bluuebunny/crossref_metadata_2025 huggingface dataset:
Enhanced phase-amplitude coupling of human electrocorticography selectively in the posterior cortical region during rapid eye movement sleep
Authors: Togawa Jumpei , Matsumoto Riki , Usami Kiyohide , Matsuhashi Masao , Inouchi Morito , Kobayashi Katsuya , Hitomi Takefumi , Nakae Takuro , Shimotake Akihiro , Yamao Yukihiro , Kikuchi Takayuki , Yoshida Kazumichi , Kunieda Takeharu , Miyamoto Susumu , Takahashi Ryosuke , Ikeda Akio
Published: February 2022

The spatiotemporal dynamics of interaction between slow (delta or infraslow) waves and fast (gamma) activities during wakefulness and sleep are yet to be elucidated in human electrocorticography (ECoG). We evaluated phase-amplitude coupling (PAC), which reflects neuronal coding in information processing, using ECoG in 11 patients with intractable focal epilepsy. PAC was observed between slow waves of 0.5–0.6 Hz and gamma activities, not only during light sleep and slow-wave sleep (SWS) but even during wakefulness and rapid eye movement (REM) sleep. While PAC was high over a large region during SWS, it was stronger in the posterior cortical region around the temporoparietal junction than in the frontal cortical region during REM sleep. PAC tended to be higher in the posterior cortical region than in the frontal cortical region even during wakefulness. Our findings suggest that the posterior cortical region has a functional role in REM sleep and may contribute to the maintenance of the dreaming experience.
Hong Kong’s National Security Law: A Socialist Legal Transplant?
Authors: Pascoe Daniel
Published: February 2022

The recently enacted Law of the People’s Republic of China on Safeguarding National Security in the Hong Kong Special Administrative Region (NSL) is unique in global perspective: it was both drafted by and adopted from a jurisdiction espousing an entirely different type of legal system. In this article, I consider the NSL as a potential socialist legal transplant from the People’s Republic of China to its Special Administrative Region of Hong Kong upon its promulgation in June 2020. I consider why, in the criminal law context, the NSL bears certain socialist characteristics and may even be classified as a socialist law. I also consider whether the NSL might be the world’s first ever socialist criminal law transplant into a common law jurisdiction, and discuss what this might mean for legal interpretation and comparative law scholarship more generally. While existing comparative law scholarship on legal transplants has focused, where relevant, on transplants into States espousing socialist legal systems or between such systems, rarely have scholars encountered and analysed laws making their way across legal boundaries in the other direction. This article uses the example of the NSL, enacted by the Standing Committee of the National People’s Congress in Beijing and applied to Hong Kong’s common law legal system, to begin to fill the gap.
Immigrant Youth Program: A Model for Educational and Personal Success
Authors: Garcia Martha Lucia , Carnes Stephanie , Hanssen Daria
Published: February 2022

Central American youth constitute one of the largest groups of newcomers in U.S. public schools, particularly in urban areas. Many have experienced traumatic events and interrupted or limited formal education. These factors, coupled with cultural and language differences, may lead these youth to struggle in public schools, unless specifically tailored programming is provided. The loss of family, and what is familiar to them, may lead them to feel alone. This article presents a model that meets the unique academic and mental health needs of Central American immigrant youth by harnessing the power of community in a school setting. The study findings indicate that a model premised on relational safety, cultural acceptance, and educational support enhances students’ motivation and commitment to their academic and professional goals. Further, creating an environment that prioritizes a sense of belonging can foster a sense of well-being. School social workers are critical to the implementation of such a model, which requires a nuanced understanding of cultural context, sociopolitical factors that surround public policy, lived experience, impact of trauma, and the recognition of the innate strength of these youth. The article presents a way for navigating the challenges, while maximizing the power of community and belonging in these children’s lives.
The effects of prey lipid on female mating and reproduction of a wolf spider
Authors: Feng Qingguo , Wen Lelei , Ma Jiayi , Yu Long , Li Changchun , Jiao Xiaoguo
Published: February 2022

As predators, the macronutrients spiders extract from their prey play important roles in their mating and reproduction. Previous studies of macronutrients on spider mating and reproduction focus on protein, the potential impact of prey lipid content on spider mating and reproduction remains largely unexplored. Here, we tested the influence of prey varying in lipid content on female mating, sexual cannibalism, reproduction, and offspring fitness in the wolf spider Pardosa pseudoannulata. We acquired 2 groups of fruit fly Drosophila melanogaster that differed significantly in lipid but not protein content by supplementing cultural media with a high or low dose of sucrose on which the fruit flies were reared (HL: high lipid and LL: low lipid). Subadult (i.e., 1 molt before adult) female spiders that fed HL flies matured with significantly higher lipid content than those fed LL flies. We found that the mated females fed with HL flies significantly shortened pre-oviposition time and resulted in a significantly higher fecundity. However, there was no significant difference in female spiders varying in lipid content on other behaviors and traits, including the latency to courtship, courtship duration, mating, copulation duration, sexual cannibalism, offspring body size, and survival. Hence, our results suggest that the lipid content of prey may be a limiting factor for female reproduction, but not for other behavioral traits in the wolf spiders P. pseudoannulata.
From inoperable to back to life: a case report of successfully treated obstructive right ventricular primary cardiac lymphoma
Authors: Al Mawed Mohammad , Brockmeier Johannes , Haertel Dirk , Ellermeier Marc , Hartmann Frank , Gielen Stephan
Published: February 2022

Background

Cardiac masses include various tumourous and non-tumourous lesions. Primary cardiac tumours are very rare and most commonly benign. Primary cardiac lymphomas (PCL) account for 1–2% of malignant primary cardiac tumours. Only 197 cases of PCL have been reported between 1949 and 2009.

Case summary

We report a case of a 73-year-old patient who presented with atrial flutter. The diagnosis was a tumourous cardiac mass in the right atrium with signs of the infiltration of the tricuspid valve insertion and pericardium. There were no signs of extracardiac disease at the initial presentation. The patient was deemed to be inoperable by cardiac surgeons. Rapid tumour progression caused atrioventricular-block type Mobitz 2 with concomitant obstruction of the tricuspid valve and axillary lymph node metastasizing. Excision of the axillary lymph node revealed a diffuse large B-cell non-Hodgkin lymphoma. An epicardial right ventricle single lead pacemaker was sited, and chemotherapy was administered, resulting in complete remission.

Discussion

Cardiac masses are rare and challenging cases. Although current imaging procedures deliver extensive information, histological examination is still required in many cases. We encountered a tumourous mass with deep infiltration. After the patient was deemed inoperable, later lymph node invasion allowed histological examination, revealing PCL. Primary cardiac lymphomas are life-threatening tumours with rapid and aggressive growth. Treatment is based on chemotherapy consisting of anthracycline-containing regimens. This case report highlights the curative potential of chemotherapy, as we report a rapid regression of the tumour as well as the disappearance of arrhythmias and conduction disorders after treatment.
Endometriosis and cardiovascular disease
Authors: Marchandot Benjamin , Curtiaud Anais , Matsushita Kensuke , Trimaille Antonin , Host Aline , Faller Emilie , Garbin Olivier , Akladios Chérif , Jesel Laurence , Morel Olivier
Published: February 2022

Endometriosis is a chronic gynaecological disease affecting 1 in 10 reproductive-age women. It is defined as the presence of endometrium-like tissue outside the uterus. Beyond this placid anatomical definition, endometriosis is a complex, hormonal, inflammatory, and systemic condition that poses significant familial, psychological, and economic burden. The interaction between the cardiovascular system and endometriosis has become a field of interest as the underlying mutual mechanisms become better understood. On the basis of accumulating fundamental and clinical evidence, it is likely that there exists a close relationship between endometriosis and the cardiovascular system. Therefore, investigating the endometriosis—cardiovascular interaction is highly clinically significant. In this review, we highlight our current understanding of the pathophysiology of endometriosis with systemic hormonal, pro-inflammatory, pro-angiogenic, immunologic, and genetic processes beyond the peritoneal microenvironment. Additionally, we provide current clinical evidence about how endometriosis interacts with cardiovascular risk factors and cardiovascular disease (CVD). To date, only small associations between endometriosis and CVD have been reported in observational studies, inherently limited by the potential influence of unmeasured confounding. Cardiovascular disease in women with endometriosis remains understudied, under-recognized, and underdiagnosed. More detailed study of the cardiovascular-endometriosis interaction is needed to fully understand its clinical relevance, underlying pathophysiology, possible means of early diagnosis and prevention.
The evolution of the human healthcare system and implications for understanding our responses to COVID-19
Authors: Kessler Sharon E , Aunger Robert
Published: February 2022

The COVID-19 pandemic has revealed an urgent need for a comprehensive, multidisciplinary understanding of how healthcare systems respond successfully to infectious pathogens—and how they fail. This study contributes a novel perspective that focuses on the selective pressures that shape healthcare systems over evolutionary time. We use a comparative approach to trace the evolution of care-giving and disease control behaviours across species and then map their integration into the contemporary human healthcare system. Self-care and pro-health environmental modification are ubiquitous across animals, while derived behaviours like care for kin, for strangers, and group-level organizational responses have evolved via different selection pressures. We then apply this framework to our behavioural responses to COVID-19 and demonstrate that three types of conflicts are occurring: (1) conflicting selection pressures on individuals, (2) evolutionary mismatches between the context in which our healthcare behaviours evolved and our globalized world of today and (3) evolutionary displacements in which older forms of care are currently dispensed through more derived forms. We discuss the significance of understanding how healthcare systems evolve and change for thinking about the role of healthcare systems in society during and after the time of COVID-19—and for us as a species as we continue to face selection from infectious diseases.
Genetic Influences on Educational Achievement in Cross-National Perspective
Authors: Baier Tina , Lang Volker , Grätz Michael , Barclay Kieron J , Conley Dalton C , Dawes Christopher T , Laidley Thomas , Lyngstad Torkild H
Published: February 2022

There is a growing interest in how social conditions moderate genetic influences on education [gene–environment interactions (GxE)]. Previous research has focused on the family, specifically parents’ social background, and has neglected the institutional environment. To assess the impact of macro-level influences, we compare genetic influences on educational achievement and their social stratification across Germany, Norway, Sweden, and the United States. We combine well-established GxE-conceptualizations with the comparative stratification literature and propose that educational systems and welfare-state regimes affect the realization of genetic potential. We analyse population-representative survey data on twins (Germany and the United States) and twin registers (Norway and Sweden), and estimate genetically sensitive variance decomposition models. Our comparative design yields three main findings. First, Germany stands out with comparatively weak genetic influences on educational achievement suggesting that early tracking limits the realization thereof. Second, in the United States genetic influences are comparatively strong and similar in size compared to the Nordic countries. Third, in Sweden genetic influences are stronger among disadvantaged families supporting the expectation that challenging and uncertain circumstances promote genetic expression. This ideosyncratic finding must be related to features of Swedish social institutions or welfare-state arrangements that are not found in otherwise similar countries.
Invasive validation of the different echo parameters and cut-offs among the trilogy of left ventricular filling pressure assessment guidelines: EACVI/ASE 2016, ESC 2016, HFA 2019
Authors: Barakat A , Alsaadi A,R
Published: February 2022

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Al-mouwasat University Hospital and University Heart Surgery Center in Damascus, Syrian Arab Republic.

Background

Left ventricular filling pressure assessment is a challenge. Three guidelines concerned about this are: EACVI/ASE 2016, ESC 2016 and the HFA 2019 guidelines. Echo assessment is a corner stone in their algorithms with different cutoffs and different parameters used depending on expert consensus that should be validated in an invasive manner as the authors stated.

Aims

This study validates and tests the accuracy of the different cutoffs and parameters used in echo LV filling pressure assessment in the three guidelines: EACVI/ASE 2016, ESC 2016 and HFA 2019 by direct measure in the catheterization lab.

Methods

82 patients with EF ≥ 50%, signs and symptoms of HF underwent transthoracic echocardiography immediately before catheterization. Av E/e", TR, LAVI, LVMI, RWT, LV wall thickness, Septal, lateral and mean e" were used to assess LV filling pressure with respect to EACVI/ASE 2016, ESC 2016 and HFA guidelines algorithms" different cutoffs and  parameters used. This study used LV pre-A wave with a cutoff >12mmhg defined high as a reference and then we compared the results.

Results

all the results of functional and structural echo parameters" diagnostic criteria (sensitivity, specificity, NPV, PPV and accuracy) are summarized in (Table:1 + 2).

Conclusion

From an echo view, each algorithm depends on  modest to high specific but low to modest sensitive echo parameters. There is no single parameter makes a guidelines superior to others. Although that the fact of combining more echo indices make the diagnosis and eventually the algorithm more reliable as in HFA 2019, that was for the cost of simplicity and ease of application. Av E/e">13 was the best cutoff (ESC 2016). Orientation for the cause of use (sensitivity, specificity, NPV or PPV) should employ the echo indices and cutoffs in best benefit, as for mitral (e"), although that septal < 7 and lateral e"<10 (EACVI/ASE 2016 and HFA 2019) had an overall more accuracy than mean e"<9 (ESC 2016), sub analysis showed that the first is better used for specificity and NPV but the latter better for sensitivity and PPV. Same idea for LVMI≥145/122 (m/f)+RWT > 0.42 (HFA 2019 major criteria) which had more specificity than LVMI≥115/95 (m/F) cutoffs (HFA2019 minor criteria and ESC2016) but in the cost of lower sensitivity, furthermore, sub analysis showed this LVMI high cutoffs were more benefit in female than in men after taking the NPV, PPV and accuracy in consideration. Abstract Figure.  Abstract Figure.
Identification of hemodynamically significant coronary artery disease with stress myocardial blood flow ratio by dynamic CT perfusion studies
Authors: Maqsood H , Ashraf T , Younus S , Rasool M W , Hameed A
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Coronary computed tomographic angiography (CTA) is an accepted noninvasive tool with high diagnostic accuracy for the evaluation of coronary artery disease (CAD). However, coronary CTA is limited in that it does not provide information on the hemodynamic relevance of coronary artery stenosis. Therefore, to determine the potential benefit of future coronary revascularization, a functional assessment is often required. A protocol combining coronary computed tomographic angiography (CTA) and CTP can provide a simultaneous assessment of both coronary artery ischemia and anatomy.

Purpose

This study sought to evaluate the diagnostic accuracy of stress myocardial blood flow ratio (SFR), a novel parameter derived from stress dynamic computed tomographic perfusion (CTP), for the detection of hemodynamically significant coronary stenosis.

Methods

A total of 98 patients (mean age 54.5 ± 10 years) with 128 vessels with either 1- or 2-vessel disease, scheduled for invasive angiography were included in this study. Stress dynamic CTP was performed followed by coronary CTA using a dual-source computed tomographic system. Fractional flow reserve was performed at subsequent invasive angiography to identify hemodynamically significant stenosis. Stress myocardial blood flow ratio (SFR) was defined as the ratio of hyperemic myocardial blood flow (MBF) in an artery with stenosis to hyperemic MBF in a non-diseased artery. The diagnostic accuracy of the SFR index was determined against the reference standard of invasive fractional flow reserve ≤0.80.

Results

58 (45.3%) vessels were deemed hemodynamically significant by fractional flow reserve (FFR) measurement. Hyperemic MBF and SFR were lower for vessels with hemodynamically significant lesions (95 ± 32.2 ml/100 ml/min vs. 140.5 ± 30.4 ml/100 ml/min; p < 0.01 for both). When compared with ≥50% stenosis by CTA, the specificity for detecting ischemia by SFR increased from 44% to 92%, while the sensitivity decreased from 93% to 58%. The combination of stenosis ≥50% by CTA and SFR resulted in an area under the curve of 0.9, which was significantly higher compared with hyperemic MBF, area under the curve = 0.79 and p < 0.01.

Conclusion

Our study concludes that the calculation of SFR by dynamic CTP provides a pioneering and accurate method to identify flow-limiting coronary stenosis. Abstract Figure.
Correlation of cardiac biomarkers with computed tomography severity score in COVID-19 patients
Authors: Rivera R , Cuenza L , Razon-Cuenza T
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

INTRODUCTION

A vast number of COVID-19 cases have been reported worldwide since the initial outbreak in China, and the disease has since become a global pandemic. Knowledge on this predominantly respiratory illness is evolving with studies suggesting myocardial injury reflected by elevated cardiac enzymes portending to more severe disease. CT scoring indices provide visual, semi-quantitative assessment of lung involvement and have aided in determining extent of COVID-19 pneumonia but, none have been validated for prognostication.

PURPOSE

Establishing a relationship between these non-invasive diagnostic parameters could provide timely identification and proper allocation of limited medical resources to patients in need of more aggressive therapy.

METHODS and RESULTS

A total of 50 COVID-19 patients were retrospectively enrolled and their clinical parameters collected from an electronic medical database. There was a total of 31 patients with troponin I-HS with chest CT scan done and another 42 patients for NT-proBNP and chest CT. The levels of both cardiac biomarkers in patients with clinically severe COVID pneumonia were higher than those with mild and moderate disease. Rank-order analysis showed that both troponin I-HS (moderate, p = 0.0003174) and NT-proBNP (moderate, p = 0.006255) correlated positively with CT severity scores. Furthermore, there is a significant relationship between mortality and septic shock with both Troponin I-HS (p < 0.001; p = 0.002) and NT-proBNP (p = 0.004; p = 0.031).

CONCLUSION

The cardiac markers troponin I-HS and NT-proBNP increased significantly at more severe CT scores and more notably, these biomarkers predicted the development of septic shock and mortality in COVID-19 pneumonia.
Characterizing patients with newly diagnosed atrial fibrillation compared to those with established atrial fibrillation: data from the CODE-AF registry
Authors: Choi J M , Lee S R , Choi E K
Published: February 2022

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Korean Healthcare Technology R&D project funded by the Ministry of Health & Welfare

OnBehalf

CODE-AF investigator

Background/Introduction: The characteristic of atrial fibrillation (AF), such as the risk of complications, may differ depending on the time after diagnosis.

Purpose

This study aimed to compare the baseline characteristics according to the AF diagnosis duration using a large multicenter prospective registry: CODE-AF (COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation).

Methods

A total of 10,021 patients with AF were enrolled between May 2016 to March 2021. We defined patients into two groups: the newly diagnosed (AF duration less than 3 months before enrollment) and the established (AF duration more than 3 months before enrollment) AF groups. We compared the baseline characteristics and the incidence of the composite outcomes (stroke, all-bleeding, heart failure and all-cause death) during follow-up period between the two groups. The survival analysis was performed using Kaplan-Meier curve analysis with validation by log-rank test.

Results

Among the 10,021 patients with AF (age 67.0 ±14.5 years, female 35.7%), patients with newly diagnosed AF were 2181, and those with established AF were 7840. Two groups did not differ between sex, weight, height, and body mass index. The newly diagnosed AF group was younger with higher tobacco and alcohol consumption compared to the established AF group. The established AF group had more comorbidities at the time of enrollment. Also, CHA2DS2-VASc score (2.36 ±1.64 vs. 2.68 ±1.67, p <0.001) and HAS-BLED score (1.55 ±1.02vs. 1.86 ±1.06 p <0.001) were both higher in established AF. The newly diagnosed AF group had a lower proportion of oral anticoagulation prescription (68.6% vs. 73.0%, p <0.001), whereas prescription of non-vitamin K antagonist oral anticoagulants was higher compared to those with established AF (75.7% vs. 68.9%, p <0.001) (Table). There was no significant difference in the event-free survival during the overall follow-up period on the composite outcomes. However, the newly diagnosed AF group showed a significantly higher risk of the composite outcomes within 90 days of enrollment than the established AF group (hazard ratio 2.01, 95% confidence interval 1.48 to 2.72) (Figure).

Conclusion

The newly diagnosed AF group showed different characteristics compared to the established AF group. Also, the composite clinical outcomes, including stroke, bleeding, heart failure, and all-cause death, had occurred more frequently during the early period after diagnosis in the newly diagnosed AF group. For the better clinical outcome of patients with newly diagnosed AF, structured assessment and comprehensive management is needed, especially during the early period after diagnosis. Abstract Figure.
A multicentre survey of paediatric out-of-hospital cardiac arrest incidence, aetiology, and survival in New South Wales over an 11-year period
Authors: Youssef D , Singh A , Ayer J , Turner C , Christoff A , Bromage J , Balit C , Numa A , Skinner J R
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Out-of-hospital cardiac arrest (OOHCA) is commonly associated with pulseless ventricular tachycardia and ventricular fibrillation (VT/VF) and cardiac aetiologies. One New South Wales (NSW) ambulance registry reported(1) cardiac aetiologies with a prevalence of 31% among OOHCA cases. Multicentre OOHCA data and NSW’s well-developed services for cardiac genetic predisposition screening motivate us to consider the following study of paediatric OOHCA in this state.

Purpose

We present a multicentre, retrospective study summarizing the demographics, clinical characteristics, incidence, presenting rhythm, and survival-to-discharge status of paediatric OOHCA cases in NSW over an 11-year period. We also present and categorize diagnostic outcomes for patients presenting with VT/VF.

Methods

A retrospective case series of 298 patients admitted to one of three NSW PICUs (two in Sydney and one in Newcastle) under 18 years of age and presenting with OOHCA between January 2009 and December 2019.

Results

Out of 296 paediatric OOHCA patients that survived until PICU admission, 187 (63.2%) were male and 160 (54.1%) survived until hospital discharge. Of those surviving to discharge, 105 (65.6%) were male. Presenting rhythm was asystole or pulseless electrical activity in 240 patients (84.8%, aged 0–17 years, median age 2 years), VT/VF in 41 patients (14.5%, aged 0–16 years, median age 9 years), and complete heart block in 2 patients (0.7%, aged 4–4 years, median age 4 years). Survival was higher in the VT/VF group (82.9%) relative to the asystole and pulseless electrical activity group (50.0%). Of the 41 patients presenting with VT/VF, 13 (31.7%) had a predisposing cardiac condition (2 truncus arteriosus, 1 arrhythmogenic right ventricular cardiomyopathy, 1 double outlet right ventricle, 1 hypoplastic right ventricle, 1 left ventricular non-compaction, 2 asystolic syncope, 2 left ventricular intramyocardial fibroma, 1 familial dilated cardiomyopathy, and 2 undetermined cardiac conditions) and 20 (48.8%) had a genetic condition (9 catecholaminergic polymorphic ventricular tachycardia, 4 hypertrophic cardiomyopathies, 1 Nkx-2.5 mutation, 2 Long QT syndrome, 2 PPA2 mutation, 1 TANGO2 mutation, 1 supraventricular tachycardia). Toxins or trauma were involved in 4 (9.8%) cases, while no cause was determined in 4 (9.8%) other cases.

Conclusions

Overall, 54.1% of paediatric OOHCA patients admitted to PICU survived until hospital discharge, rising to 82.9% among those with VT/VF. Genetic conditions (48.8%), predominated by CPVT, were present in over one-third of VT/VF cases: this figure confirms the continued need for detailed cardiac/genetic assessment for paediatric OOHCA cases.
The first survey on patient needs for remote monitoring of cardiac implantable electronic device in South Korea
Authors: Hwang Y
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background/Aims: Studies showed that remote device monitoring reduced unnecessary outpatient visits and increased patient satisfaction. As there was no local research on remote monitoring (RM) in Korea, there was a lack of evidence for policy or insurance standards due to the lack of domestic data despite high demand by domestic arrhythmia experts. In order to establish the basis for patient satisfaction, economic efficiency, and safety of wireless monitoring, a survey-based study was planned.

Methods

This was a single-university hospital survey. The satisfaction index was evaluated using a questionnaire to investigate patient satisfaction in outpatient clinics, economic efficiency (measured as home-to-clinic time, waiting time, and actual clinic time), and demand for RM in patients with implantable cardiac devices. The questionnaire was adopted and modified from the Survey on Telehealth Patient Experience by Bas-Villalobos, 2006 (modified Korean version 2.0 by You Mi Hwang, 2020).

Results

Surveys were answered by 171 patients. The mean age of these patients was 71.2 ± 12.4 years. Based on the survey, home to clinic time was usually less than one h, mean waiting time in the hospital until clinic time ranged 42.6 ± 24.5 min, and mean clinic time ranged 3.1 ± 1.7 minutes. Based on the survey, patients favored RM over hospital visits with cardiac implantable electronic device follow-up mainly because of long travel times from home to clinic.

Conclusions

Based on the survey results, there is a clear need for RM in patients who have cardiac implantable electronic devices.
Prognostic value of machine learning for acute heart failure
Authors: Shimizu M , Miyazaki H , Cho S , Misu Y , Tateishi R , Yamaguchi M , Yamakami Y , Shimada H , Manno T , Isshiki A , Kimura S , Fujii H , Suzuki M , Nishizaki M , Sasano T
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

At onset of acute heart failure (AHF), various clinical fundamental parameters including vital sign, laboratory data, or initial treatment were investigated, and we can roughly estimate the prognosis. However, machine learning method for prediction of the prognosis was not studied.

Purpose

To elucidate prognostic value of machine learning for AHF comparing conventional statistical model.

Methods

We enrolled consecutive 300 patients with AHF (79.5 ± 12.1 years, 158 Males). Patients with acute coronary syndrome, mechanical circulatory support cases, and cardio-pulmonary arrest cases were excluded. The patients were randomly divided into 80% (240 cases) and 20% (60 cases), and the former was used as train data, and the latter as validation data. Objective variable was set as cardiac death in one year. First, logistic regression analysis with Akaike’s information criterion (AIC) was performed, and extracted predictive parameters. The predictive model for the cardiac prognosis was constructed by cut-off value of ROC curve analysis of propensity score was calculated. Next, machine learning (random forest method and deep learning) to build predictive model was performed with the predictors. Finally, accuracy of each predictive model was compared.

Results

Thirty cases showed cardiac death in one year. Logistic regression with AIC extracted 8  predictors, and the cut off-value of propensity score with the 6 parameters was 0.110. The accuracy was 0.714 and area under ROC (AUROC) was 0.836. Conversely, random forest method demonstrated the accuracy as 0.927, AUROC 0.860. On deep learning, the accuracy was 0.937 and AUROC 0.901. 

The top 4 high feature importance of random forest were Cl/red blood cell count/pH/Anion Gap. However, accuracy of those predictors was lower than that of machine learning.

Conclusion

Machine learning was a powerful tool to predict cardiac prognosis of AHF, comparing with conventional statistical model. Abstract Figure. Statistical model
Prevalence and characteristics of non-ST-segment elevation in acute myocardial infarction with insignificant coronary artery disease
Authors: Sricholwattana S , Chaipromprasit J , Kosum P
Published: February 2022

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): King Chulalongkorn Memorial Hospital

Background

 Acute myocardial infarction is mostly associated with obstructive coronary artery disease. 8% to 12% of patients have insignificant coronary artery disease. Prognosis for patients with insignificant coronary artery disease is better than patients with obstructive coronary artery disease who presented with non-ST elevation myocardial infarction (NSTEMI). Prevalence of patients with non-ST elevation myocardial infarction (NSTEMI) related insignificant coronary artery disease in Thailand remains unknown.

Method

 A retrospective cohort analysis was performed in all patient who admitted for NSTEMI and underwent coronary angiography presenting to our hospital in admission (January 2018 to October 2020). The primary end point was to study the prevalence of insignificant coronary artery disease in NSTEMI patients, the secondary end point was to find associated factors of the insignificant coronary artery disease and create new scoring system for predicting insignificant coronary artery disease.

Result

 A total 522 subjects were enrolled. 74 patients (14.2%) had insignificant coronary artery disease. The median age was 68.37 years (female 37.4%), smoking 14%, diabetes 46.7%, hypertension 85.1%, dyslipidemia 78%, history of stroke 8.4% and ESRD 7.3%. There are many predictors of insignificant coronary artery disease in NSTEMI patients: Absence of regional wall motion abnormalities from echocardiogram had the strongest association with insignificant coronary artery disease (OR = 5.057, 95% CI, 2.54-10.06 ; p-value < 0.001). Other variables were; no ST segment deviation in the ECG (OR = 4.29, 95% CI, 2.16-8.52 ; p-value < 0.001), female sex (OR = 3.43, 95% CI, 1.77-6.66 ; p-value < 0.001) and the absence of dyslipidemia (OR = 2.48, 95% CI, 1.23-4.97 ; p-value = 0.01). By using multivariate analysis, a scoring system was made to predict insignificant coronary artery disease, which consist of 2 points for female, 2 points for not having history of dyslipidemia, 3 points for no ST segment deviation form the ECG and 3 points for no regional wall motion abnormalities from the echocardiogram. As shown in the ROC curve, the AUC = 0.804 and 5 is the cut point score with 72.1% sensitivity, 72.3% specificity and 72.3% accuracy.

Conclusion

 Prevalence of non-ST-segment elevation acute myocardial infarction with insignificant coronary artery disease is 14.2%. Absence of regional wall motion abnormalities from echocardiogram, no ST segment deviation in the ECG, female sex and absence of dyslipidemia were all statistically associated with insignificant coronary artery disease. With the predicting score ≥5, the patient may be considered not to proceed the coronary angiogram.
Aspirin vs. Clopidogrel as a Chronic maintenance monotherapy after PCI in patients with high ischemic risk and high bleeding risk: Subgroup analysis of the HOST-EXAM trial
Authors: Park K W , Kang J , Koo B K , Rhee T M , Yang H M , Won K B , Rha S W , Bae J W , Lee N H , Hur S H , Han J K , Shin E S , Kim H S
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

on behalf of the HOST-EXAM investigators

Background

The HOST-EXAM randomized clinical trial recently performed a comparison of clopidogrel monotherapy vs. aspirin monotherapy in patients requiring indefinite antiplatelet monotherapy after percutaneous coronary intervention (PCI). This study randomized 5,438 patients who maintained dual antiplatelet therapy without clinical events for 6–18 months after PCI with drug-eluting stents (DES) to receive a monotherapy agent of clopidogrel 75 mg once daily or aspirin 100 mg once daily for 24 months. During the 24-month follow-up, the primary outcome (a composite of all-cause death, non-fatal myocardial infarction, stroke, readmission due to acute coronary syndrome, and Bleeding Academic Research Consortium (BARC) bleeding type 3 or greater) rate was significantly lower in the clopidogrel group (hazard ratio [HR] 0.73 [95% CI 0.59–0.90]; p = 0.0035). However, it is uncertain whether the beneficial effect of clopidogrel will be consistent in patients with high ischemic risk or those with high bleeding risk.

Methods

This is a post-hoc analysis of the HOST-EXAM trial. A high ischemic risk was defined as those who had at least 1 of the following procedural features: 3 vessels treated, ≥3 stents implanted, ≥3 lesions treated, bifurcation PCI, total stent length >60 mm, or left main PCI. Patients with high bleeding risk were defined according to the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria. The co-primary outcome were thrombotic endpoints (a composite of cardiac death, non-fatal myocardial infarction, ischemic stroke, readmission due to acute coronary syndrome, and definite or probable stent thrombosis) and bleeding endpoints (BARC type ≥2 bleeding events) at 24-month follow-up.

Results

 Among the total population, 22.1% had high ischemic risk and 21.4% had high bleeding risk. Complex PCI was not associated with a higher risk of thrombotic endpoints, nor bleeding endpoints. For patients with a high bleeding risk, these patients had a higher risk of both thrombotic endpoints (HR 1.545, 95% CI 0.141-2.092, p = 0.005) and bleeding endpoints (HR 3.418, 95% CI 2.413-4.840, p < 0.001). The primary results focusing on the interaction between high ischemic risk, high bleeding and the antiplatelet regimen will be presented.

Conclusion

The current post-hoc analysis of the HOST-EXAM trial will evaluate the efficacy of clopidogrel monotherapy vs. aspirin monotherapy during the chronic maintenance period after PCI, in patients with high ischemic risk or those with high bleeding risk.
Comparison of VWF-ADAMTS13 axis involvement in atrial fibrillation and sinus rhythm in patients with ST-elevation myocardial infarction
Authors: Osawa T , Ito Y , Nakano K , Yamada Y , Abe Y , Tabata F , Koizumi T
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

 Previous studies have shown that von Willebrand factor (VWF) increases, and a disintegrin-like and metalloproteinase with thrombospondin type-1 motifs 13 (ADAMTS13) decreases in myocardial infarction. Few studies have examined the involvement of the VWF-ADAMTS13 axis in ST-elevation myocardial infarction (STEMI) patients with atrial fibrillation (AF).

Purpose

 Our aim was to investigate VWF-ADAMTS13 axis involvement in atrial fibrillation in STEMI. 

Methods

 The subjects of this study were participants in an observational study for investigating the difference in the pathology of thrombus retrieved from infarct-related artery between AF and sinus rhythm (SR). From June 2019 to August 2020, patients who underwent thrombus aspiration for STEMI at our hospital. Only subjects whose thrombus could be confirmed were enrolled. They were divided into two groups, the AF group, and the SR group. Serum biomarkers, including ADAMTS13 activity, and VWF were evaluated. 

Results

 34 patients with STEMI who were able to aspirate thrombus were enrolled in the study. They were divided into two groups: 6 patients with AF (AF group, mean age 72.5 years, 100% male) and 28 patients with SR (SR group, mean age 63.0 years, 100% male). ADAMTS13 activity was significantly lower in AF group than SR group (AF: 0.63 ± 0.14 vs. SR: 0.77 ± 0.13 U / mL, p = 0.037). There was no significant difference in VWF antigen between the two groups (AF: 251 ± 56 vs. SR: 204 ± 69%, p = 0.170). VWF/ADAMTS13 activity in AF group were significantly higher than in SR group.

Conclusion

 Our study suggests an association between the VWF-ADAMTS13 axis and atrial fibrillation in STEMI. Abstract Table. Comparison of serum biomarkers
Influence of ST2 level on the development of acute arrhythmias in NSTEMI
Authors: Maslovskyi V I , Mezhiievska I A
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Purpose

To determine the structure and relationship of cardiac arrhythmias in NSTEMI patients based on plasma ST2 level.

Methods

We studied 90 patients with NSTEMI aged from 35 to 79 years (mean 60.7 ± 0.8, median - 61, interquartile range 54 and 69). Plasma ST2 level was determined and analyzed in the NSTEMI patients group, the gradations of the ST2 level and the correlation with cardiac arrhythmias.

All of the research corresponds to the principles of the Declaration of Helsinki of the World Medical Association.

Results. Using the variation statistics method, the ST2 level gradations group were selected. Thus, the relatively low (RL) corresponded to less than 25, and the relatively high (RH) level of ST2 to more than 75 persons in the group, respectively. For patients in the main group, these levels were <26 and> 56 ng / ml, respectively. Instead, the relatively moderate (or intermediate) ST2 level (RM) for these patients was 26-56 ng / ml.

It has been determined that the most frequent rhythm disturbances were observed in the RM and RH risk groups, and more often in the RM risk group, probably due to a larger number of observations (Tab. 1). At that time, the total duration of ventricular tachycardia (VT) episodes, regardless of the number of patients, was at RH risk group. The same was observed with episodes of ST-depression.

Conclusions. Despite the number of observations, the risk of VT and ST-depression is significantly higher in patients at RH risk group. This should be taken into account when predicting the risk of complications in patients with NSTEMI.  Abstract Figure. Tab. 1
Coronary atherosclerotic burden and trimethylamine N-oxide in non-ST-segment myocardial infarction patients: SZ-NSTEMI cohort
Authors: Bin Waleed K , Wang LILI , Chang JUNLEI , Tse GARY , Xia Y L , Wu SHULIN , Ding L G
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Trimethylamine N-oxide (TMAO) is reported to accelerate atherosclerosis and adverse cardiac outcomes. Relationship between coronary atherosclerotic burden and TMAO has linked in stable coronary artery disease and ST-segment elevation myocardial infarction, but not in non-ST-segment elevation myocardial infarction (NSTEMI).

Objective

We examined an association of TMAO with coronary atherosclerosis burden in NSTEMI.

Methods

In this prospective cohort, two groups including NSTEMI (n = 73) and age-sex matched Healthy (n = 35) individuals were enrolled between 2019 and 2020. The number of diseased coronary vessels and clinical risk scores including SYNTAX and GENSINI were used to stratify coronary atherosclerotic burden. Fasting plasma TMAO was measured by isotope dilution high-performance liquid chromatography.

Results

The median plasma TMAO levels (0.59 mM; [interquartile range [IQR]: 0.43-0.78) versus (0.42 mM; IQR: 0.33-0.64) were significantly higher in NSTEMI group versus Healthy group, respectively (P = 0.006). Among the patients with NSTEMI group, the plasma TMAO levels were significantly higher in the multivessel disease (MVD) versus single vessel disease (P = 0.002), and intermediate-high risk (score³23) versus low risk (score < 23) of SYNTAX (P = 0.003) and GENSINI (P = 0.005). TMAO levels remained independently associated with MVD (odds ratio [OR]: 5.94, P = 0.005), and intermediate-high risk SYNTAX (OR: 3.61, P = 0.013) and GENSINI scores (OR: 4.60, P = 0.008) following traditional risk factors adjustment. Area under receiver operating characteristic curves (AUC) for TMAO also predicted MVD (AUC: 0.73, 95% confidence interval [Cl]: 0.60-0.86, P = 0.002), and intermediate-high SYNTAX score (AUC: 0.70, 95%Cl: 0.58-0.82, P = 0.003) and GENSINI score (AUC: 0.70, 95%Cl: 0.57-0.83, P = 0.005).

Conclusions

TMAO levels are independently associated with high coronary atherosclerotic burden in NSTEMI. Abstract Figure. Abstract
Short- and long-term outcomes in patients with right ventricular infarction according to modalities of reperfusion strategies in China: data from China Acute Myocardial Infarction (CAMI) Registry
Authors: Mengjin H , Yuejin YANG , Xiaojin G A O
Published: February 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Twelfth Five-Year Planning Project of the Scientific and Technological Department of China

Purpose We sought to investigate the short- and long-term outcomes in patients with right ventricular infarction in China.

Methods Data from China Acute Myocardial Infarction (CAMI) Registry for patients with right ventricular infarction between January 2013 and September 2014 were analyzed.

Results Of the 1,988 patients with right ventricular infarction, 733 patients did not receive reperfusion therapy, 281 patients received thrombolysis therapy, and 974 patients underwent primary PCI. Primary PCI and thrombolysis were all associated with lower risks of in-hospital (3.1% vs 12.6%; adjusted OR: 0.48; 95% CI: 0.27–0.87; P = 0.0151 and 5.7% vs 12.6%; adjusted OR: 0.43; 95% CI: 0.22–0.85; P = 0.0155, respectively) and two-year all-cause mortality (6.3% vs 20.9%; adjusted HR: 0.50; 95% CI: 0.34–0.73; P = 0.0003 and 11.0% vs 20.9%; adjusted HR: 0.59; 95% CI: 0.38–0.92; P = 0.0189, respectively) compared with no reperfusion therapy. Meanwhile, primary PCI was superior to thrombolysis in reducing the risks of in-hospital atrial-ventricular block (4.2% vs 8.9%; adjusted OR: 0.46; 95% CI: 0.23–0.91; P = 0.0257), cardiogenic shock (5.3% vs 13.9%; adjusted OR: 0.43; 95% CI: 0.23–0.83; P = 0.0115), and heart failure (8.5% vs 23.5%; adjusted OR: 0.35; 95% CI: 0.22–0.56; P < 0.0001). Primary PCI could reduce the risk of two-year major adverse cardiac and cerebrovascular event (19.1% vs 33.3%; adjusted HR: 0.72; 95% CI: 0.56–0.92; P = 0.0092) relative to no reperfusion therapy, whereas thrombolysis may increase the risk of two-year revascularization (15.5% vs 8.7%; adjusted HR: 1.90; 95% CI: 1.15–3.16; P = 0.0124) compared with no reperfusion therapy.

Conclusions Timely reperfusion therapy is essential for patients with right ventricular infarction. Primary PCI should be considered as the default treatment strategy for patients with right ventricular infarction in the contemporary primary PCI era.
The effect of remote ischemic post-conditioning on left ventricular ejection fraction in STEMI patients undergoing primary percutaneous coronary intervention
Authors: Fadil M
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

Primary Percutaneous Coronary Intervention (PPCI) in ST-Segment Elevation Myocardial Infarction (STEMI) is an effective method to limit the infarct area, reduce clinical symptoms, and improve clinical prognosis. However, it has the potential to creates an acute reperfusion injury which will result in worsening of left ventricular ejection fraction and eventually worsen the prognosis. Remote ischemic post-conditioning (RIPostC) is an additional, non-invasive, and inexpensive protective strategy that has been proved to play an important role in preventing worsening of reperfusion injury and left ventricular ejection fraction.

Purpose

The aim of this study was to evaluate whether PPCI combined with RIPostC improves the left ventricular ejection fraction of STEMI patients

Methods

This study used a post test only approach with control group design with an experimental research design. From June 2019 to June 2020, Fifty STEMI patients who underwent PPCI were randomized into PPCI with RIPostC (n = 24) and PPCI-only group (n = 26). After crossing wire or crossing balloon, RIPostC group was given 5 minutes inflating and 5 minutes deflating of cuff for 4 cycles. Furthermore, both groups were subjected to echocardiography follow up at 1 day and 6 months after PPCI. A bivariate analysis was performed to determine the effect of RIPostC on left ventricular ejection fraction in both groups.

Results

Based on baseline characteristics, beta-blocker therapy was found to be statistically more significant in PPCI with RIPostC than the control group (18 vs 7; p = 0.001). There was no statistically significant increase in left ventricular ejection fraction after 1 month and 6 months after PPCI in RIPostC group (p> 0.05) and the control group (p> 0.05). There was no significant difference in the changes of LVEDV, LVESV, and LVEF between 1 day and 6 months after PPCI between both groups. However, there was a different result in delta LVEF between RIPostC and without RIPostC, 6.21 ± 9.316 and 2.81 ± 8.079 respectively.

Conclusion(s)

The effect of RIPostC on echocardiography results in 1 day and 6 months after PPCI, as well as changes in echocardiography values in 1 day and 6 months did not appear to be statistically significant between the two groups. Abstract Figure. Baseline characteristics