bluuebunny/crossref_metadata_2025_split huggingface dataset:
Addition of biomarker high sensitivity troponin I (hSTROPI) to QRISK3 score in predicting significant coronary artery disease (CAD)
Authors: Dasari B.C.A , Oomman A , Govindarajulu P , Narra L , Mao R , Gunasekaran S , Satish S , Showkathali R , Immaneni S , Pramodkumar K.P , Reddy Y.V.C , Nayak R 
Published: November 2020

Abstract

Background
The current models to predict CAD in general population is not universally accepted. Many risk scores do not take into account factors such as south Asian ancestry, type 2 diabetes mellitus or family history of premature CAD. There is still no clarity on the position of biomarkers in addition to traditional risk factors.

Purpose
This study evaluates the role of biomarker hSTROPI in addition to QRISK3 score in predicting significant CAD.

Methods
This observational study included 103 consecutive subjects who had non cardiac pain as per ESC criteria and wanted to assess their future cardiovascular risk and to know the coronary anatomy. None had documented CAD prior. The inclusion criteria consisted of subjects who were &gt;18 years of age asymptomatic or with non-cardiac chest pain and absence of clinical cardiovascular disease. Exclusion criteria were heart failure, chronic kidney disease (CKD) and anemia (hemoglobin &lt;10 gms%). They underwent risk stratification based on QRISK3 score and measurement of hSTROPI. All of them underwent Computerized Tomography coronary angiogram (CTCA). Subjects with more than 50% lesions on CT coronary angiogram were deemed to have significant CAD. We analyzed the impact of hSTROPI in addition to QRISK3 score in picking up significant lesions by CTCA.

Results
The analysis showed sensitivity of QRISK3 &gt;17.5% of 46.43%, specificity of 75.68%, positive predictive value (PPV) of 41.94%, negative predictive value (NPV) of 78.87% and diagnostic accuracy of 67.65%.
hSTROP I &gt;3.5pg/ml showed a sensitivity of 37.93%, specificity of 81.08%, PPV of 44%, NPV of 76.92% and diagnostic accuracy of 68.93%.
When both hSTROPI &gt;3.5pg/ml and QRISK3 &gt;17.5% are combined, the sensitivity was found to be 27.59%, specificity of 91.89%, PPV of 57.14%, NPV of 76.4% and diagnostic accuracy of 73.79%.
In the study population, significant CAD was found in QRISK3 &gt;17.5% in 41.9% and QRISK3&lt;17.5% in 22.2% and (p=0.04).
Significant CAD was found in 44% of population with HSTROPI &gt;3.5 pg/ml and in 23.1% whose HSTROP I &lt;3.5pg/ml (p=0.04).
Significant CAD was found in 57.1% of population with both parameters positive (QRISK3 &gt;17.5% and hSTROPI &gt;3.5 pgm/ml), 23.6% of the population in which both parameters were negative (p=0.009).

Conclusion
Combining QRISK3 score of more than 17.5% and hSTROP I more than 3.5pg/ml have significant association with more than 50% lesion by CTCA with a specificity of 91.89%.
This may be useful in counselling intermediate risk group patients to have aggressive pharmacological primary preventive strategies like high dose statins. This may be a cost effective method of screening south Asian population who have much more risk factors and CAD at much younger age.

Funding Acknowledgement
Type of funding source: None
Association of isolated T inversion and sudden cardiac death – etiology and gender differences
Authors: Haukilahti M.A.E , Holmstrom L , Vahatalo J , Kentta T.V , Pakanen L , Tikkanen J , Perkiomaki J , Rissanen H , Knekt P , Huikuri H.V , Junttila M.J 
Published: November 2020

Abstract

Background
Inferolateral T wave inversion has been associated with increased risk of mortality and sudden cardiac death (SCD) in general population. However, the association between isolated T inversion and SCD is still unclear.

Purpose
The purpose of this study was to examine whether isolated T inversion associates with SCD, and find out possible gender differences.

Methods
FinGesture Study has systematically collected clinical data and medico-legal autopsy data from 5,869 consecutive SCD victims (mean age 64.9±12.4 yrs.) in Northern of Finland between years 1998 and 2017. Previously recorded electrocardiograms (ECG) were available and analyzed in 1,101 subjects. The control group consisted of 7,217 subjects representative of Finnish general population (mean age 51.5±12.4 yrs.). T inversion was interpreted isolated if there was at least two T inversions ≥−0.1 mV in at least two contiguous leads, and there were no ECG signs of left ventricular hypertrophy (LVH) defined by Sokolow-Lyon criteria or bunchle brand block (BBB) attached to it.

Results
In a current study, isolated T inversion was more common finding among SCD victims compared to general population: isolated T inversion in any leads 10.9% vs. 0.9% (SCD vs. general population, p&lt;0.001), laterally 7.7% vs. 0.1% (p&lt;0.001), inferiorly 3.2% vs. 0.5% (p&lt;0.001) and anteriorly 2.9% vs. 0.4% (p&lt;0.001). Particularly, isolated T inversion seemed to assoaciate with ischemic SCD taking into account that 61.5% of the total isolated T inversions were seen in ischemic SCD victims (p=0.018). In addition, 62.1% of the inferior isolated T inversions (p=0.023) and 61.7% of the lateral isolated T inversions (p=0.031) were in ischemic SCD victims versus 37.9% and 38.3% in non-ischemic SCD victims, respectively. The prevalence of isolated T inversion in any lead was also higher among male SCD victims compared to female victims (12.8% vs. 8.2%, p&lt;0.001, respectively). There was no statistically significant difference in the prevalence of LVH and strain changes between the populations. Among bundle branch blocks left BBB was predictably more typical in SCD victims (5.8% vs. 0.5%, p&lt;0.001).

Conclusion
We noticed an association between isolated T inversion and SCD. The association was most prominent in males and in those with ischemic etiology of SCD.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): The Finnish Medical Foundation, Finnish Foundation for Cardiovascular Research
CHA2DS2-VASc and CHADS2 scores for risk stratification of major adverse cardiovascular events in the COMPASS trial
Authors: Sen J , Tonkin A , Varigos J , Fonguh S , Berkowitz S.D , Yusuf S , Verhamme P , Vanassche T , Anand S , Fox K.A.A , Eikelboom J.W , Amerena J 
Published: November 2020

Abstract

Background
The COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies) trial demonstrated that the combination therapy of rivaroxaban and aspirin reduced major adverse cardiovascular events (MACE) compared to aspirin alone in patients with chronic coronary artery disease (CAD) and/or peripheral artery disease (PAD).

Purpose
We assessed whether the CHA2DS2-VASc (congestive heart failure (CHF), hypertension, age ≥75 years, diabetes, stroke/transient ischemic attack (TIA)/thromboembolism, vascular disease, age 65–75 years, and sex category) and CHADS2 (CHF, hypertension, age ≥75 years, diabetes, stroke/TIA) scores used to predict the risk of stroke in patients with atrial fibrillation, can be used identify vascular patients at highest risk of recurrent events who may derive greatest benefits of treatment.

Methods
In COMPASS patients, the predictive accuracy of CHA2DS2-VASc and CHADS2 scores were assessed for MACE, bleeding and net clinical benefit using Cox proportional hazards model. Kaplan-Meier estimates of cumulative risk and absolute risk differences were used to examine the effects of rivaroxaban plus aspirin compared with aspirin alone over 30 months according to risk score categories.

Results
In 27,395 participants with CAD and/or PAD, a high CHA2DS2-VASc score (6–9) was associated with 3 times greater absolute risk of MACE compared to a low score (1–2) (hazard ratio=3.39, 95% CI: 2.54–4.51, p&lt;0.0001). The effects of combination therapy with rivaroxaban and aspirin on MACE, bleeding and net clinical benefit were consistent across CHA2DS2-VASc and CHADS2 score categories, with the greatest benefit in those with the highest risk scores (Figure 1). The greatest reduction in MACE with rivaroxaban and aspirin compared to aspirin only was observed in patients treated for 30 months with highest CHA2DS2-VASc score (6–9) (23 events per 1000 patients prevented) or highest CHADS2 score (3–6) (25 events per 1000 patients prevented). There was increased bleeding in patients with higher CHA2DS2-VASc and CHADS2 scores, but net clinical benefit was preserved across all risk categories and was greatest in those with the highest risk scores.

Conclusion
The CHA2DS2-VASc or CHADS2 scores can be used in patients with chronic CAD and/or PAD to identify patients who are at highest risk of MACE, and therefore likely to achieve the greatest benefit of dual pathway inhibition with the combination of rivaroxaban and aspirin compared with aspirin alone.

Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): This study was sponsored by Bayer AG.
Cost-effectiveness of cardiovascular risk classification based on Ankle-Brachial Index test in association to Framingham risk score
Authors: Grasso E , Maloberti A , Cortesi P.A , Micale M , Mazzaglia G , Occhi L , Palazzini M , Peretti A , Cavasin D , Pansera F , De Chiara B , Vallerio P , Mantovani L.G , Giannattasio C 
Published: November 2020

Abstract

Objectives
An individual patient-data meta-analysis conducted on 24,955 men and 23,339 women showed that Ankle-Arm Index (ABI) in combination with FRS classifies female subjects with higher accuracy with no difference for male. The objective of this analysis is assessing the cost-effectiveness of ABI combine with FSR in primary prevention.

Methods
A decisional analytical model was developed to simulate CV risk of asymptomatic female subjects, stratified in 3 CV risk categories. The model compares the primary prevention intervention (treatment of subjects at intermediate and high risk) based on the classification with FRS alone or in association with ABI&lt;0.9 (FRS-ABI). The cost-effectiveness model used 10 years time-horizon and the point of view of the Italian National Health System. Results were presented as incremental cost-effectiveness ratios (ICERs) per QALY gained. Cost and outcomes were discounted at 3%.

Results
FRS-ABI determined a reclassification to higher risks in 7% of the female population, with an increase in costs per patient (€3,373 vs €3,198) but also greater efficacy (8,683 vs 8,689 QALYs) over a 10 years time horizon, with an ICER of €47.065 per QALY gained. While using an ABI&lt;1.10 cut-off we obtained an ICER of €28.688 per QALY gained over 10 years simulation. In the probabilistic sensitivity analysis, the FRS-ABI reported a 50% probability to be cost-effective with ABI&lt;0.9 cut-off and 80% probability with ABI&lt;1.1 at a willingness to pay threshold of €50,000 per QALY.

Conclusions
Our study showed that FRS and ABI combination is a potentially cost-effective CV risk classification approach in female population. Our results can help the healthcare decision makers in implementing better strategies for primary CV diseases prevention in Italy.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): ASST Niguarda Cà Granda Hospital, University of Milano-Bicocca, Milan, Italy
Multi-Ethnic Study of Atherosclerosis (MESA) score compared to the Pooled Cohort Equations (PCE) score for cardiovascular risk assessment
Authors: Shemesh J.S , Koren Morag K.M.N , Segev S.S , Grossman G.E 
Published: November 2020

Abstract

Introduction
The current categorization of cardiovascular (CV) disease based on the Pooled Cohort Equations Risk (PCE) broadened the scope of candidates eligible for statin therapy. Coronary artery calcium score (CCS) identifies those who are most likely to benefit from statin therapy for primary prevention. The Multi-Ethnic Study of Atherosclerosis (MESA) score is the first that includes CCS for CV risk calculation.

Aim
To find whether MESA score can better predicts CV events than the PCE score and better allocates asymptomatic subjects for statin treatment

Methods
632 consecutive subjects free of CV disease, mean age 56±7 years, 84% male, underwent clinical evaluation and CCS measuring. PCE and MESA risk scores were calculated for each subject. Patients were divided according to the 4 PCE categories of 10 years CV risk, and further analyzed according to a higher or lower risk groups than 7.5%, the cutoff above which statin is definitely indicated.

Results
During mean follow-up of 6.5±3.3 years, 54 subjects experienced a first CV event. Those with MESA risk score ≤7.5% had a favorable outcome even when the PCE indicated a risk of &gt;7.5%. The MESA risk improves the discrimination, ROC curves C-statistics increased from 0.653 for the PCE risk to 0.770. 84% (99/118) of those with borderline risk (5 to ≤7.5%) according to the PCE score, were re-allocated by the MESA risk into an higher (&gt;7.5%) or lower risk category (&lt;5%).

Conclusion
The MESA risk score better predicts CV events than the PCE score in asymptomatic, and contributes to better allocate them to statin treatment.

Funding Acknowledgement
Type of funding source: None
Independent relevance of left ventricular hypertrophy for risk of ischaemic heart disease in 25,000 Chinese adults
Authors: Clarke R , Chaikovsky I , Wright N , Du H , Chen Y , Guo Y , Bian Z , Li L , Chen Z 
Published: November 2020

Abstract

Background
The prevalence of left ventricular hypertrophy (LVH) is strongly related with established cardiovascular disease (CVD) risk factors and, hence, there has been some uncertainty about its independent relevance for ischaemic heart disease (IHD) after taking account of such risk factors.

Purpose
To examine the associations of LVH with prevalent and incident cases of IHD after adjustment for established risk factors for CVD in a population-based study of Chinese adults.

Methods
The prospective China Kadoorie Biobank cohort study was conducted in the general population of 5 urban and 5 rural areas in China, with a baseline survey in 2004–2008. A random sample of 24,786 participants had a 12-lead electrocardiogram (ECG) recorded at the second resurvey in 2013–2014. Electronic records of ECG tracings were used to estimate LVH using 5 different criteria (Sokolov, Cornell, Romhilt-Estes, Gubner and Mortara). IHD cases were recorded by linkage to electronic records of hospitalisation, death and disease registries. Cox regression was used to estimate the associations of LVH with prevalent (n=1325) and incident (n=900) cases of IHD after adjustment for age, sex, region, prior vascular disease, smoking, alcohol, SBP, diabetes, lipids and body mass index (BMI).

Results
The overall prevalence of LVH in the population varied depending on the criteria used for detection (Mortara [10%], Sokolov [14%], Cornell [6%], Romhilt-Estes [4%] and Gubner [1%]). The prevalence of LVH (using Sokolov) increased with age and was higher in men than women (20% vs 10%) and linearly with levels of SBP, but also by ∼10-fold between the 10 regions in China. Irrespective of which criteria were used for detection (Table), LVH was strongly associated with both prevalent and incident cases of IHD after adjustment for age, sex, region and established CVD risk factors. Any one measure of LVH was associated with an adjusted OR (95% CI) of 1.30 (1.10, 1.53) for prevalent IHD and 1.40 (1.20, 1.64) for incident IHD, respectively.

Conclusions
Overall, 1 in 10 Chinese adults had LVH, and LVH was associated with 30% higher risk of prevalent IHD and 40% higher risk of IHD independent of established CVD risk factors.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): UK Wellcome Trust
SUPERNOVA phenomenon in unique population exposed to starvation in early life
Authors: Rotar O , Moguchaia E.V , Boiarinova M.A , Kolesova E.P , Erina A.M , Sontsev V.N , Vasilieva E.Y , Konradi A.O , Shlyakhto E.V 
Published: November 2020

Abstract

Background
Modern concept of supernormal vascular aging (SUPERNOVA) can be verified in subjects with exceptionally low arterial stiffness for their age. Among subjects who were exposed to severe famine in the prenatal and early childhood period of life during Leningrad Siege 1941–1944 those who survived now reached advanced age of 75 years or more. As caliris restriction can be associated with slowing of arterial stiffening this group can be expected to have subject with SUPERNOVA phenomenon.

Purpose
The aim of the study was to assess predictors of SUPERNOVA phenomena in survivors of the Leningrad Siege according to different gender.

Design and methods
The arterial stiffness was assessed by SphygmoCor device (carotid-femoral pulse wave velocity (PWV)) in 232 survivors of Leningrad Siege in 2014. Blood pressure (BP) measurement and anthropometry (weight, height, waist circumference) were performed according to standard protocols. Fasting serum lipids and plasma glucose were measured by Hitachi-902. According to The Reference Values for Arterial Stiffness' Collaboration (2010) for Siege survivors group (over 70 years old) the median value (10–90 percentile) of the PWV is 8.0–14.6 m/s. SUPERNOVA phenomenon was determined in case of PWV ≤8.0 m/s. 35 (11,3%) participants had SUPERNOVA phenomenon: 9 males and 26 women, non-SUPERNOVA group of 50 males and 147 females was a control group.

Results
Comparative gender analysis revealed common and distinct predictors of SUPERNOVA presence.

Conclusions
Independently of gender SUPERNOVA phenomenon was observed in subjects with lower BP. In females normal triglycerides levels were associated with low arterial stiffness while in male gender lack of abdominal obesity was also important.

Funding Acknowledgement
Type of funding source: None
Strict compliance with ESC therapeutic guidelines after myocardial infarction treated with invasive strategy correlates with improved 18-month outcomes
Authors: Kasprzak J.D , Jankowski E , Peruga J.Z , Plewka M , Krecki R , Wcislo T , Fiutowski M , Jankowski E , Hudzik B , Gasior M , Gierlotka M 
Published: November 2020

Abstract

Background
Despite improved early outcomes in patients (pts) with acute myocardial infarction (MI) in Poland with prevalent strategy of primary angioplasty by radial access, mid- and long-term outcomes are unsatisfactory.

Objective
We hypothesized that strict implementation of secondary prevention ESC guidelines in post-infarction management may be related with improved mid-term clinical outcomes

Methods
We compared 18-month outcomes of pts treated for MI with primary invasive strategy in a tertiary university hospital (NSTEMI 470/47%, or STEMI 535/53%; N=1005; Gr-L) with similar subset from national databases AMI-PL and PL-ACS (N=117307; NSTEMI 50966/43%, STEMI 64078/57%; Gr-Pol). Females represented 38.5% / 35.7% of Gr-L/Gr-Pol and mean age was 66.1±11.5 vs 65.8±11.9% (NS). The center implemented a strict policy of optimization prognosis-modifying prescriptions at discharge according to ESC guidelines. Endpoints over 18-month follow-up were defined as total mortality and combined clinical endpoint (death, stroke, recurrent MI, recurrent revascularization).

Results
30-days survival was comparable between Gr-L and national cohort. Key medicationrates were significantly higher for Gr-L vs most recent national estimates: renin-angiotensin blockers: 94% vs 79%, statins: 98% vs 75%, beta-blockers 95% vs 85%; ASA: 99% vs 94.5%, P2Y12 inhibitors 100% vs 83%. Rehabilitation was completed in 32% and 51% (after NSTEMI/STEMI) with national average around 20% - all differences p&lt;0.05. Long-term mortality rate (overall 10.6% vs 14.5%, p=0.0005) and composite outcome rate was significantly improved in Gr-L – details shown in the table.

Conclusions
Outcomes of MI patients in primary PCI era are related to optimized medical therapy and rehabilitation planned at discharge. Our study does not prove causality but indicates on strong association of strict compliance with ESC guidelines and improved 18-month outcomes including overall survival.

Funding Acknowledgement
Type of funding source: None
Limited reproducibility of lipoprotein (A) determination in a general clinical setting: a large retrospective study
Authors: Morra S , Vivier R , Vanhaeverbeek M , Brognez M , Van De Borne P 
Published: November 2020

Abstract

Background
Lipoprotein (a) (Lp(a)) is an independent risk factor for cardiovascular disease. Because of the polymorphism of Apolipoproteine-A (Apo A), a component of LP(a) which is under tight genetic control, two main isoforms of Lp(a) exist and are responsible for a wide inter-individual variability. Despite Lp(a) levels are genetically determined, a single measurement during an entire life span may suffice for this purpose. However, this is not unequivocal, since several non genetic factors may be responsible for the natural variability of Lp(a) within individuals.

Aims
To characterize the reproducibility of Lp(a) levels; to determine the influence of several non genetic factors (inflammation, chronic kidney failure, chronic hepatic failure, dysthiroidism, hormonal status, Niacine treatment) on the natural Lp(a) variability within subjects.

Methods
Between 2004 and 2014, 15 815 Lp(a) measurements were performed by immunoturbidimetry in a reference center for 48 belgian laboratories in 11 982 subjects. 2049 individuals underwent 1 to 20 consecutive Lp(a) samplings. Reproducibility of the last Lp(a) measurement was compared to the previous one in term of time. The influence of non genetic factors on Lp(a) natural variability was studied on 300 patients randomly selected.

Results
Higher Lp(a) levels at the first measurement elicited additional Lp(a) determinations in subsequent measurements (p&lt;0.0001). Lp(a) measurement became less reproducible when exceeding ± 35 mg/dL. There is a strong association between two consecutive Lp(a) measurements (r=0.85, p&lt;0.0001). A significant but weak correlation has been found between Lp(a) and CRP levels (r=0.17, p=0.008) and the time intervals between two consecutive measurements (r=0.07, p&lt;0.0001). No correlations have been found between Lp(a) levels and others non genetic factors said above. Niacine treatement and menopause with hormonal therapy replacement are responsible for a reduced median Lp(a) level (p=0.04, p=0.02, respectively).

Conclusion
Lp(a) levels are poorly reproducible when Lp(a) levels are elevated: the higher the Lp(a) levels at the first measurement, the higher the variability between consecutive measurements. Non genetic factors such as inflammation, hormonal status, timing of sampling seem to influence the Lp(a) levels but a causal link cannot be stated.

Funding Acknowledgement
Type of funding source: Public grant(s) – EU funding. Main funding source(s): Fonds Erasme, FNRS_Fonds National pour la Recherche Scientifique