bluuebunny/crossref_metadata_2025 huggingface dataset:
Optimization of closed-loop electrical stimulation enables robust cerebellar-directed seizure control
Authors: Stieve Bethany J , Richner Thomas J , Krook-Magnuson Chris , Netoff Theoden I , Krook-Magnuson Esther
Published: February 2022

Additional treatment options for temporal lobe epilepsy are needed, and potential interventions targeting the cerebellum are of interest. Previous animal work has shown strong inhibition of hippocampal seizures through on-demand optogenetic manipulation of the cerebellum. However, decades of work examining electrical stimulation—a more immediately translatable approach—targeting the cerebellum has produced very mixed results. We were therefore interested in exploring the impact that stimulation parameters may have on seizure outcomes. Using a mouse model of temporal lobe epilepsy, we conducted on-demand electrical stimulation of the cerebellar cortex, and varied stimulation charge, frequency and pulse width, resulting in over 1000 different potential combinations of settings. To explore this parameter space in an efficient, data-driven, manner, we utilized Bayesian optimization with Gaussian process regression, implemented in MATLAB with an Expected Improvement Plus acquisition function. We examined three different fitting conditions and two different electrode orientations. Following the optimization process, we conducted additional on-demand experiments to test the effectiveness of selected settings. Regardless of experimental setup, we found that Bayesian optimization allowed identification of effective intervention settings. Additionally, generally similar optimal settings were identified across animals, suggesting that personalized optimization may not always be necessary. While optimal settings were effective, stimulation with settings predicted from the Gaussian process regression to be ineffective failed to provide seizure control. Taken together, our results provide a blueprint for exploration of a large parameter space for seizure control and illustrate that robust inhibition of seizures can be achieved with electrical stimulation of the cerebellum, but only if the correct stimulation parameters are used.
Prognostic value of pre-operative left atrial strain on composite endpoint in patients received aortic valve replacement for severe aortic stenosis: a retrospective cohort study
Authors: Tsui L , Yiu K H , Tse H F , Lam L Y , Leung C K L , Yu A S Y , Wu M Z , Ren Q W , Wong P F , Tse Y K , Yu S S Y , Li H L , Hon W L
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Objective

Severe aortic stenosis (AS) is the most common primary valvular heart disease, treatable only by aortic valve replacement (AVR).  Current literatures have shown that severe AS may precede atrial dysfunction which predicts adverse outcomes.  However, predictive value of pre-operative left atrial (LA) function on post-AVR clinical outcomes is uncertain.  The study aims to evaluate the prognostic value of pre-operative LA strain on post AVR all-cause mortality and heart failure.

Methods

Patients aged 18 years old or above with severe AS were recruited and assessed using speckle-tracking echocardiography pre-operatively.  Severe AS was defined according to 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease.  Peak Atrial Longitudinal Strain (PALS) was measured as a surrogate of LA function.  Patients with underlying pre-operative atrial fibrillation and other severe valvular heart diseases were excluded.  High PALS was defined as PALS higher than 15.94%. Patients were followed up until death or end of the study. The primary endpoint is a composite endpoint of all-cause mortality and heart failure during hospitalisation. The association of LA function with composite endpoint of all-cause mortality and heart failure was evaluated by Cox Proportional Hazards analysis.

Results

A total of 128 patients (mean age 65.3.9 ± 9.4 years, 56.3% male) were analysed. Patients were followed up for a mean period of 3.9 ± 2.4years.  A total of 65 of 128 patients (50.8%) belonged to low PALS group.  During the study period, 23 patients developed events on the composite endpoint.  Among those with composite endpoint, low PALS group accounted for 18 (78.3%) patients and high PALS group accounted for 5 (21.7%) patients.  Higher PALS was independently associated with lower risk of composite endpoint of all-cause mortality and heart failure (HR, 0.33; 95% CI 0.117-0.916, p = 0.03) after adjustment for EuroSCORE II.

Conclusion

Higher PALS, a surrogate of LA function, is associated with a lower risk of composite endpoints of mortality and heart failure in patients with severe AS undergoing AVR, independent of EuroSCORE II. Evaluation of LA function by assessing speckle tracking derived PALS may aid in prognostication for patients undergoing AVR.
Vascular inflammation in patients with obstructive sleep apnoea and coronary artery disease shown on coronary computed tomography angiography attenuation
Authors: Yuvaraj J , Cameron W , Andrews J , Lin A , Nerlekar N , Nicholls S J , Hamilton G , Issa M , Che Z C , Lim E , Wong D T L
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Obstructive sleep apnoea (OSA) is associated with increased plaque burden in coronary artery disease (CAD), but the role of vascular inflammation in this relationship is unclear. Coronary computed tomography angiography (CTA) enables surrogate assessment of systemic inflammation via subcutaneous adipose tissue attenuation (ScAT-a), and of coronary inflammation via epicardial adipose tissue volume and attenuation (EAT-v and EAT-a) and pericoronary adipose tissue attenuation (PCAT-a).

Purpose

To investigate whether vascular inflammation is increased in patients with severe OSA and high plaque burden.

Methods

Patients with clinically indicated polysomnography and coronary CTA were included. Severe OSA was classified as apnoea/hypopnoea index (AHI) >30. High plaque burden was defined as a CT-Leaman score (CT-LeSc) >8.3. Patients with both severe OSA and high plaque burden were defined as ‘Group 1’, all other patients were classified as ‘Group 2’. ScAT-a, EAT-a, EAT-v and PCAT-a were assessed on semi-automated software.

Results

A total of 91 patients were studied (59.3 ± 11.1 years). Severe OSA was associated with high plaque burden (p = 0.02). AHI correlated with CT-LeSc (r = 0.24, p = 0.023). Group 1 had lower EAT-a and PCAT-a compared to Group 2 (EAT-a: -87.6 vs. -84.0 HU, p = 0.01; PCAT-a: -90.4 vs. -83.4 HU, p < 0.01). However, among patients without high plaque burden, EAT-a was increased in patients with severe OSA versus mild-moderate OSA (-80.3 vs. -84.0 HU, p = 0.020). On multivariable analysis, EAT-a independently associated with severe OSA and high plaque burden (p < 0.02), and PCAT-a associated with severe OSA and high plaque burden, and hypertension (all p < 0.01).

Conclusions

EAT attenuation is decreased in patients with severe OSA and high plaque burden but increased in patients with severe OSA and low plaque burden. These divergent results suggest coronary inflammation may be increased in OSA independent of CAD, but larger studies are required to validate these findings.
Effects of hot balloon versus cryoballoon ablation for atrial fibrillation: a systematic review and meta-analysis
Authors: Peng X , Chen Y , Li X X
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Catheter ablation has developed as the most effective therapeutic approach and won the highest-level guideline recommendation in treating atrial fibrillation (AF) in the decades. Several balloon-based catheter ablations, including hot balloon ablation (HBA) and cryoballoon ablation (CBA), have rapidly emerged as alternative modalities to conventional radiofrequency catheter-based AF ablation. However, the differences in characteristics, effectiveness, clinical outcomes, safety, and efficacy between HBA and CBA remain undetermined. 

Purpose

To compare the differences in the prognosis and characteristics between HBA and CBA. 

Methods

Our electronic search was conducted in six databases, including PubMed, Embase, Cochrane Library, Web of Science, ClinicalTrial.gov, and medRxiv, with specific search strategies. Eligible studies were selected according to specific criteria. All records were identified up to June 1, 2021. The mean difference, odds ratios (ORs), and 95% confidence interval (95% CI) were calculated to evaluate the clinical outcomes. Heterogeneity and risk of bias were also assessed with predefined criteria.

Results

A total of 7 studies were included in our final meta-analysis. Comparing with CBA, more patients in the HBA group required touch-up ablation (OR 2.76, 95% CI, 2.02, 3.77, P = 0.000). More residual conduction was seen in the HBA group. HBA group had a longer procedure duration than the CBA group (WMD 14.24, 95%CI 4.39, 24.09, P = 0.005). More patients in the CBA group were likely to have AF occurrence (OR 0.75, 95% CI, 0.44, 1.27, P = 0.281) and accepted more antiarrhythmic drug therapy (OR 0.70, 95% CI, 0.45, 1.09, P = 0.114), although the result was insignificant. 

Conclusions

Both HBA and CBA are effective ablation approaches to treat atrial fibrillation. Patients who received HBA were more likely to receive touch-up ablation and undergo longer procedure time. Patients in the CBA group were more likely to have AF occurrence and accepted more antiarrhythmic therapies. However, the long-term safety is still unknown. Further studies of multicenter, randomized clinical trials are warranted to verify this fundamental question.
Cardiorenal effects of SGLT2i in combination with ARNI for HFrEF: a systematic review and meta-analysis
Authors: Cordovez R A B , Rivera K , Denila R A , Patricio M , Permejo C
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Recent recommendations suggest a combination of Angiotensin receptor neprilysin inhibitor (ARNI) and beta blocker with other classes of medications in heart failure with reduced ejection fraction (HFrEF) (1). Despite currently available treatment options, mortality remains high (2). From the recent robust clinical trials, both SGLT2 inhibitor (SGLT2i) and ARNI have been found to decrease HF hospitalizations and CV death (3-5). This paper aims to determine the efficacy of SGLT2i and ARNI combination versus ARNI alone in the management of HFrEF.

Methods

Randomized controlled, prospective or retrospective cohort trials on ARNI with SGLT2i versus ARNI without SGLT2i in patients with left ventricular ejection fraction of 40% or less were included. A search using Pubmed, CENTRAL, and ScienceDirect was conducted on April 29, 2021.  Risk of bias was assessed using Cochrane’s Collaboration tool for RCTs and STROBE checklist for cohort, case-control and cross-sectional studies. Review Manager version 5.4 software was used for data synthesis and analysis. Outcomes were measured as mean differences and risk ratio for continuous data and dichotomous data with 95% confidence interval.

Results

Three studies were screened with a total of 1,742 patients; 759 received a combination of SGLT2i and ARNI while 983 received standard care plus ARNI. There was a significant reduction in composite of cardiovascular death and heart failure hospitalization in the combination SGLT2i/ARNI group (HR 0.69, 95% CI 0.56-0.85, and p value of 0.0005). There was significant reduction in heart failure hospitalization in the treatment group with SGLT2i (HR of 0.61, a 95% CI 0.49-0.78) compared to the group without treatment of a SGLT2 inhibitor (< 0.0001). Composite renal event favors combination of ARNI and SGLT2i in some studies (HR of 0.73, with a 95% CI 0.39-1.38), however was not statistically significant (p value = 0.34).

Conclusion

Addition of SGLT2i with ARNI provides significant decrease in mortality and hospitalization among patients with HFrEF compared to control as well as improvement in renal function.
Association of aVR ST-elevation with outcomes in patients with acute coronary syndrome
Authors: Cordovez R A
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Evaluation of the lead aVR in the diagnosis of acute coronary syndrome has been neglected before.1 However, there is evidence that an ST segment elevation in that lead correlates to a significant coronary artery disease.1,2 This study aimed to determine the association with clinical outcomes of an aVR ST elevation in patients with acute coronary syndrome.

Purpose

Identify patients who are at high risk on presentation at the emergency department.

Methods

This was a retrospective cohort study. Patients aged 19 years and above who were diagnosed with either unstable angina, non ST-elevation MI or ST elevation MI were eligible subjects. The medical records of patients in a tertiary referral government hospital were evaluated. The independent variable was the lead aVR ST elevation, while the primary outcome was the in-hospital mortality. Descriptive statistics was used to summarise the demographic and clinical characteristics of the patients. Frequency and proportion was used for categorical variables, median and inter quartile range for non-normally distributed continuous variables, and mean and standard deviation for normally distributed continuous variables. Independent Sample T-test and Fisher’s Exact test was used to determine the difference of mean and frequency, respectively, between patients with and without in-hospital outcomes. Odds ratio and corresponding 95% confidence intervals from binary logistic regression was computed to determine significant predictors of in-hospital outcomes. Missing variables was neither replaced nor estimated. Null hypotheses was rejected at 0.05α-level of significance.

Results

There were a total of 108 patients included. Most subjects were males and aged 57-62 years old. Majority had NSTE-ACS and STEMI at presentation. Lead aVR ST elevation group had an OR of 17 (95% CI 4.38-67.50 and p < 0.001) for in-hospital mortality, compared to the group without. On coronary angiogram, these patients had either a significant left main coronary artery disease or a multi-vessel coronary artery disease.

Conclusion

The presence of a lead aVR ST segment elevation in patients with acute coronary syndrome at presentation in the emergency department is associated with increased in-hospital mortality.
Relationship of mean platelet volume to severity of coronary atherosclerosis in non-ST-segment myocardial infarction
Authors: Bin Waleed K , Tse GARY , Wang LILI , Chang JUNLEI , Changnong PENG , Yunlong X I A , Wu SHULIN , Jianghai L I U , Yihang YANG , Yicong L I , Yongkang L U
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Platelets play a crucial role in thrombotic mechanism. Mean platelet volume (MPV) is primarily indicator of platelet activation and its measurement is easy and time-effective. The MPV is associated with adverse cardiac events in coronary artery disease. However, limited data are available to assess the relationship of MPV to severity of coronary atherosclerosis through multiple indicators including SYNTAX and GENSINI scores and multivessel disease (MVD) in non-ST-segment elevation myocardial infarction (NSTEMI).

Objective

We tested the association of MPV to severity of coronary atherosclerosis via multiple indicators in NSTEMI.

Methods

Ninety-three newly diagnosed NSTEMI patients (male 80.6% male and mean age 60.1 ± 12.3) were prospectively enrolled those who underwent first-time coronary angiography. The MVD defined as having stenosis >70% in >1 coronary vessels and clinical risk scores including SYNTAX and GENSINI were calculated to stratify coronary atherosclerosis severity. These indicators were sub-categorized into low risk (score <23) versus intermediate-high risk (score ³23) SYNTAX and GENSINI scores and MVD versus single vessel disease. The MPV was obtained from complete blood count analysis prior to coronary angiography.

Results

 Patients with intermediate-high risk SYNTAX (P = 0.001) and GENSINI (P = 0.002) scores had higher MPV values as compared to low risk. The higher MPV was also observed in in MPV than single vessel disease (P = 0 .017). The MPV was positively correlated with SYNTAX score (r = 0.281, P = 0.006, Spearmen’s Correlation), GENSINI (r = 0.219, P = 0.035, Spearmen’s Correlation), and MVD (r = 0.243, P = 0.019, Spearmen’s Correlation). Using logistic regression analysis after adjustment of traditional risk factors, we observed MPV remained independently associated with intermediate-high risk SYNTAX [odds ratio (OR): 0.881(95% confidence interval (Cl): 0.247-1.516), P = 0.006) and GENSINI scores [OR: 0.782(95%Cl: 0.131-1.434), P = 0.019) and MVD [OR: 0.718(95%Cl: 0.027-1.409), P = 0.042]. Operating characteristic curves (AUC) for MPV also evaluated intermediate-high SYNTAX score [AUC: 0.696(95%Cl: 0.587-0.804), P = 0.001) and GENSINI score [AUC: 0.694(95%Cl: 0.062-0.851), P = 0.003] and MVD [AUC: 0.660(95% Cl: 0.541-0.779), P = 0.020].

Conclusions

We studied a positive relationship of MPV with high coronary severity through multiple indicators including SYNTAX, GENSINI and MVD in NSTEMI patients.
Left main PCI with second-generation DES: a single-centre experience
Authors: Jariwala P , Jadhav KARTIK
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

To characterise patients and procedures with left main (LM) percutaneous coronary intervention (PCI) and to evaluate their outcomes.

Methods

Single-centre, retrospective study performed from January 2018 to December 2019 in patients with LM PCI with second-generation drug-eluting stents (n = 104). Indications for PCI were elective PCI for stable angina (n = 39), stabilised NSTEMI (n = 27), NSTEMI with ongoing instability (n = 8), STEMI (n= 24), and non culprit lesion treatment after primary PCI for STEMI(n = 6). 25.7% of patients were in cardiogenic shock. After our first LM PCI guided with intracoronary imaging, 68.5% of the procedures were performed with it. 

Results

Patients with LM PCI were mainly male (78.1%) with a median age of 66.7 years. 53.3% of patients were diabetic and 62% had reduced ejection fraction. Previous CABG was presented in 25.7% (only patients had unprotected LM). The SYNTAX score was low (<22) in 58.6%, intermediate (22 to 32) in 32.2% and high (>33) in 9.2%. Distal LM bifurcation PCI was performed in 83.4%, and 67% of patients had two-vessel or three-vessel disease. 

43.1% of patients with distal disease were treated with a double-stent technique [DST] (1 with T-stent, 2 with TAP, and 4 with culotte technique), in which proximal optimisation technique (POT) and kissing balloon (KB) were always performed (fig.-1).  When single-stent technique [SST] was used in distal LM, POT was performed in 96.0% and kissing balloon in 85%. Pre- and post-dilatation were performed in 93.0 and 98.1% of all cases, respectively. 6.7% of patients died during the hospitalisation (2 with stent thrombosis; 5 were in cardiogenic shock). 

All patients had at least 1-year of follow-up. At follow-up, 8.9% of patients died. 76.5% of deaths were non-cardiovascular; cardiovascular deaths were due to heart failure. Non-fatal myocardial infarction occurred in 9.8% patients with 2 patients undergoing unplanned PCI (one with LM PCI). Target lesion failure occurred in 8 patients (2 had fatal stent thrombosis; 4 had stent restenosis; 1 were sent to CABG and 1 was treated with PCI). 4 patients had a stroke during hospitalisation and another during follow-up.

Conclusions

LM PCI can be considered as an alternative revascularisation in urgent situations when surgery cannot be considered. Though it can be a high-risk subset, the results in our population are encouraging.
Prognostic value of GRACE versus TIMI Score for in-hospital outcomes after non-ST-Elevation acute coronary syndrome
Authors: Kumar DILEEP , Saghir TAHIR , Ahmed Khan KAMRAN , Naseeb KHALID , Ali GULZAR , Mahfooz Ali M , Karim MUSA , Qamar NADEEM
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

The risk stratification scores are very helpful to categorize high risk patients to plan future management. Therefore, in this study we compared the predictive value of TIMI and GRACE score for predicting in-hospital outcomes after non-ST elevation acute coronary syndrome (NSTE-ACS).

Methods

This study included prospectively recruited cohort of patients presented to a tertiary care cardiac center in Pakistan who were diagnosed with NSTE-ACS. GRACE and TIMI score were obtained and in-hospital mortality was recorded. The receiver operating characteristic (ROC) curves analysis was performed and area under the curve (AUC) was obtained as indicative of predictive value for both scores.

Results

A total of 300 patients were included, out of which 76.7%(230) were male and mean age was 58.04 ± 10.71 years. Risk profile comprises of 84.3%(253) hypertensive, 42.0%(126) diabetic, 27.3%(82) smokers, 9.0%(27) obese, 15.3%(46) dyslipidemic, and 31%(93) with sedentary lifestyle. Mean GRACE and TIMI score were 120.19 ± 33.17 and 3.18 ± 0.85 respectively. In-hospital mortality rate was 5.3%(16). AUC for the GRACE score was 0.851 [0.767 - 0.934] with the optimal cutoff value of 150 with sensitivity of 68.8% and specificity of 84.9%. The AUC for the TIMI score was 0.781[0.671 - 0.891] with the optimal cutoff value of 4 with sensitivity of 75.0% and specificity of 67.6%.

Conclusion

The GRACE score has high discriminating strength for predicting in-hospital mortality after NSTE-ACS. GRACE score should be used as risk stratification modality in clinical decision making for the management of NSTE-ACS.
Impact of SARS-CoV2 pandemic onto acute ST-elevation myocardial infarction care and patient outcomes in a large tertiary cardiac center
Authors: Yong D , Sulong M A , Sundarajoo M , Am Haris N , Low M Y , Kaniappan K , Nuruddin A A
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

SARS-CoV2 pandemic has caused major impact on patient care worldwide. We experienced a surge of cases beginning March 2020 leading to the government imposing a movement control order, more commonly known as ‘lockdown’ starting 18th March 2020. As such, various changes were implemented by our center to the clinical pathway for STEMI patients including using thrombolysis as the preferred initial treatment modality.

Purpose

We aim to determine the impact of SARS-CoV2 pandemic on the clinical outcome of acute STEMI patients in our center which is a large regional tertiary hospital for cardiology.

Methods and results: This is a single center retrospective cross-sectional study from 1st January 2020 until 31st May 2020. We compared clinical outcomes of patients admitted for acute STEMI before (group 1) and after (group 2) 15th March 2020 which is the date our center implemented changes to our STEMI care pathway. A total of 172 cases of acute STEMI was admitted to our center during this period. Admission for STEMI was noticeably lower after the lockdown implementation (group 1, n = 97 vs group 2, n = 75). The median time from symptom to presentation at our center did not differ between the two groups being 4.15h[2.78,7.28] vs 4.42h[2.97,8.01] p = 0.702, suggesting no out-of-hospital delays in management. Majority of the patients in group 1 (n = 75, 77.2%) received primary percutaneous coronary intervention (PCI) vs only 17 (22.7%) in group 2. Most in group 2 (n = 54, 72%) received thrombolytic therapy and subsequently underwent coronary intervention within the same admission. This shows a shift in the preferred initial treatment modality for STEMI at our center during this period. The door to balloon time for patients undergoing primary PCI during this period was also numerically higher in group 2 but the difference was not statistically significant at 46min [38,63] vs 59min [45,72], p = 0.063, most likely due to the additional preparation needed in terms of SARS-CoV2 testing and personal protective equipment (PPE) prior to the procedure.  The primary composite endpoint of in-hospital mortality and cardiogenic shock between the two groups (17.5% vs 24.3%, p = 0.275) did not show any significant difference. The incidence of in-hospital mortality and cardiogenic shock were 4.1% vs 6.7% (p = 0.458) and 15.5% vs 21.9% (p = 0.281) respectively.

Conclusions

This study suggests that thrombolysis as the preferred initial treatment modality for STEMI could be a reasonable temporary measure during the initial phase of a global pandemic to reduce infection risk of healthcare providers without compromising patient outcomes until adequate PPE and testing modalities are available for primary PCI to be performed safely. A follow-up study is needed to determine the long-term outcome of these patients.
Prognostic implications of the proportionality of tricuspid regurgitation in tricuspid annuloplasty
Authors: Stephanie Y K , Li H L , Ren Q W , Wu M Z , Yiu K H
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

 Patients with secondary tricuspid regurgitation (TR) represent a heterogeneous group that benefits differentially from tricuspid annuloplasty. We hypothesized that TR severity may be proportional or disproportional to right ventricular (RV) remodeling and investigated the prognostic implications of this novel paradigm.

Methods

 The ratios of pre-procedural effective regurgitant orifice area (EROA) with right ventricular end-diastolic area (RVDA) and tricuspid annular plane systolic excursion (TAPSE) were retrospectively assessed in 307 patients undergoing tricuspid annuloplasty. Based on optimal thresholds derived from cubic splines and maximally selected rank statistics, patients were stratified into 3 groups: proportionate TR (Group 1: EROA/RVDA ≤1.68 and EROA/TAPSE ≤3.42), disproportionate TR to RV size (Group 2: EROA/RVDA >1.68 and EROA/TAPSE ≤3.42), and disproportionate TR to RV size and function (Group 3: EROA/RVDA >1.68 and EROA/TAPSE >3.42). 

Results

 Overall, 72 (23%), 127 (41%), and 108 (35%) patients were classified into Group 1, 2, and 3, respectively. Compared with those with proportionate TR (Group 1), patients with disproportionate TR (Group 2 and 3) had a higher prevalence of atrial fibrillation, moderate to severe aortic stenosis, and smaller left ventricular end-diastolic and end-systolic volumes. During a median (interquartile range) follow-up of 4.3 (2.6-6.3) years, 74 adverse events (42 HF hospitalizations and 32 deaths) occurred. Patients with disproportionate TR (Group 2 and 3) had higher rates of adverse events than those with proportionate TR (21% and 38% versus 8%; P = 0.010 and P < 0.001, respectively; Figure) and were independently associated with poor outcomes on multivariate analysis. Importantly, this novel framework outperformed the TR grading system recommended by current guidelines, which was unable to effectively stratify prognosis in this population (Hazard Ratio for severe versus moderate TR 1.42; 95% CI 0.84-2.38; P = 0.194).

Conclusion

 Disproportionate TR is independently associated with poor prognosis in patients undergoing tricuspid annuloplasty. Characterization of TR severity to RV size and function may aid patient selection and risk stratification for tricuspid annuloplasty. Abstract Figure.
Performance and 12 month outcomes of a wire free fractional flow reserve system for assessment of coronary artery disease, first experience in south east asia
Authors: Bhavnani C D , Fong A Y Y , Koh K T , Oon Y Y , Tan C T , Chen L S , Pang I X , Said A B , Ho K H , Shu F E P , Ling H S , Cham Y L , Thien L K , Chung B K , Ong T K
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Fractional flow reserve (FFR) using an invasive pressure wire has a Class 1A recommendation for guiding coronary revascularization in stable coronary artery disease (CAD). Angiography based ‘wire free’ FFR is an emerging technique which determines the physiological significance of a coronary lesion without requirement of a pressure wire or induction of hyperemia. It also eliminates potential complications associated with introduction of wires into the coronary arteries.

Objective

To assess the 12-month clinical outcomes of PCI deferral, guided by an angiography based fractional flow reserve (CAFFR) system. The primary end point was a composite of death from any cause, myocardial infarction (MI) or target vessel revascularization (TVR)

Methods

This was a prospective, single center study involving 69 patients (93 vessels) with angiographic stenosis of 30%-90%. Patients with CAFFR of <0.80 or poor image quality were excluded leaving 29 patients (31 vessels) for analysis. All recruited patients had a CAFFR >0.80 and thus, PCI deferral.

Wired FFR was done for comparison on 14 patients (48%) at the operator’s discretion.

Results

The mean age was 59 ± 12.6 years old. Majority of patients (83%) were male. 12 (42%) patients were diabetic, 18 (62%) were hypertensive, 17 (59%) had dyslipidemia and 18 (62%) had a smoking history. The mean LVEF was 52+/-11.4%. 72% of the patients had a recent acute coronary syndrome. We assessed the LAD artery in 15 (52%) vessels. The mean CAFFR and FFR was 0.87 ± 0.04 and 0.89 ± 0.05 respectively. The values showed agreement with each other with no statistically significant proportional bias on the Bland Altman plot (linear regression t test: t=-1.19, p = 0.257). CAFFR values >0.80 showed 100% correspondence to negative FFR values (>0.80). There were zero procedural complications from CAFFR measurement.

At 12 months, all 29 patients were alive. Only 1 patient (3.4%) met the primary end point (TVR for angina). 89.6% (26) patients remained in CCS class 1 on follow up.

Conclusion

CAFFR shows good agreement with wired FFR. The 12-month outcome data shows that CAFFR guided PCI deferral is safe and comparable to the gold standard of wired FFR guided PCI deferral. Further analysis with a larger patient pool and longer follow-up is warranted. Abstract Figure. Bland-Altman plot of FFR and CAFFR
Impact of Covid-19 on cardiovascular clinics: are we ready for tele-medicine?
Authors: Mujtaba M , Sapna  , Khanzada FAISAL , Qayyum DANISH , Saghir TAHIR , Buraro SHARF
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

World is facing Coronavirus disease (COVID-19) pandemic since December 2019. [1, 2]. COVID-19 has significantly decreased the influx of patients presenting with cardiovascular diseases at hospitals. The aim of this study was to determine the difficulties faced by patients in visiting the cardiac outpatient department during COVID-19 era and to assess the awareness regarding telemedicine and wiliness to adopt if offered in future.

Methods

This cross sectional study was carried out on patients presenting to the outpatient department in a National Institute of Cardiovascular Diseases. Data was collected after verbal consent from patients. The collected data was entered using IBM SPSS version 21, mean ± SD was calculated for continuous variables and frequency and percentages were calculated for the categorical variables.

Results

A total of 404 patients were interviewed, 42% female and 58% male with 77.5% from urban areas and 22.5% from rural areas. A total of 32.1% patients presented with shortness of breath, 28.8% with chest pain and 19% with palpitations. Regarding cardiovascular diagnosis 69.5% had ischemic heart disease, 38.3% had hypertension, 29.3% suffered from heart failure and 10.3% had valvular heart disease. A total of 26.7% visited the emergency room during the pandemic, 81.9% were compliant with medication and only 66% were compliant with a healthy lifestyle. A total of 52.8% patients found it difficult to attend the out patients department due to limited appointments, 24% due to limited mobility due to lockdown, 18.2% due to financial issues, 14.2% due to fear of acquiring infection from the hospital. Regarding telemedicine, 11.2% of the patients were aware of it and only 4.5% had previously used it, with 41.3% patients willing to opt for telemedicine in future. Regarding barriers to usage of telemedicine, a total of 40.7% of patients had no access to internet, 32.7% did not have a smart device and 11.6% were afraid of being diagnosed incorrectly.

Conclusion

It was found that distancing measures, lockdowns and restricted mobility of the masses has made it difficult for patients to visit the clinics which has led to patients visiting the emergency room. Telemedicine awareness was found to be limited, however many patients were willing to adopt provided their limitations can be overcame. Abstract Figure. Difficulty faced during OPD visit  Abstract Figure. Barriers to Tele-medicine
Long-term follow-up in patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention
Authors: Klancik Viktor , Pesl Ladislav , Neuberg Marek , Tousek Petr , Kocka Viktor
Published: February 2022

Long-term follow-up after primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI) beyond 5 years is poorly described. There are no risk-stratification systems available for routine use. This retrospective, academic, two-centre analysis included consecutive patients who presented with acute STEMI between March 2008 and December 2019. In total, 5263 patients underwent pPCI; all patients were included in the analysis only once. Baseline characteristics were gathered from prospective local registries and based on initial hospitalization. The study enrolled 5263 patients who had been treated with pPCI; it found that cardiovascular mortality was the most frequent cause of death (65.0%) on long-term follow-up to 12 years. Myocardial infarction associated mortality was 27.2%. Cardiovascular mortality was dominant, including in the landmark analysis beyond 1 year. Multivariate analysis identified significant predictors for long-term cardiovascular mortality: age, history of diabetes mellitus, history of renal insufficiency, history of heart failure, Killip class, and successful pPCI at presentation. A predictive model was built to evaluate the risk of cardiovascular death with a high discrimination value (C-statistic = 0.84). Cardiovascular diseases remain the leading cause of long-term mortality after pPCI in the Central European population. Our novel predictive model provides risk stratification; it could identify patients who would experience the greatest benefit from aggressive secondary prevention measures.
Perceived vs. objective frailty in patients with atrial fibrillation and impact on anticoagulant dosing: an ETNA-AF-Europe sub-analysis
Authors: Diemberger Igor , Fumagalli Stefano , Mazzone Anna Maria , Bakhai Ameet , Reimitz Paul Egbert , Pecen Ladislav , Manu Marius Constantin , Gordillo de Souza José Antonio , Kirchhof Paulus , De Caterina Raffaele
Published: February 2022

Aims

Frailty is common in patients with atrial fibrillation (AF), with possible impact on therapies and outcomes. However, definitions of frailty are variable, and may not overlap with frailty perception among physicians. We evaluated the prevalence of frailty as perceived by enrolling physicians in the Edoxaban Treatment in Routine Clinical Practice for Patients With Non-Valvular AF (ETNA-AF)-Europe registry (NCT02944019), and compared it with an objective frailty assessment.

Methods and results

ETNA-AF-Europe is a prospective, multi-centre, post-authorization, observational study. There we assessed the presence of frailty according to (i) a binary subjective investigators’ judgement and (ii) an objective measure, the Modified Frailty Index. Baseline data on frailty were available in 13 621/13 980 patients. Prevalence of perceived frailty was 10.6%, with high variability among participating countries and healthcare settings (range 5.9–19.6%). Conversely, only 5.0% of patients had objective frailty, with minimal variability (range 4.5–6.7%); and only <1% of patients were identified as frail by both approaches. Compared with non-frailty-perceived, perceived frail patients were older, more frequently female, and with lower body weight; conversely, objectively frail patients had more comorbidities. Non-recommended edoxaban dose regimens were more frequently prescribed in both frail patient categories.

Conclusions

Physicians’ perception of frailty in AF patients is variable, mainly driven by age, sex, and weight, and quite different compared with the results of an objective frailty assessment. Whatever the approach, frailty appears to be associated with non-recommended anticoagulant dosages. Whether this apparent inappropriateness influences hard outcomes remains to be assessed.
Reducing hydrological disturbances in absolute gravity observations by combining global hydrological models with a regional run-off model
Authors: Bramanto B , Breili K , Gerlach C , Ophaug V , Gjevestad J G O
Published: February 2022

Since the beginning of the 1990s, absolute gravity has been observed at several locations in Norway with FG5-type instruments to investigate the temporal gravity changes due to glacial isostatic adjustment (GIA). Previous work suggests that some of the estimated secular gravity trends may be affected by remaining unmodelled geophysical effects, such as the effect of local hydrology. In this work, we compute hydrological gravity effects from global hydrological models for the far zone and a combination of regional run-off models and modelling of residual hydrological effects for the near zone. The method developed in this paper is first tested at the geodetic observatory in Wettzell, Germany, where both high-resolution superconducting gravimeter data as well as a regional hydrological model are available. Next, the method is transferred to two Norwegian gravity sites (NMBU and TRYC), with long time-series of frequent absolute gravity observations using FG5-226. At these sites, we investigate the impact of the hydrological gravity correction on data variability as well as estimated secular gravity trends. We find that the data variability is reduced by up to 40 per cent when applying the modelled hydrological gravity effect at TRYC. The reduction is less at NMBU where the amplitude of the hydrological signal and in consequence also the signal-to-noise ratio are smaller. We also note that it is challenging to determine the near zone residual hydrological effects without carefully taking into account the hydrogeological setting of the area for modelling such effects. When utilizing the long corrected absolute gravity series to determine the gravity trends, we find that the estimated trends are not significantly different from the uncorrected observations. However, the uncertainty of the estimated trends is reduced significantly for a limited corrected gravity series. We further suggest repeatability analysis of the absolute gravimeter. From the long time-series at NMBU we find a significant step coinciding with hardware replacement. We find that the fit between observed and modelled secular trends improves when introducing the step. Further analysis of gravity rates at other stations is needed to verify the existence of a real instrumental offset.
Engineering CAR-NK cells: how to tune innate killer cells for cancer immunotherapy
Authors: Schmidt Dayane , Ebrahimabadi Sima , Gomes Kauan Ribeiro de Sena , de Moura Aguiar Graziela , Cariati Tirapelle Mariane , Nacasaki Silvestre Renata , de Azevedo Júlia Teixeira Cottas , Tadeu Covas Dimas , Picanço-Castro Virginia
Published: February 2022

Cell therapy is an innovative approach that permits numerous possibilities in the field of cancer treatment. CAR-T cells have been successfully used in patients with hematologic relapsed/refractory. However, the need for autologous sources for T cells is still a major drawback. CAR-NK cells have emerged as a promising resource using allogeneic cells that could be established as an off-the-shelf treatment. NK cells can be obtained from various sources, such as peripheral blood (PB), bone marrow, umbilical cord blood (CB), and induced pluripotent stem cells (iPSC), as well as cell lines. Genetic engineering of NK cells to express different CAR constructs for hematological cancers and solid tumors has shown promising preclinical results and they are currently being explored in multiple clinical trials. Several strategies have been employed to improve CAR-NK-cell expansion and cytotoxicity efficiency. In this article, we review the latest achievements and progress made in the field of CAR-NK-cell therapy.
Descending colon cancer in a patient with situs inversus totalis: a case report and literature review
Authors: Cheng Long , Feng Yi-Guo , He Lin , Xie Jie-Bin , Zhou Cen-Ji , Liu Jian-Jun , Wang Pan
Published: February 2022

Situs inversus totalis (SIT) is a congenital disorder of anatomical position, and the operation of patients with total visceral inversion often brings great challenges to surgeons. Although there have been previously documented on patients with SIT and colonic cancer, this is the first case report of descending colon cancer in patient with SIT. The current report presents a case of a 67-year-old female patient with descending colon cancer and SIT. After preoperative preparation and discussion, open left hemicolectomy was performed for the patient. The postoperative recovery of the patient was smooth; however, there was a mild lymphatic leakage in the patient, which was cured by conservative treatment for 5 days. The patient was discharged on postoperative Day 10. There was no tumor recurrence or other discomfort in 1 year follow-up period.
Variability of methanol and OH masers in G339.62−0.12
Authors: Seidu Mavis , Goedhart S , van der Walt D J
Published: February 2022

The study of the periodic variability of masers has greatly increased after the discovery of periodic class II methanol (CH3OH) masers. Currently, more than 20 masers associated with various high-mass star-forming regions have shown this interesting behaviour. Since the mainline OH masers are pumped under similar conditions as that of the class II methanol masers, it becomes necessary to also search for periodic behaviour of OH masers. In this paper, we present the results of the 6.7 GHz methanol and mainline OH masers associated with G339.62−0.12 observed using the 26 m HartRAO single-dish and the KAT-7 telescopes, respectively. We find evidence of variability, however, periodic variability is clearly visible for the masers that are blue-shifted from the systemic velocity ($\mathrm{\mathit{ \mathit{V}}_{lsr} = -34.2~km\, s^{-1}}$ ). Using the Lomb–Scargle periodogram, the blue-shifted methanol masers have periods of 208 ± 4 d while the blue-shifted OH 1665 and 1667 MHz masers have average periods of 208 d. Further analysis suggests that the maser profiles are similar, having a delay of 5 d (∼870 au) between the 6.7 GHz methanol maser and the 1667 MHz OH maser, as well as a delay of 15 d (∼2600 au) between the 6.7 GHz methanol maser and the 1665 MHz OH maser. To further interpret the observed periodic behaviour as well as the similarities found in the profiles of these masers will require high-resolution observations of the OH and methanol masers and high-resolution mm/sub-mm observations of the G339.62−0.12 source.
Long-term general relativistic magnetohydrodynamics simulations of magnetic field in isolated neutron stars
Authors: Sur Ankan , Cook William , Radice David , Haskell Brynmor , Bernuzzi Sebastiano
Published: February 2022

Strong magnetic fields play an important role in powering the emission of neutron stars. Nevertheless, a full understanding of the interior configuration of the field remains elusive. In this work, we present general relativistic magnetohydrodynamics (MHD) simulations of the magnetic field evolution in neutron stars lasting ${\sim } {880}\,$ms (∼6.5 Alfvén crossing periods) and up to resolutions of $0.1155\,$km using Athena++. We explore two different initial conditions, one with purely poloidal magnetic field and the other with a dominant toroidal component, and study the poloidal and toroidal field energies, the growth times of the various instability-driven oscillation modes, and turbulence. We find that the purely poloidal setup generates a toroidal field, which later decays exponentially reaching $1{{\ \rm per\ cent}}$ of the total magnetic energy, showing no evidence of reaching equilibrium. The initially stronger toroidal field setup, on the other hand, loses up to 20 per cent of toroidal energy and maintains this state till the end of our simulation. We also explore the hypothesis, drawn from previous MHD simulations, that turbulence plays an important role in the quasi-equilibrium state. An analysis of the spectra in our higher resolution setups reveals, however, that in most cases we are not observing turbulence at small scales, but rather a noisy velocity field inside the star. We also observe that the majority of the magnetic energy gets dissipated as heat increasing the internal energy of the star, while a small fraction gets radiated away as electromagnetic radiation.
Potential of the prognostic nutritional index to determine the risk factor for severe infection in elderly patients with rheumatoid arthritis
Authors: Isoda Kentaro , Tsuji Shigeyoshi , Harada Yoshinori , Yoshimura Maiko , Nakabayashi Akihiko , Sato Megumi , Nagano Hiromichi , Kim Dong-seop , Hashimoto Jun , Ohshima Shiro
Published: February 2022

Objective

To investigate the influence of nutritional status on severe infection complications in patients with rheumatoid arthritis (RA)

Methods

This retrospective cohort study on 2108 patients with RA evaluated the prognostic nutritional index (PNI) as an index of nutritional status. Patients were classified into the high or low PNI group according to the cutoff PNI value (45.0). Based on propensity score matching analysis, 360 patients in each group were selected for comparing the incidence of serious infection, clinical findings, and PNI scores.

Results

The incidence of infection was significantly higher in the low PNI group than in the high PNI group (p < 0.001). The occurrence rate of infectious complication at 104 weeks was significantly higher in the low PNI (<45.0) group than in the high PNI group (p < 0.001). The incidence of infection was particularly high in elderly patients (≥65 years) with a low PNI, but the incidence in elderly patients with a high PNI was similar to that in nonelderly patients with a high PNI.

Conclusions

Patients with RA and malnutrition had a higher incidence of severe infection; thus, evaluating and managing nutritional status is necessary for the appropriate and safe treatment of elderly patients with RA.
Brief self-exercise education for adults with chronic knee pain: A randomized controlled trial
Authors: Jinnouchi Hiroshige , Kitamura Akihiko , Matsudaira Ko , Kakihana Hironobu , Oka Hiroyuki , Yamagishi Kazumasa , Kiyama Masahiko , Iso Hiroyasu
Published: February 2022

Objectives

Effective brief instructions for self-management of chronic knee pain are needed.

Methods

Forty-six participants with chronic knee pain were randomly allocated into two programmes: material-based education alone or brief self-exercise education (brief-See), which comprised a 100-minute instruction for self-exercise combined with compact pain education. Total function (KOOS4, 4-subscale average of knee injury and osteoarthritis outcome score), pain intensity (NRS, numeric rating scale), self-efficacy (PSEQ, pain self-efficacy questionnaire), and health-related quality of life (EQ-5D, European quality of life-5 dimensions) were evaluated at baseline and 4 and 12 weeks after the initial intervention. A generalized mixed linear model estimated average group differences in changes from baseline and 95% confidence intervals (95% CIs) using intention-to-treat principle.

Results

Compared to material-based education alone, the brief-See provided significant additional improvements of 9.4% (95% CI: 2.3 to 16.4) on the KOOS4 and 5.4 points (0.3 to 10.4) on the PSEQ at 12 weeks but did not on the NRS and EQ-5D. Adherence and satisfaction were favourable in the brief-See without any notable adverse event.

Conclusions

Adding the brief-See to material-based education could be more acceptable and restore total function and self-efficacy, which could contribute to the self-management of chronic knee pain in primary care.