bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dual antiplatelet therapy with 3rd generation P2Y12 inhibitors in STEMI patients: impact of Body Mass Index on high on-treatment platelet reactivity
Authors: Scudiero F , Canonico M E , Sanna G D , Saba P G , Esposito G , Parodi G 
Published: October 2021

Abstract

Background
High on-treatment platelet reactivity (HTPR) has been associated with high risk of ischemic events in STEMI patients. Body mass index (BMI) and specifically overweight and obesity are risk factors for increased platelet reactivity in different series of patients, however data regarding their relationship with pharmacodynamic response to oral 3rd generation P2Y12 inhibitors is still lacking.

Purpose
This study aims to assess the association between BMI and HTPR in STEMI patients treated with oral 3rd generation P2Y12 inhibitors.

Methods
Overall, 429 STEMI were enrolled in this study. Patients were divided into two groups according to BMI (BMI &lt;25; BMI ≥25). A propensity score matching (1:1) was performed to balance potential confounders in baseline study characteristics. Platelet reactivity was assessed by VerifyNow at baseline and after 3rd generation P2Y12 inhibitor (ticagrelor or prasugrel) loading dose (LD). Blood samples were obtained at baseline (T0), 1 hour (T1), 2 hours (T2), 4–6 hours (T3) and 8–12 hours (T4) after the LD. HTPR was defined with a platelet reactivity unit values ≥208 units.

Results
The mean age of the enrolled population was 62±12 and male rate was 75%. Patients with a BMI ≥25 were younger (61±12 Vs 64±11, p=0.006), with a higher prevalence of male gender (78% vs 68%, p=0.035), and hypertension (56% vs 46%, p=0.072), and they were less frequently treated with pre-PCI mophine use (30% Vs 42%; p=0.018). After propensity score matching (Table), patients with BMI ≥25 had similar values of baseline platelet reactivity [T0: 308 (285–342) vs 300 (281–330), p=0.396), while they had higher level of platelet reactivity at 1 and 2 hours after the LD [T1: 285 (200–308) vs 265 (196–320), p=0.047); T2: 241 (87–305) vs 200 (56–256), p=0.004)] and higher rate of HRPT [T1: (66% vs 47%, p=0.004); T2: (40% vs 24%, p=0.006)]. Furthermore, multivariable analysis demonstrated that BMI ≥25 was an independent predictor of HTPR at 2h (OR 2.01, 95% CI 1.18–3.42; p=0.009). Conversely, starting from 4 hour after the LD, platelet reactivity values [T3: 68 (7–173) vs 15 (6–71), p=0.76); T4: 38 (4–104) vs 44 (4–82), p=0.958)] and HRPT rates (T3: 13% vs 10%, p=0.595; T4: 1% vs 1%, p=0.320) were comparable among the study groups.

Conclusions
A BMI ≥25 is associated with decelerated pharmacodynamic response to oral 3rd generation P2Y12 inhibitors LD and resulted a strong predictor of HRPT in STEMI patients treated by dual antiplatelet therapy with ticagrelor or prasugrel.

Funding Acknowledgement
Type of funding sources: None. Table, panel ATable, panel B
Efficacy and safety of early aspirin withdrawal and continuation of ticagrelor monotherapy post PCI for STEMI. A post hoc analysis of the randomized global leaders trial
Authors: Gamal Setih A , Hara H , Tomaniak M , Lunardi M , Gao C , Ono M , Kawashima H , Juni P , Vranckx P , Windecker S , Hamm C , Gabriel Steg P , Onuma Y , Serruys P ,   Global Leaders Trial Investigators
Published: October 2021

Abstract

Background
Clinical presentation with STEMI is considered as a highly prothrombotic condition often associated with recurrent ischemic events. The role of aspirin as part of antiplatelet regimens in STEMI patients needs to be clarified especially in the context of new potent P2Y12 inhibitors

Aim
To assess the benefit and risk of 23-month ticagrelor monotherapy after one month of DAPT against the conventional 12-month DAPT with aspirin and ticagrelor followed by aspirin monotherapy among STEMI patients in the GLOBAL LEADERS trial.

Methods
We did a post hoc analysis of STEMI patients in the GLOBAL LEADERS trial (2092 patients). We compared the experimental ticagrelor monotherapy group (1062 patients) with the standard 12-month DAPT group (1030 patients) in rates of GLOBAL LEADERS predefined primary (composite of all-cause mortality or non-fatal, new Q-wave myocardial infarction (MI) and secondary end points (BARC 3 or 5 bleeding). NACE (Net Adverse Clinical Events) and POCE (Patient- Oriented Composite End points). We also compared GLOBAL LEADERS predefined end points in STEMI, UA, NSTEMI and CCS in both treatment arms.

Results
At two years, there were no significant differences in rates of GLOBAL LEADERS primary end points in patients who had or did not have STEMI. BARC bleeding in either treatment group didn't vary significantly among STEMI, NSTEMI and UA. Nevertheless, the experimental strategy had led to significant increase in BARC bleeding in CCS compared with STEMI at 1 and 2 years. There were similar rates of NACE and POCE in both the experimental and reference treatment groups at 1 and 2 years post PCI.

Conclusions and relevance
The incidence of GLOBAL LEADRER defined end points has not been impacted by STEMI presentation. Our findings suggest that an earlier cessation of DAPT at 1 month post primary PCI, with continuation of a potent P2Y12 antagonist monotherapy, could be safe and avoids additional bleeding risk in the STEMI setting. Given the post-hoc nature of the analysis, our findings should not necessitate changes in recommendations for practice by professional associations and regulatory agencies. However, all reported findings should rather be considered only as hypothesis-generating and need be replicated in dedicated large-scale randomized trials to further assess the role of Aspirin free antithrombotic strategies post PCI in STEMI.

Funding Acknowledgement
Type of funding sources: None.
Inorganic nitrate attenuates endothelial dysfunction consequent to systemic inflammation
Authors: Lau C , Shabbir A , Rathod K S , Chhetri I , Ono M , Hamers A J P , Amarin J J , Ibrahim A , Nuredini G , Godec T , Kapil V , Ahluwalia A 
Published: October 2021

Abstract

Introduction
Chronic cardiovascular diseases are characterised by low-grade systemic inflammation and attenuated nitric oxide (NO) bioavailability resulting in endothelial dysfunction. Inorganic nitrate augments NO bioavailability and improves markers of vascular dysfunction in patients with cardiovascular risk factors. However, the exact mechanism of this effect is uncertain.

Purpose
To determine whether inorganic nitrate supplementation alters systemic inflammation-induced endothelial dysfunction.

Methods
62 healthy male volunteers were randomised 1:1 to receive ∼8–10 mmol of dietary inorganic nitrate in beetroot juice or nitrate-free beetroot juice (placebo) once daily for 6 days. Measures of brachial artery flow-mediated dilatation (FMD), brachial blood pressure (BP), pulse wave analysis and carotid-femoral pulse wave velocity (PWV) by Vicorder were taken prior to and at 8 hours after a typhoid vaccine (to induce mild systemic inflammation). Plasma, urine and saliva samples were also collected. Clinicaltrials.gov: NCT02715635.

Results
Baseline characteristics were similar between the two groups. Inorganic nitrate significantly elevated plasma nitrite (placebo = Δ0.02±0.5 μM, inorganic nitrate = Δ0.63±1.2 μM; p=0.01) and nitrate levels (p&lt;0.0001) compared to placebo. There were significant increases in urine nitrite (p&lt;0.0001) and nitrate (p&lt;0.0001) in addition to salivary nitrite (p&lt;0.0001) and nitrate (p&lt;0.0001) compared to placebo. After 8 hours, typhoid vaccine induced an increase in circulating white cells (placebo = Δ3.34±3.37x109/L, inorganic nitrate = Δ2.9±2.78x109/L; p=0.58) that was similar in in both arms. However, there was a significant reduction in the FMD response in the placebo group at 8-hours post vaccine; an effect that was absent in volunteers treated with inorganic nitrate (placebo = Δ−1.33±1.53%, inorganic nitrate = Δ−0.07±1.84%, p=0.005). Importantly, there were no statistically significant differences in baseline vessel diameter (p=0.78), time to peak diameter in response to flow (p=0.87) and peak shear rate (p=0.57) between the groups. When comparing change from baseline to 8 hours after the vaccine, there were no significant differences in brachial systolic BP (p=0.12), central systolic BP (p=0.12) and PWV (p=0.60) between groups, but a significant reduction in brachial diastolic BP in the inorganic nitrate group (p=0.048).

Conclusions
Inflammation-induced endothelial dysfunction was prevented in those receiving dietary inorganic nitrate suggesting that elevating circulating nitrite and delivering NO to the blood vessel wall, through dietary approaches may offer potential therapeutic benefit in those cardiovascular diseases which typically exhibit low grade inflammation and deficiencies in bioavailable NO.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): British Heart Foundation
Linking salt preference to enjoyment of low sodium diet in patients with heart failure
Authors: Chung M L , Lennie T A , Miller J L , Moser D K 
Published: October 2021

Abstract

Background
Preference for salty foods is linked to dietary sodium intake. Increased salt preference is a barrier to low sodium diet (LSD) adherence due to perceived poor taste. Although patients with heart failure (HF) are advised to follow a LSD, the adherence remains poor. Understanding the relationship among attitudes, subjective norms (individuals' beliefs about how much they follow the advice of respected others), and perceived control for following a LSD, salt preference, and LSD enjoyment will help in designing interventions to increase adherence in patients with HF.

Purpose
The purpose of this study was to examine whether attitudes toward following a LSD, subjective norms about LSD, and perceived behavioral control for following a LSD mediated the association between salt preference and enjoyment of a LSD in patients with HF.

Methods
In this cross-sectional study, outpatients with HF completed the Dietary Sodium Restriction Questionnaire (DSRQ) based on the Theory of Planned Behavior, and rated salt preference and enjoyment of a LSD on a scale from 0 to 10 with 10 indicating the highest salt preference and enjoyment of LSD. Parallel mediation analyses were conducted using the PROCESS macro program in SPSS with 5,000 bootstrap samples controlling for age and gender. Three subscales of the DSRQ (i.e., attitude, subjective norms, and perceived behavioral control) were used as mediators.

Results
A sample of 117 patients with HF (65% male, mean age = 61.2±14.3, range 27 to 94, 82% white) completed the study. The mean salt preference rating was 5.26 (SD=2.7), and the LSD enjoyment rating was 4.56 (SD=2.5). Salt preference was not directly associated with LSD enjoyment (direct effect = −0.0506, 95% CI: [−0.2394, 0.1381]). There was a significant indirect effect of salt preference on the enjoyment of LSD through perceived behavioral control (indirect effect = −0.1178, 95% CI: [−0.0321, 0.0446]) (Figure 1). Patients with a high salt preference were more likely to have low levels of LSD enjoyment through the mediator of having low levels of perceived behavioral control over following a LSD. Subjective norms and attitudes toward LSD were not significant mediators of the association between salt preference and LSD enjoyment.

Conclusion
High preference for salty food decreased perceived behavioral control of LSD, which reduced enjoyment of LSD in patients with HF. Salt preference and perceived behavioral control in LSD are behavioral barriers in hedonic shift in LSD enjoyment. The findings suggest that intervention to promote LSD adherence should include strategies to increase perceived behavioral control in eating LSD and decreasing salt preference.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institutes of Health in the USA
A telephonic cardiology advice line was effective during the COVID-19 pandemic in both reassuring patients and in ensuring patients received optimal urgent care
Authors: Devlin J , Peace A J , McGlinchey P G 
Published: October 2021

Abstract

A decrease in patients accessing health care was documented during the first COVID-19 surge.
We established a 24/7 cardiology telephone advice service during the first surge, this was provided by an experienced cardiology nurse based in a nurse-led cardiac assessment unit. Various options were available on the basis of the telephone consultation. We particularly wanted to see the outcomes of reassurance of patients (to see if the approach was safe) and the outcomes of patients who were directed to emergency departments (to see if this identified patients with significant cardiological and medical problems who may not otherwise have accessed healthcare).
We reviewed the progress of the first 999 patients who used the telephonic service for which we had 90 day follow-up data.
141 patients were initially reassured by the nurse at the telephone call. Of these, 55 patients had no further engagement with healthcare providers in the subsequent 90 days. 7 were followed-up within the cardiac rehabilitation program that they were already participating in. 21 were referred to cardiology by their GP but all subsequently had normal assessment and/or investigation. 30 attended an emergency department of whom 22 were discharged directly from the ED; the other 8 patients were admitted to hospital which included 2 patients with non-cardiac chest pain and 2 with exacerbations of known heart failure. 28 patients recontacted the telephonic service during the 90 days and had subsequent face-to-face assessment. There was one death amongst the 141 patients, from a known malignancy.
161 patients were advised to attend an emergency department following telephonic evaluation of whom 50 did not attend. 84 patients were discharged home following assessment in the emergency department of whom 18 were discussed or referred to cardiology for outpatient assessment. 20 patients were admitted under cardiology (8 non-STEMI, 1 complete heart block, 1 profound bradycardia, 1 atrial fibrillation, 1 congestive cardiac failure, 1 critical aortic stenosis, 1 chemotherapy associated cardiotoxicity, 4 no significant cardiac issue found). Nine patients were admitted to non-cardiac wards.
We believe that nurse-led telephonic triage can be effective in the management of patients in the community with established cardiac disease or with potential cardiac symptoms. We intend to further develop the service we established during the first surge of the COIVD-19 pandemic.

Funding Acknowledgement
Type of funding sources: None.
The feasibility of algorithm-based ECG interpretation in remote monitoring – 53,748 recordings from the Dutch HartWacht program
Authors: Blok S , Slaats B M I , Somsen G A , Tulevski I I , Hofstra L , Winter M M 
Published: October 2021

Abstract

Background
Symptom driven remote monitoring programs for cardiac arrhythmias hold great promise, but scalability is limited due to high additional workload for healthcare providers. The Dutch HartWacht arrhythmia program consists of a connected single lead ECG device operated remotely by the patient, an algorithm for classification and a dedicated team of specialized nurses and cardiologists for additional remote interpretation. Correct classification as sinus rhythm (SR) by the algorithm would reduce workload of the HartWacht team, as it makes double-checking redundant.

Purpose
We investigated agreement of the ECG-classification between the algorithm and the HartWacht team and determined feasibility of the algorithm to classify sinus rhythm (SR).

Methods
We investigated the algorithm accompanying a single lead, handheld ECG-device that is integrated in the Dutch HartWacht program. We retrospectively studied the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the algorithm for classifying SR on home measured 30-second single lead ECGs. We included all recordings that were classified as SR by the algorithm. We used the classification of the HartWacht team as a reference standard.

Results
Between April 2020 and January 2021, 1,671 patients with (suspected) arrhythmias (female = 982 (59%), mean age = 58 (±15) years, participating in the HartWacht program, recorded 53,748 ECGs, of which the algorithm interpreted 35,388 (66%) as SR, 10,899 (20%) as possible AF and 7,461 (14%) as other. All recordings were also interpreted by the HartWacht team. Compared to the classification by the team, the algorithm showed a sensitivity for SR of 0.953, specificity of 0.985, PPV of 0.996 and NPV of 0.841. A total of 137 (0,3%) ECGs from 50 (2,8%) patients showed false positive outcomes, classifying recordings as SR while the HartWacht team detected arrhythmias. In 42 of those patients, arrhythmias were detected by the algorithm in other recordings within the program. The remaining 8 (0,5%) patients made a total of 14 (&lt;0,1%) recordings with false positive outcomes without having any other recordings with arrhythmias within the HartWacht program.

Conclusion
For classifying SR in home measured single lead ECGs, the algorithm and the HartWacht team showed a nearly perfect agreement. The recordings without agreement did not lead to relevant individual changes in diagnostic or therapeutic strategy for the patient. Therefore, the algorithm is feasible as standalone classification. With 66% of the recordings within the HartWacht program showing SR, a corresponding workload reduction can be achieved which importantly increases scalability and cost-effectiveness of remote monitoring of arrhythmia patients.

Funding Acknowledgement
Type of funding sources: None.
Telerobotic interventions from a distance: an initial experience in 3D phantom mapping
Authors: Ailoaei S , Wright P , Griffiths S , Jansen M , Ernst S 
Published: October 2021

Abstract

Introduction
The current COVID-19 pandemic has fostered several accelerations in “remote” patient care such as video and telephone clinics, as well as multidisciplinary collaborations using online platforms with experts consulting the local teams from a distance. The next logical step would be to also offer remote-controlled interventions which the expert operator not on site, but in support of the local team. This is especially valuable for complex interventions when either patient or expert operator can not be present at the same place.

Purpose
We aimed to demonstrate that an expert operator located at far distance (Austria) could directly interact with the remote magnetic navigation system in London (UK) whilst mapping a 3D phantom using an electroanatomical mapping system.

Method
Two experienced operators of the magnetic navigation system were tasked with creating fast anatomic maps (FAM) of the atrial and ventricular chambers of a 3D phantom using remote magnetic navigation in combination with 3D electroanatomical mapping. One was located in the control room of the magnetic catheter lab (UK) and the second one was in Tirol, Austria and connected through a secure remote desktop connection (via high speed fibre optic cable). Using a solid tip magnetic catheter connected to a mechanical drive, all interactions with the system were carried out via the Odyssey platform. Acquisitions for right and left atrium, as well as right and left ventricles plus aorta was compared with regards to mapping duration, map completeness (as judged by the average distance of surface points from 3D CT scan reconstruction), total 3D map volume and need for additional radiation exposure during the mapping process.

Results
Mapping time and map completeness when performed by the distant operator was not inferior to the local operator and both did not require any additional radiation exposure during the mapping process. Table 1 demonstrates the mean parameters for each chamber, respectively. Figure 1 depicts the matched data for chamber completeness as compared for the LA (green= local operator, pink= distant operator) using a contrast CT scan as the gold standard.

Conclusion
Telerobotic 3D mapping of a 3D phantom from a distance was equally fast delivered from the control room as compared to an operator located 1200 km away without compromising on map completeness. This demonstrates the feasibility of telerobotic interventions and stress the need for remote collaboration which is especially valuable when travel of patients and/or physician experts is restricted.

Funding Acknowledgement
Type of funding sources: None. Matched data for aorta
Home monitoring program for patients following cardiac surgery
Authors: Sokolskaya M , Shvartz V A , Bockeria O L , Bockeria L A 
Published: October 2021

Abstract

Patient compliance with medical recommendations and monitoring of the cardiovascular system parameters after discharge from the hospital are important in the postoperative period.

Material and methods
The program of remote home monitoring of patients after cardiac surgery was created and is used in clinical practice of the department of surgical treatment of interactive pathology. First of all, we analyzed the capabilities of apps for mobile phones, ECG monitoring devices, and blood pressure monitors with the ability to remotely reset data via Bluetooth which are available in Russia. In accordance with the requirements of the high-tech clinic, the following applications were selected: MediSafe (control of drug therapy), MedMBP (control of blood pressure), Ritmer (ECG monitoring), MiFit (a step tracker). In the follow-up program 25 patients (15 men, 10 women) were included. The average age is 59±11 years (min-29, max-91). Performed interventions: 7 patients underwent RFA, 6-valve replacement with a mechanical prosthesis, 2-valve replacement with a bioprosthesis, 7-CABG, 5-PCI. The patients gave their voluntary consent to participation, confirmed their readiness and ability to use apps and devices. The initial psychological status and the quality of life were assessed using the SF 36 and HADS questionnaires. All patients were given a tonometer for BP measuring, an ECG device and a step tracker to evaluate physical activity. According to the protocol, patients measure BP and ECG daily or additionally if they feel worse; using the mobile app, they note the taken medications. All data are sent to the server and analysis by the doctor. The doctor reviews the received indicators every day and, if necessary, contacts the patient to discuss treatment tactics.

Results
For today the follow-up period is 3 months. During this period, 96% of patients strictly follow the program protocol. One patient has difficulties when using the ECG recorder, does not regularly follow the recommendations for drug therapy, which requires an individual approach. Based on the monitoring results, correction of antihypertensive therapy was necessary in 40% of cases, antiarrhythmic therapy-in 20%. In one case, a sinus node weakness syndrome was detected, and the patient was called to the hospital for the pacemaker implantation.

Conclusion
The remote monitoring program is an effective and promising tool for monitoring patients after discharge from the hospital. It is clear that the results obtained from more patients and after a longer follow-up period would be more informative. However, the intermediate initial result indicates the necessity and effectiveness of this program.

Funding Acknowledgement
Type of funding sources: None. Figure 1