bluuebunny/crossref_metadata_2025 huggingface dataset:
Optical coherence tomography and artificial intelligence for calcium quantification in coronary disease of diabetic patients
Authors: Di Muro F M , Demola P , Nardi G , Ciardetti N , Meucci F , Stolcova M , Ristalli F , Di Mario C , Mattesini A
Published: October 2022

Background

Diabetes mellitus (DM) is associated with increased cardiovascular morbidity and mortality. Coronary artery disease in diabetic patients is characterized by a greater burden of lipidic plaques and calcifications. Little is known on the quantitative and qualitative characteristics of calcific plaques in diabetics vs non diabetics. The recent application of Artificial Intelligence (AI) to optical coherence tomography (OCT) enables unique evaluation of coronary calcification.

Purpose

To compare qualitative and quantitative characteristics of coronary calcified plaques in diabetic and non-diabetic patients using AI-OCT.

Methods and material

We recruited 78 patients admitted for chronic coronary syndrome (CCS) or acute coronary syndrome (ACS) undergone intracoronary imaging with OCT between January 2019 to October 2021. Differences in plaques characteristics assessed by Artificial Intelligence applied at OCT runs were compared in DM and non-DM population using generalized estimating equations. To estimate the burden of calcification we classified the calcific lesions according to the Fujino score, an OCT based calcium scoring system.

Results

A total of 78 patients were included (54 non-DM lesions, 29 DM lesions). The culprit lesion was examined by OCT in all patients without any peri- or postprocedural complications. The population was homogeneous for cardiovascular risk factors even if we observed a higher prevalence of peripheral arterial disease (PAD) in the DM cohort (22.2% vs 2% p value 0.003). There were no statistical differences in previous PCI or CABG but we observed more multivessel PCI in the history of DM patients if compared with non-diabetic ones (33.3% vs 11.8% p value 0.021). The clinical presentation in DM groups was more often unstable angina (22.2% vs 0% p value <0.001) while STEMI, NSTEMI or CCS had the same prevalence in the two cohorts. At baseline angiography, patients with diabetes had more often multivessel disease (29.6% vs 17.6% p=0.014) with all the vessels equally involved. There were no qualitative differences in plaque morphology but using the Fujino score to estimate the calcium burden in the two population we found hardest calcific plaques expressed by higher Fujino score more frequently in DM patients compared to non-DM ones (50% vs 26.9%, p=0.04 of Fujino score 4).

Conclusion

DM has an impact on atherosclerotic process and plaque remodeling. Applying AI methods at OCT plaque analysis, we can extract important and standardized information on calcium burden in diabetic. This might help the interventional cardiologist in image interpretation, therapeutic strategy decision, improving workflow and clinical outcomes.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): University of Florence
Repeatability of bolus and continuous thermodilution for assessing coronary microvasculatory function
Authors: Gallinoro E , Fernandez-Peregrina E , Bertolone D T , Paolisso P , Bermpeis K , Esposito G , Belmonte M , Candreva A , Mileva N , Munhoz D , Sonck J , Barbato E , Collet C , De Bruyne B
Published: October 2022

Introduction

The bolus thermodilution-derived index of microcirculatory resistance (IMR) has emerged over years as the standard of reference to invasively define coronary microvascular dysfunction (CMD). However, the technique still presents some limitations, mainly related to the fact that manual injection of saline bolus accounts for some variance in the measurements. Continuous intracoronary thermodilution has been recently introduced as a tool to directly quantify absolute coronary flow and microvascular resistance both at rest and during hyperemia and has shown to be safe and operator independent. Microvascular resistance reserve (MRR), derived from continuous thermodilution, has been validated as novel index specific for microcirculation and independent from myocardial mass.

Purpose

To compare head-to-head the intra-observer repeatability of bolus and continuous thermodilution for assessing microvascular function.

Methods

Patients undergoing coronary angiography in the absence of obstructive coronary artery disease were prospectively enrolled. Bolus and continuous intracoronary thermodilution measurements were performed in duplicates in the left anterior descending artery (LAD). Patients were randomly assigned in a 1:1 ratio to undergo first bolus thermodilution or first continuous thermodilution assessment.

Results

A total of 102 patients were enrolled. Average FFR was 0.86±0.06. Coronary Flow Reserve (CFR) calculated with continuous thermodilution (CFRthermo) was significantly lower than bolus thermodilution-derived CFR (CFRbolus) (2.63±0.65 and 3.29±1.17, respectively, p<0.001). CFRthermo showed a lower variability and a higher agreement than CFRbolus (variability 12.74±10.41% vs 31.26±24.85%, respectively, p<0.001; ICC= 0.78 (0.70–0.85) and 0.48 (0.32–0.62), respectively, p<0.001, Figure 1). Both MRR and IMR showed a good agreement (ICC 0.81 (0.74–0.87) and 0.80 (0.71–0.86)) but the variability of the MRR was significantly lower (12.44±10.06% vs 24.24±19.27, respectively, p<0.001, Figure 1). Reproducibility data of all indices derived from duplicated measurements of bolus and continuous thermodilution are reported in Table 2.

Conclusion

Continuous intracoronary thermodilution has a higher repeatability than bolus thermodilution in the assessment of CMD.

Funding Acknowledgement

Type of funding sources: None.
Changes in the treatment strategy following intracoronary pressure wire in a contemporaneous real-life cohort of patients with intermediate coronary stenosis. Results from a nationwide registry
Authors: Rodriguez Leor O , Toledano B , Lopez Palop R , Rivero F , Brugaletta S , Linares J A , Puigfel M , Sadaba M , Vaquerizo B , Rondan J , Gomez I , Saez R , Planas A , Lozano F , Perez De Prado A
Published: October 2022

Background

Intracoronary pressure wire is useful to guide revascularization in patients with coronary artery disease.

Aims

To evaluate changes in diagnosis (coronary artery disease extent), treatment strategy and clinical results after intracoronary pressure wire study in real-life patients with intermediate coronary artery stenosis.

Methods

Observational, prospective and multicenter registry of patients in whom pressure wire was performed. The extent of coronary artery disease and the treatment strategy based on clinical and angiographic criteria were recorded before and after intracoronary pressure wire guidance. 12-month incidence of MACE (cardiovascular death, non-fatal myocardial infarction or new revascularization of the target lesion) was assessed.

Results

1414 patients with 1781 lesions were included. Complications related to the procedure were reported in 42 patients (3.0%). The extent of coronary artery disease changed in 771 patients (54.5%).

Figure 1 shows extent of coronary artery disease based on coronary angiographic analysis and following intracoronary pressure wire study. Figure 2A shows the extent of coronary artery disease based on coronary angiographic analysis and its reclassification following intracoronary pressure wire study. Figure 2B shows the extent of coronary artery disease following pressure wire study and its classification when only considering the coronary angiographic analysis.

Figure 2 shows change in treatment strategy following intracoronary pressure wire study. There was a change in treatment strategy in 779 patients (55.1%) (18.0% if medical treatment; 68.8% if PCI; 58.9% if surgery (p<0.001 for PCI vs medical treatment; p=0.041 for PCI vs CABG; p<0.001 for medical treatment vs CABG). In patients with PCI as the initial strategy, the change in strategy was associated with a lower rate of MACE (4.6% vs 8.2%, p=0.034).

Conclusions

The use of intracoronary pressure wire was safe and led to the reclassification of the extent of coronary disease and change in the treatment strategy in more than half of the cases, especially in patients with PCI as initial treatment.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): The registry was endorsed by the Intracoronary Diagnostic Techniques Working Group of the Interventional Cardiology Association of the Spanish Society of Cardiology. The study was supported by an unconditional grant from Philips-Volcano, Abbott Vascular, and Boston Scientific. The sponsors did not have access to the database or the final results until the preparation of this abstract. None of them participated in the preparation or review of this abstract.
Individual lifetime benefit from low-dose colchicine in chronic coronary artery disease patients
Authors: Burger P , Dorresteijn J , Fiolet A , Koudstaal S , Eikelboom J , Nidorf S , Thompson P , Cornel J , Budgeon C , Steg P , Cramer M , Teraa M , Bhatt D , Visseren F , Mosterd A
Published: October 2022

Background

Low-dose colchicine reduces the risk of cardiovascular events in patients with chronic coronary artery disease (CAD), but the absolute benefit may vary between patients. Individual benefit from preventive therapies can be estimated using the guideline-recommended SMART-REACH model.

Purpose

This study aimed to assess the range of individual absolute 10-year and lifetime benefit from low-dose colchicine according to patient risk profile.

Methods

The SMART-REACH model was combined with the relative treatment effect of low-dose colchicine, and applied to all participants from the LoDoCo2 trial (n=5,522), and patients with chronic CAD from the UCC-SMART cohort (n=5,308). Individual treatment benefit was expressed as (i) 10-year absolute risk reductions (ARRs) for myocardial infarction, ischemic stroke, or cardiovascular death (MACE), and (ii) life-years gained free of MACE. Predictions were also performed for MACE plus ischemia-driven coronary revascularization (MACE+), through development of a new competing risk-adjusted lifetime prediction model in data from the REACH registry (n=14,522). Low-dose colchicine was compared to alternative intensive prevention goals, i.e. low density lipoprotein-cholesterol (LDL-c) reduction to <1.4 mmol/L, and systolic blood pressure (SBP) reduction to <130 mmHg.

Results

Median individual 10-year ARR for MACE from low-dose colchicine therapy was 4.6% (interquartile range [IQR] 3.6–6.0%), and median gain in life expectancy free of MACE was 2.0 (IQR 1.6–2.5) years. Median 10-year ARR for MACE+ was 8.6% (IQR 7.6–9.8%), and median gain in MACE+-free life expectancy was 3.4 (IQR 2.6–4.2) years. For intensified LDL-c and SBP reduction respectively, median 10-year ARRs were 3.0% (IQR 1.5–5.1%) and 1.7% (IQR 0.0–5.7%) for MACE, and 5.2% (IQR 2.5–8.7%) and 2.9% (IQR 0.0–9.5%) for MACE+. Median life-years gained from LDL-c and SBP reduction were 1.2 (IQR 0.6–2.1) and 0.7 (IQR 0.0–2.3) years free of MACE, and 1.8 (IQR 0.8–3.3) and 0.9 (IQR 0.0–3.4) years free of MACE+.

Conclusion

The individual absolute benefit from low-dose colchicine varies between patients. In an era where lipid- and blood pressure-lowering therapies are already routinely used, the benefits of low-dose colchicine are expected to be of at least similar magnitude to those of intensified LDL-c and SBP reduction in patients with chronic CAD.

Funding Acknowledgement

Type of funding sources: None.
Coronary plaque characteristics associated with major adverse cardiovascular events in atherosclerotic patients and lesions – a systematic review and meta-analysis
Authors: Gallone G , Bellettini M , Bruno F , Scudeler L , De Filippo O , Iannaccone M , Baldetti L , Kwon-Koo B , Pontone G , Depaoli A , Libby P , Stone G W , Narula J , De Ferrari G M , D'Ascenzo F
Published: October 2022

Background

The clinical value of high-risk coronary plaque characteristics (CPCs) to inform intensified medical therapy or revascularization of non-flow-limiting lesion remains uncertain.

Purpose

We performed a systematic review and meta-analysis to study the prognostic impact of CPCs on patient-level and lesion-level major cardiovascular adverse events (MACE).

Methods

We systematically reviewed MEDLINE, EMBASE, and the Cochrane database for studies evaluating the association of CPC with patient-level and lesion-level MACE. CPCs included high plaque burden, low minimal lumen area, thin cap fibroatheroma, high lipid core burden index, low attenuation plaque, spotty calcification, napkin ring sign, or positive remodelling.

Results

Thirty studies (21 retrospective, 9 prospective) with 30,369 patients were included. CPCs were evaluated by invasive intravascular techniques in 9 studies (optical coherence tomography=4, intravascular ultrasound imaging=3, near-infrared spectroscopy intravascular ultrasound imaging=2) and by coronary computed tomography angiography (CCTA) in 21 studies. CPCs significantly predicted patient-level and lesion-level MACE in both unadjusted and adjusted analyses. For each CPC, the risks were higher for lesion-level (HR range 3.2–16.8) as compared with patient-level MACE (HR range 1.8–4.1). Accuracy was modest to good for most CPCs at the patient-level (AUC for MACE ranging between 0.53 and 0.84) and moderate to good for most CPCs at the lesion-level (AUC for MACE ranging between 0.71 and 0.83). Plaques with more than one CPC had the highest accuracy for lesion-level MACE (AUC 0.87, 95% CI 0.84–0.90). The pooled sensitivities of CPCs for lesion-level MACE ranged between 40% and 63% and specificities between 73% and 98%. As the pooled prevalence of CPCs among plaques was low (3% to 28%), the estimated positive predictive values for lesion-level MACE were modest (range 1% to 26%).

Conclusions

CCTA and intravascular imaging characterization of CPCs identifies high-risk atherosclerotic plaques that place lesions and patients at risk for future MACE, albeit with modest sensitivity and positive predictive value (PROSPERO identifier: CRD42021251810).

Funding Acknowledgement

Type of funding sources: None.
Ten-year prognostic impact of acute heart failure in STEMI patients: a prospective cohort study
Authors: Kozhukhov S , Parkhomenko A , Irkin O , Lutay Y A , Dovganych N
Published: October 2022

Background

Cardio-vascular death (CVD) in patients with acute myocardial infarction (AMI) significantly decreased due to reperfusion and advances in pharmacotherapy. Acute heart failure (AHF) remains a common and unfavorable AMI-related complication.

Aim

To determine the incidence and prognostic value of Killip Class II–IV of AHF in long term follow-up of patients with ST-elevation myocardial infarction (STEMI).

Methods

All patients with STEMI were admitted to our emergency cardiology department during 1995–2011. CVD up to ten years after STEMI was the main outcome endpoint. We compared CVD in patients with and without AHF, and revascularization. Survival curve was generated by the Kaplan-Meier method. Predictors of mortality after STEMI were determined by multivariable Cox regression.

Results

Prospective cohort study includes 1625 STEMI patients; the mean age of the patients was 54.4±0.3 years, time from symptom onset was 5.0±0.2 hour, 1497 were men (92.1%), and 899 patients (55.5%) were revascularized (TLT – 632 (38.9%), PCI – 267 (16.4%), including 159 patients with stent implantation (9.8%). 412 patients had AHF - Killip Class II–IV (25.4%) during first 24 hours. Ten-year survival after STEMI was 85%; survival exceeded 88% in patients without AHF, but was 75% for those with AHF. Among patients who underwent revascularisation ten-year survival was 82.9% for patients in group with AHF, and was 87.1% for those without AHF. In multivariable Cox regression, age ≥65 years, female gender and HF were the predictive factors for CVD. Kaplan-Meier survival curves demonstrated higher incidence of CVD in AHF patients in compare with those without AHF in long-term follow-up (Figure 1).

Conclusion

According to the study AMI care is associated with high rates of long term survival, ten-year rates exceed 85%. AHF during first 24 hour in patients with STEMI worsens the prognosis, but reperfusion therapy increases survival. Further efforts to improve survival should be directed to patients with AHF and low revascularization rate that are associated with poor survival after AMI.

Funding Acknowledgement

Type of funding sources: None.
Correlation between NSTE-ACS risk scores with Syntax: can we predict coronary lesion complexity before angiography?
Authors: Maltes S , Paiva M S , Madeira S , Teles R C , Almeida M S , Mendes M
Published: October 2022

Background and aim

Standard single antiplatelet regimen (SAPT) is currently recommended before invasive risk stratification in non-ST elevation acute coronary syndromes (NSTE-ACS). However, there are subsets in whom dual antiplatelet therapy (DAPT) may be more protective according to the coronary anatomy and revascularization strategy. We aimed to identify pre-procedural predictors of coronary artery complexity that may be helpful in selecting an individualized antiplatelet regimen.

Methodology

Retrospective single-center study including patients with NSTE-ACS performing coronary angiography between January 2020 and July 2021. Clinical variables and classical NSTE-ACS risk scores (TIMI, GRACE and HEART) were captured and SYNTAX 1 score was calculated. Patients were divided into low (0–22), moderate (23–32) and high (≥33) SYNTAX score. Multivariate logistic regression analysis was performed to determine predictors of anatomical complexity (defined as significant left main disease [stenosis ≥50%] or SYNTAX ≥33).

Results

A total of 448 patients were included (mean age 67±13 years; 74% males; 85% with NSTE-myocardial infarction). Overall, 350 (78%), 63 (14%) and 35 (8%) patients had a low, moderate or high-SYNTAX score, respectively. Thirty-one (7%) patients had significant left main disease.

At multivariate analysis (adjusted for age, diabetes, renal function, GRACE and TIMI scores), the HEART score (hazard ratio 2.3, 95% confidence interval 1.5–3.3, p<0.001) predicted a high anatomical complexity. When performing ROC curve analysis, the HEART score had a high discriminative ability in identifying those with complex coronary anatomy (area under the curve 0.79, 95% CI 0.72–0.86, p<0.001) (Figure 1) – a score >7 showed a sensitivity of 76% and specificity of 75% in identifying such patients.

Conclusion

In this cohort of NSTE-ACS patients, the HEART score was an independent predictors of complex coronary anatomies. These results suggest that those with high (>7) HEART score may merit from SAPT as opposed to DAPT, given the high probability of complex lesions amenable to CABG.

Funding Acknowledgement

Type of funding sources: None.
Complications in acute coronary syndrome with contemporary care, and predictors of high risk
Authors: Nilsson T , Mokhtari A , Ekelund U
Published: October 2022

Introduction

With the implementation of early reperfusion therapy, the number of complications in patients with acute coronary syndrome (ACS) has diminished significantly.

However, ACS patients are still routinely admitted to units with high-level monitoring such as the coronary or intensive care unit (CCU/ICU). The cost of these admissions is high and there is often a shortage of beds.

Purpose

The aim of this study was to map the complications in contemporary ACS patients, and to explore the possibility of creating simple decision rules for risk assessment.

Methods

This observational study included 26547 chest pain patients ≥18 years at five Swedish emergency departments (ED) from the ESC-TROP trial. Complications were defined as the following within 30 days: Death, cardiac arrest, cardiogenic shock, respiratory failure, ventricular arrythmia, high-degree AV-block that required a pacemaker, and mechanical complications such as ventricular septum defects (VSD). Logistic regression including age, sex, history of myocardial infarction, hypertension, hypercholesterolemia, angina pectoris, diabetes mellitus was used to identify factors predicting high risk of complications.

Results

Of all 26547 patients, 2463 (9.3%) were diagnosed with ACS, and 146 of these (5.9%) suffered any complication within 30 days. Mean age was higher in patients with (78.9 years) than without (69.4 years) complications, and more were female (39.7% vs 33.1%).

Seventy-nine (3.2%) patients died, 33 (1.3%) had cardiac arrest, 10 (0.4%) cardiogenic shock, 20 (0.9%) respiratory failure, 6 (0.2%) ventricular arrythmia, 13 (0.5%) high-degree AV block, and 2 (<0.1%) VSD. More than 40% of the complications were present already at the ED, and 40% of patients with complications were not admitted to the CCU/ICU. Only 78 (53%) of the patients with complications underwent coronary angiography and 62 were revascularized (PCI or CABG). Sixty-two patients (42%) were managed without coronary angiography and 6 (4%) had palliative care from the start. Only age >80 years (OR 4.8, p<0.001) appeared to be a significant factor for increased risk of complications.

Conclusion

With current care, serious complications occurred in only 6 out of 100 ACS patients, and the complications were often present already at the ED. Many patients with complications were not admitted to the CCU/ICU and did not undergo coronary angiography.

Algorithms to improve the identification of ACS patients with a need of high-level monitoring could help optimize the use of hospital resources.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): ALF research grantSwedish Research Council
Clinical utility and prognostic value of right atrial function in severe tricuspid regurgitation. One more piece of the puzzle
Authors: Hinojar Baydes R , Gonzalez-Gomez A , Garcia-Martin A , Monteagudo J M , Garcia-Lunar I , Rivas S , Sanroman M A , Pardo A , Jimenez-Nacher J J , Sanchez-Recalde A , Zamorano J L , Fernandez-Golfin C
Published: October 2022

Background

Optimal management of severe tricuspid regurgitation (TR) remains controversial. While right ventricular systolic function is an established prognostic marker of outcomes, the potential role of right atrial (RA) function is unknown.

Purpose

This study was aimed to describe RA function by 2D speckle tracking echocardiography (STE) in severe TR and to evaluate its potential association with cardiovascular outcomes

Methods

Consecutive patients with at least severe TR (severe, massive or torrential TR) evaluated in the Heart Valve Clinic following a comprehensive clinical protocol were included. Consecutive control subjects and patients with permanent atrial fibrillation (AF) were included for comparison. RA function was measured with 2D-STE and 3 components of RA function were calculated: reservoir (RASr), conduit (RAScd) and contractile (RASct) RA values using an automatic 2D strain analytical software (AutoStrain, Philips Medical Systems the EPIQ system, Figure 1). A combined endpoint of hospital admission due to heart failure (HF) or all-cause mortality was defined. The interobserver variability of RA strain was assessed in 30 randomly selected subjects (20 TR+5 AF+5 controls).

Results

A total of 176 patients with severe TR, 20 AF patients and 20 controls subjects were included in this study. Patients with at least severe TR showed lower RASr and RAScd compared to controls and to AF patients (Figure 1 and Table 1, p<0.05). After a median follow-up of 28 months (IQR: 15–48 months), n=65 patients with severe TR (37%) reached the combined endpoint. 65 (37%) were admitted for right heart failure and 8% of the population (n=14) died. Patients with events showed lower values of RASr and RAScd (p<0.01 for both). Between both parameters RASr was more strongly associated with outcomes compared to RAScd (AUC 0.74 vs. 0.65, p<0.01). RASr was an independent predictor of heart failure and all cause mortality adjusted by additional imaging prognostic parameters in a multivariable analysis (biplane vena contracta, RV end-diastolic area, and RV-free wall longitudinal strain [LR χ2: 49.7, p<0.001]). RA area or volume was not associated with outcomes. A cut-off value of RASr of <9.4% held the best accuracy to predict outcomes (adjusted HR 3.2 (1.81–5.84), p<0.001, Figure 1). Inter-observer agreements for RA strain values across the whole cohort were high (intraclass correlation coefficient for RASr, RAScd and RASct, r=0.95, r=0.86, r=0,92 respectively)

Conclusions

Evaluation of RA function by 2D-STE is feasible, reproducible and is an independent predictor of heart failure and all-cause mortality in patients with at least severe TR.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): INSTITUTO CARLOS III
The impact of age on the 99th percentile of cardiac troponin
Authors: Hasselbalch R , Strandkjaer N , Kristensen J , Joergensen N , Kock T O , Rye Ostrowski S , Vesterager Pedersen O B , Torp-Pedersen C , Bundgaard H , Bor V , Afzal S , Kamstrup P , Dahl M , Hilsted L , Iversen K I
Published: October 2022

Introduction

The 99th percentile upper reference limit (URL) of cardiac troponin (cTn) is diagnostic cutoff for myocardial infarction (MI). Several factors are known to lead to an increase in cTn including sex, kidney function, left ventricular function and various comorbidities. Similarly, studies have shown that cTn concentration of patients increase with age. However, the impact of age on the concentration of cTn in healthy individuals is unclear as several studies of healthy populations showed little to no impact of age.

Purpose

To determine the effect of age on the URL of cTn for the Danish population.

Methods

We invited active and retired blood donors with the aim of including 250 participants of each sex in each of four age groups, <50, 50–60, 60–70 and >70 years, for a total of about 2000 participants. cTn levels were measured by 4 cTn assays (Siemens Atellica and Vista cTnI, Roche cTnT and Abbott Alinity cTnI). The age specific URL were calculated using the non-parametric method. Quantile regression for the 99th percentile was adjusted for sex and creatinine concentration.

Results

A total of 2287 participants were sampled in the study, of which 4 (0.2%) were excluded due to a history of heart disease and 7 (0.3%) were excluded due to insufficient plasma for screening biomarkers. The median age was 58.6 (IQR 48.2–69.7), and 52.6% were female. Figure 1 shows the distribution of cTn concentrations in age intervals. There was a significant increase in cTn with age for all assays (all p<0.001). After adjusting for sex and creatinine concentration, increasing age was only significantly associated with cTnT (0.40 ng/L increase per year, p=0.03). Figure 2 panel A shows the age specific URL for each assay, where we observed a significant difference for cTnT with the URL increasing from 15.8 ng/L (90% CI 12.4–33.9 ng/L) for participants <50 years to 37.6 ng/L (90% CI 34.6–41.5 ng/L) for participants >70 years. The proportion of participants with concentrations above the manufacturers URL increased with age for cTnT from 1.5% in participants <50 years to 25.6% for participants >70 years (p<0.001), figure 2 panel B. This changed little when removing participants with decreased kidney function (eGFR <60 mL/min/1.73 m2) as 24.3% of the remaining participants >70 years had a cTnT above the URL.

Conclusions

The concentration of cTn increased with age for all assays. This was clearest for cTnT in which the 99th percentiles of participants were significantly different for participants age >70 years of whom a quarter had cTnT levels above the level for myocardial injury according to the manufacturer's URL.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): HelsefondenMauritzen La Fountaine Foundation
Elements of Long-Term Care That Promote Quality of Life for Indigenous and First Nations Peoples: A Mixed Methods Systematic Review
Authors: Brooks Deborah , Johnston Sandra , Parker Christina , Cox Leonie , Brodie Melissa , Radbourne Catherine , MacAndrew Margaret
Published: October 2022

Background and Objectives

Little is known about elements of long-term care (LTC) that promote quality of life (QoL) for older Indigenous and First Nations peoples. This systematic review aimed to extend understanding of those deemed most important.

Research Design and Methods

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, systematic database and hand-searching were used to find published and unpublished qualitative studies and textual reports. A convergent integrated approach was used to synthesize data, according to the Joanna Briggs Institute methodology for mixed methods systematic reviews.

Results

Included papers (11 qualitative; seven reports) explored views and experiences of Indigenous residents, families, and LTC staff from North America (8), South Africa (1), Norway (1), New Zealand (1), and Australia (7). Elements of care included: (a) codesigning and collaborating with Indigenous and First Nations communities and organizations to promote culturally safe care; (b) embedding trauma-informed care policies and practices, and staff training to deliver culturally safe services; (c) being respectful of individual needs, and upholding cultural, spiritual and religious beliefs, traditional activities and practices; (d) promoting connection to culture and sense of belonging through sustained connection with family, kin, and Indigenous and First Nations communities.

Discussion and Implications

This review identifies elements or models of care that promote QoL for Indigenous and First Nations peoples in LTC. While included papers were mostly from the United States and Australia, the congruence of elements promoting QoL was evident across all population groups. Findings may be used to inform standards specific to the care of Indigenous and First Nations peoples.
Identification of Implementation Strategies Using the CFIR-ERIC Matching Tool to Mitigate Barriers in a Primary Care Model for Older Veterans
Authors: Shin Marlena H , Montano Anna-Rae L , Adjognon Omonyêlé L , Harvey Kimberly L L , Solimeo Samantha L , Sullivan Jennifer L
Published: October 2022

Background and Objectives

As the proportion of the U.S. population over 65 and living with complex chronic conditions grows, understanding how to strengthen the implementation of age-sensitive primary care models for older adults, such as the Veterans Health Administration’s Geriatric Patient-Aligned Care Teams (GeriPACT), is critical. However, little is known about which implementation strategies can best help to mitigate barriers to adopting these models. We aimed to identify barriers to GeriPACT implementation and strategies to address these barriers using the Consolidated Framework for Implementation Research–Expert Recommendations for Implementing Change (CFIR-ERIC) Matching Tool.

Research Design and Methods

We conducted a content analysis of qualitative responses obtained from a web-based survey sent to GeriPACT members. Using a matrix approach, we grouped similar responses into key barrier categories. After mapping barriers to CFIR, we used the Tool to identify recommended strategies.

Results

Across 53 Veterans Health Administration hospitals, 32% of team members (n = 197) responded to our open-ended question about barriers to GeriPACT care. Barriers identified include Available Resources, Networks & Communication, Design Quality & Packaging, Knowledge & Beliefs, Leadership Engagement, and Relative Priority. The Tool recommended 12 Level 1 (e.g., conduct educational meetings) and 24 Level 2 ERIC strategies (e.g., facilitation). Several strategies (e.g., conduct local consensus discussions) cut across multiple barriers.

Discussion and Implications

Strategies identified by the Tool can inform on-going development of the GeriPACT model’s effective implementation and sustainment. Incorporating cross-cutting implementation strategies that mitigate multiple barriers at once may further support these next steps.
Modified reporting of positive urine cultures to reduce treatment of asymptomatic bacteriuria in long-term care facilities: a randomized controlled trial
Authors: Rehan Zahra , Pratt Claire , Babb Kim , Filier Brenda , Gilbert Laura , Wilson Robert , Daley Peter
Published: October 2022

Objectives

We conducted a prospective, randomized, unblinded superiority trial of the safety and efficacy of modified reporting of positive urine cultures to improve the appropriateness of treatment for asymptomatic bacteriuria (ASB) and urinary tract infection (UTI) in long-term care facilities (LTCFs).

Methods

Consecutive positive urine cultures collected from LTCF patients were randomized between standard (identification and susceptibility) or modified (without identification and susceptibility) laboratory reports. Exclusion criteria were current antibiotic treatment, neutropenia, or transfer to acute care. The diagnosis of UTI or ASB was made prospectively.

Results

One hundred and sixty-nine urine cultures were considered, 100 were randomized and included in ITT analysis, and 96 were included in PP analysis. Sixty-two out of 100 (62%) patients had ASB [41/62 (66%) treated] and 38/100 (38%) had UTI [35/38 (92%) treated]. The lab was called to report the identification and susceptibility in 31/51 (61%) modified reports. The rate of appropriate treatment was higher in the modified report arm: 31/51 (61%) versus 25/49 (51%) (+10%, P = 0.33). Untreated ASB was higher in the modified report arm: 13/32 (41%) versus 8/30 (27%) (+14%, P = 0.25). There were two deaths (one treated ASB, one untreated ASB) and 15 adverse events in the modified arm. There were no deaths (P = 0.16) and 11 adverse events (P = 0.43) in the standard arm. Three patients with untreated UTI survived.

Conclusions

Modified reporting of urine culture improved the appropriateness of treatment by reducing treatment of ASB, but not significantly. Many LTCF prescribers requested standard urine culture reports. Modified reporting may not be suitable for LTCF implementation.
Discontinuation of outpatient medications: implications for electronic messaging to pharmacies using CancelRx
Authors: Pitts Samantha I , Yang Yushi , Thomas Bridgette , Chen Allen R
Published: October 2022

Electronic communication of prescription discontinuation, or CancelRx, has the potential to improve medication safety. We aimed to describe the proportion of discontinued outpatient medications that would result in a CancelRx message to understand its impact on medication safety. We used a data report to identify all outpatient medications discontinued in the electronic health record (EHR) of an academic health system in 1 month (October 2018). Among all 63 485 medications discontinued, 23 118 (36.4%) were e-prescribed, 25 982 (40.9%) were patient-reported or reconciled, and the remainder prescribed nonelectronically. Discontinued high-risk medications were more likely to be e-prescribed (2768 of 5896, 47.0%). A discontinuation reason was specified in 37 353 (58.9%) of all discontinued medications. Approximately one-third to one-half of discontinued medications were e-prescribed within the same EHR and would result in a CancelRx message to the pharmacy. Extension of this functionality to medications reconciled in the EHR could significantly expand the impact of CancelRx on medication safety. In addition, complete and accurate discontinuation reasons are needed to optimize CancelRx implementation.
3M™ Petrifilm™ Rapid Aerobic Count (RAC) Plate Method for the Enumeration of Aerobic Bacteria on Selected Surfaces: AOAC Official MethodSM 2015.13
Authors: Lingle Cari K , Schumacher April J , Rosauer Micki L , Silbernagel Karen M , Deterding Andrew
Published: October 2022

Background

The 3M™ Petrifilm™ Rapid Aerobic Count (RAC) Plate is a sample-ready culture medium system designed to facilitate colony enumeration in 24 h (48 h for dry powders) for selected food and environmental surfaces.

Objective

The objective of this study is to evaluate the 3M Petrifilm RAC Plate in a matrix extension study for the enumeration of aerobic bacteria on stainless steel, sealed concrete, and rubber surfaces.

Method

The 3M Petrifilm RAC Plate was compared to the U.S. Food and Drug Administration Bacteriological Analytical Manual, Ch. 3 (January 2001): Aerobic Plate Count in a paired matrix study for enumeration of aerobic bacteria on stainless steel, sealed concrete, and rubber environmental surfaces.

Results

The 3M Petrifilm RAC Plate showed no statistically significant differences when compared to the reference method for enumeration of aerobic bacteria from stainless steel, sealed concrete, and rubber environmental surfaces. There were no significant statistical differences between the 3M Petrifilm RAC Plate and reference method results for the three matrixes evaluated.

Conclusions

The 3M Petrifilm RAC Plate is an effective plating method for aerobic plate count when analyzing stainless steel, sealed concrete, and rubber surfaces.

Highlights

The 3M Petrifilm RAC Plate is robust, quick, and simple to perform, providing enumerable colonies in 22 to 26 h after incubation when compared to the 48 h of the reference method. The small size of the Petrifilm Plate allows for less space to be occupied by plates in the incubators. The visual biochemical and enzymatic indicators make enumeration of colonies a simple task by presenting colonies in either a blue or red color.
SARS-CoV-2 spike protein as a bacterial lipopolysaccharide delivery system in an overzealous inflammatory cascade
Authors: Samsudin Firdaus , Raghuvamsi Palur , Petruk Ganna , Puthia Manoj , Petrlova Jitka , MacAry Paul , Anand Ganesh S , Bond Peter J , Schmidtchen Artur
Published: October 2022

Accumulating evidence indicates a potential role for bacterial lipopolysaccharide (LPS) in the overactivation of the immune response during SARS-CoV-2 infection. LPS is recognized by Toll-like receptor 4, mediating proinflammatory effects. We previously reported that LPS directly interacts with SARS-CoV-2 spike (S) protein and enhances proinflammatory activities. Using native gel electrophoresis and hydrogen–deuterium exchange mass spectrometry, we showed that LPS binds to multiple hydrophobic pockets spanning both the S1 and S2 subunits of the S protein. Molecular simulations validated by a microscale thermophoresis binding assay revealed that LPS binds to the S2 pocket with a lower affinity compared to S1, suggesting a role as an intermediate in LPS transfer. Congruently, nuclear factor-kappa B (NF-κB) activation in monocytic THP-1 cells is strongly boosted by S2. Using NF-κB reporter mice followed by bioimaging, a boosting effect was observed for both S1 and S2, with the former potentially facilitated by proteolysis. The Omicron S variant binds to LPS, but with reduced affinity and LPS boosting in vitro and in vivo. Taken together, the data provide a molecular mechanism by which S protein augments LPS-mediated hyperinflammation.
Work-up of Patients with Decreased Hemoglobin A2 Identified by Capillary Zone Electrophoresis: A North American Institutional Experience
Authors: Moore Margaret , Courville Elizabeth L
Published: October 2022

Objective

Isolated low hemoglobin A2 (HbA2) is rarely encountered in our clinical practice using capillary zone electrophoresis. The study goal was to characterize the work-up at our institution of patients with low HbA2.

Methods

Patients with low HbA2 and a control cohort with normal capillary zone electrophoresis were identified and relevant information extracted from the medical record.

Results

Of 44 patients with isolated decreased HbA2, 28 (64%) had corresponding complete blood count/ferritin values. Compared to control patients, patients with low HbA2 were more likely to have iron deficiency and demonstrated a more microcytic, hypochromic blood picture. However, 46% (13/28) of patients with low HbA2 and ferritin for evaluation did not have iron deficiency. Only 2 patients had genetic testing.

Conclusion

This study redemonstrates the association between low HbA2 and iron deficiency and reinforces the need for iron indices to interpret capillary zone electrophoresis results. Our study population showed incomplete or absent iron studies in most cases.
Record linkage of routine and cohort data of children in Portugal: challenges and opportunities when using record linkage as a tool for scientific research
Authors: Doetsch Julia Nadine , Dias Vasco , Lopes Inês , Redinha Regina , Barros Henrique
Published: October 2022

Linking records could serve as a useful tool for scientific research and as a facilitator for local policymaking. This article examines the challenges and opportunities for researchers to lawfully link routinely collected health and education data with cohort data of children when using it as a tool for scientific research in Portugal. Such linking can be lawfully conducted in Portugal if three requirements are met. First, data processing pursues a legitimate purpose, such as scientific research. Secondly, data linking complies with the legal obligations of research entities and researchers, acting as data controllers or processors, and it respects the rights of children as data subjects. Finally, data linking is based on the explicit written consent of those with parental responsibility for the child. So far, the implementation of the General Data Protection Regulation in Portugal has not facilitated record linkage. It is argued that further harmonised implementation of that Regulation across European Union and European Economic Area Member States, establishing a minimum shared denominator for record linkage in scientific research for the common good, including without explicit consent, is needed.
After the Trauma: The Role of Rehabilitation Medicine in U.S. DoD Global Health Engagement
Authors: Smolinski George , Licina Derek
Published: October 2022

The U.S. Department of Defense (DoD) possesses significant expertise with rehabilitation of combat injured personnel. This is an area of growing interest with Global Health Engagement (GHE), particularly in countries with active conflict such as Ukraine. Effective rehabilitation can contribute to both development and security, and by leveraging its inherent expertise via rehabilitation-based GHE, the DoD can contribute to these strategic objectives.
A real-time transient detector and the living Swift-XRT point source catalogue
Authors: Evans P A , Page K L , Beardmore A P , Eyles-Ferris R A J , Osborne J P , Campana S , Kennea J A , Cenko S B
Published: October 2022

We present the Living Swift-XRT Point Source (LSXPS) catalogue and real-time transient detector. This system allows us for the first time to carry out low-latency searches for new transient X-ray events fainter than those available to the current generation of wide-field imagers, and report their detection in near real time. Previously, such events could only be found in delayed searches, e.g. of archival data; our low-latency analysis now enables rapid and ongoing follow-up of these events, enabling the probing of time-scales previously inaccessible. The LSXPS is, uniquely among X-ray catalogues, updated in near real time, making this the first up-to-date record of the point sources detected by a sensitive X-ray telescope: the SwiftX-ray Telescope. The associated upper limit calculator likewise makes use of all available data allowing contemporary upper limits to be rapidly produced on demand. These facilities, which enable the low-latency transient system, are also fully available to the community, providing a powerful resource for time-domain and multimessenger astrophysics.
Factors Associated With Liver Steatosis in People With Human Immunodeficiency Virus on Contemporary Antiretroviral Therapy
Authors: Riebensahm Carlotta , Berzigotti Annalisa , Surial Bernard , Günthard Huldrych F , Tarr Philip E , Furrer Hansjakob , Rauch Andri , Wandeler Gilles ,   Swiss HIV Cohort Study
Published: October 2022

Background

Given the impact of new antiretroviral drugs on weight and metabolic parameters, their potential contribution to the development of liver steatosis is of concern. We investigated the determinants of liver steatosis in patients on antiretroviral therapy (ART) in the Swiss HIV Cohort Study (SHCS).

Methods

Between 2019 and 2021, we measured liver stiffness and controlled attenuation parameter (CAP) using transient elastography in consecutive SHCS participants at Bern University Hospital. Individuals with viral hepatitis coinfection and pregnant women were excluded. We used multivariable logistic regression to explore factors associated with steatosis.

Results

Of 416 participants, 113 (27.2%) were female, median age was 51 years (interquartile range [IQR], 43–59), 305 (73.3%) were of European origin, and 212 (51.0%) were overweight/obese (body mass index [BMI] ≥25 kg/m2). Liver steatosis (CAP ≥248 dB/m) was present in 212 (51.0%) participants, 11 (5.2%) of whom had significant fibrosis or cirrhosis. One hundred seventy-nine (43.0%) met the criteria for metabolic-associated fatty liver disease (MAFLD). Among 64 individuals with a BMI <25 kg/m2 and liver steatosis, 31 (48.4%) had MAFLD. In multivariable analyses, BMI ≥25 kg/m2 (adjusted odds ratio, 5.76; 95% confidence interval, 3.57–9.29), age ≥50 years (1.88, 1.14–3.09), European origin (3.16, 1.69–5.89), and current use of tenofovir alafenamide (1.70, 1.08–2.69) were associated with liver steatosis. Exposure to integrase inhibitors was not associated with liver steatosis (0.83, 0.51–1.37).

Conclusions

Our findings suggest a high prevalence of liver steatosis among people with HIV (PWH) on ART in Switzerland. In addition to established risk factors, the use of tenofovir alafenamide was associated with hepatic steatosis.
Palbociclib with Fulvestrant or Letrozole in Endocrine-Sensitive Patients with HR-Positive/HER2-Negative Advanced Breast Cancer: A Detailed Safety Analysis of the Randomized PARSIFAL Trial
Authors: Di Cosimo Serena , Pérez-García José Manuel , Bellet Meritxell , Dalenc Florence , Gil Gil Miguel J , Ruiz Borrego Manuel , Gavilá Joaquín , Sampayo-Cordero Miguel , Aguirre Elena , Schmid Peter , Marmé Frederik , Gligorov Joseph , Schneeweiss Andreas , Albanell Joan , Zamora Pilar , Wheatley Duncan , Martínez-De Dueñas Eduardo , Carañana Vicente , Amillano Kepa , Mina Leonardo , Malfettone Andrea , Cortés Javier , Llombart-Cussac Antonio
Published: October 2022

Background

Palbociclib has gained a central role in the treatment of hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2−) advanced breast cancer (ABC). Despite its manageable toxicity profile, venous thromboembolism (VTE) or interstitial lung disease (ILD)/pneumonitis may infrequently occur. Therefore, we provide a comprehensive summary of the safety and tolerability of the combination of endocrine therapy and palbociclib among patients included in the randomized phase 2 PARSIFAL study.

Materials and Methods

Patients with endocrine-sensitive HR+/HER2- ABC and no prior therapy in an advanced setting (n = 486) were randomly assigned 1:1 to receive fulvestrant–palbociclib (FP) or letrozole–palbociclib (LP). Laboratory tests and the incidence of adverse events (AEs) were recorded at baseline and day 1 of each cycle. Progression-free survival (PFS) was estimated for patients with and without VTE.

Results

A total of 483 patients were analyzed. Neutropenia, leukopenia, anemia, asthenia, arthralgia, fatigue, and diarrhea were the most frequent AEs in both groups. Febrile neutropenia occurred in 3 (1.2%) patients of the FP group and in 1 (0.4%) patient in the LP group. Six (2.5%; 0.4% grade 3) patients in the FP group and 6 patients (2.5%; 0.4% grade 3) in the LP group experienced ILD/pneumonitis. Pulmonary embolism was reported in 12 (5.0%) patients in the FP group and 6 (2.5%) patients in the LP group. Advanced age at baseline was the only factor significantly associated with an increased risk of pulmonary embolism (P < .01).

Conclusion

The PARSIFAL data confirmed the favorable safety profile of both palbociclib regimens. VTE and ILD/pneumonitis were occasionally reported, and their early detection allowed patients to continue treatment effectively without detriment to efficacy.

ClinicalTrials.gov Identifier

NCT02491983; https://clinicaltrials.gov/ct2/show/NCT02491983).