bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pharmacogenetic testing in the management of patients with prosthetic heart valves
Authors: Gorbunova E.V , Ponasenko A.V , Barbarash O.L 
Published: November 2020

Abstract

Background
This study examined clinical, demographic, anthropometric, and inheritance factors that influence individual sensitivity to warfarin therapy after heart valve surgery. The clinical significance of the pharmacogenetic approach was assessed using the individual time frame and time spent in the INR therapeutic range.

Purpose
To study the influence of the preemptive panel-based pharmacogenetic testing on the effectiveness and safety of anticoagulant therapy in patients with prosthetic heart valves.

Materials and methods
The study included 928 patients (519 men and 409 female) (mean age 56±10 years) living in Western Siberia, Russia. Mainly there were patients with rheumatic heart disease, heart failure III NYHA and atrial fibrillation in 35% of cases. Mechanical heart valve prostheses were used in 70% of cardiac surgery cases. Real-time polymerase chain reaction was used for molecular genetic testing for polymorphisms VKORC, CYP2C9*2, CYP2C9*3, and CYP4F2.

Results
The frequencies of alleles and genotypes of CYP2C9 and VKORC1 in the study population of patients with heart valves prosthetic correspond to the distribution in Caucasian populations. Correlation between the calculated and actual therapeutic doses of warfarin was found according to the B.F Gage algorithm. In analyzing the dependence of the actual therapeutic dose of warfarin on polymorphic variants of the CYP2C9 and VKORC1 genes, it was shown that all the studied variants were associated with a therapeutic dose of warfarin, which was significantly different in carriers of different genotypes. Genotypes A/A CYP2C9*3 and G/G VKORC1 were associated with the largest deviations of the actual therapeutic dose from the calculated one. The clinical effectiveness of the pharmacogenetic approach was assessed according to the prevalence of the studied polymorphic variants of the CYP2C9 and VKORC1 genes in patients with prosthetic heart valves in the Kemerovo region. As a result, two groups of patients were formed using the “copy pair” method, without statistically significant differences in genetic, clinical, demographic, and anthropometric data. Usage of the pharmacogenetic testing at the beginning of warfarin therapy twice reduced time required to select a therapeutic dose of the anticoagulant, while the time within therapeutic INR range was increased by 20.2%.

Conclusion
The use of the panel-based pharmacogenetic approach at the beginning of warfarin therapy in patients with prosthetic heart valves increases the effectiveness and safety of anticoagulant therapy in the early postoperative period.

Funding Acknowledgement
Type of funding source: None
Mixed reality interactive visualization of cardiovascular anatomy in interventional lab – clinical implementation in transvascular patent ductus arteriosus closure
Authors: Kasprzak J.D , Kierepka M , Zlahoda-Huzior A , Stanuch M , Zolna D , Serafin J , Kasprzak J.I , Witowski J , Lipiec P , Wdowiak-Okrojek K , Peruga J.Z 
Published: November 2020

Abstract

Aim
Three-dimensional (3D) noninvasively acquired datasets containing anatomical information about the heart are a modern option for procedural support during percutaneous cardiac interventions. We present initial experience of patent ductus arteriosus (PDA) closure with workflow integrated with innovative mixed reality display (MRD) to improve 3D perception and navigation in 3D computed tomography angiographic (CTA) datasets.

Methods
We report incorporation of intraprocedural mixed-reality display of segmented CTA (computed tomography angiography) data using a voice- and gesture controlled head-mounted display during routine percutaneous occlusions of PDA in adults. A dedicated software pathway was used for files conversion, real-time Wi-Fi streaming of 3D rendering from PC to device and manipulation of spatial data during the procedures.

Results
Pre-recorded CTA studies of aorta and ductus were manually segmented and uploaded into custom designed 3D DICOM for realtime export to MRD device. 3D holograms were successfully displayed during the procedure by commercially available head-mounted display allowing touchless control and image sharing within cath-lab. Wiring of PDA aortic orifice was assisted by 3D hologram controlled by the imaging specialist and shared by the operator. Thus, MRD using evolving versions of custom software was successfully executed with segmented data presented as a semitransparent cubic hologram positioned in a convenient part of visual field allowing real-world action and with touchless control by medical team. Operator appreciated the use of MRD hologram realistically visualizing spatial relationships as practical aid to establish anatomical relationships and facilitate entry into ductus orifice. Procedures were successfully completed using arteriovenous guidewire loop to implant vascular occluders.

Conclusions
We demonstrate the methodology and software evolution (segmentation, data fusion) allowing practical implementation of intraprocedural mixed reality display of 3D CTA data, with sterile, touchless control of holographic image shared by interventional and imaging team to support percutaneous PDA closure.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): MEDAPP
Premature ventricular contraction detection system from the 12 leads ECG by artificial intelligence
Authors: Kim Y , Kim J.H , Lee M.Y , Kim Y.K 
Published: November 2020

Abstract

Background
Electrocardiographs (ECG) are obtained by a digital signal. However, they are still printed out of paper to read by physicians. Digitizing the analog ECG from the paper to digital signal make us much easier to access of bid data pool form the daily clinical practice and previous resources.

Objective
The goal of this study is to digitize paper ECG to detect premature ventricular contraction (PVC).

Methods
This system consists of 2 steps; digitization and PVC detection.

Results
First, for digitization, ECG are filtered by the specific cut-off value of red, green and blue, then the filtered ECG image is changed into gray scale. In order to extract ECG signal, the algorithm fine the only one of the biggest white body throughout the X-axis. The X and Y axis is matched with distance and amplitude, depending on dots per inch (DPI). Second, to detect PVC, ECG signal is filtered to eliminate baseline wandering. The characteristics of PVC is higher amplitude and longer duration than normal sinus rhythm, we set two criteria to detect the PVC: 1.5 times the duration, 1.2 points out of the amplitude. For the synchronization of timing, lead II rhythm strip was used by PVC detection and then the rest of 12-lead ECG is matched based on lead II synchronization (Figure 1). We applied this algorithm to the 300 real patient's ECG. 290 of 300 (96.7%) ECG are successfully digitized signal and PVC detection.

Conclusion
We successfully developed the algorithm analog ECG signal into digital signal to detect PVC. In the future, this method helps to gather big data from ECG papers to develop a new algorithm to localization of PVC.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Korean Heart Rhythm Society 2019 Research Fund
Use of social media by health care professionals: is patients' privacy respected?
Authors: Castrichini M , Nuzzi V , Sinagra G , Cleland J , Pellicori P 
Published: November 2020

Abstract

Background
The internet has a key role in sharing and expanding medical knowledge. Social networks offer health-care professionals the possibility to communicate, debate and learn from each other in real-time, thereby improving access to expertise and creating new knowledge. On Facebook, there are many groups that health-care professionals can join to discuss clinical cases. However, it is unknown if patient-privacy is respected and whether users are aware that they might be inadvertently involved in a criminal act for which they might be sued.

Methods
We identified the most popular Facebook group for cardiologists, “ECHO BOARD REVIEW forum” that has more than 47,000 users. We retrospectively evaluated all content posted by this group between February 6th and February 14th 2020. Information about the type of data posted, personal patient details, geographic location reported on images or videos, number of reactions and comments was collected. Privacy was considered fully violated when name and/or surname of the patient was identifiable. A comparison between the two cases (privacy preserved vs. privacy violated) was performed.

Results
Of 53 posts evaluated, 50 (94%) were echocardiograms; the remaining three cases were of an electrocardiogram, a cardiac magnetic resonance video and a coronary angiogram. The patient's identity was revealed in seven cases (13%). Compared to cases where identity was concealed, those revealing the patient's identify were more likely to report other important personal details including date of birth (n=0 (0%) vs 2 (29%)), age (n=14 (30%) vs 5 (71%)) and sex (n=15 (33%) vs 6 (86%)). The country (n=46, 87%), city (n=39, 74%), and hospital (n=34, 64%) where the cases were being evaluated were also frequently disclosed. Most cases were from Asia (n=23, 43%) or Africa (n=17, 32%). Of the 7 cases in which privacy was fully violated, 43% were from Africa, 27% were from South America and 14% were from Asia. In the majority of cases, the author of the post was seeking diagnostic help (n=33), less frequently a diagnosis was already made by the author (n=17). The median (interquartile range) number of comments/post was 12 (5–23), and of likes/post was 21 (12- 37), with no significant difference between cases in which privacy was violated or not.

Conclusion
Social media allows knowledge and expertise to be shared amongst health care professionals, but, alarmingly, violation of patient-confidentiality is common. In order to maintain patient-confidentiality and avoid breaking the law, strict rules should be applied to regulate the use of social media by health-care professionals.

Funding Acknowledgement
Type of funding source: None
Time-to-reperfusion in ST-segment elevation myocardial infarction undergoing inter-hospital transfer using WhatsApp smartphone application
Authors: Bendary A , Mansour A.M , Kabil H.K , Mostafa S.M 
Published: November 2020

Abstract

Aim
Current guidelines recommend that patients with ST-elevation myocardial infarction (STEMI) receive primary percutaneous coronary intervention (PCI) with a door-to-balloon (D2B) time of 90 minutes. This time frame has been difficult to achieve in developing countries. We aimed to test the hypothesis that using WhatsApp for inter-hospital transfer in STEMI primary PCI would result in shorter D2B time through avoiding emergency department (ED) waiting.

Methods
In the period from May 2018 to April 2019, 300 patients with STEMI treated with primary PCI were prospectively enrolled in a multi-center observational study covering 3 PCI-capable centers in our city. Patients were categorized into 3 groups: G-1; Self-presenting to the ED, G-2; Transferred by ambulance to the ED and G-3; those transferred from non-PCI capable centers directly to catheterization laboratory (bypassing the ED as possible) after the team was pre-activated through an ECG image sent using WhatsApp. The primary endpoint was between-groups difference in total ischemic and D2B times.

Results
All groups were matched regarding baseline criteria. WhatsApp use was associated with significantly shorter D2B time (166.5±33.8 vs 157.8±29.6 vs 120.8±35.2 minutes in groups 1, 2 and 3 respectively, P&lt;0.001) and shorter total ischemic time (258.9±33.9 vs 249.6±29.4 vs 212.7±35.4 minutes in groups 1, 2 and 3 respectively, P&lt;0.001). Linear regression showed that WhatsApp referral significantly reduces ED waiting time by about 20.4 minutes (95% CI −21.6 to −19.3 minutes, P&lt;0.001).

Conclusion
Using WhatsApp for inter-hospital transfer in primary PCI is associated with significantly shorter D2B times.
Key time intervals among study groups

Funding Acknowledgement
Type of funding source: None
AI and telemedicine: total remote guidance of AMI management
Authors: Mehta S , Gibson M , Niklitschek S , Fernandez F , Villagran C , Escobar E , Vera F , Frauenfelder A , Vieira D , Quintero S , Merchant S , Tamayo C.J , Ceschim M , Vallenilla I , Prieto L 
Published: November 2020

Abstract

Background
For a decade, Latin American Telemedicine Infarct Network (LATIN) Telemedicine has transformed AMI management in Brazil, Colombia, Mexico, Chile, and Argentina. With a hub and spoke strategy, AMI coverage was expanded to 100 million population and 877,177 telemedicine encounters were performed. Cost savings from avoiding unnecessary transfer of patients was $291 million. We are now rapidly escalating on a path to making the telemedicine process “physician-free” by utilizing Artificial Intelligence (AI) protocols.

Purpose
To demonstrate that AI can replace a cardiologist for remote AMI telemedicine guidance.

Methods
The process of total AI guidance focused on both aspects of our telemedicine strategy – accurate AMI diagnosis and tele-guidance of the entire STEMI process. We developed our innovative approach by initially creating AI algorithms for computer-aided diagnosis. Next, we incorporated logistic variables (duration of chest pain, transfer times to LATIN hub, etc) to the algorithm for physician-free triage into thrombolysis, primary PCI and pharmaco-invasive management. The intent of creating AI algorithms was early STEMI detection and triage. After the patient was efficiently transferred to the hub, a final treatment decision was made by the hub cardiologists.

Results
Three crucial areas of telemedicine efficiency are being monitored – Time-to-Telemedicine Diagnosis (TTD), Door-In-Door-Out (DIDO) and Transfer Times (TT). All are showing improvements. Detailed results will be available at the time of presentation.

Conclusions
We are encouraged with the possibility of making the entire telemedicine guidance of AMI management “physician-free”. Next-Gen improvements are being contemplated by including a Single Lead EKG for AMI detection that will impact symptom-to-balloon times.

Funding Acknowledgement
Type of funding source: None
Tradicar, practical training program in Diabetes for today s cardiologist
Authors: Garcia Iglesias D , Rozado Castano J , Soroa M , Barja N , Junco A , Adeba A , Vigil-Escalera M , Alvarez R , Capin E , Rubin Lopez J.M , Colunga S , Moris De La Tassa C , Delgado E , De La Hera Galarza J.M 
Published: November 2020

Abstract

Introduction
Diabetes Mellitus (DM) is an importan Cardiovascular Risk-factor and glucose-lowering drugs have shown to improve cardiovascular prognosis. We believe that specific training programs in DM are necessary, and so we have developed a web platform (Tradicar.es) to guide and provide educational tools.

Objectives
To evaluate characteristics of DM patients and the impact on active glycemic control strategies after the continuous training system.

Methods
We have created a web platform that allows direct consult with experts in diabetes and cardiology, immediately obtaining a recommendation. In addition, users have to propose a treatment, to evaluate their training progression. Prospectively, all DM patients admitted (Apr/18-Feb/19) were included. Personal history and preadmission, proposed and recommended treatment are recorded. For the comparison between proposed and recommended treatment we used a Cohen kappa, and for the comparison between previous and prescribed treatment, a chi-square test was performed.

Results
117 patients were analyzed, 72 (64.9%) male, with a mean of 70.51 (±16.2) y.o. For other clinical variables see table.
An active strategy was taken in 105 patients (89.7%), which resulted in an increased prescription of antidiabetic treatment. Specifically, SGLT2i prescription was significantly increased from 12 (10.9%) to 40 (34.2%) patients, p&lt;0.01. The coincidence index increases from 0.76 (±0.21) in the first 4 months, to 0.9 (±0.2) in the last 4 months, p=0.03.

Conclusions
The cardiovascular prognostic impact of new glucose-lowering treatments forces us to to update and expand our DM training. Electronic tools allow immediate contact and are essential to improve the medical care we offer.
Figure 1. A: Included patients (bars) and Cohen kappa (dots). B: Comparison of glucose-lowering drugs at hospitalization and discharge.

Funding Acknowledgement
Type of funding source: None
Barriers to and facilitators of the uptake of digital health technology in cardiology: a systematic review
Authors: Whitelaw S , Pellegrini D , Van Spall H.G.C 
Published: November 2020

Abstract

Background
Digital health technology has the potential to revolutionize the quality and efficiency of healthcare delivery. However, the uptake of digital health technology has been low in clinical practice. The factors that contribute to the limited adoption of digital health technology, particularly in cardiology, are unclear.

Purpose
We identified and synthesized the barriers to and facilitators of digital health technology uptake in cardiology, with a focus on provider- and patient- level barriers and facilitators.

Methods
We searched MEDLINE, EMBASE and CINAHL databases for studies published January 2000 - December 2019 that reported barriers to and/or facilitators of digital health technology adoption in cardiology. Two reviewers screened and extracted data independently. We conducted a thematic analysis to identify major themes pertaining to digital health technology uptake by both providers and patients.

Results
The search identified 3062 unique studies, of which 23 qualitative studies met eligibility criteria. Seventeen studies included semi-structured interviews and 6 included focus groups. Five (22%) studies reported provider-level facilitators, which included technology usability, integration into clinical workflow, and improved patient outcomes. Eighteen (78%) studies reported patient-level facilitators, which included ongoing technical support, improved access to healthcare services, and improved self-management. Six (26%) studies reported provider-level barriers, which included lack of integration into clinical workflow, increased healthcare costs, and lack of validation and reliability of technology. Finally, 19 (83%) studies reported patient-level barriers which included lack of knowledge about technology, limited internet access, and physical impairments making use of technology difficult.

Conclusions
Identifying barriers to and facilitators of digital health technology could help improve its uptake in cardiology. The findings of this study can be used to inform researchers, clinicians, and stakeholders who wish to develop and implement digital health technologies that meet the needs of providers and patients.

Funding Acknowledgement
Type of funding source: None
mHealth interventions in the management of heart failure, ischaemic heart disease and hypertension: a systematic review and meta-analysis of randomised controlled trials
Authors: Indraratna P , Tardo D , Yu J , Delbaere K , Brodie M , Lovell N , Ooi S 
Published: November 2020

Abstract

Introduction
Cardiovascular disease (CVD) remains the leading cause of death in the world. Mobile phones have become ubiquitous in most developed societies. Smartphone applications, telemonitoring and clinician-driven short message service (SMS) allow for novel methods in managing chronic cardiovascular conditions such as ischaemic heart disease, heart failure and hypertension.

Purpose
To evaluate the impact of mobile phone-based interventions (MPIs) on mortality, hospitalisations and blood pressure and body mass index (BMI) in patients diagnosed with either acute coronary syndrome, heart failure or hypertension.

Methods
A systematic review was conducted using seven electronic databases, identifying all randomised control trials (RCTs) featuring an MPI in the management of these conditions. Meta-analysis was performed by using standard analytical techniques. The odds ratio (OR) was used as a summary statistic.

Results
Twenty-six RCTs including 6,713 patients were identified. Of these 26 studies, 13 examined text messaging intereventions, 10 studied telemonitoring interventions and three described smartphone applications with other functions. Twelve studies were included for meta-analysis. In patients with heart failure (n=1683), MPIs were associated with a significantly lower rate of all-cause hospital admissions at six months (31% vs. 36%, OR 0.77, 95% CI 0.62–0.97, p=0.03, I2 = 0). A significant difference was also demonstrated for heart-failure admissions (14.0% vs. 18.5%, OR 0.69, 95% CI 0.48 to 0.98, p=0.04, I2 = 26%). There was no difference in mortality (10.4% vs. 11.6% p=0.45). In patients with hypertension, the difference in systolic BP was 4.3mmHg less in the intervention group (95% CI: −7.8 to −0.78 mmHg, p=0.02). Four studies examined medication compliance as an endpoint in patients with ischaemic heart disease, and all four demonstrated a significant difference favouring the MPI group (see table 1). However, due to variable quantification of compliance, meta-analysis was not possible. There was no significant difference in the change in BMI from four studies after six or more months (mean difference −0.46, 95% CI: −1.44 to 0.52, P=0.36).

Conclusions
The available data suggests MPIs may have a role as valuable adjuncts in the management of chronic CVD.
Figure 1

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Health and Medical Research Council (NHMRC)