bluuebunny/crossref_metadata_2025 huggingface dataset:
Clustering analysis based on automated electrocardiographic measurements to identify prognostically distinct phenotypes in patients hospitalized for heart failure: a retrospective cohort study
Authors: Chan J S K , Zhou J , Li A , Tan M , Wong W T , Ciobanu A , Gkouziouta A , Letsas K , Liu T , Liu Y , Zhang Q , Tse G
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Heart failure (HF) is a heterogeneous disease with complex structural and electrophysiological derangements of the heart. Attempts to classify HF from the electrophysiological perspective are lacking.

Purpose

To use electrocardiographic (ECG) data for phenotypic classification of patients with HF.

Methods

In this retrospective cohort study, all adult patients hospitalized for HF during 2010-2016 at a tertiary center were included. Automated measurements of the first ECG obtained during the index admission were recorded. K-means clustering using premorbid conditions and selected ECG measurements were used to classify the cohort into four mutually exclusive clusters. The primary (all-cause and cardiovascular mortality) and secondary (ventricular arrhythmia (VA)) outcomes were compared between clusters using Cox regression analysis.

Results

In total, 2849 patients (1363 males, age 75.1 ± 13.4 years) were included. Over a mean follow-up period of 5.37 ± 4.10 years, all-cause and cardiovascular mortality occurred in 2071 (72.7%) and 600 (21.1%) patients respectively, while VA occurred in 110 patients (3.9%). Cluster 1 was characterised by a low heart rate and low ventricular activation time (VAT). Cluster 2 was characterised by old age, low absolute QRS area, and high QTc and QT dispersion. Cluster 3 was characterised by young age, and left ventricular hypertrophy (LVH), and few had history of VA. Cluster 4 was characterised by wide QRS, hypertension, ischaemic heart disease, high VAT, and high absolute T wave area. Cluster 4 had the highest and cluster 1 the lowest risks of all-cause (hazard ratio (HR) 2.96 [1.09, 1.50], p = 0.003; Figure A) and cardiovascular mortality (HR 2.90 [1.15, 2.11], p = 0.004; Figure B). Meanwhile, cluster 2 had the highest risk of VA (HR 2.23 [1.09, 3.85], p = 0.025; Figure C) while clusters 1 and 3 similarly had the lowest risks.

Conclusion

HF presents with clinically and electrophysiologically distinct phenotypes. Clustering analysis is useful in identifying HF phenotypes which are prognostically significant. Abstract Figures A, B, and C
GDF-15: a novel biomarker of heart failure predicts 30-day all-cause mortality and 30-day HF rehospitalization in patients with acute heart failure syndrome
Authors: Kosum P , Mattanapojanat N , Kongruttanachok N , Ariyachaipanich A
Published: February 2022

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Ratchadapiseksomphotch Fund, Faculty of Medicine, Chulalongkorn University

Background

Growth Differentiation Factor-15 (GDF-15) is a distant member of the transforming growth factor-β (TGF-β) cytokine super family. The increased expression of GDF-15 has been observed during various cardiac diseases include heart failure (HF) and may associated with worse outcomes. However, the relationship is still not well understood, and evidences are not existed in Thai patients.

Purpose

To study association between biomarker (GDF-15, NT-proBNP and hs-Troponin T) at the time of admission and discharge in patient with AFHS and their association with 30-day all-cause mortality and 30-day heart failure rehospitalization

Methods

This is a prospective, single center study of patients admitted for acute HF syndrome regardless of ejection fraction between December 2018 to June 2019. GDF-15 were measured within 24 hours after admission and at the time of discharge. Patient characteristics, orthoedema congestion score, biomarkers, treatment and outcome including 30-day, all-cause mortality and rehospitalization were collected. Logistic regression analysis was used to evaluate the relationship between GDF-15 level and outcomes.

Results

Total of 103 patients were screened and 84 patients were enrolled (mean age of 69 ± 14 years, 52.4% females). Ischemic heart diseases were reported in 38.1% and 23.1% of patients had history of HF with reduced ejection fraction. The orthoedema congestion score at the time of admission and discharge were 2.29 ± 0.1 and 0.38 ± 0.8, respectively (score from 0 to 4, with lower scores are less congestion). The GDF-15 level was significantly decrease during admission (at the time of admission 9118 ± 6010 pg/mL, at time of discharge 7107 ± 4787 pg/mL, mean differences 1528 ± 4469; p = 0.006). The 30-day all-cause mortality was 5.95%. The 30-day rehospitalization occurred in 22 (26.1%) patients (13 HF rehospitalization and 9 non-HF rehospitalization). Univariate analysis showed that the admission GDF-15 level, but not troponin or NT-proBNP, was associated with 30-days all-cause mortality (p = 0.029) and multivariate analysis showed reduction in GDF-15 level from admission to discharge was associated with lower 30-days rehospitalization (p = 0.023).

Conclusion

In this single center study, the rate of mortality and rehospitalization is very high in patient discharge after acute HF hospitalization. the GDF-15 levels were elevated during acute HF and improving by the time of discharge. This novel biomarker may offer additional value in predicting the risk of outcomes in patient with acute HF.
Machine learning based diagnosis of heart failure with preserved ejection fraction among South Asian patients
Authors: Cherukupalli R , Achanta A , Cherukupalli A , Potukuchi S
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Diagnosis of Heart Failure with preserved Ejection Fraction (HFpEF) remains challenging even for an astute clinician with the current diagnostic tests, algorithms and scoring systems.  The use of Machine Learning (ML) in cardiovascular research has expanded exponentially in recent years.

Purpose

In this study we studied the predictive accuracy of a machine-learning model for the diagnosis of HFpEF in South Asian patients.

Methods

A single centre retrospective data of 1068 admitted patients with a clinical diagnosis of HF were obtained.  From this data outliers were removed based on box-and-whisker plot study.  This data was then segregated into three: without HF, HF with reduced ejection fraction and HFpEF.  Finally, we arrived at 530 patients’ data with left ventricular ejection fraction (LVEF) values of >45%. This data set was randomly divided into two parts: 80% as Training dataset and 20% as Test dataset.  Two ML techniques such as Logistic Regression and Neural Networks were chosen to build the prediction models. Orange Data Mining Software version 3.28 was used to build these models. The overall performance of the ML methods has been reported using Precision, Recall and F1 scores of precision and recall; measure that combines precision and recall.

Results

The table summarizes precision, recall and F1 score of both models. The predicted results from the ML models are compared with HFA PEFF score.

Conclusion

ML based diagnosis using two different models showed acceptable predictive accuracy for HFpEF. Limitations of using LVEF as a predictor for the diagnosis of HF by ML and discussion on how the combination of an expert clinician opinion with ML further improves the diagnostic ability will be made. Abstract Figure.
Predictors of elevated follow-up high sensitivity troponin after an initial normal value during acute exacerbations of chronic obstructive pulmonary disease
Authors: Yew M S , Abisheganaden J A , Xu H Y
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

BACKGROUND

Elevation of cardiac troponin (cTn) may be seen in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and is both diagnostic for myocardial injury and confers a poorer prognosis.  Serial cTn testing after an initial normal value is often performed even though the yield is low.  

PURPOSE

We aim to investigate factors predicting an abnormally elevated cTn after an initial normal cTn value.

METHODS

Retrospective data analysis of patients with AECOPD admitted between 1st January 2017 to 30th June 2017 with at least 2 serial high sensitivity cTn I (HScTnI) performed within 24 hours of presentation.  Binary logistic regression was used to explore predictors of abnormally elevated (>40 ng/L) serial HScTnI after an initial normal value.

RESULTS

There were 240 cases with an initial normal HScTnI (mean age 74 years, 92.1% male).  Amongst these, 97 cases had another follow-up HScTnI performed within 24 hours of presentation.  Patients in the groups with or without follow-up HScTnI were similar in terms of demographics, COPD stage, cardiovascular risk factors, history of coronary disease and vital parameters.  Significantly more patients in the group with follow-up HScTnI had ischaemic electrocardiographic changes (10.3 vs 2.1%, p = 0.006).  There were 22/97 (22.7%) cases with abnormally elevated follow-up HScTnI.  The mean time interval between the initial and follow-up HScTnI was not significantly different between the groups with or without elevated HScTnI (12.8 vs 10.4 hours, p = 0.858).  Cases with elevated follow-up HScTnI had significantly higher heart rate (109 vs 97bpm, p = 0.007), initial HScTnI (24 vs 17ug/L, p = 0.009), C reactive protein (43.1 vs 7.6mg/L, p = 0.004) and procalcitonin (0.16 vs 0.07ug/L, p = 0.014) levels.  They also had a greater proportion of chest radiographs showing consolidation (15 vs 9%, p = 0.046).  On univariate analysis, heart rate (OR 1.037 [1.009 - 1.066], P = 0.009), temperature (OR 1.897 [1.119 - 3.217], p = 0.017), initial HScTnI value (OR 1.063 [1.014 - 1.115], p = 0.012) and neutrophil counts (OR 1.039 [1.000 - 1.078], p = 0.049) were significant predictors of an abnormally elevated follow-up HScTnI.  Only heart rate remained as a significant predictor (Adj OR 1.050 [CI 1.015 - 1.086] p = 0.005) after multivariate analysis.

CONCLUSIONS

Less than a quarter of AECOPD patients with an initial HScTnI had an elevated level on serial testing.  A higher heart rate is a significant predictor of a subsequent elevated HScTnI after an initial normal value and may identify patients for selective serial cTn testing.  Larger studies are needed to identify predictors that can reliably risk stratify patients for serial cTn testing.
Predictions of arrhythmic, heart failure and mortality outcomes in pericarditis using automatic electrocardiogram analysis: a retrospective cohort study
Authors: Lakhani I , Zhou J Z , Li A L , Lee S L , Liu T L , Zhang Q Z , Tse G T
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

 Pericarditis is a relatively rare disease with a global burden. Despite its strong association with adverse cardiovascular outcomes, identification of patients at risk of future heart failure or arrhythmic events is difficult. In the following study, automated electrocardiogram (ECG) variables were used to predict new onset ventricular tachycardia/fibrillation (VT/VF), atrial fibrillation (AF) and heart failure with reduced ejection fraction (HF) in an Asian cohort of pericarditis patients.

Purpose

Assessing the use of automated ECG parameters to predict prognosis in pericarditis patients.

Methods

Consecutive patients admitted to a single tertiary center in China, for a diagnosis of pericarditis between 1st January 2005 and 31st December 2019, were included. Patients with existing AF or HF were excluded. The follow-up period was until the 31st December 2020, or death. Cox regression was applied to identify significant predictors of the incident VT/VF, AF or HFrEF.

Results

A total of 874 patients were included. The cohort was 57% male and had a median age of 59 (IQR: 50-70) years old. During follow-up, 57 patients (6.5%), 156 (17.8%) and 168 (19.2%) suffered from VT/VF, AF and HF, respectively. Cox regression identified baseline VT/VF, terminal angle of the QRS vector in the transverse plane, mean QRS duration and mean QTc intervals as significant predictors of incident VT/VF events, with only the foremost maintaining significance in multivariate analysis. In contrast, baseline age, prior diagnoses of hypertension, malignancy and atrial flutter, initial angle and magnitude of the QRS vector in the transverse plane, P-wave and QRS axis in the frontal plane, ST segment axis in the frontal and horizontal planes, mean PT interval, mean PR segment duration and QTc intervals were all univariate predictors of incident AF, albeit only baseline age and initial angle of the QRS vector in the transverse plane retained significance after multivariate adjustment. As it pertains to new-onset HFrEF, several clinical and electrocardiographic parameters demonstrated an association in univariate analysis, with history of hypertension, history of sudden cardiac death (SCD), initial QRS angle in transverse plane, initial 40ms QRS complex axis, ST-segment axis in the horizontal plane, T-wave frontal axis and atrial rate all showcasing significant relationships in multivariate analysis.

Conclusions

AF and HFrEF are relatively common complications, whilst VT/VF occurs less frequently in the context of pericarditis. Different clinical and ECG predictors of these outcomes were identified. Future studies are still needed to evaluate their use for risk stratification in the clinical setting.
Clinical manifestation of coronary pulmonary arterial fistula diagnosed by cardiac computed tomography
Authors: Funabashi N , Kobayashi Y
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

 Coronary pulmonary arterial fistula (CPAF) may cause enlargement of an aneurysm, which may rupture or compress other organs, or occurrence of steal phenomenon of coronary arterial (CA) blood flow. We hypothesize that there are various clinical characteristics of CPAF including patient age at diagnosis, method of diagnosis, observed symptoms, complications, and surgical interventions

Methods

 From a total of >17,000 patients undergoing CT from 2000-2019 in our institute, 11 patients diagnosed as having CPAF were analyzed retrospectively. One was treated surgically prior to analysis, and the remaining 10 (3 males; 56 ± 12 years) were followed for a mean of 52 ± 64 months.

Results

 5 were diagnosed as having CPAF through cardiac CT and 2 were diagnosed by invasive coronary angiograms. One was diagnosed by TTE and another patient was diagnosed by TTE and cardiac CT to differentiate from a mediastinal tumor. 4 had dyspnea, 2 had chest pain, and 1 had palpitation. 5 showed other cardiovascular disease (1 with left ventricular non-compaction, and persistent left superior vena cava; 1 with vascular type Ehlers-Danlos syndrome; 1 with hypertrophic cardiomyopathy; 1 with aortic valve regurgitation (AR); and 1 with vasospastic angina pectoris). The occurrence of steal phenomenon of CA blood flow was diagnosed in 4. CA aneurysm was observed in 5. 2 had abnormal flow from descending aorta to pulmonary arteries through CA. Pulmonary arterial systolic pressure >30 mmHg was observed in 2. During the observed periods, 4 underwent surgical procedure to eliminate CA aneurysm (N = 2), or for significant steal phenomenon of CA blood flow (N = 1). A patient with AR underwent CPAF elimination simultaneously with aortic valve replacement. The mean periods between initial diagnoses and surgical intervention was 27 ± 36 months. The remaining 6 were followed without surgical intervention for a mean of 69 ± 76 months without any cardiac events.

Conclusion

 CPAF was diagnosed at a mean age of 56 years and half were diagnosed incidentally by cardiac CT. Five of the 11 patients (45%) underwent a surgical procedure. Patients with CPAF showed various symptoms due to complicating diseases, anatomical configurations, and outcomes. Abstract Figure. Typical CT images of CPAF
Randomized comparison of proximal and distal radial access for coronary angiography and interventions
Authors: Dadarwal A , Garg N , Kapoor A , Tewari S , Kumar S , Khanna R , Sahu A , Goel P K
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Vascular access for coronary procedures is of paramount important not only for successful procedure but also to prevent complications. In comparison to femoral access, proximal radial artery (PRA) access at wrist is associated with decreased bleeding complications and mortality.  The most important complication of PRA access is radial artery occlusion Use of the proximal radial artery (PRA) approach at wrist has several limitations:  the need to supinate the hand, which can exacerbate chronic joint pain, the depth of the radial artery in large arms, which could make arterial puncture challenging even under ultrasound guidance, the risk of sporadic bleeding in the forearm, and the risk of radial artery occlusion. All above limitations can be overcome by distal radial artery (DRA) access in anatomical snuff box.  Randomized Studies are lacking for the comparison between DRA and PRA approach in coronary procedures.

Aims and objective

To compare safety, efficacy and feasibility between PRA and DRA approach in randomized fashion.

Material and methods

This was single center randomized controlled trial. 320 patients were randomized in PRA and DRA groups. PRA approach was in wrist and DRA approach was in anatomical snuff box. Primary endpoint was cannulation failure (failure to achieve radial access) and transradial failure (failure to complete procedure after successful access). Secondary safety outcome includes major (compartment syndrome, need for vascular surgery, hand dysfunction, nerve palsy ,arteriovenous fistula, hematoma requiring blood transfusion, proximal radial artery occlusion) and minor (radial artery spasm, hematoma not requiring transfusion or causing compartment syndrome, ecchymosis, local edema, paresthesia, pseudoaneurysm) complications; secondary efficacy outcome were puncture attempts, cannulation time, procedure time, radiation dose, hemostasis time  and quality of life endpoint  was pain score .

Results

 Each group was having 160 patients. In DRA group 73.9 % were CAG and 26.1 % were PCI; in PRA group and 75.7 were CAG and 24.3 were PCI. Cannulation failure was more in DRA group (7.5 % vs 2.5 %, P < 0.001) without difference in transradial failure (n = 3 vs 4, p =0.764). There were no major complications in both groups except PRAO which was significantly less in DRA group (0 % vs 5.2 %, p= 0.007). Puncture attempts, cannulation time, pain score were more in DRA (1.65 vs 1.29, P < 0.001;3.23 vs 2.62 minutes, p < 0.001;25.5 vs 21.6 minutes, p = 0.039 respectively). There was no significant difference for minor complications in both groups.

Conclusion

DRA approach is as safe and feasible as PRA approach and causes significantly less PRAO. DRA approach may be advocated as default approach where radial access is chosen for coronary procedures. Abstract Figure. primary outcome  Abstract Figure. Procedural characteristic
Intravascular lithotripsy during percutaneous coronary intervention for calcified coronary lesions: analysis of patient and procedural characteristics and clinical outcomes
Authors: Leung J , Pender P , French J , Leung D , Mussap C , Asrress K , Taylor D , Naguib Badie T , Kadappu K , Gibbs O , Kachwalla K , Nguyen P , Hopkins A , Lo S
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

Coronary artery calcification is frequently encountered during percutaneous coronary intervention (PCI). It can reduce PCI success and increase intra-procedural and post-procedural complications, including stent embolization, under-expansion and mal-apposition. Intravascular lithotripsy (IVL) is a new tool developed to treat calcified coronary lesions.

Purpose

Retrospective analysis of all cases of intravascular lithotripsy performed within our local health district to examine patient and procedural characteristics and clinical outcomes.

Methods

All patients undergoing PCI with intravascular lithotripsy between September 2019-August 2021 within our local health district were analysed. Patient and procedural characteristics and clinical outcomes were recorded.

Results

67 patients (50 men) were included with mean age 71.4 ± 8.7years. Risk factors prevalence included smoking (34%), hypertension (82%), dyslipidaemia (69%) and diabetes (46%). Trans-radial artery access was used in 38 patients (57%). IVL was performed most commonly in the left anterior descending artery (52%),[Figure 1]. IVL was utilised in 9 chronic total occlusions and 12 bifurcation lesions. Intracoronary (IC) imaging was performed in 59 patients (88%), intravascular ultrasound in 41(61%) and optical coherence tomography in 18 (27%). 41 (69%) patients had imaging performed pre and post IVL and post PCI.  IC imaging identified 14 cases with 270º calcification arc and 45 cases with 360º arc. Nine cases (13.4%) required rotational atherectomy prior to IVL (most commonly 1.75mm burr). Mean reference vessel diameter was 3.2 ± 0.3mm. Mean lesion length was 36.3 ± 16.5mm. Mean pre-PCI stenosis was 85.5 ± 10.8%. Drug eluting stents were successfully deployed in 57 cases (85%), 10 had balloon angioplasty alone. Mean stent length was 39.2 ± 17.8mm. Mean post-PCI stenosis was 4.5 ± 13.3% (median 0%). Figure 2 shows a statistically significant increase in minimum lumen diameter and minimum lumen area post-IVL and minimal-stent-area (MSA) post-PCI. Mean stent expansion was 83%. Mean screening time 35.8 ± 17.8 minutes with mean contrast used 207.3 ± 78.7mL. No sustained arrhythmias or side-branch loss occurred. Vessel rupture was recorded in one patient necessitating urgent cardiac surgery (due to oversized balloon) and in 4 cases the IVL balloon could not cross the lesion.

Conclusion

Our experience shows that IVL is safe and effective and facilitates stent delivery and expansion. Intracoronary imaging is important to determine the need for calcium modification and evaluate its success prior to stent delivery and to confirm optimised stent expansion. Abstract Figure. Breakdown of PCI Artery  Abstract Figure. IC Dimensions Pre/Post IVL/Post PCI
Platinum chromium everolimus-eluting stent versus cobalt chromium zotarolimus-eluting stent in very late stent thrombosis: a meta-analysis of randomized controlled trials
Authors: Baterna J J , Susanto A , Cheng F
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Very late stent thrombosis is a rare but potentially lethal outcome for drug-eluting stents used in percutaneous coronary intervention. There is limited research currently on the occurrence of very late stent thrombosis as a complication of two most used second-generation drug-eluting stents, i.e. platinum chromium everolimus-eluting stent (PtCR-EES) and cobalt chromium zotarolimus-eluting stent (CoCr-ZES).

Purpose

The study provides comparative information on the formation of very late stent thrombosis as a long-term outcome of PtCr-EES and CoCr-ZES. Results of this study may guide interventional cardiologists in decision-making regarding the choice of stent.

Methods

Randomized controlled trials (RCTs) which compared stent thrombosis end point of PtCr-EES and CoCr-ZES were identified through Pubmed.

Results

Data from three RCTs analyzed a total of 7,911 participants, with 4,574 in the PtCr-EES and 3,324 in the CoCr-ZES. Treatment with either stent showed no significant difference in the incidence of very late stent thrombosis.

Conclusion

  Both stents showed comparable incidence of very late stent thrombosis. Additional RCTs are recommended to further establish the results for very late stent thrombosis. Longer follow-up is also suggested to discover more long-term outcomes.
Association of body mass index with systolic and diastolic blood pressure in rural Indians
Authors: Inamdar Aniket
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Body mass index (BMI) is positively and independently associated with morbidity and mortality from hypertension, cardiovascular disease, type II diabetes mellitus, and other chronic diseases. In Caucasian and Asian populations, a strong association has been depicted between BMI and mortality. Globally, high blood pressure is estimated to cause 7.1 million deaths, about 13% of the total. About 62% of cerebrovascular disease and 49% of ischemic heart disease are attributable to suboptimal BP (systolic > 115 mm Hg). Overweight and obesity increase the risks of high BP, coronary heart disease, ischemic stroke, type II diabetes mellitus, and certain cancers. Worldwide, about 58% of diabetes mellitus and 21% of ischemic heart disease are attributable to BMI above 21 kg/m2. The combination of blood pressure and Body Mass Index (BMI) contribute more than 60% cases of cardiovascular disease.

Purpose

The main objective was to determine the correlation between BMI and systolic and diastolic blood pressure of rural Indian patients.

Materials and Methods

310 patients who visited our hospital in rural India from January 15,2021 to February 15,2021 were included in this study and their systolic and diastolic blood pressure, weight and height were measured. BMI was calculated by weight in kilograms divided by square of height in meters. Using this, the patients were categorized as underweight (<18.5 kg/m2), normal or lean BMI (18.5–22.9 kg/m2), overweight (23.0 –24.9 kg/m2) and obese (≥25 kg/m2) based on the revised consensus guidelines for India. Descriptive analysis and Spearman correlation test were used to analyze the data.

Results

The results of the bivariate analysis using Spearman correlation test showed that there is significant relationship between BMI and systolic blood pressure (p < 0.001, r = 0.375) as well as BMI and diastolic blood pressure (p <0.001, r = 0.432). This study shows that as BMI increases both systolic and diastolic blood pressure increases.

Conclusion

This study shows statistically significant relationship between Body Mass Index (BMI) and systolic and diastolic blood pressure in rural Indian patients. Weight gain seems to be an important risk factor for development of hypertension. Weight loss has been recommended for obese hypertensive patients and has been shown to be most effective non pharmacological treatment approach. Physical activity and caloric restriction should be promoted to control the obesity epidemic which will significantly reduce global cardiovascular disease burden.
A survey-based comparison of cardiovascular health risk behaviours in Indian men and women during the pandemic
Authors: Chockalingam P , Natarajan V , Sekar T
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiovascular disease (CVD), the leading cause of mortality globally, is caused by a combination of behavioral, clinical and genetic risk factors. The rising prevalence of unhealthy diet, inadequate exercise, psychosocial factors and tobacco use in urban and rural populations of India has posed a major epidemiological and healthcare threat in the recent past.

Purpose

This study aims to understand the cardiovascular health risk behaviors in Indian men and women during the pandemic.

Methods

A survey-based study was conducted at different time points between April 2020 and August 2021. A pre-tested anonymized self-administered questionnaire was distributed online as a pre-program assessment of participants registering for the health awareness webinars conducted by our team. Demographic data and CVD risk behaviors pertaining to dietary consumption, exercise routine, sedentary behavior, psychosocial factors, sleep pattern, tobacco use and alcohol consumption were collected. Not meeting daily intake of whole grains and at least 4 portions of vegetables and fruits, non-performance of at least 150 minutes of brisk aerobic exercise per week, chronic stress and use of tobacco were considered risky behaviors, as per the international guidelines.

Results

Of the 573 subjects, 305 (53%) were women and 236 (41%) were 15-30 years old. Majority of subjects were not meeting their requirements pertaining to whole grains (76%) and fruits/vegetables (72%). Inadequate exercise (48%), chronic stress (31%) and tobacco use (5%) were noted. Significantly more women than men (p = 0.0001) were falling short in their exercise requirement. Significantly more men than women (p = 0.0001) were using tobacco products (Figure).

Conclusion

Cardiovascular risk behaviors are highly prevalent in Indian men and women during the pandemic calling for a coordinated effort to increase awareness and modify to a healthy behavior. Abstract Figure. Risk behaviors in study subjects  Abstract Figure. Comparison of risk behaviors
The association of liver enzymes with systolic and diastolic blood pressure in young adults
Authors: Correa T , Freitas D F , Brum C B , De Oliveira I O
Published: February 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Science and Technology Department, Brazilian Ministry of Health.

Introduction

Nonalcoholic fatty liver (NAFLD) disease has been associated with metabolic syndrome and cardiovascular risk factors including cholesterol, type 2 diabetes, obesity, and hypertension. Patients with NAFLD also have increased risk of coronary artery disease and major adverse cardiovascular events.

Purpose

The aim of this study was to assess the associations of liver enzymes with systolic and diastolic blood pressure in 22-year-old individuals from a 1993 birth cohort in Brazil.

Methods

During 1993, all live born babies in the city were invited to take part in a prospective study and sub-samples of this cohort were followed-up since then. At the 22-year follow-up, the liver enzymes evaluated were aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyl transferase (GGT). Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were obtained calculating the mean of two measurements (at the beginning and the end of the interview) using a blood pressure monitoring device. The co-variables taken into consideration were sex, fasting period, body mass index (BMI), waist circumference (WC), triglycerides, cholesterol, excessive alcohol consumption (>8 points in the Alcohol Use Disorders Identification Test), and physical inactivity. Adjusted linear regressions have been performed and p < 0.05 was considered statistically significant.

Results

The sample was composed of 2603 (49.6%) men and 2645 (50.4%) women of approximately 22 years old. Median (IQR) AST (U/L) was 21 (18-26), and GGT (U/L) 24 (18-33). Mean (±SD) ALT (U/L) was 19 ± 16.5, SBP (mmHg) 123.9 ± 13.8, and DBP (mmHg) 73 ± 8.7. An increase of 1 U/L in ALT concentrations corresponded to a predicted increase of 0.87 mmHg in SBP and 0.62 mmHg in DBP (Table). This was stronger for GGT, as an increase of 1 U/L in GGT concentrations corresponded to a predicted increase of 1.41 mmHg in SBP and 1.14 mmHg in DBP (Table). AST was not associated with SBP (p = 0.094) or DBP (p = 0.093) (Table).

Conclusions

ALT and GGT are positively associated with SBP and DBP independent of potential confounders since early adult age. As causal roles remain unclear, prospective large-scale studies are necessary to better understand this association. Abstract Figure.
High visit-to-visit cholesterol variability predicts new-onset heart failure and adverse cardiovascular events: a retrospective population-based cohort study
Authors: Chan J S K , Zhou J , Satti D I , Lee T T L , Chou O H I , Wai A K C , Ciobanu A , Liu Y , Liu T , Zhang Q , Tse G
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Hyperlipidaemia is associated with adverse cardiovascular outcomes. However, the long-term prognostic value of visit-to-visit cholesterol variability is less certain, particularly regarding the risks of new-onset heart failure (HF). We investigated the associations between visit-to-visit cholesterol variability and adverse cardiovascular events.

Methods

This was a retrospective cohort study of patients attending family medicine clinics in a Chinese city during 2000-2003 with follow-up until 2019. Patients with at least three sets of blood cholesterol (low-density (LDL-C) and high-density (HDL-C) lipoprotein cholesterol, and total cholesterol) levels available at different visits were included. Patients with prior HF, myocardial infarction (MI), use of HF medications, and pregnancy were excluded. Visit-to-visit variability was calculated using standard deviation and coefficient of variation (CV). The primary outcome was new-onset HF. The secondary outcomes were cardiovascular mortality, and myocardial infarction. Multivariable Cox regression with adjustments for significant baseline predictors of outcomes were used to evaluate the association between cholesterol variability and the outcomes.

Results

A total of 5662 patients were included (2152 males; mean age 63.3 ± 12.4 years). The mean follow-up period was 15.3 ± 4.6 years. Lower mean HDL-C and total cholesterol predicted new-onset HF and MI, while higher mean LDL-C and total cholesterol and lower HDL-C predicted cardiovascular mortality (Table 1). Cholesterol variability was a significant predictor of the outcomes (Table 1). Higher variability of HDL-C (hazard ratio (HR) for CV: 14.202 [6.524, 30.916], p < 0.0001; Figure 1A) and total cholesterol (HR for CV: 10.340 [4.582, 23.336], p < 0.0001; Figure 1B) predicted new-onset HF. These also predicted MI (HR for CV: 40.738 [14.412, 115.150], p < 0.0001, and 34.285 [11.450, 102.660], p < 0.0001, respectively), as did higher variability of LDL-C (HR for CV: 3.798 [1.903, 7.578], p = 0.0002). Lower variability of LDL-C (HR for CV: 0.234 [0.104, 0.526], p < 0.0001) predicted cardiovascular mortality. This was probably driven by the association between cardiovascular mortality and higher mean LDL-C. Variability of HDL-C and total cholesterol did not predict cardiovascular mortality

Conclusion

Higher visit-to-visit cholesterol variability was associated with significantly increased long-term risks of new-onset HF and adverse cardiovascular events. Variability of different types of cholesterol had varying prognostic values, with HDL-C showing particular importance for new-onset HF. Visit-to-visit cholesterol variability may be a clinically relevant and important tool for HF and general cardiovascular risk stratification. Abstract Figure 1  Abstract Table 1
Palliative care for patients with cardiovascular disease and COVID-19 in a major referral hospital
Authors: Correa T , Simao A M S , Sobreira J V B , Yarshell F , Anbar F B , De Carvalho R T
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

COVID-19 disease has a wide spectrum of severity, ranging from asymptomatic to severe acute respiratory syndrome. Although the estimated mortality is around 3% in the general population, individuals with comorbidities such as cardiovascular disease (CVD) may develop worse virus-related outcomes and have higher mortality rates. Furthermore, triage systems in pandemics may have low sensitivity to the need for palliative care, leaving many patients without appropriate end-of-life support.

Purpose

The aim of this study was to evaluate the palliative care offered to patients with CVD and COVID-19 in a major referral hospital in Brazil.

Methods

Descriptive and retrospective study of adult patients with CVD and COVID-19 admitted to a major referral hospital in Brazil. Medical records of patients with CVD and COVID-19 were reviewed. Patients were screened for the need for palliative care through the Supportive and Palliative Care Indicators Tool (SPICT). Pearson’s chi-squared tests were performed and p < 0.05 was considered statistically significant.

Results

The sample was composed of 526 (53.6%) males and 456 (46.4%) females. Median [IQR] age was 65 [55-73] years old. Regarding department of admission, 194 (19.8%) patients were admitted to the wards, 359 (36.5%) to the emergency room (ER), and 429 (43.7%) to the intensive care unit (ICU). Regarding SPICT criteria, 285 (29%) were at risk of deteriorating and dying. Palliative care was offered to 82 (8.4%) patients. From the patients who met SPICT criteria (n = 285), only 64 (22.5%) had access to palliative care during hospitalization. Patients who received palliative care were more likely to be ≥60 years old, to meet SPICT criteria, and to die (p < 0,001) (Table). Sex and department of admission were not associated with the likelihood of receiving palliative care (Table). Regarding outcomes, 356 patients died (36.3%), 573 were discharged (58.3%), and 53 (5.4%) were transferred to another unit. From the patients who died (n = 356), only 65 (18.3%) had access to palliative care.

Conclusions

In our study, there was a high mortality rate in patients with CVD and COVID-19, although a considerable proportion of them did not have access to palliative care before dying. It is important to give further attention to the end-of-life support offered to patients with CVD and COVID-19. Abstract Figure.
WormBase in 2022—data, processes, and tools for analyzing Caenorhabditis elegans
Authors: Davis Paul , Zarowiecki Magdalena , Arnaboldi Valerio , Becerra Andrés , Cain Scott , Chan Juancarlos , Chen Wen J , Cho Jaehyoung , da Veiga Beltrame Eduardo , Diamantakis Stavros , Gao Sibyl , Grigoriadis Dionysis , Grove Christian A , Harris Todd W , Kishore Ranjana , Le Tuan , Lee Raymond Y N , Luypaert Manuel , Müller Hans-Michael , Nakamura Cecilia , Nuin Paulo , Paulini Michael , Quinton-Tulloch Mark , Raciti Daniela , Rodgers Faye H , Russell Matthew , Schindelman Gary , Singh Archana , Stickland Tim , Van Auken Kimberly , Wang Qinghua , Williams Gary , Wright Adam J , Yook Karen , Berriman Matt , Howe Kevin L , Schedl Tim , Stein Lincoln , Sternberg Paul W
Published: February 2022

WormBase (www.wormbase.org) is the central repository for the genetics and genomics of the nematode Caenorhabditis elegans. We provide the research community with data and tools to facilitate the use of C. elegans and related nematodes as model organisms for studying human health, development, and many aspects of fundamental biology. Throughout our 22-year history, we have continued to evolve to reflect progress and innovation in the science and technologies involved in the study of C. elegans. We strive to incorporate new data types and richer data sets, and to provide integrated displays and services that avail the knowledge generated by the published nematode genetics literature. Here, we provide a broad overview of the current state of WormBase in terms of data type, curation workflows, analysis, and tools, including exciting new advances for analysis of single-cell data, text mining and visualization, and the new community collaboration forum. Concurrently, we continue the integration and harmonization of infrastructure, processes, and tools with the Alliance of Genome Resources, of which WormBase is a founding member.
Bayesian differential moment tensor inversion: theory and application to the North Korea nuclear tests
Authors: Jia Zhe , Zhan Zhongwen , Helmberger Donald
Published: February 2022

Moment tensors are key to seismic discrimination but often require accurate Green's functions for estimation. This limits the regions, frequency bands and wave types in moment tensor inversions. In this study, we propose a differential moment tensor inversion (diffMT) method that uses relative measurements to remove the path effects shared by clustered events, thereby improving the accuracy of source parameters. Using results from regular inversions as a priori distribution, we apply Bayesian Markov Chain Monte Carlo to invert the body- and surface wave amplitude ratios of an event pair for refined moment tensors of both events. Applications to three North Korea nuclear tests from 2013 to 2016 demonstrate that diffMT reduces the uncertainties substantially compared with the traditional waveform-based moment tensor inversion. Our results suggest high percentages of explosive components with similar double-couple components for the North Korea nuclear tests.
High-resolution velocity estimation from surface-based common-offset GPR reflection data
Authors: Liu Yu , Irving James , Holliger Klaus
Published: February 2022

Surface-based common-offset ground-penetrating radar (GPR) reflection profiling is a popular geophysical exploration technique for obtaining high-resolution images of the shallow subsurface in a cost-effective manner. One drawback of this technique is that, without complementary borehole information in form of dielectric permittivity and/or porosity logs along the profile, it is currently not possible to obtain reliable estimates of the high-frequency electromagnetic velocity distribution of the probed subsurface region. This is problematic because adequate knowledge of the velocity is needed for accurate imaging and depth conversion of the data, as well as for quantifying the distribution of soil water content. To overcome this issue, we have developed a novel methodology for estimating the detailed subsurface velocity structure from common-offset GPR reflection measurements, which does not require additional conditioning information. The proposed approach combines two key components: diffraction analysis is used to infer the smooth, large-scale component of the velocity distribution, whereas the superimposed small-scale fluctuations are inferred via inversion of the reflected wavefield. We test and validate our method on two synthetic data sets having increasing degrees of complexity and realism before applying it to a field example from the Boise Hydrogeophysical Research Site, where independent control data in the form of neutron–neutron porosity logs are available for validation. The results obtained demonstrate the viability and robustness of the proposed approach. Further, due to its efficiency, both in terms of field effort and computational cost, the method can be readily extended to 3-D, which further enhances its attractiveness compared to multi-offset-based GPR velocity estimation techniques.
Markovian Linearization of Random Walks on Groups
Authors: Bordenave Charles , Dubail Bastien
Published: February 2022

In operator algebra, the linearization trick is a technique that reduces the study of a non-commutative polynomial evaluated at elements of an algebra ${\mathcal {A}}$ to the study of a polynomial of degree one, evaluated on the enlarged algebra ${\mathcal {A}} \otimes M_r ({\mathbb {C}})$, for some integer $r$. We introduce a new instance of the linearization trick that is tailored to study a finitely supported random walk $G$ by studying instead a nearest-neighbour coloured random walk on $G \times \{1, \ldots , r \}$, which is much simpler to analyze. As an application, we extend well-known results for nearest-neighbour walks on free groups and free products of finite groups to coloured random walks, thus showing how one can obtain new results for finitely supported random walks, namely an explicit description of the harmonic measure and formulas for the entropy and drift.
Antimicrobial Susceptibility Survey of Invasive Neisseria meningitidis, United States 2012–2016
Authors: Potts Caelin C , Rodriguez-Rivera Lorraine D , Retchless Adam C , Hu Fang , Marjuki Henju , Blain Amy E , McNamara Lucy A , Wang Xin
Published: February 2022

Background

Historically, antimicrobial resistance has been rare in US invasive meningococcal disease cases.

Methods

Meningococcal isolates (n = 695) were collected through population-based surveillance, 2012–2016, and national surveillance, 2015–2016. Antimicrobial susceptibility was assessed by broth microdilution. Resistance mechanisms were characterized using whole-genome sequencing.

Results

All isolates were susceptible to 6 antibiotics (cefotaxime, ceftriaxone, meropenem, rifampin, minocycline, and azithromycin). Approximately 25% were penicillin or ampicillin intermediate; among these, 79% contained mosaic penA gene mutations. Less than 1% of isolates were penicillin, ampicillin, ciprofloxacin, or levofloxacin resistant.

Conclusions

Penicillin- and ampicillin-intermediate isolates were common, but resistance to clinically relevant antibiotics remained rare.
Spectrophotometric detection of azole-resistant Aspergillus fumigatus with the EUCAST broth microdilution method: is it time for automated MIC reading of EUCAST antifungal susceptibility testing of Aspergillus species?
Authors: Meletiadis Joseph , Efstathiou Ioanna , van der Lee Hein A L , Astvad Karen M T , Verweij Paul E , Arendrup Maiken Cavling
Published: February 2022

Objectives

Current reference susceptibility testing methods of Aspergillus require visual reading, which is subjective and necessitates experienced staff. We compared spectrophotometric and visual MIC reading of EUCAST E.Def 9.3.2 susceptibility testing of Aspergillus fumigatus for a large collection of isolates with different azole resistance mechanisms.

Methods

A. fumigatus (n = 200) were examined, including 62 WT and 138 non-WT with the following alterations: TR34/L98H (n = 57), TR46/Y121F/T289A (n = 54) or single point mutations (n = 27). EUCAST E.Def 9.3.2 susceptibility testing was performed for amphotericin B, itraconazole, voriconazole, posaconazole and isavuconazole. MICs were determined after 48 h of incubation visually and spectrophotometrically, as the lowest concentration corresponding to a 1%, 3%, 5%, 10% or 15% OD increase above the background OD. The best spectrophotometric endpoint (SPE) was identified based on the highest essential agreement (EA; ±1 two-fold dilution) and categorical agreement (CA) and fewer very major errors (VMEs) and major errors (MEs).

Results

Τhe best SPEs were 5% and 10% for all drugs. The best agreement between visual and spectrophotometric MICs was found with the 10% growth endpoint, which resulted in identical median MICs with 90% of differences being ≤1 two-fold and higher EA (91%–100%) and CA (100%) and no VMEs and MEs compared with the 5% endpoint (77%–100%, 96%–98%, 0% and 0%–4%, respectively).

Conclusions

Spectrophotometric MIC reading can be used for A. fumigatus susceptibility testing and for detecting azole resistance. A visual inspection of the plate should be performed to confirm equal inoculation, absence of well contamination and proper growth, and to identify potential uncommon phenotypes or subpopulations.