bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Predictive role of speckle-tracking and left ventricular ejection fraction estimation using 2D and 3D echocardiography in the detection of chemotherapy related cardiotoxicity
Authors: Oliveira C C , Coutinho R , Flores R , Medeiros P , Pires C , Mane F , Silva R , Braga C , Vieira C , Pereira V H 
Published: October 2021

Abstract

Background
2D left ventricular ejection fraction (LVEF) estimation through echocardiography has been the classic parameter for cancer therapy–related cardiac dysfunction (CTrCD) detection. However, it is hypothesized that other parameters can be used in order to detect early stages of subclinical cardiotoxicity when LVEF is still preserved. Therefore, 3D LVEF and 2D and 3D strain parameters assessments have been evaluated in patients submitted to anthracyclines treatment.

Objectives
To compare 2D and 3D LVEF and strain parameters estimation using echocardiography regarding its ability to predict and detect subclinical and clinical cardiotoxicity during and after anthracyclines treatment.

Search methods and criteria
A systematic review was done and search was performed on PubMed and EMBASE from January 1st of 2000 to October 31th of 2020. Observational studies comparing 2D and 3D echocardiographic exams performed in adult patients submitted to anthracyclines were analyzed. Studies that evaluated survivors of pediatric cancer were excluded. 11 studies were included (n=844 patients).

Main results
2D and 3D LVEF decreased throughout the echocardiographic assessments of 7 studies, but 2D LVEF drops were not statistically significant in 4 studies and 3 studies showed that 3D LVEF detected a superior number of patients with abnormal LVEF. Compared to 3D LVEF,
2D GLS decreased at an earlier point of treatment and detected a superior number of patients with subclinical LV dysfunction. Despite 2D and 3D GLS decreased throughout treatment, 3D GLS measurements were consistently lower and had higher relative variation. All 3D strain parameters decreased during and after the treatment and have higher relative variations than 2D GLS, with the exception of 1 study. 3D GLS reference values are not yet recognized by guidelines, so subclinical LV dysfunction was not evaluated.

Conclusions
LVEF estimation through 3D proved to be a better parameter for CTrCD detection vs 2D imaging. GLS is superior to 3D LVEF in detecting earlier LV changes, even if calculated using 2D echocardiography. Moreover, GLS reduction can be a predictor of subsequent LVEF decrease. 3DE is a growing potential technique and may be superior to 2DE in detecting and predicting subclinical LVEF dysfunction and CTrCD, respectively. Though 3D strain parameters presented promising results, more studies are needed to prove its incremental value over 2D strain echocardiography

Funding Acknowledgement
Type of funding sources: None.
Prognosis of adverse outcomes in patients with ST-elevation myocardial infarction and acute ischemic kidney injury
Authors: Mitkovskaya N , Brankovskaya E 
Published: October 2021

Abstract

Background
The category of patients with ST-segment elevation myocardial infarction (STEMI) remains in the focus of attention of cardiologists across the globe due to the high rates of hospital and long-term mortality. Acute ischemic kidney injury represents one of the most serious complications of STEMI, due to its highly negative impact on the disease prognosis. Therefore, it is critical for a clinician to identify STEMI and acute ischemic kidney injury patients who are at high risk of developing adverse outcomes.

Purpose
To identify key prognostic markers of adverse outcomes in patients with STEMI and acute ischemic kidney injury.

Methods
The study included 173 patients (ages 37–75), who were admitted to the intensive care unit with STEMI. Two groups of patients were identified based on their renal function: a group with STEMI and acute ischemic kidney injury (main group, n=111) and a group with STEMI and normal renal function (comparison group, n=62). Acute ischemic kidney injury diagnosis was confirmed on the basis of KDIGO (2012) recommendations - when patients with MI were hospitalized with creatinine level increased by up to ≥1.5 times as compared to baseline creatinine level before hospital admission. A critical condition for confirming the diagnosis was absence of chronic kidney disease and urinary tract disorders in patients' medical history. To identify risk factors of adverse outcomes, multivariate logistic regression analysis was used.

Results
Regression analysis was performed in order to build a predictive model for the development of adverse outcomes (death from cardiovascular causes, recurrent MI, unstable angina within 12 months). The analysis was based on the results of clinical, laboratory and instrumental evaluations of the focus patients. The derived prognostic model included the following features: age, level of the N-terminal fragment of brain natriuretic peptide (NT-pro-BNP), C-reactive protein level, creatinine level and local contractility index. A mathematical model for predicting the likelihood of adverse outcomes was developed on the basis of regression analysis data. ROC analysis including building of a ROC curve was conducted in order to test the quality of the model; the AUC was 0,996. The resulting model achieved 90,6% sensitivity, 100% specificity and 97,1% positive predictive value.

Conclusion
The following prognostic markers of adverse outcomes development in patients with STEMI and acute ischemic kidney injury were identified as most critical: age, NT-pro-BNP level, C-reactive protein level, creatinine level and local contractility index based on echocardiography results. The mathematical model for predicting the likelihood of adverse outcomes, developed as a result of the study, will become a powerful clinical tool for improving the survival rate in patients with STEMI and acute ischemic kidney injury.

Funding Acknowledgement
Type of funding sources: None.
Predictive association of pulmonary hypertension with risks of adverse renal outcomes in type 2 diabetes
Authors: Wu M , Ren Q W , Yu Y J , Tse H F , Yiu K H 
Published: October 2021

Abstract

Background
Diabetic kidney disease is a major diabetic complication which contributes to the end-stage renal disease and renal deaths in diabetic patients. The aim of our study was to investigate the role of pulmonary hypertension (PHT) in the development of adverse renal outcomes in patients with type 2 diabetes (T2DM).

Methods
A total of 1479 diabetic patients (mean age 67±13 years; women, 44.7%) were recruited. Pulmonary artery systolic pressure (PASP) was estimated by transthoracic echocardiography at baseline. Adverse renal outcomes were defined as a composite endpoint of a sustained 40% decline in eGFR, end-stage renal disease requiring renal replacement therapy, kidney transplantation or renal deaths. Cox regression hazard model was used to assess the association between PHT and incident adverse renal outcomes.

Results
Patients were divided into three groups based on their baseline PASP: no PHT (n=1204, 75.1%), mild PHT (321, 20.0%) and significant PHT (78, 4.9%). A total of 474 adverse renal outcomes occurred during a median follow-up of 53 months, Kaplan-Meier survival curve showed that patients with significant PHT had highest risk of adverse renal outcomes. Multivariate cox regression demonstrated both mild PHT (HR=1.66, 95% CI 1.33, 2.06, P&lt;0.001) and significant PHT (HR=2.09, 95% CI 1.45, 3.02, P&lt;0.001) were independently associated with the incident adverse renal outcomes.

Conclusion
The presence of PHT was associated with adverse renal outcomes in patients with T2DM.

Funding Acknowledgement
Type of funding sources: None.
Behavioral economics strategies for promoting adherence to treatment in heart failure patients
Authors: Lipatova T , Malinova L , Eremin A 
Published: October 2021

Abstract

Heart failure (HF) is characterized by an increased risk of both fatal and nonfatal adverse cardiovascular events, which required life-long and costly treatment. At the same time every cardiology practitioner is well aware, that despite huge efforts on patient's education there remains a substantial part of patients who do not always make rational choices regarding their treatment. Patient's knowledge does not always translate into adherence, so we must find ways to minimize the intent-behavior gap to improve the efficacy of HF treatment. We presume that behavioral economics can provide us with tools that will promote positive present behavior of patients.
The purpose of the study was to examine the utility of behavioral economics-related concepts in understanding long-term treatment strategy in heart failure patients and acute heart failure survivors.

Methods
We performed an open prospective study involving male patients with both chronic and acute heart failure (CHF n=65 and AHF n=54). Involved patients were surveyed on symptom severity, behavioral economics “parameters”. Cognitive complexity was measured via “real life” case simulations. We assessed stress and depression with HADS and Zung's scales serially: on admission, 3d day of hospitalization and day before discharge. In patients with AHF, first assessment was performed after clinical stabilization. The primary outcomes were set as an adherence to prescribed medication assessed 6 and 36 months after discharge, rehospitalization due to cardiovascular reasons and self-assessed well-being.

Results
We observed opposite patterns of stress dynamics in CHF and AHF groups. AHF patients demonstrated significant reduction of stress level on the 3d day since admission: 9.0 (7.1; 9.9) vs 6.4 (5.7; 7.4) units, p=0.037, with further increase at discharge, while in CHF patients there was tendency to significant change in parameter was absent.
Patients who survived AHF demonstrated higher 6 month adherence to prescribed medication (62.9% vs 49.2%, p=0.047), at the same time there was the strong positive correlation between medication's price and self-induced therapy interruption (R=0.74, p&lt;0.05). Both AHF and CHF reported financial planning as the major contributor for decision making in “real life” cases. Surprisingly in study population self-assessed well-being did not correlated with rehospitalization rate.
Parameters that were significantly associated with CV rehospitalization included symptoms at admission (OR 2.1 CI 1.4; 3.2, p=0.002), regularly saving money (OR =2.7 CI 1.9; 4.6, p=0.001) and stress level at discharge (OR 1.6 CI 1.1; 2.4, p=0.027).

Conclusion
Received results may be useful to identify heart failure patients at higher risk of self-induced treatment interruption. These patients could be offered focused support and counseling designed to enhance adherence to prescribed medication in order to improve long-term heart failure outcomes.

Funding Acknowledgement
Type of funding sources: None.
Gender bias in ACS management
Authors: Murray P , Blake W M , Ward D 
Published: October 2021

Abstract

Background
Cardiovascular disease is implicated in approximately 1 in every 3 deaths occurring in both women and men worldwide. Numerically, it is responsible for more female than male deaths each year, due largely to longer life expectancy amongst women. Consequently, guidelines from the major international bodies recommend against the use of sex as a discriminating factor in the evaluation of chest pain. Still there remains a public perception of excess cardiovascular risk in men, contributing to a delay in the seeking of medical attention by women with symptoms of acute coronary syndrome (ACS). We hypothesise the attendant concern that unconscious gender bias amongst clinicians influences the management of patients presenting with ACS from triage to invasive assessment and treatment.

Aim
To examine the relationship between patient gender and clinical management of ACS.

Methods
We conducted a retrospective cross sectional study of all patients in whom ACS was suspected during a year long period using the laboratory database of a tertiary cardiac referral centre in Ireland. In all patients for whom high sensitivity cardiac troponin T assay was ordered during the full calendar year 2019, age, sex and troponin level were recorded. We determined the likelihood of invasive angiography for male versus female patients after adjustment for age and troponin result.

Results
A total of 30,560 requests for high sensitivity cardiac troponin T (troponin) were made to the laboratory in the year ending December 2019. Excluding 464 for technical and sampling issues, 30,096 assays were included in the analysis. 43.84% (N=13,194) of samples were female and 56.16% (N=16,902) male. These samples were collected from 10,807 patients (5,294 female and 5,513 male). Median age was 58 for females and 57 for males. The upper limit of normal in our institution for serum troponin is &lt;14ng/L and there is no adjustment for sex. 22.01% (N=1,165) of females and 33.39% (N=1,841) of males had at least one troponin level reported above the normal range. Of female patients with at least one troponin above the normal limit, 10.21% (N=119) underwent invasive coronary angiography compared to 18.52% (N=341) of males. Of females in whom all troponin results were normal, 5.84% (N=241) proceeded to invasive angiography versus 9.18% (N=337) of males.

Conclusion
Notwithstanding the limitations of lack of adjustment for risk profile, the results of this analysis demonstrate a higher rate of invasive angiography in males compared with females independently of troponin level. This is in keeping with previous research suggesting a gender gap in the approach of clinicians to ACS, and suggests an unconscious sex-based discrimination when making decisions around diagnosis and treatment. Education regarding the prevalence of coronary atherosclerosis, and interventions to alter the attitudes of clinicians, are some of the interventions suggested to close this gap.

Funding Acknowledgement
Type of funding sources: None.
Association between NPC1L1 and HMGCR gene polymorphisms with residual cholesterol risk in patients with premature triple-vessel disease
Authors: Li J , Zhao X , Yang Y , Gao R , Yuan J ,   State Key Laboratory of Cardiovascular Disease, Fuwai Hospital
Published: October 2021

Abstract

Background
Management of dyslipidemia is the primary recommend in current guidelines in patients with coronary heart disease (CHD). Despite intense statins therapy, patients with low-density lipoprotein cholesterol (LDL-C) level of more than 1.8 mmol/L still have residual cholesterol risk. Premature triple-vessel disease (PTVD) is a severe CHD. Recent studies have established that both residual cholesterol risks and PTVD were associated with adverse cardiovascular events. Niemann-Pick C1-like 1 (NPC1L1) and 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) is involved in exogenous cholesterol absorption and endogenous cholesterol synthesis respectively, which play a vital part on dyslipidemia.

Purpose
The present study aimed to investigate the association between NPC1L1 and HMGCR gene polymorphisms and residual cholesterol risk in patients with PTVD.

Methods
A total of 609 PTVD patients treated with statins were consecutively enrolled from April 2004 to February 2011. Residual cholesterol risk was defined as low-density lipoprotein cholesterol (LDL-C) &gt;1.8 mmol/L. According to LDL-C levels, the patients were divided into two groups: residual cholesterol risk group (n=521, &gt;1.8 mmol/L) and non-residual cholesterol risk group (n=88, LDL-C ≤1.8 mmol/L). Four single nucleotide polymorphisms (SNP) of NPC1L1 gene including rs11763759, rs4720470, rs2072183 and rs2073547 and three SNPs of HMGCR gene including rs12916, rs2303151 and rs4629571 were genotyped.

Results
After adjusted for age and sex, multivariate logistic regression analysis showed that rs12916 of HMGCR gene was associated with 2.082 times higher residual cholesterol risk in recessive model (OR: 2.082, 95% CI: 1.156–3.749, P=0.015), and the homozygous TT of rs12916 (OR: 2.262, 95% CI: 1.155–4.429, P=0.017) was associated with 2.262 times higher residual cholesterol risk in codominant model while there was no significant association for the heterozygous CT of rs12916 in codominant model (OR: 1.140, 95% CI: 0.678–1.917, P=0.621). There was no significant association between the SNPs of NPC1L1 gene and residual cholesterol risk in various models (P&gt;0.05).

Conclusions
We reported for the first time that the rs12916 on HMGCR gene were associated with residual cholesterol risk in patients with PTVD, providing new insight in genetic treatment in dyslipidemia.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): CAMS Innovation Fund for Medical Sciences (CIFMS); Key Science and Technology Project of Shihezi
Coronary artery cavitation as a trigger for atherosclerotic plaque progression: a numerical and computational fluid dynamic demonstration
Authors: Rigatelli G , Zuin M , Roncon L , Nguyen T 
Published: October 2021

Abstract

Background
Coronary cavitation is supposed to be generated by both concentric and eccentric coronary artery stenosis creating microbubbles which exploded when the fluid pressure was lower than the vapor pressure at a local thermodynamic state.

Aims
To assess, using computational fluid dynamic analysis (CFD), the potential role of cavitation in inducing coronary artery endothelial damage and promote atherosclerotic plaque progression.

Methods
We retrospectively reviewed the procedural records of consecutive patients evaluated between 1st January 2013 and 1st January 2014 with an isolated hemodynamically significant Left Main (LM) disease. Each bifurcation was reconstructed on the patient-specific geometries derived from the CCTA applying patient-specific hemodynamic features. Vapour has been modelled as discrete vapour bubbles and its trajectory determined using a Lagrangian frame of reference. Cavitation started with micro-cavitation nuclei which subsequently grow into bubbles undergoing different physical processes determined in a stochastic Monte-Carlo approximation.

Results
Among the 12 patients analysed [8 males, mean age 68.2±12.8 years old], the mean LM stenosis was 72.3±3.6%. In all subjects, LM stenoses induced cavitation which propagates downstream the vessel. The higher concentration of vapour region was detected before the carina (within 0.8 to 1.3 cm from the stenosis). The mean bubbles radius observed before the carina was 4.2±1.4 μm; their impact with the endothelial surface generated a mean peak pressure of 3.9±0.5 MPa determining a local shockwave (Figure 1).

Conclusion
The collapse of micro-bubbles alongside the endothelium generated micro-shockwaves determining repeated dynamic load measurable as an instantaneous pressure-peaks able to induce endothelial injury or dysfunction.

Funding Acknowledgement
Type of funding sources: None. Figure 1. (A) The simulation illustrates the vapour fraction iso-surfaces and the scattered bubble plots as predicted by the Langrangian model. Notably, most cavitation bubbles that form at the inlet of left main bifurcation do not collapse immediately but they are transported towards the vessel determining several interactions with the endothelium. (B) Graphical representation of the bubble radius modification and related pressure transmitted to the endothelium if the bubble collapse happened near to this last one. The magnification in boxes (B1-B4) evidences the dynamic modification of bubbles. The re-entry jet causing the collapse is evidenced with a red arrow.
Could the miniaturize techonologies improve patients adherence and assure better quality of life?
Authors: Rosiello F , Pietrantonio F , Di Lorenzo J , Bertani G , Anzidei A , Laurelli G , Cipriano E , Di Iorio C , Montagnese F , Pascucci M 
Published: October 2021

Abstract

Background
From 2000 to today, the use of information technology in the medical field is increasingly widespread, reaching a new milestone following the COVID 19 syndemia. It is increasingly evident that wireless monitoring allows patients to be followed more easily, detecting complications early at home and allowing to limit the contagion of healthcare personnel by reducing the interaction with patients in hospital rooms

Methods
A pilot Multicenter Open-label Randomized Controlled Trial (RCT) was performing comparing wearable wireless vital parameters continuous monitoring (WVPCM) system and regular monitoring. Data were collected to provide a clinical-economic impact (costs, program effectiveness and QALY gains) of complex patients (CPs) discharged from Internal Medicine Units. Cost were estimated by mean of the identification, measuring and valorisation of the resources uptake.

Results
143 patients (37 M/38 F, mean age: 78.7 years). Major complications: respiratory failure detection (6,5 vs 3,8); reduction of sudden deaths (9.3% vs 16% experimental); care-related infections (6,5 vs 7,5), glycemic decompensation (4,3 vs 1,9). Hospital readmission within 21 days were 7% vs 11%. Relevant cost driver was time spent by nurses: 58 minutes/day/patient (vs 132) allow to save €54-90/patient. One way and multiway sensitivity analyses confirmed the robustness of our results with nearly 99% of the replications involved

Conclusions
WVPCM, detecting early complication during the post-discharge CPs monitoring, may facilitate a timely response ensuring a more appropriate management of complex patients seen (&gt;25% of total admissions), reduce the time to diagnosis, improve efficiency/efficacy of disease management and reduce unnecessary clinic visits and hospital (re)admissions. The miniaturized technologies can improve patient adherence and assure better quality of life. WVPCM allows patients to be sent home safely and to effectively integrate Hospital and Community services.

Key messages
Wearable wireless vital parameters continuous monitoring (WVPCM) system reduce time and cost of nursing. Wearable wireless vital parameters continuous monitoring (WVPCM) system can detect early complication improve patient adherence and assure better quality of life.