bluuebunny/crossref_metadata_2025 huggingface dataset:
Antithrombotic strategies after cryptogenic stroke: a systematic review, pairwise, and network meta-analysis of randomized controlled trials
Authors: Abuelazm M , Mazen A M , Ali H T , Nazir A , Ayyad M , Ramadan S , Tanashat M , Abouzid M , Abdelazeem B
Published: October 2024

Background

No definite etiology is identified in 30-40% of ischemic stroke cases, which is known as cryptogenic stroke. Several antithrombotic strategies have been investigated for cryptogenic stroke management; however, the optimal strategy remains unknown.

Purpose

We aim to assess the efficacy and safety of oral anticoagulants (OACs) versus aspirin, and the comparative efficacy and safety of different OACs after cryptogenic stroke.

Methods

A systematic review and meta-analysis synthesizing evidence from randomized controlled trials (RCTs) obtained from PubMed, Embase Cochrane, Scopus, and WOS until February 2024. We used the fixed-effects model to report dichotomous outcomes using a risk ratio (RR), with a 95% confidence interval (CI). Analysis was conducted using R, version 4.2.0.

Results

Seven RCTs with 15.240 patients were included. In pairwise analysis, there was no difference between OACs and aspirin regarding all-cause mortality (RR: 1.13, CI [0.89, 1.43], P= 0.33) and stroke recurrence (RR: 0.93, CI [0.82, 1.07], P= 0.31). However, OACs were associated with a significantly increased incidence of major bleeding (RR: 1.6, CI [1.24, 2.05], P= 0.01), with no difference regarding the incidence of intracranial hemorrhage (RR: 1.09, CI [0.3, 3.97], P= 0.9). Moreover, in network analysis, none of the OACs showed a significant efficacy in preventing all-cause mortality and stroke recurrence compared to aspirin. However, only rivaroxaban significantly increased the incidence of major bleeding (RR: 2.69, CI [1.67, 4.33]).

Conclusion

OACs did not protect against stroke recurrence or decrease the incidence of all-cause mortality but increased the incidence of major bleeding in patients with cryptogenic stroke.
ECG as a screening tool for detection of significant functional mitral regurgitation in patients with left bundle branch block
Authors: Andrei D O , Calin A , Barbu F S , Oprean L V , Musat D L
Published: October 2024

Background

Functional mitral regurgitation (FMR) may occur in the left bundle branch block (LBBB) due to mechanical left ventricular (LV) dyssynchrony, by the imbalance between the tethering and the closing forces exerted on the mitral apparatus1-3. Progressive FMR and LV remodeling result in a reciprocal worsening downward spiral and worse clinical outcomes1-3. Therefore, timely screening and follow-up of these patients to prevent the irreversible progression of FMR is required. To date, only LBBB morphology and QRS duration have been proven predictors of FMR4.

Purpose

This study aimed to assess the relationship between ECG parameters of LV dyssynchrony and the severity of FMR in patients with LBBB.

Methods

We retrospectively included 154 consecutive patients with LBBB, in sinus rhythm, who had an echocardiogram, with no more than mild organic valvular heart disease. We measured the following intraventricular dyssynchrony markers: LV activation times (LVAT), intrinsicoid deflection (ID) in lateral and aVF leads and a newly defined marker – the difference (Diff) between aVL and aVF ID’s (Diff_IDaVL_aVF). These two leads record the electrical activation of the two opposing myocardial segments adjacent to the posteromedial and anterolateral papillary muscles, respectively5 (Figure 1). Based on the severity of FMR, the patients were divided into two groups: no/mild FMR (grade II or less) (61%), and significant FMR (grade III and IV) (39%).

Results

In patients with significant FMR, the LVAT measured in lateral leads, the IDaVL and Diff_IDaVL_aVF were significantly longer, but IDaVF was significantly shorter compared to patients with no/mild FMR (p<0.001). Of all studied ECG parameters, the Diff_IDaVL_ aVF was the parameter that had the strongest correlation with significant FMR (r correlation coefficient 0.82, p < 0.001). In multivariable analysis the Diff_IDaVL_aVF (p = 0.010) was the only parameter independently correlated with significant FMR. On ROC analysis the best cut-off for significant FMR prediction was 55 ms (AUC of 0.99, sensitivity 90% and specificity 97%) (Figure 2).

Conclusions

In LBBB, a simple intraventricular dyssynchrony ECG parameter can provide insights into FMR severity. A 55 msec Diff_IDaVL_aVF identifies significant FMR that may benefit from early medical or CRT treatment to avoid progression and worse prognosis.
CS585, a novel prostacyclin receptor agonist, demonstrates sustained efficacy in vivo in the prevention of thrombosis
Authors: Stanger L , Rickenberg A , Flores M , Dahlof B , Holinstat M
Published: October 2024

Background

Uncontrolled platelet activity resulting from cardiovascular disease can lead to occlusive thrombi, culminating in myocardial infarction or stroke. Despite major advances in anti-platelet therapeutics, many patients remain at risk. Although prostacyclin (IP) receptor agonists are currently used for the treatment of pulmonary arterial hypertension (PAH), activation of the IP receptor has been shown to decrease platelet reactivity. However, engaging the IP receptor as a therapeutic target was previously considered unviable due to the lack of a sustained effect of current IP agonists in the blood. The development of an IP agonist with sustained effects in the blood would represent a novel prevention strategy in targeting platelet hyperreactivity and thrombosis.

Purpose

Assess the stability profile of CS585, an IV and orally bioavailable IP agonist, compared to FDA-approved IP agonists iloprost and selexipag, with regards to sustained activity in vivo in the blood in limiting platelet activation and thrombosis.

Methods

Using ex vivo and in vivo mouse models, we assessed the timeframe of effect of CS585, iloprost and selexipag in blood. Blood was drawn from wild-type mice 24 hours following a single IV dose of CS585, iloprost or selexipag. Platelet adhesion and blood clotting were measured using perfusion flow chamber at arterial shear and total thrombus activation system (T-TAS), respectively. In vivo, platelets and fibrin were labelled 24 hours post IV or oral administration of CS585, iloprost or selexipag, and accumulation at the site of injury was measured using the cremaster arteriole injury thrombosis assay.

Results

Blood drawn from mice administered CS585 was observed to show a decrease in platelet adhesion and clot formation in the perfusion flow chamber and T-TAS assays. The effects of iloprost and selexipag are no longer observed at 24 hours post-administration. Administration of CS585 resulted in sustained inhibition of platelet accumulation and fibrin formation in the laser-induced cremaster arteriole thrombosis assay up to 18 hours post-administration. In mice administered iloprost, a decrease in thrombus formation was observed 10 minutes post-administration, but thrombus size returned to vehicle levels by 4 hours. Selexipag-dosed mice demonstrated inhibition of thrombus formation up to 4 hours, but effects were no longer observed at 18 hours.

Conclusions

CS585, a novel IP agonist, inhibits platelet activation and clot formation up to 24 hours post-administration. In both in vivo and ex vivo models, we demonstrate the sustained effects of CS585. In contrast, current FDA-approved IP agonists do not possess an effect profile sufficient to target the IP receptor in blood. By overcoming the sustainability challenge facing IP agonists, CS585 represents a novel approach to anti-platelet treatment of thrombotic diseases, which could include thrombosis, VTE, secondary prevention after MI and stroke, and PAH.
Clopidogrel versus aspirin monotherapy for secondary prevention after percutaneous coronary intervention - a nationwide population-based study
Authors: Cho J H
Published: October 2024

Background

After percutaneous coronary intervention (PCI), patients are maintained on single antiplatelet therapy (SAPT) for secondary cardiovascular prevention after completing the guideline-recommended duration of DAPT for a period of time. We sought to compare the efficacy and safety of clopidogrel versus aspirin monotherapy for secondary prevention in patients who undergoing PCI in a population-based cohort study using the database from the National Health Insurance Service (NHIS) in Korea.

Methods

Of those who underwent PCI from 2009 to 2020, 133,343 patients were selected for analysis. (aspirin 65,802 patients, clopidogrel 67,653 patients). To balance between aspirin and clopidogrel users for the comparison of efficacy and safety, we applied the inverse probability of treatment weighting (IPTW) of propensity score method.

The primary effectiveness outcome was major cardiovascular events (MACEs) as the composite of cardiovascular death, myocardial infarction (MI) or stroke. The primary safety outcome was any bleeding.

We divided the short DAPT user (< 6 months of DAPT in patients with CCS or < 12 months of DAPT in patients with ACS) and long DAPT user (≥ 6 months of DAPT in patients with CCS or ≥ 12 months of DAPT in patients with ACS) by DAPT duration.

Results

After IPTW matching, overall the mean age of participants was 63.8±16.3 and the median SAPT duration was 3.3 (1.3 – 6.2). During period, the overall primary effectiveness outcome occurred in 4.1% in aspirin group and 2.8% in clopidogrel group (hazard ratio [HR], 0.684; 95% CI, 0.656 – 0.712; p-value <0.0001) (Figure 1-A). the overall primary safety outcome occurred in 2.4% in aspirin group and 2.1% in clopidogrel group (HR, 0.945; 95% CI, 0.899 – 0.994; p-value, 0.0287) (Figure 1-B). In short DAPT group, clopidogrel reduced the risk of MACE (HR, 0.761; 95% CI, 0.715 – 0.811; p-value, <0.0001) but did not reduce the risk of bleeding (HR, 0.973; 95% CI, 0.893 – 1.056; p-value, 0.5067) comaped with aspirin. However, in the long DAPT group, clopdiogrel reduced both MACE (HR, 0.633; 95% CI, 0.600 – 0.669; p-value <0.0001) and bleeding risk (HR, 0.931; 95% CI, 0.873 – 0.992; p-value, 0.028) compared with aspirin. (Figure 2)

Conclusion

Clopidogrel monotherapy, compared with aspirin monotherapy during the chronic maintenance period after PCI reduced the risk of MACEs and bleeding. As shown in randomized controlled trials, clopidogrel monotherapy was superior to aspirin monotherapy in preventing future clinical adverse events in real-world bid database.
Evaluating off-target drug effects seen in RCTs using proteomics and mendelian randomisation
Authors: Brody J A , Sitlani C M , Ye T , Bis J C , Davies N M , Floyd J S
Published: October 2024

Introduction

Serious adverse drug effects are often not detected until late in drug development after thousands of patients have been exposed to an investigational drug in long and costly clinical trials. More efficient approaches are desirable. Proteomics-informed Mendelian randomisation (MR) can identify potential molecular mechanisms underlying off-target effects of pharmaceuticals and drug repurposing opportunities.

Purpose

As a demonstration of this approach, we used findings from a previous plasma proteomics study nested within a clinical trial of torcetrapib, which was terminated early because of an increased risk of cardiac events and mortality, in which 200 plasma proteins significantly increased (n=68) or decreased (n=132) after three months of torcetrapib use. We surveyed potential plasma protein-mediated causal effecs of torcetrapib on a wide array of relevant phenotypes in three broad domains: cardiovascular(n=10), immunological(n=9) and cancer(n=4), representing major categories of adverse outcomes that were more common in the treatment arm.

Methods

We performed three-sample MR on torcetrapib-associated proteins. First, we identified independent cis-pQTL instruments for these proteins in the Atherosclerosis Risk in Communities (ARIC) Study. Then, we used pQTL effect estimates from the deCODE study, to reduce the potential for bias due to winner’s curse and to increase precision. Lastly, we conducted MR analyses on disease-relevant phenotypes using a debiased-IVW estimator and summary results from the largest available GWAS on these phenotypes: coronary artery disease, ischaemic stroke, blood pressure, lipids, heart rate, QT interval, eGFR, serious infections, blood cell counts, immune cell fractions, and several cancers. The significance level for causal protein-phenotype associations was p=1.85E-5 (0.05/(104*26)), correcting for the 104 proteins with valid instruments and the 26 tested outcomes.

Results

Thirty-three proteins had evidence of a causal association with at least one phenotype. Seventeen proteins were associated with cardiovascular outcomes, including 8 for blood pressure and 9 for lipid levels. We identified more proteins, 25, associated with immune-related phenotypes. One protein was associated with cancer. Of note, 9 proteins had pleiotropic effects across several domains.

Conclusions

Our approach of using Mendelian randomisation to investigate the causal effects of plasma proteins impacted by medication with known off-target adverse effects revealed several novel causal relationships, highlighting the role of immune function in the development of cardiovascular disease. These results support the use of intermediate omics evaluation to identify potential biomarkers for safety monitoring for drug development and reveal avenues of investigation for drug repurposing.
Development of a cardiotoxicity evaluation system using a Heart-on-a-Chip Microdevice with aligned fiber device
Authors: Murata K , Takamura K , Abulaiti M , Nagagaki Y , Kato K , Masumoto H
Published: October 2024

Background and Purpose

Cardiovascular cells differentiated from human induced pluripotent stem (iPS) cells, such as cardiomyocytes, are expected to be useful for evaluating cardiac pharmacology and toxicity in humans. In recent years, myocardial damage caused by anticancer drugs has begun to attract attention. Being able to evaluate human cardiotoxicity early in the development of novel drugs like anticancer agents confers advantages in terms of cost and development speed. The aim of this study was to develop a highly sensitive bioassay system that can evaluate the physiological function of the human heart, and to validate the efficacy of the system toward detection of cardiotoxicity of drugs.

Methods

We differentiated human iPS cells into cardiovascular cells (cardiomyocytes, endothelial cells and mural cells) and applied dynamic culture training to generate vascularized microtissues (VCM) with vascular network structures. By integrating this VCM with a microfluidic chip containing microchannels, we developed a heart-on-a-chip microdevice (HMD) specialized for evaluating cardiac function (Figure 1). Furthermore, through a collaborative study with the Stem Cell & Device Laboratory (SCAD), application of their aligned fiber device improved throughput and stability, allowing development of a SCAD-HMD capable of evaluating longer-term cardiotoxicity.

Results

SCAD-HMD can quantify physiological parameters of VCM such as ejection volume and force based on displacement of particles within the microchannels. Our results showed that SCAD-HMD not only exhibited pharmacological responses to representative circulatory stimulants, but also reproduced clinical events occurring in actual practice, demonstrating that the anticancer drug trastuzumab, commonly used for breast cancer treatment, causes myocardial disfunction when combined with doxorubicin.

Conclusions

This study demonstrated that SCAD-HMD can stably evaluate the toxicity of drugs on the human heart. In the future, establishing SCAD-HMD using iPS cells derived from individual patients and assessing responses to specific drugs may enable "individualized cardiotoxicity assessment systems" that can preemptively avoid cardiac complications associated with anticancer drugs and other pharmacological agents.
Cardiac rehabilitation ambassadors - a new model to enhance patient participation
Authors: Kevill J , Cacavas G , Hooper S
Published: October 2024

Introduction

Participation in outpatient Cardiac Rehabilitation (CR) is considered an integral part of secondary treatment of heart disease. Despite being considered standard care, participation remains low internationally. Encouraging patients to enrol in CR during their hospital stay is linked to higher participation. [1] This study was conducted at a hospital that provides acute cardiac and rehabilitation services in Australia.

Purpose

As a provider of cardiac care, we identified that increasing nurses’ knowledge of the of CR would improve their capacity to promote CR during patient’s hospital stay.

Methods

Utilising a quality improvement methodology, the Cardiac Ambassador Initiative was developed with key stakeholders working on cardiac units in 2022.

The program consisted of an immersion experience for cardiac nurses to shadow CR nurses working in a specialist rehabilitation centre providing best practice CR for patients with a variety of cardiac conditions.

To evaluate the impact of the program, cross-sectional surveys and individual interviews were conducted with participants and Nurse-Unit-Managers (NUMs). Key outcomes included: ambassadors’ knowledge and confidence to promote CR participation to their patients on the wards and NUM's perceptions of the impact of the program.

Results

The program was run over two years. The NUMs and CR-coordinator selected a total of 13 nurses to participate. In 2022 4 participants attended a total of 5 days each. Following evaluation, the program was modified to 3 days for participants in 2023, which enabled 9 participants to attend.

All participants described not fully understanding the nature of CR and its impact on patients until they attended a program. Prior to attendance, 100% of participants considered it was important or somewhat important for patients to attend CR. Following attendance 100% of participants consider it essential or important for patients to attend. They also reported feeling more confident to discuss CR with patients and colleagues and encourage patient participation following the immersion experience. Pre-attendance 100% of participants felt either not at all confident or somewhat confident to discuss CR with their patients and this improved post program with 100% feeling very confident. 100% of participants also indicated that their confidence and skill in discussing CR with patients greatly improved and recommended that others should participate in the CR Ambassador program.

Nurse Unit Managers reported that the CR Ambassadors were a valuable resource for both staff and patients on the cardiac unit and that they had identified a need to review the accessibility of CR information and referral documentation available on their wards.

Conclusion

The immersion experience represents a feasible and sustainable approach to establishing CR ambassadors on acute cardiac wards with the skills needed to promote CR participation to colleagues and patients.
Quantifying cardiac tissue heterogeneity using high-density grid catheter: validation in porcine model
Authors: Ronda Rute L , Ramirez E , Ruiperez-Campillo S , Millet J , Castells F , Hejc J
Published: October 2024

Background and Objectives

Characterizing cardiac substrate is crucial for diagnosing and treating cardiac arrhythmias due to its association with the presence of fibrotic tissue. Omnipolar Electrogram (EGM) technology provides orientation-independent signal generation and instantaneous propagation direction determination. Although traditionally, the amplitude of the bipolar signal has been the most used metric, it alone does not suffice for comprehensive tissue characterization. Recently, a novel metric has been developed to quantify the degree of directional propagation disorganization within cardiac tissue, defined as Vector Field Heterogenity (VFH)[1] that can provide additional insights to the tissue characterization. Due to the presence of tissues with varying impedance, changes in the direction of propagation of cardiac electrical signals can occur. Therefore, the objective of this study is to characterize how the presence of fibrotic or necrotic tissue can influence the disorganization of electrical activity propagation, and thus assess the effectiveness of the heterogeneity metric in characterizing these tissues.

Method

We worked with a database of a female swine records of the left atrium. These records include data pre and post-ablation by electroporation. From the unipolar signals available in the database, we have calculated the Omnipolar EGMs in cross configuration. From the omnipolar signals, we calculated the propagation direction. On this propagation direction, we applied the heterogeneity metric for each catheter position along all the left atrium. This metric has a normalized range between 0 and 1, 0 describing the minimum disorganization and 1 the maximum. These calculations have been applied in the same way in the registers pre and post-ablation to evaluate the differences.

Results

Pre-procedure bipolar peak-to-peak voltages averaged 2.7591mV (SD = 3.4257), decreasing post-procedure to 0.754mV (SD = 1.1666), (p< 0.0001) indicating a significant decrease in bipolar amplitude following ablation. Heterogeneity scores increased post-ablation (mean = 0.3753, SD = 0.21218; post: mean = 0.53526, SD = 0.1320, p<0.0001. This indicates that after ablation, not only does the signal amplitude decrease, but also the level of disorganization of electrical propagation increases. These findings are visually depicted in Figure 1.

Conclusion

The ablation procedure led to reduced tissue electrical activity, manifested by decreased amplitude and increased propagation heterogeneity, indicative of tissue disorganization. Transitioning from homogeneous to heterogeneous conduction post-ablation suggests the presence of necrotic tissue, hindering uniform wave propagation. This highlights the significance of heterogeneity scoring in evaluating tissue health and ablative intervention outcomes.Figure 1.Catheter HD Grid
A prehabilitation programme is feasible and acceptable for mild-to-moderately frail patients undergoing cardiac surgeries
Authors: Li P W C , Yu D S F
Published: October 2024

Background

Preoperative frailty is a strong prognostication in cardiac surgical patients to predict poorer health outcomes. Intervening at the preoperative stage through prehabilitation is gaining increasing research attention. Previous studies tested a single frailty-reversing strategy, either nutritional or exercise, the exercise protocols were mainly aerobic-focused, which deviates from the exercise prescription principles suggested for frailty management, rendering an effective prehabilitation intervention is yet to be developed in cardiac surgical patients.

Purpose

This study aimed to examine the preliminary effects and explore the feasibility of a multi-component frailty-specific prehabilitation programme for mild-to-moderately frail patients undergoing cardiac surgeries/procedures. We hypothesised that compared with patients who receive usual care, patients awaiting cardiac surgeries who participate in the prehabilitation programme would have improved functional capacity, frailty status, quality of life and psychological outcomes, increased serum albumin and reduced C-reactive protein.

Methods

This study adopted a mixed-method design comprising a pilot randomised controlled trial and a qualitative study. Adult patients with a Clinical Frailty Scale score between 4 and 6, waiting for coronary artery bypass grafting surgery and/or valve repair/replacement, with at least 5 weeks of procedural waiting time and without contraindications for exercise were recruited. They were randomized in a 1:1 ratio to receive the prehabilitation programme or usual care. The programme comprised a structured preoperative education, nutritional optimization, stress management; and a multi-component exercise training with 3 sessions/week and 60 minutes/session. The exercise training lasted at least 4 weeks and maintained throughout the preoperative period.

Results

Twenty participants were randomized into the intervention (n = 11) or control (n = 9) group. The programme was feasible, acceptable and no severe adverse events were recorded. The lost to follow-up rate was 7.9%, and the overall attendance was 96%. The intervention group showed significantly greater improvement in functional capacity, frailty status and psychological outcomes than the control group at post-intervention. Participants gave positive comments about the programme and its delivery mode. They expressed that the one-on-one home-based practice enabled them greater confidence to overcome kinesiophobia. Two participants voiced out the preference for exclusive home-based training, rather than having hospital-based training in the first two weeks.

Conclusion(s)

The prehabilitation programme is feasible and acceptable for patients waiting for cardiac surgeries. It improves the functional performance, frailty status and psychological outcomes in these patients. A full-scale randomised controlled trial is warranted to investigate its longer-term and clinical effects.
Heart rate variability to predict 1-day atrial fibrillation episode onset using machine learning
Authors: Gregoire J M , Gilon C , Bersini H , Groben L , Nguyen T , Godart P , Carlier S
Published: October 2024

Background

Studies using AI assessment of 10-second 12-lead ECG suggest that it provides incremental identification of AF risk compared with clinical scores. However, it is not clear what preventive treatment should be given as the exact time of AF onset remains unknown. The use of machine learning (ML) with 2-lead Holter ECG allows the development of predictive models for paroxysmal AF within a short time window, potentially allowing an optimised pill-in-the-pocket (PITP)-like strategy.

Aim

To identify patients who are still in sinus rhythm but will develop an episode of AF in the next few hours using 24-hour Holter recordings and ML.

Materials and methods

We created a new database of 95871 Holter recordings that were manually analysed. We identified 1319 paroxysmal AF episodes from 872 patients. A total of 835 AF episodes from 506 recordings had more than 60 minutes of normal sinus rhythm (NSR) before AF onset and more than 10 minutes of AF after onset, and a total of 964 AF episodes had 30 minutes or more of NSR before AF onset. Patients were divided into five groups: all patients, patients younger than 60 years, 60-70 years, 70-80 years, and older than 80 years. A total of 365 recordings from 347 patients without rhythm abnormalities were identified and classified in our database, from which we took two ECG windows. We used a gradient-boosted decision tree model with heart rate variability (HRV) parameters as input.

Results

The most significant results were obtained from recordings with more than 5 minutes of AF with an AUROC of 0.919 (95% CI: 0.879-0.958) and an AUPRC of 0.919 (0.879-0.958) 15H08 ± 13H05 hours before the onset of AF (Figures 1 - 2). Using a threshold of 0.5, the accuracy was 84.5% (81.2-87.8), the sensitivity was 83.0% (79.5-86.4), the specificity was 86.6% (79.3-93.9), the PPV was 90.2% (85.5-94.9), the NPV was 78.4% (74.7-82.1) and the F1 score was 86.2% (83.5-89.0) for all patients.

Conclusion

These results suggest that the most important information for short-term prediction of AF onset is contained in HRV, allowing a preventive strategy. This could be exploited by wearables in mHealth allowing the use of a PITP-like preventive strategy to reduce the burden of AF. Prospective studies are needed to confirm the encouraging potential of these findings.AUROC of the XGBoost modelPrecision-recall curves
Evaluating trends and insights in cardiovascular risk among the polish population
Authors: Kubielas G , Uchmanowicz I , Lisiak M , Czapla M , Wleklik M
Published: October 2024

Introduction

Cardiovascular diseases (CVD) are the leading cause of death in Poland and worldwide. Lifestyle changes and early diagnosis can reverse this unfavorable trend. In the face of escalating global health challenges, the identification of CVD risk factors becomes paramount, especially within national contexts where demographic shifts and lifestyle changes can significantly impact the health profile of the population.

Aim of the study. Determining the prevalence of CVD risk factors in the Polish population and analyzing their changes over time.

Material and Methods

Data of 705,420 Poles aged 35-55 years who were enrolled in CVD disease prevention programme between 2012 and 2021 were analysed. The prevalence of the following CVD risk factors was determined: nicotinism, hypertension, elevated total cholesterol, elevated LDL, reduced HDL, elevated triglycerides, elevated glucose (indicating pre-diabetes), low physical activity, overweight, obesity, SCORE ≥5%. In addition, we assessed how the mean SCORE, BMI, systolic blood pressure, diastolic blood pressure, total cholesterol, LDL cholesterol, LDL cholesterol, triglycerides, glucose levels and waist circumference changed over time.

Results

Nicotinism affected 17.98%-24% of women (W) and 27.29%-36% of men (M). Hypertension was in 7.04%-8.58% of W and 17.45%-19.62% of M. Elevated total cholesterol were in 55.69%-63.64% of W and 65.91%-72.68% of M. Elevated LDL were in 44.77%-54.2% of W and 58.26%-65.48% of M. Reduced HDL were in 9.84%-11.52% of W and 14.48%-16.57% of M. Elevated triglyceride were in 13.44%-15.37% of W and in 33.81%-36.29% of M. Elevated glucose indicating a pre-diabetic status were in 10.70%-13.16% of W and in 18.91%-22.76% of M. Low physical activity was in 75.96%-82.2% of W and 73.32%-81.67% of M. Overweight conditions were in 30.37%-31.67% of W and 48.61%-49.45% of M. Obesity affected 14.04%-17.12% of W and 20.67%-24.69% of M. SCORE ≥ 5% was in 0.23%-0.38% of W and in 13.08%-18.72% of M. There was a decrease in the mean SCORE value (-0.08; 95%CI: -0.09 - -0.06) from 2012. An increase over time was noted in mean BMI (-0.01; 95%CI: -0.05 - 0.04). There was a slight decrease followed by a notable increase over time in mean systolic (-0.35; 95%CI: -0.47 - -0.24) and diastolic blood pressure (-0.25; 95%CI: -0.32 - -0.18). There was a decrease in mean total cholesterol (-3.29; 95%CI: -4.27 - -2.31) and mean LDL cholesterol (-3.11 95%CI: -4.22 - -2.01). A notable increase was observed in mean glucose values (0.01; 95%CI: 0-0.01). Over time, there was an increase in mean waist circumference value (-0.19; 95%CI: -0.54-0.16).

Conclusions

The escalation of CVD risk among the Polish population is illustrated, with a marked increase in obesity, sedentary lifestyles and indicators of metabolic syndrome. These trends highlight the urgent need for targeted public health initiatives and for the implementation of comprehensive strategies to mitigate these risks
Prediction of nonsustained ventricular tachycardia development by the analysis of premature ventricular complex-related intervals on 24-hour rhythm monitoring and testing a novel index
Authors: Erdem A , Oguz M , Uzun M , Dogan S , Babaoglu M , Orhan A L
Published: October 2024

Introduction

Ventricular tachycardia (VT) and ventricular fibrillation (VF) are life- threatening arrhythmias, with non-sustained ventricular tachycardia (NSVT) serving as a potential precursor. Identifying individuals at risk of NSVT is crucial for effective management and prevention of sudden cardiac death in high-risk patients. In daily clinical practice, premature ventricular complex (PVC) and sometimes NSVT are frequently detected on 24-hour ambulatory rhythm monitoring.

Purpose

In this study, we aimed to predict the development of NSVT by analyzing PVC morphology and intervals in 24- hour ambulatory rhythm monitorings.

Methods

A retrospective analysis of 24-hour ambulatory rhythm monitoring recordings from 2018 to 2023 was conducted. Inclusion criteria required clear measurement of PVC intervals, at least 100 PVC in the recording, and two preceding normal QRS beats. NSVT diagnosis was based on four consecutive PVC lasting <30 s and a rate >100/min. Various PVC-related parameters were analyzed, and new variables were derived. Statistical analysis included Mann-Whitney U tests and ROC analysis.

Results

The study included 202 patients, revealing significant differences in several VES temporal variables between groups with only PVC (Group I) and PVC with NSVT (Group II). Notably, Age-Adjusted Sum of Intervals Index (AASI Index-(100 x [(Tp-to- QRSvpa)+(coupling time)+(Qtc1)]/age), long coupling times, extended Tp-to-QRSvpaintervals, and prolonged Tpe-vpa intervals were associated with NSVT development. Age played a pivotal role in predicting NSVT when integrated into a specific variable AASI index. The optimal cut-off value was 4.21, with 84% sensitivity and specificity.

Conclusion

The study suggests that ventricular arrhythmias may be predicted using temporal parameters of PVC, especially when age is included as a modifier. The AASI index calculated on a PVC and preceeding two normal beats on 24-hour ambulatory rhythm monitoring seems to be promising parameter. These findings hold potential for future development of artificial intelligence-based algorithms for use in any PVC to identify at-risk patient groups, provided larger datasets are utilized to refine predictive models.Variables included in the analysis for cDefinitions of variables and ROC curve
Exercise intolerance at hospital discharge as a predictor for readmission and mortality after aortic aneurysm repair
Authors: Shibuya M , Hamazaki N , Kobayashi S , Ichikawa T , Kariya H , Uchida S , Noda T , Ueno K , Maekawa E , Meguro K , Kamiya K , Matsunaga A , Kitamura T , Ako J , Miyaji K
Published: October 2024

Background

As procedures of aortic aneurysm repair have advanced, an increased number of surgeries performed for older patients and those with comorbidities and low activities of daily living. Conversely, since these patients frequently suffer from difficulty returning to their daily activities after the surgery, physical function is considered an important indicator for risk classification and treatment effect evaluation. However, in patients following aortic aneurysm repair, the association between physical performance and clinical outcomes is not thoroughly evaluated.

Purpose

We aimed to clarify whether physical function at hospital discharge predicted clinical outcomes, including readmission rates and mortality, in patients following aortic aneurysm repair.

Methods

This was a single-centre cohort study. We included the patients admitted to a tertiary hospital to undergo surgery or endovascular repair for aortic aneurysm and who received cardiovascular rehabilitation during hospitalisation. As patient characteristics during hospitalisation, age, sex, body mass index (BMI), urgent or standby surgery, surgical type (open repair or endovascular), and comorbidities were obtained from medical records. We also reviewed 6-minute walk distance (6MWD) as physical function at hospital discharge, and 6MWD <300 m was defined as exercise intolerance. The primary and secondary endpoints were readmission and death for all causes, respectively. The multivariate Cox regression analysis was used to examine whether exercise tolerance predicted the endpoints.

Results

The 365 patients were studied for analysis. Exercise intolerance was observed in 107 patients (29.3 %). During the median follow-up period of 2.3 years, readmission and mortality for all causes occurred in 161 (44.1 %) and 39 (10.7 %), respectively. After adjusting for patient characteristics, including age, sex, BMI, urgent or standby surgery, and surgical type, exercise intolerance defined by 6MWD <300 m was significantly associated with higher mortality (adjusted hazard ratio [aHR]: 2.21, 95% confidence interval [CI]: 1.05–4.66, Figure 1-A) and readmission rates (aHR: 1.63, 95% CI: 1.13–2.34, Figure 1-B).

Conclusions

In patients following aortic aneurysm repair, exercise intolerance at hospital discharge independently predicted readmission and death for all causes. Our findings suggest that physical function after the aortic aneurysm repair is a useful predictor for patient risk classification and an indicator for treatment effect evaluation.
Evaluating an integrated clinical pharmacy service model in an ambulatory cardiac clinic- a single centre study
Authors: Khalil V , Nguyen G , Doody H , Tran M , Duong J
Published: October 2024

Background

Evidence suggests that multidisciplinary cardiology clinics improve patient outcomes. Currently, there is limited data on the type of pharmacist-led interventions occurring in cardiac ambulatory clinics in the Australian setting.

Purpose

The primary aim of this pilot audit is to examine the frequency and type of pharmacist-led interventions in the ambulatory clinics of this specialist hospital. The secondary aim is to assess factors associated with hospital readmissions within 30 days of Pharmacists' reviews.

Methods

A retrospective pilot audit was conducted for patients who attended an integrated multidisciplinary Heart Failure (HF) and Hypertension (HTN) clinic from April 2023 to February 2024. Patients’ demographics, Charlson comorbidity index (CCI), and the number and types of pharmacist interventions and readmission data 30 days post clinic review were recorded.

Descriptive statistics were used to evaluate patient characteristics and logistic regression for hospital readmissions.

Results

A total of 398 patients were reviewed by pharmacists, with 300 (75%) from the HF clinics and 98 (25%) from the HTN clinics. Patients’ median age was 63± 14.8 years and median CCI was 4± 3.7. Pharmacists documented medication histories for all patients (100%) and provided 355 recommendations, of which 213 (60%) were actioned by the cardiologist. Pharmacists had a face-to-face consultation and provided education and counselling to 175 (44%) patients. The most common types of interventions were related to guideline-directed prescribing and deprescribing (68, 39%), followed by up-titration of current therapies (61, 35%). Pharmacists also provided education on medication adherence and lifestyle modifications (28, 16%) as well as optimizing medications related to other comorbidities (18, 10%). A total of 8 patients (2%) were re-admitted l within 30 days of clinic review from either heart failure exacerbation or hypertensive crisis. Patients who had a face-to-face consultation and education with a pharmacist were less likely to be readmitted within 30 days (P=0.048). However, none of the other predictors tested for readmission such as age (P= 0.572), gender (0.296), history of non-compliance (0.834), CCI (0.984) or a diagnosis of HF or HTN (0.473) were predictors for readmission within 30 days of clinic review.

Conclusion

Pharmacists play an integral role in the cardiac ambulatory setting by providing expert medication advice and patient education to optimize patients’ outcomes. This study demonstrates that the activities performed by pharmacists working in Australian cardiac clinics are consistent with other international ambulatory clinics. The study also identified opportunities to develop a similar service for other ambulatory clinics at this hospital such as lipid and atrial fibrillation clinics. Additionally, further research is required to assess long term benefit of pharmacist led interventions on cardiac patients.
Development of a novel Patient-Reported Outcome Measure (PROM) for adults with an Inherited Cardiac Condition (ICC)
Authors: Van Pottelberghe S , Van Der Crabben S N , Amin A S , Wilde A A , Scheirlynck E , Nekkebroeck J , Hes F , Kupper N
Published: October 2024

Background

Research on the quality-of-life (QoL) among patients with inherited cardiac conditions (ICC) is limited. Existing evidence from a systematic review indicates that most studies rely on generic measures of health-related QoL, which may not adequately capture ICC-specific factors. The current study aims to develop a disease-specific patient-reported outcome measure to address this gap.

Methods

Using a qualitative study design, we first conducted focus groups until data saturation was achieved (n=15). Additionally, an expert panel of healthcare professionals was interviewed to ascertain their perspectives on patient-centered care and to evaluate face validity. Transcripts of all focus groups and interviews were analyzed thematically using Atlas.ti, qualitative analysis software, to identify concepts and formulate survey items for the initial instrument. We used the ‘Centre for Health Promotion’ QoL model, consisting of three domains- Being, Belonging, and Becoming- as the theoretical framework for our analysis.

Results

Our analysis revealed alignment with specific QoL domains of the overarching framework and identified a gap in genetic-specific domains. A novel overarching theme, genetic well-being, was identified, encompassing specific constructs related to future uncertainty, reproductive concerns, and the anticipation of disease development, thus enriching the conceptualization of QoL in the context of inherited cardiac conditions. The discussion will include an exploration of the face validity of the draft instrument.

Conclusion

Patients diagnosed with an inherited cardiac condition (ICC) face a spectrum of challenges originating from both disease-related stressors and hereditary factors alike. Recognizing that relying solely on objective clinical assessment may fail to capture the full impact of the disease, there has been an increasing focus on incorporating patient-reported measures into disease evaluation. This qualitative study contributes to developing a comprehensive patient-reported outcome measure tailored to individuals with ICC.PROM development study
Defibrillation deactivation state and activation status in patients with implantable cardioverter-defibrillators at the end of life
Authors: Narumi S , Kondo Y K , Nakano M , Kajiyama T , Ito R , Chiba T , Yoshino Y , Ryuzaki S , Komai Y , Takanashi Y , Ono H , Hosoya Y , Kitamura A , Tsuchiya Y , Kobayashi Y
Published: October 2024

Background

Implantable cardioverter-defibrillators (ICDs) are effective in preventing sudden cardiac death due to lethal arrhythmias. Defibrillation is also known to cause physical and emotional distress to patients, and guidelines on palliative care for cardiovascular disease recommend that when patients with ICDs reach the end of life, the benefits and burdens of ICDs should be fully explained to patients and a policy regarding the cessation of defibrillation discussed. However, there are few reports on the treatment status and defibrillation deactivation in patients with ICDs in the terminal phase.

Aim

To investigate defibrillation activation and defibrillation deactivation in terminally ill patients with ICDs.

Results

Death was confirmed in 146 patients in the medical record, and a DNAR policy was decided in 46 patients. The decision to deactivate defibrillation was informed to 24 patients (16%), and 15 patients (10%) were deactivated (11 patients in terminal heart failure and 4 patients in others). Four of the nine patients (6%) who did not deactivate defibrillation had a shock before death.Of the 22 patients (14 cardiovascular deaths and 8 others) who were not explained about the deactivation of defibrillation, 4 had shock activation before death.Of the 24 patients who received explanation about defibrillation deactivation, 6 (25%) had the policy decided by the patient and family, and 18 (75%) had the policy decided by the family because the patient's will could not be confirmed due to deterioration of end-stage condition.

Discussion

This study showed that defibrillation was deactivated in only 10% of Japanese patients with end-stage ICDs.ICD patients do not always reach the end of life due to heart failure. It is important for physicians, clinical engineers, and device nurses involved in device care to provide information and to confirm the wishes of patients and their families regarding the deactivation of defibrillation so that they can be supported in their decision-making regarding defibrillation no matter under what circumstances they reach the end of life.

Conclusion

Discussion of ICD deactivation in palliative care is needed to reduce the risk of painful shock and distress at the end of life.
Predicting major adverse cardiovascular events in suspected myocarditis patients using cmr late gadolinium enhancement radiomics: a time-to-event prognostication modeling
Authors: Shiri I , Baj G , Mohammadi Kazaj P , Balzer S , Schutze J , Valenzuela W , Pavlicek-Bahlo M , Kwong R , Graeni C
Published: October 2024

Background

Myocarditis, characterized by inflammation of the heart tissue, exhibits a wide range of clinical manifestations; however, stratifying its risk is difficult.

Objective

We aimed to prognosticate Major Adverse Cardiovascular Events (MACE, i.e., death, sustained ventricular arrhythmia, heart failure hospitalization, and recurrent myocarditis) in patients with suspected myocarditis using cardiac magnetic resonate (CMR) late gadolinium enhancement (LGE) radiomic features.

Method

We enrolled consecutive 1099 patients (age: 47.68±16.56, 39.63% female) undergoing CMR with the initial suspicion of myocarditis based on the judgment of the referring physician, recruited from two major registries. We used fully automated deep learning tools to determine the segmental extent of LGE in the left ventricle. Furthermore, we pre-processed the dataset through bias-field correction and intensity normalization to ensure the model consistency across various image acquisitions. Different radiomic features, including shape, intensity, and texture, were extracted from CMR-LGE. We employed several feature selection methods and time-to-event survival models based on radiomics features. The development process, covering pre-processing, feature selection, and hyperparameter optimization, utilized 70% of the dataset (10-fold cross-validation). The evaluation was performed on the remaining 30% of the test set. Model performance was measured using the c-index and cumulative AUC (C-AUC) on the untouched 30% test set.

Results

The top-performing model, employing a 90% variance threshold with the survival support gradient boosting model, achieved a C-Index of 0.76 and a cumulative C-AUC of 0.80. The Random Forest Survival model was a close second, with a C-Index of 0.75 and a C-AUC of 0.79. The conventional multivariate Cox-PH model achieved a C-Index of 0.67 and a C-AUC of 0.70.

Conclusion

Utilizing radiomics features from the CMR-LGE, combined with machine learning algorithms, allows accurate prediction of MACE in suspected myocarditis patients. The performance of the Radiomics model could be improved by including other modality information.