bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differences in mitral and tricuspid annular geometry in elite athletes with versus without functional mitral regurgitation: a 3D echocardiographic study
Authors: Fabian A , Lakatos B K , Tokodi M , Kiss A , Sydo N , Csulak E , Babity M , Szucs A , Kiss O , Merkely B , Kovacs A 
Published: October 2021

Abstract

Intense exercise exposes the heart to significant hemodynamic demands, resulting in adaptive changes in cardiac morphology and function. Nevertheless, the athletic adaptation of the atrioventricular valves remains to be elucidated. Our study aimed to characterize the geometry of mitral (MA) and tricuspid (TA) annuli in elite athletes using 3D echocardiography.
Thirty-four athletes presented with functional mitral regurgitation (FMR) were retrospectively identified and compared to 34 athletes without MR, and 34 healthy, sedentary volunteers. 3DE datasets were used to quantify MA and TA geometry and leaflet tenting by dedicated softwares.
MA and TA areas, as well as tenting volumes, were higher in athletes compared to controls. MA area was significantly higher in athletes with MR compared to those without (8.2±1.0 vs. 7.2±1.0 cm2/m2, p&lt;0.05, Figure 1). Interestingly, athletes with MR also presented with a significantly higher TA area (7.2±1.1 vs. 6.5±1.1 cm2/m2, p&lt;0.05, Figure 2). Non-planar angle describing the MA's saddle shape was less obtuse in athletes without MR, whereas the values of athletes with MR were comparable to controls (Figure 1). The exercise-induced relative increases in left ventricular (35±25%) and left atrial (40±29%) volumes were similar; however, the increment in the MA area was disproportionately higher (63±23%, overall p&lt;0.001). The relative increase in TA area (40±23%) was also higher compared to the increment in right ventricular volume (34±25%, p&lt;0.05).
Atrioventricular annuli undergo a disproportionate remodeling in response to regular exercise. Athletic adaptation is characterized by both annular enlargement and increased leaflet tenting of both valves. There are differences in MA geometry in athletes presented with versus without FMR.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Research, Development and Innovation Office of Hungary (NKFIA; NVKP_16-1-2016-0017 National Heart Program). The research was partly financed by the Thematic Excellence Programme (Tématerületi Kiválόsági Program, 2020-4.1.1.-TKP2020) of the Ministry for Innovation and Technology in Hungary, within the framework of the Therapeutic Development and Bioimaging programmes of the Semmelweis University. Figure 1Figure 2
Plasma concentration of proneurotensin and prediction of cause-specific mortality in a middle aged cohort during long-term follow-up
Authors: Fawad A , Butt Z , Bergmann A , Schulte J , Nilsson P , Bennet L , Melander M , Melander O 
Published: October 2021

Abstract

Purpose
To examine the prediction of proneurotensin (Pro-NT) on total and cause-specific mortality in a middle-aged cohort.

Methods
In the population-based middle-aged cohort (n=4632 participants, mean age 57 years) of the Malmo Diet and Cancer (MDC) study, Pro-NT was assessed and total- as well as cause-specific mortality were studied. Main cause of death were based on the International Classification of Diseases (ICD). Assessments were done using Cox proportional hazards models adjusted for age and sex.

Results
During a mean follow-up of 20±3 years, 950 men and 956 women died. There was a significantly increased risk of total mortality in subjects belonging to quartile 4 of Pro-NT (Pro-NT ≥149 pmol/L) compared with quartiles 1–3 (Pro-NT &lt;149 pmol/L), hazard ratio (HR) of 1.29 (95% confidence interval [CI] 1.17–1.42; P&lt;0.001) after adjustment for age and sex. No significant interaction was observed between Pro-NT and gender on total mortality. Individuals within quartile 4 vs. quartiles 1–3 had a HR of 1.41 (95% CI 1.18–1.68; P&lt;0.001) for death due to cardiovascular diseases (n=595/4632), 2.53 (95% CI 1.37–4.67; P=0.003) due to digestive tract diseases (n=42/4632), 1.62 (95% CI 1.04–2.52; P=0.032) due to mental and behavioural diseases (n=90/4632), and 1.91 (95% CI 1.15–3.19; P=0.013) due to unspecific causes of death (n=64/4632). No significant relationships between Pro-NT and deaths due to cancer, infections, neurological or other causes were observed. Adjustments for cardiovascular risk factors only marginally changed these results.

Conclusions
Pro-NT is a predictor of total mortality and the increased risk is driven by deaths due to cardiovascular- digestive tract- mental and behavioural diseases, as well as deaths attributed to unspecific causes.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Knut and Alice Wallenberg Foundationthe Swedish Heart and Lung Foundation.
Bleeding risk and selective serotonin reuptake inhibitors treatment after percutaneous coronary intervention: a propensity-matched study
Authors: Gonzalez-Manzanares R , Ruiz-Moreno M , Carmona-Artime L , Rodriguez-Nieto J , Piserra A , Perea-Armijo J , Flores G , Fernandez-Ruiz A , Ojeda S , Hidalgo F J , Suarez De Lezo J , Mazuelos F , Segura J M , Romero M , Pan M 
Published: October 2021

Abstract

Background
Cardiovascular disease and mental disorders frequently coexist. Selective serotonin reuptake inhibitors (SSRIs) are often used to treat depressive and anxiety disorders but have been associated with an increased risk of bleeding due to platelet dysfunction. Up to 10% of patients with coronary artery disease are concomitantly treated with dual antiplatelet therapy (DAPT) and SSRI. Previous studies have assessed the risk of bleeding in patients treated with SSRI and clopidogrel-based DAPT, with contradictory results. However, there is no data regarding the use of SSRI and potent P2Y12 inhibitors (ticagrelor, prasugrel) or triple antithrombotic therapy (TAT).

Purpose
To evaluate the bleeding outcomes in a real-world population of patients undergoing percutaneous coronary intervention (PCI) treated with SSRI and DAPT or TAT after a year follow-up.

Methods
We conducted a retrospective study including all patients undergoing PCI at a high-volume center during 2018. Patients taking SSRI were propensity-score-matched (PSM) 1:1 using nearest neighbor matching with patients not taking SSRI. The primary endpoint was major bleeding as defined by the International Society on Thrombosis and Haemostasis (ISTH) at 1 year. Kaplan-Meier and Cox regression were used to compare outcomes between treatment groups.

Results
Of 1063 patients that underwent PCI during the study period, 1002 met the inclusion criteria and 139 (13.9%) were receiving SSRI. Propensity score distributions, baseline characteristics and standardized mean differences (SMD) of the covariates used for PSM before and after adjustment are shown in Figure 1. In matched survival analysis, there was no significant difference in the primary endpoint at 1 year follow-up: mayor bleeding occurred in 2.9% of patients who received SSRI and in 2.9% of those with no SSRI (HR 1.01; CI 0.25 to 4.03; p=0.991) (Figure 2).

Conclusion
In routine clinical care, patients treated with SSRI and DAPT or TAT after PCI did not have a higher risk of bleeding after a year follow-up.

Funding Acknowledgement
Type of funding sources: None. Figure 1. Baseline characteristicsFigure 2. Survival curves by SSRI treatment
Cardiovascular risk associated with long-term anabolic-androgenic steroid abuse: an observational study from Norway
Authors: Saetereng T , Vanberg P , Steine K , Atar D , Halvorsen S 
Published: October 2021

Abstract

Background
The use of anabolic-androgenic steroids (AAS) has become highly prevalent among recreational weightlifters. Numerous case reports have suggested an association between AAS use and a vast range of different cardiovascular diseases, including sudden cardiac death (SCD) and coronary artery disease (CAD). Few clinical studies have evaluated the risk of SCD and the prevalence of CAD in individuals with long-term AAS use.

Purpose
To evaluate the risk of ventricular arrhythmias and the prevalence of CAD among men with long-term AAS use.

Methods
Strength-trained men with at least three years of cumulative AAS use were recruited from recreational gyms. The control group consisted of strength-trained competing athletes who self-reported never using any performance enhancing drugs (non-users). AAS use was verified by sophisticated blood and urine analyses. Study participants went through a comprehensive cardiovascular evaluation including exercise ECG, 24 h ECG, heart rate variability (HRV) measures, signal averaged ECG (SAECG) and QT dispersion (QTd). Coronary computed tomography angiography (CCTA) was performed in AAS users. Not all participants had all tests.

Results
We included 51 AAS users and 21 non-users. Median age (25th-75th percentile) was 33 (29–37) years in the user group and 33 (29–42) years in the non-user group. Forty-eight (94%) of the users had been using AAS for five years or more. Characteristics are presented in the table. AAS users had significantly lower HDL values compared to non-users (p&lt;0.001). No signs of ischemia or arrhythmias were detected during exercise ECG, however maximal exercise capacity was lower than in the control group and also compared to age-standardized values. A considerable, but statistically non-significant reduction was seen in overall HRV estimated as the standard deviation of the RR intervals for normal sinus beats (SDNN) (p=0.05). No difference was seen regarding left ventricular late potentials or QTd (table). Eight (19%) of the forty-two AAS users undergoing CCTA had at least a mild degree of CAD, and four of them three-vessel disease.

Conclusion
No ECG-findings indicated an increased risk of ventricular arrhythmias among the long-term AAS users. However, their maximal exercise capacity was lower than in controls, and one fifth of the long-term AAS users had verified CAD on CT coronary angiography.

Funding Acknowledgement
Type of funding sources: None. Table 1
Polypharmacy in older adults after transcatheter or surgical aortic valve replacement
Authors: Rodighiero J , McDonald E G , Lee T C , Piazza N , Martucci G , Langlois Y , Morin J F , Bendayan M , Piancova P , Lantagne S , Ouimet M C , Mantzanis H , Afilalo J 
Published: October 2021

Abstract

Background
Polypharmacy is associated with higher rates of adverse drug events and unplanned hospital visits in medical patients. Little is known about polypharmacy in frail older adults undergoing transcatheter (TAVR) or surgical (SAVR) aortic valve replacement.

Purpose
To determine the prevalence and prognostic implications of polypharmacy and potentially inappropriate medications (PIM) following TAVR or SAVR.

Methods
A post hoc analysis of the McGill Frailty Registry was conducted. Patients 70 years of age or older who were discharged alive after TAVR or SAVR at two university hospitals were included. Discharge prescriptions were codified and analyzed using the MedSafer electronic tool that has been validated to flag drug interactions and PIMs considering patient-specific comorbidities. Associations with the primary outcome of 30-day all-cause readmission were examined by logistic regression after adjusting for age, sex, Charlson Comorbidity Index, and procedure type.

Results
The cohort consisted of 495 patients (52% TAVR, 21% isolated SAVR, 27% combined SAVR). The mean age was 80.1±5.5 years with 52% females. The mean number of medications was 10.2±3.7 with 90% having 5 or more medications. A total of 55 patients were readmitted within 30 days. While the total number of medications was not predictive, three specific PIMs were found to be harmful and one PIM was found to be protective for readmission: clopidogrel with warfarin or heparin (OR 3.99; 95% CI 1.47, 10.82), diltiazem with heart failure (OR 3.16; 95% CI 1.04, 36.41), doxazosin or terazosin with hypertension (OR 6.21; 95% CI 0.99, 38.88), and any proton pump inhibitor (OR 0.47; 95% CI 0.26, 0.86). Of note, the combination of clopidogrel with direct oral anticoagulants was not found to be harmful for readmission.

Conclusion
The prevalence of polypharmacy is elevated in older patients undergoing TAVR or SAVR. Specific PIMs, but not total number of medications prescribed, were found to be associated with potentially preventable readmissions.

Funding Acknowledgement
Type of funding sources: None.
Thrombotic and hemorrhagic complications during pregnancy, delivery and the postpartum period in females with prosthetic heart valves
Authors: Sefieva G G , Shadrina U M , Karelkina E V , Li O A , Bautin A E , Yakubov A V , Moiseeva O M , Vavilova T V , Irtyuga O B 
Published: October 2021

Abstract

Background/Introduction
Women with mechanical prosthetic heart valves are at greatest risk of developing complications.The main reason is that mechanical prosthetic heart valves require lifelong anticoagulation to reduce the high risk of associated thrombotic and hemorrhagic complications.

Purpose
The main goal of this study was to estimated risk factors and frequency of thrombotic and hemorrhagic complications during pregnancy, delivery and the postpartum period in women with prosthetic heart valves

Methods
According to retrospective cohort analyses in this study were included 70 patients with prosthetic heart valves who delivered in a specialized perinatal center from October 2010 to February 2020. All the patients were divided into two groups depending on prosthesis type: mechanical prostheses (44 deliveries in 44 patients), biological prostheses (22 deliveries in 19 patients). All patients were performed ECHO (Vivid 7, GE, USA). The average age were 30.7±5.2 years. The N-terminal brain natriuretic propeptide (NT-proBNP) concentration was determined by the quantitative electrochemiluminescence method using a Cobas E 411 analyzer (Roche, Switzerland). The activity of the anti –Xa factor was measured by chromogenic assays.

Results
In 9 (21.4%) pregnants with a mechanical valve prosthesis (MVP), prosthetic thrombosis was recorded until 2016. In 1 patient with mechanical valve prosthesis (2%) during pregnancy was complicated by an acute cerebral circulation disorder. Since 2016 there were monitored the activity of the anti –Xa factor. In 7 patients on the background of a change in anticoagulant therapy, pregnancy stopped in the early stages. Before pregnancy, 31.4% of the patients didn't have heart failure clinical manifestations, but in 12 (17.1%) patients during pregnancy had increase in NYHA Class maximum to NYHA Class III.
The average NT-proBNP concentration was 912.3±1586.6 pg / ml. The frequency of the cesarean section in both groups was high: in patients with mechanical valve prosthesis in 78.5% and in the group of patients with biological valve prostheses in 68.1% of cases. There were not registered any new cases of prosthetic thrombosis after delivery, however, 9 patients had hemorrhagic complications in the early postpartum period, which required relaparotomy and blood transfusions. Regardless of frequent complications during pregnancy and in the postpartum period, no fatal outcomes have been reported.

Conclusion
The absence of mortality over the 9-years old observation and delivery in patients with valvular prostheses demonstrates the feasibility of monitoring and delivery of this category of patients in a specialized multidisciplinary medical center with experience in managing patients during pregnancy with valvular prostheses on anticoagulant therapy.

Funding Acknowledgement
Type of funding sources: None.
Long-term prognostic impact of renin-angiotensin system blockade in tako-tsubo syndrome
Authors: Cespon Fernandez M , Nunez Gil I , Jamhour K , Abu-Assi E , Aritza Conty D , Vedia O , Almendro Delia M , Sionis A , Martin Garcia A C , Corbi Pascual M , Martinez Selles M , Uribarri A , Guillen M , Garcia Acuna J M , Raposeiras Roubin S ,   RETAKO investigators
Published: October 2021

Abstract

Introduction
Medical therapy in TakoTsubo Syndrome (TTS) remains mainly empirical, given the lack of randomized studies evaluating different pharmacological strategies.
The prognostic benefit of angiotensin-converting-enzyme inhibitors and angiotensin II receptor blocker (ACEI/ARB) is not well established. The clinical data published so far are often based on small sample registries and offer opposite results, both in terms of survival and TTS recurrence.
Expert recommendations seem favorable to the prescription of ACEI and ARB. Nevertheless, clinical investigation is encouraged for validating the observed results.

Purpose
The aim of our study was to evaluate the long-term prognostic impact of renin-angiotesin blockers (ACEI or ARB) in terms of mortality and TTS recurrence.

Methods
The data analyzed in this study were obtained from the nationwide registry “RETAKO”. It included TTS post-discharge survivors, between January 1, 2003, and July 31, 2018. A total of 1062 patients were included for analysis. Cox regression analysis and inverse probability weighting (IPW) propensity score analysis were performed to asses the prognostic benefit of ACEI/ARB. Primary endpoint was a composite outcome of all-cause mortality and TTS recurrence.

Results
A total of 1062 TTS patients were included. ACEI or ARB were used in 639 patients (60.2%). During a mean follow-up of 2.7±3.5 years, there were 101 deaths (3.9 per 100 patients/year) and 34 recurrences of TTS (1.3 per 100 patients/year). We found no significant difference in follow-up mortality or TTS recurrence in unadjusted and adjusted Cox regression analysis (Hazard Ratio [HR] 0.69, 95% Confidence Interval [CI] 0.47–1.02) between patients treated and untreated with ACEI/ARB. After performing propensity score matching, differences in long term prognosis (all-cause mortality or recurrence) remained no statistically significant (HR 0.73, 95% CI 0.45–1.18).

Conclusions
In this observational study, we found that ACEI and ARB therapy was not significantly associated with improved long term survival free of recurrence in post-discharged TTS patients.

Funding Acknowledgement
Type of funding sources: None. Incidence of primary endpoint
Dabigatran as first-line treatment for heparin-induced thrombocytopenia in the intensive cardiac care setting
Authors: Szyda Ł.S , Klosinska M K , Poninska N P , Mrozowska-Peruga E M P , Kasprzak J D K 
Published: October 2021

Abstract

Introduction
Heparin-induced thrombocytopenia (HIT) is a rare immune-mediated disorder related to the use of unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) which is associated with increased risk of vascular thrombosis. HIT constitute a relevant and not so uncommon clinical issue in the intensive cardiac care unit setting. Parenteral non-heparin anticoagulants are recommended for the treatment of HIT. The efficacy of dabigatran, direct oral anticoagulant, is poorly documented in this indication. In laboratory-confirmed HIT only few cases with short-term use and early conversion to and from another anticoagulant were reported.

Purpose
The purpose of our study was to evaluate the efficacy and safety of dabigatran as a first-line and the only one anticoagulant used in the treatment of HIT.

Methods
We prospectively enrolled 5 patients with the diagnosis of HIT who were hospitalized in our intensive cardiac care unit in 2017–2021. Heparin was stopped immediately on the suspicion of HIT and off-label dabigatran therapy was initiated the same day. There were no conversion to another non-heparin anticoagulant – dabigatran was used continuously from suspicion of HIT for at least 3 months. In all patients we used latex immunoassay to confirm the diagnosis of HIT. Lower-extremity compression ultrasonography was performed to exclude thrombosis. We distinguished HIT with thrombosis (HITT) and isolated HIT (HIT without thrombosis). The minimal follow-up period on dabigatran treatment was 3 months and the maximal 4 years.

Results
All the patients were male with the median age of 73 years (interquartile range, 52–78 years) and all were exposed to both, UFH and LMWH. The median platelet (PLT) count before exposition to heparin was 182000/μl (interquartile range, 171000/μl–321000/μl). Platelet count fall &gt;50% was observed after a median time of 9 days (interquartile range, 7–11 days) after exposition to heparin and a median PLT count nadir was 87000 μl/l (interquartile range, 25000/μl–103000/μl). Two patients had intermediate and three high probability of HIT. HITT was diagnosed in one patient. The manifestation of HITT was upper-extremity arterial thrombosis and pulmonary embolism. Four patients were diagnosed with isolated HIT. PLT count recovery &gt;15ehab724.2982/μl was observed after a median time of 3 days on dabigatran treatment (interquartile range, 2–7 days). In the patient with HITT, a complete resolution of upper-limb arterial thrombosis was observed. At the minimal observation period end point (3 months) all the patients survived without bleeding or new thrombotic event. Moreover, neither bleeding nor recurrence of HIT occurred during the total follow-up period.

Conclusion
Dabigatran is safe and efficient as first-line treatment for HIT and can be used as the only one anticoagulant in this challenging, clinical scenario.

Funding Acknowledgement
Type of funding sources: None.
Prediction of acute myocardial infarction or death in acute chest pain patients with machine learning models or first troponin T alone
Authors: Olsson De Capretz P , Bjorkelund A , Mokhtari A , Bjork J , Ohlsson M , Ekelund U ,   AIR Lund chest pain
Published: October 2021

Abstract

Background
Machine learning approaches are increasingly being explored for use in healthcare systems, but there is a trade-off between increased accuracy and decreased explainability with more complex models. We aimed to evaluate the diagnostic performance for acute myocardial infarction (AMI) or death within 30 days of index visit. Machine learning models were trained using demographic factors, ECG and blood markers, and to compare them to a single high sensitivity TnT (hs-cTnT) value.

Methods
Using records from 9519 ED patients from two hospitals in Skåne, Sweden, we created machine learning models based on both logistic regression and artificial neural networks. Inputs in the models varied and included sex and age, first hs-cTnT value at the ED, glucose, creatinine, hemoglobin, and ECG signal data. The models were adapted to meet the following criteria for safe rule-out of 30-day myocardial infarction or death: Negative predictive value (NPV) &gt;99.5% and sensitivity &gt;99%. For rule-in of myocardial infarction or death, a positive predictive value (PPV) of &gt;70% was set. The models were then compared to the performance of a first hs-cTnT &lt;5 ng/L for rule-out, and &gt;51 ng/L for rule-in. The patient population was split by arrival date and models were trained on the initial 50% of patients. Thresholds were selected from the subsequent 25%, and tests were performed on the final 25% (2379 patients).

Results
The best model, a convolutional neural network, identified 1309 (55%) patients for rule-out and 125 (5.3%) for rule-in, with the required NPV, sensitivity and PPV. In comparison, a single hs-cTnT value identified 1123 (47.2%) patients for rule-out and 158 (6.6%) for rule-in, but failed to reach the required sensitivity and PPV levels.

Conclusions
These results indicate that more complex models are able to safely identify a large proportion of patients for early rule-out or rule-in without the need for serial troponin tests. In future studies attempts should be made to improve the explainability of these models.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): VR; grant no. 2019-00198