bluuebunny/crossref_metadata_2025_split huggingface dataset:
Echocardiographic assessment of the right heart pulmonary circulation unit in mitral regurgitation due to mitral valve prolapse
Authors: Maheut R , Trousselle L , Eggenspieler F , Pace N , Filippetti L , Fraix A , Popovic B , Vanhuyse F , Huttin O , Selton-Suty C 
Published: October 2024

Abstract

Background
Right ventricular evaluation is essential in the context of chronic mitral regurgitation (MR). Chronic MR is associated with a progressive cardiac remodeling with enlargement and dysfunction of all cardiac chambers, and the development of functional tricuspid regurgitation (TR). Besides, right ventricle (RV) dysfunction and functional TR have been shown to influence patient prognosis.

Purpose
The aim of this study was to evaluate simple and combined echocardiographic parameters analysing the right heart – pulmonary circulation unit, according to the severity of MR.

Methods
In this monocentric retrospective study, echocardiographic studies of patients followed for a mitral valve prolapse (with or without MR) were reviewed. Usual parameters analysing RV morphology, load and function were obtained. Combined parameters of RV – pulmonary artery (RV-PA) coupling were calculated: TAPSE/PASP and RVFWS/PASP. Comparison between MR grades were performed with ANOVA or Kruskal Wallis tests as appropriate. Two-by-two post-hoc comparisons of continuous variables across the 5 groups were made using the Bonferroni correction.

Results
158 patients with mitral valve prolapse (MVP) were included: 37 without MR, 28 with mild MR, 23 with mild-to-moderate MR, 21 with moderate-to-severe MR and 49 with severe MR. Clinical and echocardiographic results are presented in Table 1. Patients with a higher-grade MR tended to be older and were more likely to be men. They were also significantly more symptomatic. Most echocardiographic parameters were significantly different between grades of MR. RV remodeling, studied with morphologic parameters, started with the first grade of MR and had a linear progression between levels of MR severity (Figure 1A). Load parameters were stable until grade 2 and then showed progressive increase of RV afterload. RV free wall strain slightly increased with MR grade 1, and then decreased with each grade of MR (Figure 1B). RV fractional area change, Tissue Doppler MPI and RV free wall strain rate tended to stagnate between grade 0 and 2, and then they progressively decreased. Combined parameters of RV-PA coupling including load and function, increased with the first grade of MR, and then gradually decreased (Figure 1C).

Conclusion
In this study, multiparametric assessment of the cardiopulmonary unit in patients with MVP showed that RV morphologic remodeling starts with the first grades of MR, before any significant increase of pulmonary pressure. This remodeling seemed to initially enhance RV function (evaluated with parameters of RV – pulmonary artery coupling) in the first grade of MR and was then followed by a progressive decrease of RV function with the increasing severity of MR.
Prognostic prediction of cardiovascular adverse events in patients after percutaneous coronary intervention using machine learning
Authors: Okada K , Kusu K K , Kikuchi S K , Etou H E , Iguchi A I , Onimura Y O , Tsutsumi K T , Hanajima Y H , Kirigaya H K , Nakahashi H N , Matsushita K M , Gohbara M G , Sugano T S , Seki Y S , Hibi K H 
Published: October 2024

Abstract

Introduction
While prevention of major cardiovascular adverse events (MACE) is important in the management of patients after percutaneous coronary intervention (PCI), risk stratification of MACE remains a significant challenge with increasingly diverse and complex patient backgrounds. In response to that, this retrospective observational study aimed to explore whether machine learning (ML) methods can predict future MACE after PCI using a variety of features extracted from electronic medical records (EMRs).

Methods
In 3,016 patients with coronary artery disease who performed PCI, 3 machine learning (ML) algorithms (gentle boost, random forest, and neural network) and statistical model were retrospectively applied to predict the occurrence of MACE within two years after PCI (564 patients, 18.7%). MACE was defined as composite endpoint of cardiac death, myocardial infarction (MI), any revascularization, and congestive heart failure (CHF). Basic patient information (e.g., age, sex, coronary risk factors) and laboratory test results were used for the analysis. Feature importance was calculated to identify key factors for MACE. Hold-out method with an 8:2 split between training and test was used to calculate sensitivity, specificity, positive predictive value, negative predictive value, and F-value for each model.

Results
As shown in Figure 1, ML models showed excellent diagnostic accuracies in the prediction of MACE after PCI, demonstrating higher F-values compared with statistical model (logistic regression analysis). Similar results were seen in the subgroup analyses for estimating cardiac death, MI, revascularization, or CHF. Although the weighting of feature importance for MACE recurrence varied among ML models, infarct size (peak CK levels), increased inflammatory status, and traditional coronary risk factors were identified as important features for predicting MACE within two years after PCI (Figure 2).

Conclusions
It is suggested that ML using EMRs is promising for inferring future MACE within two years after PCI. Further studies are warranted to address whether ML-based risk stratification could lead to improved clinical decision-making after PCI.
The association between elevated systemic inflammation response index and long-term mortality in patients with triple-vessel coronary disease
Authors: Li Q X , Yuan J Q 
Published: October 2024

Abstract

Background
Inflammation is a critical factor in the development of coronary artery disease. The systemic inflammatory response index (SIRI) is a novel biomarker of inflammation. Studies have shown that SIRI is associated with the severity of coronary artery disease. However, there is currently a lack of research on the relationship between SIRI and adverse outcomes in patients with multivessel coronary artery disease. Our study aimed to investigate the correlation between SIRI and long-term mortality risk in patients with triple-vessel coronary disease (TVD) and explore the interaction between SIRI and treatment strategies.

Methods
After excluding patients with missing data or loss to follow-up, a total of 8559 patients with TVD were included in our study. Based on their SIRI levels during hospitalization, patients were evenly divided into three groups (SIRI-L, SIRI-M, and SIRI-H). All patients received appropriate treatment, including medical therapy alone (MT), percutaneous coronary intervention (PCI), or coronary artery bypass grafting (CABG). The primary endpoint was all-cause death. SIRI was calculated by the formula: neutrophil counts × monocyte counts / lymphocyte counts.

Results
During a median follow-up of 6.58 years, a total of 1264 all-cause deaths (14.8%) were recorded. Elevated SIRI was significantly associated with increased mortality rates (11.1%, 14.6%, and 18.6% in the SIRI-L, SIRI-M, and SIRI-H groups, respectively). The risk of all-cause mortality was significantly higher in the SIRI-M and SIRI-H groups compared to the SIRI-L group (adjusted HR: 1.203, 95% CI: 1.037-1.395, p=0.015; adjusted HR: 1.400, 95% CI: 1.212-1.617, p&lt;0.001; respectively). In elderly patients, the relationship between elevated SIRI and the risk of all-cause mortality was more pronounced, while it attenuated in younger patients. Additionally, it is noteworthy that there was an interaction between SIRI and treatment strategy (p=0.037). In patients of the SIRI-L group, there was no significant difference between PCI and CABG treatment. However, in patients of the SIRI-M and SIRI-H groups, CABG shows a significant survival advantage over PCI.

Conclusion
Evaluating SIRI may help identify high-risk groups among patients with triple-vessel coronary disease and guide the selection of treatment strategies.Kaplan-Meier curves
Galectin-3 and cancer mortality in patients with suspected or known coronary artery disease: the ANOX study
Authors: Wada H , Suzuki M , Matsuda M , Ajiro Y , Shinozaki T , Sakagami S , Yonezawa K , Shimizu M , Funada J , Takenaka T , Nakayama T , Iguchi M , Abe M , Akao M , Hasegawa K 
Published: October 2024

Abstract

Background
Galectin-3 is a multifunctional carbohydrate-binding lectin that is involved in inflammation, tissue remodeling, and fibrosis. High circulating levels of galectin-3 are associated with all-cause mortality, cardiovascular (CV) mortality, and/or major adverse CV events in patients with CV diseases such as heart failure and coronary artery disease (CAD). However, the associations of galectin-3 with non-CV mortality and cancer mortality in patients with suspected or known CAD are unknown.

Methods
Serum galectin-3 levels were measured in 2,418 patients with suspected or known CAD undergoing elective coronary angiography. The outcomes were all-cause death, CV death, non-CV death, cancer death, and other non-CV death. Patients were followed up over a 6-year period.

Results
During the follow-up, 536 (22.2%) deaths occurred, including 166 (6.9%) CV deaths, 326 (13.5%) non-CV deaths, 128 (5.3%) cancer deaths, 198 (8.2%) other non-CV deaths, and 44 (1.8%) undetermined deaths. After adjustment for potential clinical confounders (i.e., age, sex, body mass index, hypertension, dyslipidemia, diabetes, current smoker, estimated glomerular filtration rate, the Gensini score, previous myocardial infarction, previous stroke, previous heart failure hospitalization, atrial fibrillation, valvular heart disease, malignancies, anemia, antihypertensive drug use, statin use, and aspirin use) and established CV biomarkers (i.e., N-terminal pro-brain natriuretic peptide, high-sensitivity cardiac troponin I, and high-sensitivity C-reactive protein), galectin-3 levels were significantly associated with all-cause death (hazard ratio [HR] for 1-SD increase, 1.22; 95% confidence interval [CI], 1.13–1.31), CV death (HR, 1.16; 95% CI, 1.02–1.33), non-CV death (HR, 1.27; 95% CI, 1.15–1.40), cancer death (HR, 1.31; 95% CI, 1.07–1.61), and other non-CV death (HR, 1.30; 95% CI, 1.15–1.46). The addition of galectin-3 levels to the model with potential clinical confounders and established CV biomarkers significantly improved the prediction of all-cause death (P&lt;0.001 for continuous net reclassification improvement [NRI], P&lt;0.001 for integrated discrimination improvement [IDI]) and cancer death (P=0.001 for NRI, P=0.005 for IDI), but not that of CV death (P=0.601 for NRI, P= 0.708 for IDI), non-CV death (P=0.060 for NRI, P=0159 for IDI), or other non-CV death (P=0.266 for NRI, P=0.699 for IDI).

Conclusions
The galectin-3 level independently predicted all-cause mortality and cancer mortality in patients with suspected or known CAD.
The incidence of cardiovascular conditions in patients admitted to hospital with and without COVID-19 in the South-East of Scotland
Authors: Bularga A , Gruber F , Lyell I , Kimenai D , Anand A , Pollock K , Sandler S , Mills N 
Published: October 2024

Abstract

Background
Multiple studies have reported an increased risk of acute myocardial infarction, cardiac arrhythmia, heart failure, myocarditis, and venous thromboembolism in patients admitted to hospital with COVID-19 infection. Whether the incidence of these cardiovascular conditions differ in patients hospitalised with COVID-19 compared to those who have COVID-19 excluded is not clear.

Methods
In a prospective, multi-centre, cohort study in secondary and tertiary care hospitals in Scotland, consecutive adults with symptoms of suspected COVID-19 were identified by the attending clinician using an electronic form integrated into the care pathway. Using linked electronic health record data, we evaluated the incidence of acute myocardial infarction, atrial fibrillation, heart failure hospitalisation, myocarditis, and venous thromboembolism during the index admission and the first 90 days following the index admission. In multivariable regression models the frequency of cardiovascular conditions at 90 days were compared in patients with confirmed COVID-19 infection defined by RT-PCR test with those in whom COVID-19 was excluded.

Results
Between April 2020 and May 2022, 53,644 (median age 68 [interquartile range, IQR 49-90] years, 54% women) consecutive patients were hospitalised and underwent RT-PCR for suspected COVID-19 infection. In total, 4,365 (8%) had COVID-19 confirmed and 49,279 (92%) had COVID-19 excluded. At 90 daythe myocardial infarction was less common (2% versus 5%) and venous thromboembolism was more common (6% versus 4%) in patients with COVID-19 compared to those without, but the proportion with atrial fibrillation (15% versus 14%), heart failure hospitalisation (10% versus 9%), and myocarditis (&lt;0.1% versus &lt;0.1%) were similar. Overall, the proportion with a cardiovascular condition at 90 days did not differ in patients with or without COVID-19 (Figure). Age (over 65 years, adjusted hazard ratio [aHR] 2.75, 95% confidence interval [CI] 2,61 to 2.89), male sex (aHR 1.35, 1.30 to 1.40), and risk factors (diabetes [aHR 1.13, 1.08 to 1.19], hyperlipidaemia [aHR 1.09, 1.01 to 1.18], hypertension [aHR 1.45, 1.39 to 1.52]) were independent predictors of cardiovascular complications, whilst COVID-19 status was not associated with increased risk (aHR 0.94, 0.88 to 1.01).

Conclusion
Cardiovascular conditions are common in patients hospitalised with suspected COVID-19, however the incidence at 90 days does not differ in those with or without COVID-19 and COVID-19 infection does not confer an increase in risk.
Single spot albumin to creatinine ratio as an independent predictor of 12 years follow-up mortality in acute coronary syndromes without ST-segment elevation
Authors: Higa C , Castro Ortega J S , Montoya R , Gambarte M J , Korolov Y , Donato M S , Ciambrone M G , Novo F A 
Published: October 2024

Abstract

Background
To the best of our knowledge there is no evidence of the association between microalbuminuria, measured as single spot urine albumin to creatinine ratio (ACR), with very long-term mortality in patients with non-ST segment Elevation Acute Coronary Syndromes.

Aim
To evaluate the association between admission ACR and very long-term all-cause mortality in an unselected cohort of non-ST-segment elevation acute coronary syndromes patients.

Methods
A prospective cohort study was conducted, including patients with non-ST-segment elevation acute coronary syndromes admitted in the Intensive Care Unit. The ACR was determined in spontaneous urine samples during the first 24 hours after admission and analyzed by immunoturbidimetry. The primary endpoint was all-cause mortality during the follow-up. Actuarial survival curves were compared by log rank test and a logistical Cox regression analysis was performed to identify variables independently associated with mortality in the follow-up. Statistics were calculated using the IBM Statistics program SPSS version 26.

Results
600 patients were analyzed. The overall average ACR value was 7 mg/gr (95% CI 4-26). 76% had normoalbuminuria (ACR 0-30 mg/gr), 22% had microalbuminuria (ACR 30-300 mg/gr), and 1.5% had macroalbuminuria (ACR &gt; 300 mg/gr). The median and interquartile range of follow-up was 12 years (95% IC 11-14). The average ACR among those who met the primary endpoint was 59.15 mg/gr (95% CI 52-66) and among the survivors, 27.66 mg/gr (95 % CI 63-77), p &gt; 0,003. ACR terciles were defined by 33th and 66th percentiles: tercile 1: patients with ACR of 0 to 4 mg/gr, tercile 2: ACR from 4 to 17 mg/g and tercile 3 values greater than 17mg/gr. Strong associations were observed between ACR with age, hypertension, stroke and history of COPD, previous use of angiotensin II converter/blocking enzyme inhibitors, systolic blood pressure at admission, ST segment deviation, left ventricle ejection fraction and elevation of serum Troponin T and CPK MB. All cause-mortality during the follow-up was 14% (CI 95% 11-17). Elevation of ACR was significantly associated with long term mortality risk: log rank test chi square: 133.936, p = 0.0001. By multivariate Cox regression analysis adjusted by age, gender, diabetes, hypertension, serum creatinine, troponin T elevation, ST segment deviation, previous AMI, prior use of aspirin, statins and percutaneous coronary intervention after hospitalization, the ACR was independently associated with a 12-year follow-up mortality: OR 13 (95% IC 5-35; p &lt; 0.0001).

Conclusion
Single spot urine ACR at admission is a strong predictor of 12-year follow-up mortality in an unselected cohort of patients with non-ST-segment elevation acute coronary syndromes.Baselines characteristics of cohortsMultivariable COX regression analysis
Electrocardiogram-based artificial intelligence to identify prevalent coronary artery disease
Authors: Kany S , Friedman S F , Al-Alusi M , Khurshid S , Raemoe J T , Pipilas D , Pirruccello J P , Reeder C , Phillippakis A A , Ho J E , Maddah M , Ellinor P T , Fahed A C 
Published: October 2024

Abstract

Background
Coronary artery disease (CAD) often goes undetected for years before it manifests and results in substantial morbidity and mortality. Some patients have neither typical risk factors nor symptomatic angina despite progressive disease.

Purpose
Develop a deep-learning model to detect prevalent CAD and identify people at risk for adverse events using electrocardiograms (ECG) in a primary care setting.

Methods
We developed a convolutional neural network using 12-lead ECG waveforms to discriminate the presence of CAD defined using diagnostic codes ("ECG2CAD"). ECG2CAD was trained on 764,670 ECGs from 137,199 individuals at the Massachusetts General Hospital (MGH). Model performance for discrimination of prevalent CAD was measured using AUROC and AUPRC, and compared against a model comprising age and sex, as well as the Pooled Cohort Equations (PCE), in three test sets independent of model training: MGH, Brigham and Women’s Hospital (BWH) and UK Biobank. ECG2CAD was assessed across subgroups of age, sex and self-reported ethnicity and for incident CAD-related events in the BWH primary care subset.

Results
ECG2CAD was evaluated in MGH (N=18,706 [N=6,051 cases], age 57±16 years), BWH (N=88,270 [N=27,898 cases], age 57±16 years), and UK Biobank (N=42,147 [N=1,509 cases], age 65±8 years). ECG2CAD consistently discriminated prevalent CAD (MGH: AUROC 0.782, AUPRC 0.639; BWH: AUROC 0.747, AUPRC 0.588; UK Biobank: AUROC 0.760, AUPRC 0.155) and incrementally improved upon both a model based on age and sex (p&lt;0.01) and the PCE (p&lt;0.01) in MGH and BWH.
In the BWH primary care subset (N=51,808), model performance was consistent in subgroups defined by age, sex and self-reported ethnicity/race. The incorporation of ECG2CAD in addition to age and sex consistently improved discrimination (AUROC delta of 0.011-0.086) in all subgroups.
In the BWH primary care subset with over 10 years of follow-up, we observed that either the presence of ECG2CAD-predicted CAD (HR 2.18, 95% CI 2.00-2.38, P&lt;0.001) and ICD-based known CAD (HR 2.13, 95% CI 1.86-2.45, P&lt;0.001) were associated with increased risk for incident myocardial infarction. The presence of both definitions was associated with an almost five-fold increase in risk (HR 4.97, 95% CI 4.51-5.48, P&lt;0.001).
The risk of incident adverse events was highest among people in the top quintile of ECG-based predicted risk (high risk) compared with people from quintile 4-2 (intermediate risk) or the lowest quintile (low risk), even when excluding those with known prevalent CAD at baseline.

Conclusions
Artificial intelligence-enabled analysis of the 12-lead ECG may facilitate efficient identification of individuals with possible undiagnosed CAD and inform downstream testing and preventive measures.
Diagnostic performance of coronary computed tomography angiography for coronary in-stent re-stenosis
Authors: Kim D , Cho S W , Kim B G , Kim G S , Byun Y S , Hwang J , Kim G , Doh J H 
Published: October 2024

Abstract

Background
Through the development of CT equipment and proper preparation before CT scanning, the accuracy of Coronary computed tomography angiography (CCTA) diagnosis of ischemic heart disease (IHD) is improving, and the role of CCTA in treatment decision is gradually expanding. The latest guidelines recommend CCTA as Class IIa to evaluate stent patency and native vessels in patients with chronic coronary disease. However, diagnostic performance of CCTA to evaluate stent patency in patients who underwent coronary stent was not clarified, respectively the role of CCTA in the evaluation of IHD in native coronary artery was established..

Purpose
In the present study, we evaluate the agreement between CCTA and CAG in assessing stent patency in patients with de novo ischemic chest pain who underwent percutaneous coronary intervention (PCI) and evaluated which factors contribute to the differences.

Methods
From January 1, 2010 to December 31, 2020, we analyzed 845 patients who underwent new CCTA and CAG sequentially for the evaluation of chest pain previously underwent PCI. In CAG and CCTA, ISR is equally defined as a stenosis greater than 50% of the vessel diameter of within the stented segment or its edge (5-mm segments adjacent to the stent). The degree of In-stent restenosis was analyzed by an independently by quantitative coronary angiography (QCA).

Results
A total of 208 stents were analyzed, the pooled sensitivity and specificity for CCTA on the diagnosis of ISR were 0.78 (0.65-0.89) and 0.93 (0.88-0.96), respectively. LR+ and LR- were 11.19 (6.22-20.15) and 0.23 (0.14-0.39). As a result of analyzing the ISR diagnostic agreement of CCTA by dividing into ACS and CCD group, the agreement of CCTA for ISR diagnosis was relatively low in the ACS group (Sensitivity 0.69 (0.48-0.86) vs. 0.88 (0.69-0.97), specificity 0.92 (0.84-0.97) vs. 0.94 (0.86-0.98), LR+ 9 (4-20.24) vs. 13.9 (5.88-32.88), LR- 0.33 (0.19-0.6) vs. 0.13 (0.04-0.37)) (Table 1). As a result of analyzing related factors in cases of discrepancy in ISR diagnosis, the degree of stenosis in both ACS and CCD groups was mostly intermediate stenosis, which often required additional clinical evaluation (Figure 1).

Conclusion
When new ischemic chest pain occurred in a patient who previously underwent PCI, the diagnostic accuracy of ISR by CCTA differed depending on the patient’s IHD category. In the CCD group, the diagnostic usefulness of CCTA was comparable both native vessels and ISR, but not in the ACS group. As majority of ISR diagnostic discrepancies were in intermediate lesions, even in the ACS group, CCTA may be considered as a diagnostic tool.