaluated in the VHA from October 1, 1999 to September 30, 2019. We estimated age-adjusted incidence rates of dementia (International Classification of Diseases, 9th and 10th Edition codes) by sex, and used Fine–Gray proportional hazards models with age as time scale to examine time to diagnosis, accounting for competing risk of death.

Results

During the follow-up (mean 8.4 years), 11.3% (n = 106 977, 11.4% men and 8.0% women) of Veterans developed dementia. Age-adjusted incidence was 12.6/1 000 person-years for men and 12.7/1 000 person-years for women. Compared to male Veterans, risk dementia was slightly higher among females (hazard ratio = 1.15; 95% confidence interval: 1.10–1.20), and on average, female Veterans developed dementia 0.2 years earlier than male Veterans. After additional adjustment for race, education, medical, and psychiatric conditions, results were similar.

Conclusions

Among older Veterans in a national cohort, women had a slightly increased risk for developing dementia compared to men after accounting for competing risk of death.
Socioeconomic Disparities Do Not Explain the U.S. International Disadvantage in Mortality
Authors: Barbieri Magali
Published: February 2022

Objectives

The articles examines the contribution of internal socioeconomic disparities in mortality to the U.S. international disadvantage in life expectancy at birth.

Methods

Using individual death records from the U.S. national vital statistics system for years 1982–2019 and data for other countries from the Human Mortality Database, we compare age-specific death rates and life expectancy between counties classified into 10 socioeconomic categories and 20 high-income countries. We also calculate the number of years of life lost in each socioeconomic decile in relation to the comparison set.

Results

There is a clear and increasing socioeconomic gradient of mortality in the United States, but the growing divergence in internal mortality trends does not explain the rising gap between the country and its peers. In 2019, even American women in the most socioeconomically advantaged decile lived shorter lives, while only 10% of men in the most affluent decile fared better than their peers. The long-standing U.S. disadvantage in young adult mortality has been growing and the country’s previous advantage in mortality at ages 75 years and older has virtually disappeared for all but for Americans in the most affluent counties.

Discussion

The similar age pattern of differences in mortality rates between each socioeconomic deciles and the comparison group suggests that the underlying factors might be the same. The role of external causes (including drug overdoses) for middle-aged adults and a slowing down in progress to control cardiovascular diseases at older ages at the national level are consistent with this pattern.
Longitudinal multimodal MRI characterization of a knock-in mouse model of Huntington’s disease reveals early gray and white matter alterations
Authors: Pérot Jean-Baptiste , Célestine Marina , Palombo Marco , Dhenain Marc , Humbert Sandrine , Brouillet Emmanuel , Flament Julien
Published: February 2022

Pathogenesis of the inherited neurodegenerative disorder Huntington’s disease (HD) is progressive with a long presymptomatic phase in which subtle changes occur up to 15 years before the onset of symptoms. Thus, there is a need for early, functional biomarker to better understand disease progression and to evaluate treatment efficacy far from onset. Recent studies have shown that white matter may be affected early in mutant HTT gene carriers. A previous study performed on 12 months old Ki140CAG mice showed reduced glutamate level measured by Chemical Exchange Saturation Transfer of glutamate (gluCEST), especially in the corpus callosum. In this study, we scanned longitudinally Ki140CAG mice with structural MRI, diffusion tensor imaging, gluCEST and magnetization transfer imaging, in order to assess white matter integrity over the life of this mouse model characterized by slow progression of symptoms. Our results show early defects of diffusion properties in the anterior part of the corpus callosum at 5 months of age, preceding gluCEST defects in the same region at 8 and 12 months that spread to adjacent regions. At 12 months, frontal and piriform cortices showed reduced gluCEST, as well as the pallidum. MT imaging showed reduced signal in the septum at 12 months. Cortical and striatal atrophy then appear at 18 months. Vulnerability of the striatum and motor cortex, combined with alterations of anterior corpus callosum, seems to point out the potential role of white matter in the brain dysfunction that characterizes HD and the pertinence of gluCEST and DTI as biomarkers in HD.
Prior intake of new oral anticoagulants adversely affects outcome following surgery for acute type A aortic dissection
Authors: Sromicki Juri , Van Hemelrijck Mathias , Schmiady Martin O , Krüger Bernard , Morjan Mohammed , Bettex Dominique , Vogt Paul R , Carrel Thierry P , Mestres Carlos-A
Published: February 2022

OBJECTIVES

Oral anticoagulation prior to emergency surgery is associated with an increased risk of perioperative bleeding, especially when this therapy cannot be discontinued or reversed in time. The goal of this study was to analyse the impact of different oral anticoagulants on the outcome of patients who underwent emergency surgery for acute type A aortic dissection (ATAAD).

METHODS

This was a single-centre retrospective study of patients treated with oral anticoagulation at the time of surgery for ATAAD. Outcomes of patients on new oral anticoagulant (NOAC) therapy were compared to respective outcomes of patients on Coumadin. Additionally, a survival analysis was performed comparing these 2 groups with patients who were operated on with no prior anticoagulation.

RESULTS

Between January 2013 and April 2020, a total of 437 patients (63.8 ± 11.8 years, 68.4% male) received emergency surgery for ATAAD; 35 (8%) were taking oral anticoagulation at the time of hospital admission: 20 received phenprocoumon; 14, rivaroxaban; and 1, dabigatran. Compared to Coumadin, NOAC was associated with a greater need for blood-product transfusions and haemodynamic compromise. Operative mortality was 53% in the NOAC group and 30% in the Coumadin group. A 5-year survival analysis showed no significant difference between the NOAC and the Coumadin group (P = 0.059). Compared to 402 patients treated during the study period without anticoagulation, patients taking NOAC had significantly worse survival (P = 0.001), whereas that effect was not observed in patients undergoing surgery who were taking Coumadin (P = 0.99).

CONCLUSIONS

Emergency surgery for ATAAD in patients taking NOAC is associated with high morbidity and mortality. NOAC are a major risk factor for uncontrollable bleeding and haemodynamic compromise. New treatment strategies must be defined to improve surgical outcomes in these high-risk patients.
Modelling of plant circadian clock for characterizing hypocotyl growth under different light quality conditions
Authors: Pay Miao Lin , Kim Dae Wook , Somers David E , Kim Jae Kyoung , Foo Mathias
Published: February 2022

To meet the ever-increasing global food demand, the food production rate needs to be increased significantly in the near future. Speed breeding is considered as a promising agricultural technology solution to achieve the zero-hunger vision as specified in the United Nations Sustainable Development Goal 2. In speed breeding, the photoperiod of the artificial light has been manipulated to enhance crop productivity. In particular, regulating the photoperiod of different light qualities rather than solely white light can further improve speed breading. However, identifying the optimal light quality and the associated photoperiod simultaneously remains a challenging open problem due to complex interactions between multiple photoreceptors and proteins controlling plant growth. To tackle this, we develop a first comprehensive model describing the profound effect of multiple light qualities with different photoperiods on plant growth (i.e. hypocotyl growth). The model predicts that hypocotyls elongated more under red light compared to both red and blue light. Drawing similar findings from previous related studies, we propose that this might result from the competitive binding of red and blue light receptors, primarily Phytochrome B (phyB) and Cryptochrome 1 (cry1) for the core photomorphogenic regulator, CONSTITUTIVE PHOTOMORPHOGENIC 1 (COP1). This prediction is validated through an experimental study on Arabidopsis thaliana. Our work proposes a potential molecular mechanism underlying plant growth under different light qualities and ultimately suggests an optimal breeding protocol that takes into account light quality.
Documentation of hospitalization risk factors in electronic health records (EHRs): a qualitative study with home healthcare clinicians
Authors: Hobensack Mollie , Ojo Marietta , Barrón Yolanda , Bowles Kathryn H , Cato Kenrick , Chae Sena , Kennedy Erin , McDonald Margaret V , Rossetti Sarah Collins , Song Jiyoun , Sridharan Sridevi , Topaz Maxim
Published: February 2022

Objective

To identify the risk factors home healthcare (HHC) clinicians associate with patient deterioration and understand how clinicians respond to and document these risk factors.

Methods

We interviewed multidisciplinary HHC clinicians from January to March of 2021. Risk factors were mapped to standardized terminologies (eg, Omaha System). We used directed content analysis to identify risk factors for deterioration. We used inductive thematic analysis to understand HHC clinicians’ response to risk factors and documentation of risk factors.

Results

Fifteen HHC clinicians identified a total of 79 risk factors that were mapped to standardized terminologies. HHC clinicians most frequently responded to risk factors by communicating with the prescribing provider (86.7% of clinicians) or following up with patients and caregivers (86.7%). HHC clinicians stated that a majority of risk factors can be found in clinical notes (ie, care coordination (53.3%) or visit (46.7%)).

Discussion

Clinicians acknowledged that social factors play a role in deterioration risk; but these factors are infrequently studied in HHC. While a majority of risk factors were represented in the Omaha System, additional terminologies are needed to comprehensively capture risk. Since most risk factors are documented in clinical notes, methods such as natural language processing are needed to extract them.

Conclusion

This study engaged clinicians to understand risk for deterioration during HHC. The results of our study support the development of an early warning system by providing a comprehensive list of risk factors grounded in clinician expertize and mapped to standardized terminologies.
Canadian Gastroenterology Career Pathway Experiences: Exploring the Gender Divide
Authors: Jawaid Noor , Boctor Monica , LoMonaco Jordan , Bollegala Natasha
Published: February 2022

Background

We aimed to determine the persistence of differential career experiences between male and female gastroenterologists in Canada >20 years after they were first noted in the literature.

Methods

A 51-question mixed-methods survey was developed focusing on personal, professional and financial characteristics. The survey was disseminated via email and fax to practicing gastroenterologists using provincial college registries and the Canadian Association of Gastroenterology. Numerical data were analyzed using the chi-square test. Qualitative thematic analysis was conducted for short answer responses.

Findings

There were a total of 114 responses (17% response rate) with 35% female respondents. Mean age was 49 years for males and 41 years for females (P = 0.001). Clinical practice types included general GI (63%), urban (82%) and academic (51%). Males reported more endoscopy time (P = 0.001) versus females who spent more time on research (P < 0.001). Men were more likely to be married (P = 0.011), but women were more likely to be responsible for childcare (P = 0.016). Women were more likely to choose between marriage and career and more chose marriage compared to men (P = 0.045). Males earned >$100,000/year higher income than females even when offset by age and work hours (P = 0.048). A salary >$600,000 was reported by 32% of men, compared to 3% of women. Female gastroenterologists reported less mentorship during GI training, challenging relationships with support staff, reduced promotion opportunity, more difficulty publishing and having their competency challenged.

Interpretation

Compared to previous data, there has not been significant gender-related progress in the past two decades regarding female gastroenterologists’ clinical practices, remuneration and work-life balance.