bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating trends and insights in cardiovascular risk among the polish population
Authors: Kubielas G , Uchmanowicz I , Lisiak M , Czapla M , Wleklik M 
Published: October 2024

Abstract

Introduction
Cardiovascular diseases (CVD) are the leading cause of death in Poland and worldwide. Lifestyle changes and early diagnosis can reverse this unfavorable trend. In the face of escalating global health challenges, the identification of CVD risk factors becomes paramount, especially within national contexts where demographic shifts and lifestyle changes can significantly impact the health profile of the population.
Aim of the study. Determining the prevalence of CVD risk factors in the Polish population and analyzing their changes over time.

Material and Methods
Data of 705,420 Poles aged 35-55 years who were enrolled in CVD disease prevention programme between 2012 and 2021 were analysed. The prevalence of the following CVD risk factors was determined: nicotinism, hypertension, elevated total cholesterol, elevated LDL, reduced HDL, elevated triglycerides, elevated glucose (indicating pre-diabetes), low physical activity, overweight, obesity, SCORE ≥5%. In addition, we assessed how the mean SCORE, BMI, systolic blood pressure, diastolic blood pressure, total cholesterol, LDL cholesterol, LDL cholesterol, triglycerides, glucose levels and waist circumference changed over time.

Results
Nicotinism affected 17.98%-24% of women (W) and 27.29%-36% of men (M). Hypertension was in 7.04%-8.58% of W and 17.45%-19.62% of M. Elevated total cholesterol were in 55.69%-63.64% of W and 65.91%-72.68% of M. Elevated LDL were in 44.77%-54.2% of W and 58.26%-65.48% of M. Reduced HDL were in 9.84%-11.52% of W and 14.48%-16.57% of M. Elevated triglyceride were in 13.44%-15.37% of W and in 33.81%-36.29% of M. Elevated glucose indicating a pre-diabetic status were in 10.70%-13.16% of W and in 18.91%-22.76% of M. Low physical activity was in 75.96%-82.2% of W and 73.32%-81.67% of M. Overweight conditions were in 30.37%-31.67% of W and 48.61%-49.45% of M. Obesity affected 14.04%-17.12% of W and 20.67%-24.69% of M. SCORE ≥ 5% was in 0.23%-0.38% of W and in 13.08%-18.72% of M. There was a decrease in the mean SCORE value (-0.08; 95%CI: -0.09 - -0.06) from 2012. An increase over time was noted in mean BMI (-0.01; 95%CI: -0.05 - 0.04). There was a slight decrease followed by a notable increase over time in mean systolic (-0.35; 95%CI: -0.47 - -0.24) and diastolic blood pressure (-0.25; 95%CI: -0.32 - -0.18). There was a decrease in mean total cholesterol (-3.29; 95%CI: -4.27 - -2.31) and mean LDL cholesterol (-3.11 95%CI: -4.22 - -2.01). A notable increase was observed in mean glucose values (0.01; 95%CI: 0-0.01). Over time, there was an increase in mean waist circumference value (-0.19; 95%CI: -0.54-0.16).

Conclusions
The escalation of CVD risk among the Polish population is illustrated, with a marked increase in obesity, sedentary lifestyles and indicators of metabolic syndrome. These trends highlight the urgent need for targeted public health initiatives and for the implementation of comprehensive strategies to mitigate these risks
Prediction of nonsustained ventricular tachycardia development by the analysis of premature ventricular complex-related intervals on 24-hour rhythm monitoring and testing a novel index
Authors: Erdem A , Oguz M , Uzun M , Dogan S , Babaoglu M , Orhan A L 
Published: October 2024

Abstract

Introduction
Ventricular tachycardia (VT) and ventricular fibrillation (VF) are life- threatening arrhythmias, with non-sustained ventricular tachycardia (NSVT) serving as a potential precursor. Identifying individuals at risk of NSVT is crucial for effective management and prevention of sudden cardiac death in high-risk patients. In daily clinical practice, premature ventricular complex (PVC) and sometimes NSVT are frequently detected on 24-hour ambulatory rhythm monitoring.

Purpose
In this study, we aimed to predict the development of NSVT by analyzing PVC morphology and intervals in 24- hour ambulatory rhythm monitorings.

Methods
A retrospective analysis of 24-hour ambulatory rhythm monitoring recordings from 2018 to 2023 was conducted. Inclusion criteria required clear measurement of PVC intervals, at least 100 PVC in the recording, and two preceding normal QRS beats. NSVT diagnosis was based on four consecutive PVC lasting &lt;30 s and a rate &gt;100/min. Various PVC-related parameters were analyzed, and new variables were derived. Statistical analysis included Mann-Whitney U tests and ROC analysis.

Results
The study included 202 patients, revealing significant differences in several VES temporal variables between groups with only PVC (Group I) and PVC with NSVT (Group II). Notably, Age-Adjusted Sum of Intervals Index (AASI Index-(100 x [(Tp-to- QRSvpa)+(coupling time)+(Qtc1)]/age), long coupling times, extended Tp-to-QRSvpaintervals, and prolonged Tpe-vpa intervals were associated with NSVT development. Age played a pivotal role in predicting NSVT when integrated into a specific variable AASI index. The optimal cut-off value was 4.21, with 84% sensitivity and specificity.

Conclusion
The study suggests that ventricular arrhythmias may be predicted using temporal parameters of PVC, especially when age is included as a modifier. The AASI index calculated on a PVC and preceeding two normal beats on 24-hour ambulatory rhythm monitoring seems to be promising parameter. These findings hold potential for future development of artificial intelligence-based algorithms for use in any PVC to identify at-risk patient groups, provided larger datasets are utilized to refine predictive models.Variables included in the analysis for cDefinitions of variables and ROC curve
Exercise intolerance at hospital discharge as a predictor for readmission and mortality after aortic aneurysm repair
Authors: Shibuya M , Hamazaki N , Kobayashi S , Ichikawa T , Kariya H , Uchida S , Noda T , Ueno K , Maekawa E , Meguro K , Kamiya K , Matsunaga A , Kitamura T , Ako J , Miyaji K 
Published: October 2024

Abstract

Background
As procedures of aortic aneurysm repair have advanced, an increased number of surgeries performed for older patients and those with comorbidities and low activities of daily living. Conversely, since these patients frequently suffer from difficulty returning to their daily activities after the surgery, physical function is considered an important indicator for risk classification and treatment effect evaluation. However, in patients following aortic aneurysm repair, the association between physical performance and clinical outcomes is not thoroughly evaluated.

Purpose
We aimed to clarify whether physical function at hospital discharge predicted clinical outcomes, including readmission rates and mortality, in patients following aortic aneurysm repair.

Methods
This was a single-centre cohort study. We included the patients admitted to a tertiary hospital to undergo surgery or endovascular repair for aortic aneurysm and who received cardiovascular rehabilitation during hospitalisation. As patient characteristics during hospitalisation, age, sex, body mass index (BMI), urgent or standby surgery, surgical type (open repair or endovascular), and comorbidities were obtained from medical records. We also reviewed 6-minute walk distance (6MWD) as physical function at hospital discharge, and 6MWD &lt;300 m was defined as exercise intolerance. The primary and secondary endpoints were readmission and death for all causes, respectively. The multivariate Cox regression analysis was used to examine whether exercise tolerance predicted the endpoints.

Results
The 365 patients were studied for analysis. Exercise intolerance was observed in 107 patients (29.3 %). During the median follow-up period of 2.3 years, readmission and mortality for all causes occurred in 161 (44.1 %) and 39 (10.7 %), respectively. After adjusting for patient characteristics, including age, sex, BMI, urgent or standby surgery, and surgical type, exercise intolerance defined by 6MWD &lt;300 m was significantly associated with higher mortality (adjusted hazard ratio [aHR]: 2.21, 95% confidence interval [CI]: 1.05–4.66, Figure 1-A) and readmission rates (aHR: 1.63, 95% CI: 1.13–2.34, Figure 1-B).

Conclusions
In patients following aortic aneurysm repair, exercise intolerance at hospital discharge independently predicted readmission and death for all causes. Our findings suggest that physical function after the aortic aneurysm repair is a useful predictor for patient risk classification and an indicator for treatment effect evaluation.
Evaluating an integrated clinical pharmacy service model in an ambulatory cardiac clinic- a single centre study
Authors: Khalil V , Nguyen G , Doody H , Tran M , Duong J 
Published: October 2024

Abstract

Background
Evidence suggests that multidisciplinary cardiology clinics improve patient outcomes. Currently, there is limited data on the type of pharmacist-led interventions occurring in cardiac ambulatory clinics in the Australian setting.

Purpose
The primary aim of this pilot audit is to examine the frequency and type of pharmacist-led interventions in the ambulatory clinics of this specialist hospital. The secondary aim is to assess factors associated with hospital readmissions within 30 days of Pharmacists' reviews.

Methods
A retrospective pilot audit was conducted for patients who attended an integrated multidisciplinary Heart Failure (HF) and Hypertension (HTN) clinic from April 2023 to February 2024. Patients’ demographics, Charlson comorbidity index (CCI), and the number and types of pharmacist interventions and readmission data 30 days post clinic review were recorded.
Descriptive statistics were used to evaluate patient characteristics and logistic regression for hospital readmissions.

Results
A total of 398 patients were reviewed by pharmacists, with 300 (75%) from the HF clinics and 98 (25%) from the HTN clinics. Patients’ median age was 63± 14.8 years and median CCI was 4± 3.7. Pharmacists documented medication histories for all patients (100%) and provided 355 recommendations, of which 213 (60%) were actioned by the cardiologist. Pharmacists had a face-to-face consultation and provided education and counselling to 175 (44%) patients. The most common types of interventions were related to guideline-directed prescribing and deprescribing (68, 39%), followed by up-titration of current therapies (61, 35%). Pharmacists also provided education on medication adherence and lifestyle modifications (28, 16%) as well as optimizing medications related to other comorbidities (18, 10%). A total of 8 patients (2%) were re-admitted l within 30 days of clinic review from either heart failure exacerbation or hypertensive crisis. Patients who had a face-to-face consultation and education with a pharmacist were less likely to be readmitted within 30 days (P=0.048). However, none of the other predictors tested for readmission such as age (P= 0.572), gender (0.296), history of non-compliance (0.834), CCI (0.984) or a diagnosis of HF or HTN (0.473) were predictors for readmission within 30 days of clinic review.

Conclusion
Pharmacists play an integral role in the cardiac ambulatory setting by providing expert medication advice and patient education to optimize patients’ outcomes. This study demonstrates that the activities performed by pharmacists working in Australian cardiac clinics are consistent with other international ambulatory clinics. The study also identified opportunities to develop a similar service for other ambulatory clinics at this hospital such as lipid and atrial fibrillation clinics. Additionally, further research is required to assess long term benefit of pharmacist led interventions on cardiac patients.
Development of a novel Patient-Reported Outcome Measure (PROM) for adults with an Inherited Cardiac Condition (ICC)
Authors: Van Pottelberghe S , Van Der Crabben S N , Amin A S , Wilde A A , Scheirlynck E , Nekkebroeck J , Hes F , Kupper N 
Published: October 2024

Abstract

Background
Research on the quality-of-life (QoL) among patients with inherited cardiac conditions (ICC) is limited. Existing evidence from a systematic review indicates that most studies rely on generic measures of health-related QoL, which may not adequately capture ICC-specific factors. The current study aims to develop a disease-specific patient-reported outcome measure to address this gap.

Methods
Using a qualitative study design, we first conducted focus groups until data saturation was achieved (n=15). Additionally, an expert panel of healthcare professionals was interviewed to ascertain their perspectives on patient-centered care and to evaluate face validity. Transcripts of all focus groups and interviews were analyzed thematically using Atlas.ti, qualitative analysis software, to identify concepts and formulate survey items for the initial instrument. We used the ‘Centre for Health Promotion’ QoL model, consisting of three domains- Being, Belonging, and Becoming- as the theoretical framework for our analysis.

Results
Our analysis revealed alignment with specific QoL domains of the overarching framework and identified a gap in genetic-specific domains. A novel overarching theme, genetic well-being, was identified, encompassing specific constructs related to future uncertainty, reproductive concerns, and the anticipation of disease development, thus enriching the conceptualization of QoL in the context of inherited cardiac conditions. The discussion will include an exploration of the face validity of the draft instrument.

Conclusion
Patients diagnosed with an inherited cardiac condition (ICC) face a spectrum of challenges originating from both disease-related stressors and hereditary factors alike. Recognizing that relying solely on objective clinical assessment may fail to capture the full impact of the disease, there has been an increasing focus on incorporating patient-reported measures into disease evaluation. This qualitative study contributes to developing a comprehensive patient-reported outcome measure tailored to individuals with ICC.PROM development study
Defibrillation deactivation state and activation status in patients with implantable cardioverter-defibrillators at the end of life
Authors: Narumi S , Kondo Y K , Nakano M , Kajiyama T , Ito R , Chiba T , Yoshino Y , Ryuzaki S , Komai Y , Takanashi Y , Ono H , Hosoya Y , Kitamura A , Tsuchiya Y , Kobayashi Y 
Published: October 2024

Abstract

Background
Implantable cardioverter-defibrillators (ICDs) are effective in preventing sudden cardiac death due to lethal arrhythmias. Defibrillation is also known to cause physical and emotional distress to patients, and guidelines on palliative care for cardiovascular disease recommend that when patients with ICDs reach the end of life, the benefits and burdens of ICDs should be fully explained to patients and a policy regarding the cessation of defibrillation discussed. However, there are few reports on the treatment status and defibrillation deactivation in patients with ICDs in the terminal phase.

Aim
To investigate defibrillation activation and defibrillation deactivation in terminally ill patients with ICDs.

Results
Death was confirmed in 146 patients in the medical record, and a DNAR policy was decided in 46 patients. The decision to deactivate defibrillation was informed to 24 patients (16%), and 15 patients (10%) were deactivated (11 patients in terminal heart failure and 4 patients in others). Four of the nine patients (6%) who did not deactivate defibrillation had a shock before death.Of the 22 patients (14 cardiovascular deaths and 8 others) who were not explained about the deactivation of defibrillation, 4 had shock activation before death.Of the 24 patients who received explanation about defibrillation deactivation, 6 (25%) had the policy decided by the patient and family, and 18 (75%) had the policy decided by the family because the patient's will could not be confirmed due to deterioration of end-stage condition.

Discussion
This study showed that defibrillation was deactivated in only 10% of Japanese patients with end-stage ICDs.ICD patients do not always reach the end of life due to heart failure. It is important for physicians, clinical engineers, and device nurses involved in device care to provide information and to confirm the wishes of patients and their families regarding the deactivation of defibrillation so that they can be supported in their decision-making regarding defibrillation no matter under what circumstances they reach the end of life.

Conclusion
Discussion of ICD deactivation in palliative care is needed to reduce the risk of painful shock and distress at the end of life.
Predicting major adverse cardiovascular events in suspected myocarditis patients using cmr late gadolinium enhancement radiomics: a time-to-event prognostication modeling
Authors: Shiri I , Baj G , Mohammadi Kazaj P , Balzer S , Schutze J , Valenzuela W , Pavlicek-Bahlo M , Kwong R , Graeni C 
Published: October 2024

Abstract

Background
Myocarditis, characterized by inflammation of the heart tissue, exhibits a wide range of clinical manifestations; however, stratifying its risk is difficult.

Objective
We aimed to prognosticate Major Adverse Cardiovascular Events (MACE, i.e., death, sustained ventricular arrhythmia, heart failure hospitalization, and recurrent myocarditis) in patients with suspected myocarditis using cardiac magnetic resonate (CMR) late gadolinium enhancement (LGE) radiomic features.

Method
We enrolled consecutive 1099 patients (age: 47.68±16.56, 39.63% female) undergoing CMR with the initial suspicion of myocarditis based on the judgment of the referring physician, recruited from two major registries. We used fully automated deep learning tools to determine the segmental extent of LGE in the left ventricle. Furthermore, we pre-processed the dataset through bias-field correction and intensity normalization to ensure the model consistency across various image acquisitions. Different radiomic features, including shape, intensity, and texture, were extracted from CMR-LGE. We employed several feature selection methods and time-to-event survival models based on radiomics features. The development process, covering pre-processing, feature selection, and hyperparameter optimization, utilized 70% of the dataset (10-fold cross-validation). The evaluation was performed on the remaining 30% of the test set. Model performance was measured using the c-index and cumulative AUC (C-AUC) on the untouched 30% test set.

Results
The top-performing model, employing a 90% variance threshold with the survival support gradient boosting model, achieved a C-Index of 0.76 and a cumulative C-AUC of 0.80. The Random Forest Survival model was a close second, with a C-Index of 0.75 and a C-AUC of 0.79. The conventional multivariate Cox-PH model achieved a C-Index of 0.67 and a C-AUC of 0.70.

Conclusion
Utilizing radiomics features from the CMR-LGE, combined with machine learning algorithms, allows accurate prediction of MACE in suspected myocarditis patients. The performance of the Radiomics model could be improved by including other modality information.
Selective use of implatable loop recorders improves diagnostic potential for unexplained syncope
Authors: Archontakis S , Oikonomou E , Sideris K , Venetsanos D , Tsalamandris S , Trantalis G , Dourvas P , Milaras N , Kostakis P , Klogkeri T , Paraskevopoulou D , Triantafyllou E , Gika A , Gatzoulis K , Skevos S 
Published: October 2024

Abstract

Background
Syncope remains a common medical problem with significant socio-economic consequences. Recently, the role of dedicated Syncope Units (SU) and implantable loop recorders (ILR) has emerged, in the investigation of unexplained syncope.

Purpose
To investigate the possibilities for a more rational and targeted use of various diagnostic tools.

Methods
In this retrospective study, 196 patients with Unexplained Syncope admitted in a single SU, between March 2019 and February 2023 were included. Various diagnostic tools were utilised during the investigational process, according to clinical judgement. Patients were retrospectively allocated into Group A including those who, among other tests, underwent ILR insertion and Group B including patients investigated without ILR implantation. Data were also compared with Group C, including patients assessed prior to SU establishment.

Results
There was no difference between Group A (n=133) and Group B (n=63) in the diagnostic yield (74% vs. 76%, p=0.22). There was significant difference between Group A and B regarding age (67.3 ± 16.9 years vs. 48.3 ± 19.1 years, p&lt;0.001) and regarding cause of syncope (cardiogenic in 69% of group A and reflex syncope in 77% of group B, p&lt;0.001). The diagnosis was based on electrocardiography (ECG) in 55% of group A and in 19% of group B (p&lt;0.001). Time to diagnosis was 4.2 ± 2.7 months in patients with ILR implantation and 7.5 ± 5.6 months in Group B, p&lt;0.001. In Group C, the diagnostic yield was 57.9% and the ECG-based diagnostic yield was 18.3%.

Conclusions
A selective use of ILR according to the clinical and electrocardiographic characteristics represents an acceptable diagnostic pathway that increases the effectiveness of the structured SU-approach by further preserving financial resources
Multi-modality deep learning prediction of heart age: insights from UK-Biobank
Authors: Siontis G , Le Goallec A , Prost J B , Collin S , Diai S , Vincent T , Patel C 
Published: October 2024

Abstract

Background
Identification of apparently healthy individuals at high cardiovascular risk who may benefit from targeted preventive strategies remains challenging. Predicted heart age, the chronological age of individuals with similar absolute cardiovascular disease (CVD) risk but with no risk factors, has been proposed to appropriately describe the absolute CVD risk over conventional prediction tools.

Purpose
To develop multi-modality based deep learning predictors for heart age in UK-Biobank individuals.

Methods
We used deep learning to develop a heart age predictor based on videos from heart magnetic resonance imaging (MRI) (anatomical dimension), electrocardiograms (ECG) (electrical dimension) or both from 45000 individuals of the UK Biobank cohort (age range 45-81 years) (Figure). We estimated the heritability of heart aging and identified single-nucleotide polymorphisms associated with accelerated heart aging. We performed X-wide association study to identify non-genetic factors potentially associated with accelerated heart aging.

Results
We predicted age with a mean absolute error (MAE) of 2.5±0.03 years (R2=85.6±0.6%) and found that accelerated heart aging is heritable at more than 35%. MRI-based anatomical features predicted age better than ECG-based electro-physiological features (MAE=2.29±0.03 years versus 4.90±.0.08 years), and heart anatomical and electrical aging were weakly correlated (Pearson correlation=0.249±0.002). Our attention maps highlighted the aorta, the mitral valve, and the interventricular septum as key anatomical features driving heart age prediction in videos that capture the entire heartbeat cycle. We found accelerated anatomical and electrical heart aging to be genetically correlated (Pearson correlation=0.508±0.089). The most significant locus was in TTN (Titin) and it was associated with heart anatomical aging. Cardiovascular diseases, general health status, and mental health disorders were highly associated with accelerated heart aging.

Conclusions
A multi-modality based deep learning approach was highly predictive of heart age. Accelerated heart age has a complex biological basis with genetic and environmental correlates. Leveraging of the described pipeline to predict survival and the onset of age-related cardiovascular diseases may shed light on heart aging role in health outcomes and effectively guide personalized preventive strategies.