bluuebunny/crossref_metadata_2025_split huggingface dataset:
P5706Finding predictors and causes of cardiac surgery ICU readmission using machine learning and causal inference
Authors: Lee J , Ahmidi N , Srinivasan R , Alejo D , Dinatale J , Schena S , Whitman G , Sussman M , Shpitser I 
Published: October 2019

Abstract

Background
“Bounce-back” to the intensive care unit (ICU) occurs when patients return to the ICU for critical changes in clinical status within the same hospital admission. Bounce-backs post-cardiac surgery increase resource utilisation, total cost of care, are associated with higher mortality and morbidity. However, prediction of bounce-back has proved to be challenging. Previous work addressed the feasibility of predicting bounce-back, but these models required significant physician input to design and calibrate the predictive variables.

Purpose
We aimed to develop an automated machine learning model that would identify patients at risk of bounce-back by selecting the most relevant variables from those available before onset of bounce-back. Additionally, we highlight the differences between predictive and causal inference, to demonstrate that purely associative methods of prediction can mislead clinical decision-making.

Methods
Clinical records of adult cardiac surgery patients between 2011 to 2016 were collected from our institutional Society for Thoracic Surgeons (STS) database and our institutional electronic health record (EHR) system. For bounce-back prediction, an L1 regularised logistic regression model was applied, which also automatically determined important variables with highest prediction effect from the initial 151 variables. For causal inference, the g-computation algorithm was used to compare the differences between causal and predictive regression effects. We quantified the performance of our system on clinically relevant metrics such as specificity, sensitivity, and area under the ROC curve (AUC).

Results
Of the 6189 patients, 357 (5.7%) bounced back to the ICU. The prediction model achieved an AUC score of 0.75 (0.03) and 22% specificity at 95% sensitivity, Further analysis showed 79% of the false positive patients had faced other severe postoperative complications but none of the false negative patients had downstream complications. Subsequent causal analysis revealed that the actual causal effects of treatments differed from the predictive model estimates, e.g. administration of intra-operative tranexamic acid increased the probability of bounce-back by 13% but its causal effect on bounce-back after removing confounders was negligible (an increase of only 0.5%).

Conclusions
Our predictive machine-learning model can successfully predict patients at risk of ICU bounce-backs, using linked STS registry data with the comprehensive electronic health record. The prediction model automatically detects important subset of variables. In addition, we note that causal and predictive model estimates of the same parameters differed, indicating that reliance on predictive models for interventional clinical decision-making may not be appropriate.

Acknowledgement/Funding
National Institutes of Health, Office of Naval Research, Defense Advanced Research Projects Agency
P5712Research Network in Africa (RNA): quality assessment of antihypertensive generic drugs in 10 African countries
Authors: Macquart De Terline D , Zabsonre P , Balde D , Ikama S , N Guetta R , Tchabi Y , Sidi Aly A , Damourou J M F , Takombe J L , Bernard M , Do B , Diop B I , Jouven X , Antignac M , Ali Toure I 
Published: October 2019

Abstract

Introduction
Hypertension results in more deaths than any other risk factor and has been on the rise in Sub-Saharan Africa over the past few decades. Generic drugs have helped improve accessibility and affordability of antihypertensive therapy in developing countries. However, assessment of quality standards of these products is important.

Purpose
We performed a quality assessment of five commonly used antihypertensive generic drugs in ten Sub-Saharan African countries and studied the impact of price on quality.

Methods
Drug samples were prospectively collected using standardized methods between 2012 and 2014. We developed a validated reversed-phase liquid chromatography with tandem mass spectrometry method to accurately quantify the active ingredient in a certified public laboratory. Quality was defined based on the percentage ratio of measured to expected dosage of active ingredient.

Results
A total of 1185 samples were assessed, of which 70.0% were generic (n=830). Among the generic drugs, the percentage of poor quality drugs was 24.3% (n=202/830). The percentage ratio of measured to expected dosage of active ingredient ranged from 49.2% to 111.3%; the majority (81.7%) of the poor quality samples had insufficient quantity of the active ingredient. Moreover, poor quality was not associated with purchase price of the drug.

Conclusion
In this study from ten Sub-Saharan African countries, nearly one-quarter of the available generic antihypertensive drugs were found to be of poor quality. Concerted measures to improve the quality of antihypertensive drugs could lead to major improvements in hypertension control with attendant reduction of its deleterious consequences in low and middle income countries.
Figure 1. Percentage of poor quality in generic antihypertensive drugs according to the country of purchase.

Acknowledgement/Funding
Grant AAP-2014-042, ANSM (Agence Nationale Sécurité du Médicament
P5739Venoarterial Extracorporeal Membrane Oxygenation in Cardiogenic Shock: exploring prognostic variables and risk prediction tools
Authors: Goncalves Teixeira P M , Passos Silva M , Mbala D , Ana Canelas M , Varela M , Raquel Barbosa A , Guerreiro C , Mosalina A , Dias T , Queiros P , Fontes-Carvalho R , Ponte M , Dias A , Caeiro D , Braga P 
Published: October 2019

Abstract

Introduction
The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) to support patients in cardiogenic shock has been increasing in Portugal over the past few years. Nonetheless, epidemiologic, prognostic and clinical outcome data are scarce.

Purpose
We aim to identify clinical variables with prognostic significance in this challenging population, as well as the performance of various risk scores in mortality prediction.

Methods
All patients that underwent VA-ECMO support at our Cardiac ICU between 2011 and 2018 were included in the analysis. Logistic regression analysis was used to assess the relationship between clinical variables and outcomes.

Results
Short-term mechanical support with VA-ECMO was given to 40 patients, with a mean age of 52±11 years. At the time of the implant, the mean SOFA score was 11.2±4.0, and mean SAVE score was −4.75±4.6. Mean ECMO support duration was 116±96 hours. In 70% (N=28) of patients, VA-ECMO was successfully weaned. In-hospital mortality was observed in 52.5% of patients, which was in accordance with the predicted mortality by SOFA score (22.5% to 82% in our population risk range) and by SAVE score (60 to 70%). Those who placed the VA-ECMO as a bridge to transplant or to long-term mechanical LV assist device had greater in-hospital mortality rates (91.6 vs 41.9%, p=0.013), as well as those under ≥2 inotropic/vasopressors (69.2 vs 21.4%, p=0.012) or when adrenaline use was needed (100% vs 44.1%, p=0.01). No other between-group differences were observed in what concerns short-term mortality. After logistic regression analysis, independent predictors of in-hospital mortality included AMI setting, number of vasoactive amines used, and necessity of a LV venting device. SAVE score had the greater predictive ability in these patients (AUC = 0.638) among the most utilized clinical risk scores (SOFA score AUC = 0.37; APACHE II score AUC = 0.59; SAPS II score AUC = 0.54).

Conclusion
In our analysis, patients in profound cardiogenic shock on VA-ECMO support had slightly better survival rates than predicted by classical Risk Scores. The SAVE score may be the most accurate tool to predict in-hospital mortality in this specific, and yet heterogeneous, clinical subset. Other well recognized clinical markers of severity may also help refine short-term prognosis, and potentially improve organ transplant or other destination therapy prioritization.
P5746Human induced pluripotent stem cell-derived mesenchymal stem cell therapy effectively reduced brain infarct volume and preserved neurological function in rat after acute intracranial hemorrhage
Authors: Li Y C , Lee F Y , Chua S , Yip H K 
Published: October 2019

Abstract

Intracerebral hemorrhage (ICH) causes 10%-20% of all strokes and results in higher morbidity compared to other subtypes of cerebral stroke. Although early surgical intervention can clear the expanding hematoma, clinical outcomes following ICH have not significantly improved over the decades. Since ICH elicits neuroinflammation to exacerbate brain edema, damage the blood-brain barrier (BBB), lead to secondary neuronal injury, anti-inflammation may be a critical therapeutic strategy. Mesenchymal stem cell (MSC) therapy processes anti-inflammatory, immunomodulatory and tissue regenerative properties, suggesting that MSC therapy could be an effective therapy for ICH. Therefore, this study tested the hypothesis that human induced pluripotent stem cell-derived mesenchymal stem cell (iPSC-MSC) therapy could effectively reduce brain-infract volume (BIV) and improve neurological function in rat after acute ICH induced by a weight-drop device. Adult-male SD rats (n=40) were equally divided into group 1 (sham-operated control), group 2 (ICH), group 3 (ICH + hyaluronic acid (HA)/intracranial injection/3h after ICH), group 4 [ICH + HA + iPSC-MSC (1.2x106 cells/intracranial injection/3h after ICH)] and euthanized by day 28 after ICH procedure. In vitro study showed that hemorrhagic-brain tissue augmented protein expressions of inflammation (HMGB1/MyD88/TLR-4/TLR-2/NF-κB/TNF-α/iNOS/IL-1β) in cultured neurons that were significantly inhibited by iPSC-MSC treatment (all p<0.001). By days 7/14 after ICH procedure, circulating inflammatory levels of TNF-α/IL-6/MPO expressed were lowest in group 1, highest in group 2 and significantly lower in group 4 than in group 3 (all p<0.0001). By day 14 after ICH procedure, neurological function and BIV expressed an opposite pattern, whereas protein expressions of inflammation (HMGB1/MyD88/TLR-4/TLR-2/NF-κB/I-kB/TNF-α/iNOS/IL-1β/MMP-9), oxidative stress (NOX-1/NOX-2/oxidized protein) and apoptosis (mitochondrial-Bax/cleaved-caspase-2/PARP) in brain exhibited an identical pattern to circulating inflammation among the four groups (all p<0.001). Microscopy demonstrated that the number of vascular remodeling/GFAP+/53BP1+/γ-H2AX+ cells displayed an identical pattern of inflammation, whereas the NeuN+ cells displayed an opposite pattern of inflammation among the four groups (all p<0.001). In conclusion, iPSC-MSC therapy markedly reduced BIV and preserved neurological function mainly by inhibiting inflammatory/oxidative-stress generation.

Acknowledgement/Funding
Kaohsiung Chang Gung Memorial Hospital, Taiwan Society of Stem Cell Research
P5748Impact of specific crossing techniques in chronic total occlusion percutaneous coronary intervention on recovery of absolute myocardial perfusion
Authors: Schumacher S P , Stuijfzand W J , Driessen R S , Van Diemen P A , Bom M J , Everaars H , Kockx M , Raijmakers P G , Boellaard R , Van De Ven P M , Van Rossum A C , Opolski M P , Nap A , Knaapen P 
Published: October 2019

Abstract

Background
Multiple techniques in chronic coronary total occlusion (CTO) percutaneous coronary intervention (PCI) have been developed to cross CTOs.

Purpose
To compare recovery of quantitative myocardial blood flow (MBF) after different CTO PCI techniques.

Methods
Consecutive patients with [15O]H2O positron emission tomography perfusion imaging before and three months after successful CTO PCI were included. Change in quantitative hyperemic MBF, coronary flow reserve (CFR) and perfusion defect size were compared between antegrade wire escalation (AWE), retrograde wire escalation (RWE), antegrade dissection and reentry (ADR) and retrograde dissection and reentry (RDR), and further between specific subintimal crossing and reentry techniques.

Results
193 patients were treated with AWE (N=90), RWE (N=24), ADR (N=35) and RDR (N=44). Significant improvements (all p<0.01) in hyperemic MBF (1.19±0.77, 0.94±0.65, 1.09±0.63, and 1.02±0.75 mL min–1 g–1, respectively), CFR (1.34±1.08, 1.14±1.09, 1.31±0.96, and 1.24±0.99, respectively), and perfusion defect size (3.17±2.13, 3.00±2.21, 2.74±2.09, and 2.93±1.92 segments, respectively) were comparable between the four approaches (p=0.40, p=0.84, and p=0.77, respectively). Recovery of hyperemic MBF was less pronounced after subintimal crossing with a knuckle-wire-technique compared to the use of CrossBoss in controlled ADR and RDR (p=0.02), and less after reentry with subintimal tracking and reentry (STAR) in ADR compared with controlled ADR (Stingray) or limited antegrade subintimal tracking (LAST) (p=0.02 and p<0.01).

Conclusions
Recovery of hyperemic MBF, CFR, and perfusion defect size was significant after CTO PCI and comparable between different crossing techniques. Improvement of hyperemic MBF was inferior after using the knuckle-wire subintimal crossing technique and STAR compared to other subintimal crossing and reentry techniques.

Acknowledgement/Funding
None
P5974Prognostic value of global tangential strain by three-dimensional echocardiography heart failure patients with intermediate ECG criteria for cardiac resynchronization therapy
Authors: Sugahara M , Ashida K , Fukuhara E , Kishima H , Goda A , Mine T , Ishihara M , Masuyama T 
Published: October 2019

Abstract

Background
In the current clinical guidelines, cardiac resynchronization therapy (CRT) is recommended in heart failure (HF) patients with left bundle branch block (LBBB) with QRS width ≥150ms as Class I indication. In terms of HF patients with intermediate ECG criteria, prediction for benefit of CRT is still controversial in routine echocardiography.

Purpose
The aim was to assess whether three-dimensional (3D) echocardiographic indexes of global LV function at baseline has a prognostic value following CRT implantation in patients who fulfilled with intermediate ECG criteria.

Methods
We studied 62 HF patients who fulfilled with the indication criteria of CRT implantation according to current the clinical guidelines. In addition to routine two-dimensional echo, 3D echo dataset was acquired for determination of 3D global tangential strain (GTS) and 3D global longitudinal strain (GLS). We tracked predefined unfavorable outcomes for 3 years after CRT implantation: death, hospitalization due to worsening HF.

Results
LBBB with QRS width ≥150ms was evident in 26 of 62 patients (aged 68±11 years with 160±26 ms of QRS duration and 29±7% of LV ejection fraction), and the other 36 patients only fulfilled intermediate ECG criteria (QRS width 120–149ms or non-LBBB). Unfavorable events occurred in 21 patients (34%). The median GTS was −15.4%. Although GLS was not predictive, GTS greater than −15.4% had high probability of unfavorable outcomes over 3 years (Log-rank, p<0.05). There is no difference in the probability of unfavorable outcomes between LBBB and intermediate ECG criteria. Baseline GTS in patients with intermediate ECG criteria was associated with unfavorable outcomes: −12.6±2.6% vs. −17.3±3.8% (p<0.05). Outcome was better in the intermediate ECG criteria patients with GTS ≤−15.4% than in those with LBBB and in those with intermediate ECG criteria patients with GTS >−15.4% (Log-rank: p<0.05, p<0.0001, respectively).

Conclusions
Baseline GTS by 3D echocardiography is useful for predicting outcome over 3 years after CRT implantation regardless of the ECG criteria for CRT indication.
P5979Impact of disease stage on performance of strain markers for prediction of atrial fibrillation
Authors: Ramkumar S , Pathan F , Kawakami H , Ochi A , Yang H , Potter E , Marwick T H 
Published: October 2019

Abstract

Background
Efforts to predict incident atrial fibrillation (AF) may be associated with complications, and there is interest in AF prediction in primary prevention (PP; pts with risk factors) and secondary prevention (SP; pts with possible AF complications). These pts have different risk levels, we sought whether that influenced the predictive value of LV dysfunction (measured as global longitudinal strain, GLS) or LA dysfunction (LA reservoir strain).

Methods
The PP cohort comprised 351 community-based pts ≥65 years with ≥1 risk factor for AF (age 70±4y,43% male, median follow-up 22 months) and the SP cohort comprised 532 pts after transient ischaemic attack or stroke (age 68±12y, 51% male, median follow-up 36 months). GLS and LA strain were measured offline (Image Arena-Tomtec, Germany). AF was diagnosed by 12 lead ECG, Holter or by single lead monitor. The clinical and echocardiographic characteristics of those with AF were compared to those in sinus rhythm. Nested Cox-regression models were used to assess for independent and incremental predictive value of LA strain/GLS in both cohorts.

Results
Compared to SP, PP had higher clinical AF risk (CHARGE-AF 5.6±5.5% vs 4.7±12.1%, p=0.02) but a lower thromboembolic risk (CHA2DS2-VASC 3±2 vs. 4±2, p<0.001). AF developed in 42 PP pts (12%) and 61 SP (12%). AF patients were older, with higher CHARGE-AF score, LA volume and LV mass. Pts developing AF had reduced GLS (17±4% vs. 20±3%, p<0.001), reservoir (28±11% vs. 35±8%, p<0.001) and pump strain (13±7% vs. 17±5%, p<0.001). GLS and LA strain had greater AUC in SP (0.84 vs 0.58 for GLS and 0.85 vs 0.57 for reservoir strain, both p<0.001). Nested cox-regression models showed that LA reservoir strain was independently associated with AF in both cohorts (p<0.05). GLS was only independently associated with incident AF in SP (Figure).

Conclusion
LA reservoir strain is independently associated with AF in different risk cohorts and its effect is incremental to clinical parameters and LA volume. GLS may be more useful in AF risk assessment in those in SP.

Acknowledgement/Funding
This study was partially supported by the Tasmanian Community Fund and Siemens Healthcare Australia.
P5984Clinical results and predictors of long-term mortality after Transcatheter Aortic Valve Replacement in according to gender
Authors: Munoz-Garcia E , Munoz-Garcia M , Munoz Garcia A J , Dominguez-Franco A J , Carrasco-Chinchilla F , Alonso-Briales J H , Hernandez-Garcia J M , Jimenez-Navarro M F , Gomez-Doblas J J 
Published: October 2019

Abstract

Although it is well known, the differences between both sexes in cardiovascular disease, however, there is a lack of data in aortic valve, treated with Transcatheter Aortic Valve Replacement (TAVR). The purpose of our study was to analyze the long-term clinical results of patients treated with TAVR in the female and male population.

Material
Between April 2008 and December 2017, 647 patients with aortic stenosis and 20 patients with aortic prosthesis dysfunction, were treated with TAVR consecutively in our center. The primary objective was to analyze, by Cox regression, the predictors of long-term mortality in both sexes.

Results
59.1% were women. Males had a higher number of comorbidities and after a mean follow-up of 2.87±2.2 years (range between 0 and 9 years), mortality was higher for male patients 40.7% vs. 32% (HR = 1.447 [95% CI 1.057–2.009], p=0.022) and there were no differences for the presence of threatening bleeding (HR = 1.654 [IC95% 0.719–3.808], p=0.237), myocardial infarction (HR = 1,768 [IC95% 0.753–4.132], p=0.191), stroke (HR = 0.992 [IC95% 0.564–1.743], p=0.976) and hospitalizations for heart failure (HR = 1.388 [IC95% 0.811–2.376], p=0.231). Among the predictors of long-term mortality, common to both sexes were: threatening bleeding, heart failure, Charlson index, Karnofsky, and STS score.

Conclusion
In our series, there was clinical differences between both sexes, which has an impact on survival, being worse for men due to comorbidities, however, in the population of patients with aortic stenosis treated with TAVI, we found predictors of late mortality similarities between in female and male.
P6019His-Purkinje system pacing in single centre experience after 324 cases
Authors: Jastrzebski M , Moskal P J , Bednarek A , Kielbasa G , Czarnecka D 
Published: October 2019

Abstract

Introduction
His-Purkinje system pacing preserves or restores physiologic depolarization of the left ventricle during permanent pacing. It consists of two complementary techniques: His bundle pacing (HB-P) and the recently introduced left bundle branch pacing (LBB-P). There is limited data on HB-P outcomes and only a few reports of LBB-P results.

Purpose
Our aim was to investigate success rate, complications, acute and early pacing parameters in patients undergoing HB-P and LBB-P in the setting of a cardiology tertiary centre that routinely implants HB-P and LBB-P pacemakers.

Methods
On the basis of a prospective database we performed a longitudinal cohort study of all consecutive patients with His-Purkinje system devices implanted in the years 2014–2019. In all cases, model 3830 lumen-less 4.1 Fr pacing lead was used. HB-P was achieved via HB mapping or pace mapping, LBB-P was achieved via deep septal lead deployment under electrophysiological and 12-lead ECG guidance.

Results
Since 2014 there were 324 implantations of His-Purkinje system pacemakers. Baseline patients' characteristics are presented in Table. The overall success rate was 81.5%. Selective HB-P, non-selective HB-P and LBB-P were achieved in 53%, 19% and 28% of successful cases. The mean fluoroscopy time was 11±9 min. The lead delivery was performed using single sheath (C315His) in 83% cases, while in 17% extra steerable sheath was necessary (C304XL). The acute mean LBB-P capture threshold @0.5 ms was significantly lower than in HB-P (0.65±0.43V vs. 1.47±0.8V). The mean chronic LBB-P capture threshold @1.0 ms was also lower than in HB-P (0.45±0.3V vs. 0.95±0.7V, p<0.001). The acute sensing amplitude was significantly higher in LBB-P vs HB-P (10±5mV vs 4±3mV). The mean paced QRS duration was significantly shorter for selective HB-P (113±22 ms) and LBB-P (108±12 ms) vs. non-selective HB-P (132±22 ms). The complications included: 4 cases of threshold increase that required lead revision; 3 early lead dislodgments; 1 loss of LBB capture, 3 pocket hematomas, 2 system infections and 1 pneumothorax.
Baseline characteristics Age; sex 73±12 years (19–95 years); 64% males Mean EF; mean QRS duration; Presence of heart failuire or ischemic heart disease 47±15%; 128±32 ms; 48%; 37.5% Pacing indication AV block 31%; sinus node disease 12%; atrial fibrillation with bradycardia 37%; CRT 20% QRS morphology narrow QRS 61%; LBBB 20%; other 14%; IVCD 6% CRT, Cardiac Resynchronization Therapy; IVCD, Interventricular Conduction Delay.

Conclusion
His-Purkinje system pacing in routine practice has an acceptable success rate, pacing parameters and complication rate; the LBB-P provides better pacing parameters than HB-P. We believe that such single-centre experience paves the way for a large randomized trial of physiologic pacing.