bluuebunny/crossref_metadata_2025_split huggingface dataset:
Natural language processing realises the potential of electronic health records: identifying risk factors for disease progression and major adverse limb events in intermittent claudication
Authors: Froud J , Landin M , Patel A , Smith A , Wu H C , O' Gallagher K , Modarai B 
Published: October 2024

Abstract

Background/Introduction
Peripheral Arterial Disease (PAD) is a common pathology, affecting 4.5% of the UK population. Symptomatic PAD manifests as intermittent claudication (IC). Predictors of IC progression to Chronic-Limb-Threatening Ischaemia (CLTI) and complications including Major Adverse Limb Events (MALE), such as smoking history and diabetes, have been described previously in resource-intensive cohort studies. Novel Natural Language Processing (NLP) approaches transform routinely collected, unstructured health records into datasets for real-world analysis of PAD.

Purpose
This study leverages NLP based interrogation of electronic health records to efficiently identify risk factors for disease progression and MALE in patients presenting with IC.

Methods
A retrospective cohort study of patients with PAD at a large, tertiary vascular referral centre identified using the SNOMED terms of IC in the Medcat-NLP-AI toolkit. Demographics, Index of Multiple Deprivation (IMD), and indicators of disease progression, and revascularisation and amputation (MALE) were analysed using Kaplan-Meier survival and Cox Proportional-Hazards analysis.

Results
5,027 patients (Mean age 73.7(61.8-85.6), Males 66.1% (n=2,781) were identified. Self-reported population ethnicity was 4.72% Asian, 15.5% Black, 79.7% White. All-cause mortality was 19.5% (n=979) after 10 years of follow-up, with 5.85% of patients progressing to CLTI (n=294). 2.32% of Asian patients, 5.78% of Black patients and 5.04% of White patients progressed to CLTI, respectively. 5.09% of Asian patients, 8.99% of Black patients, and 7.36% of White patients underwent amputation. Multivariate analysis of risk factors for progression to CLTI, demonstrated that diabetes (HR 2.36, 95%CI: 1.22 - 4.48, p = .01) and smoking history (HR 1.76, 95%CI: 1.19 - 2.59, p = .004) independently predicted progression. No risk factors for MALE reached significance.

Conclusions
Diabetes and smoking behaviour are well-described in the literature as risk factors for progression to CLTI. This study demonstrates the utility of NLP as a resource efficient, validated, methodological tool. Disparities in MALE may exist between patients within a universal healthcare system, although our sample size was insufficient to demonstrate statistical significance. A larger, multicentre analysis is warranted. NLP represents a valuable tool for efficiently identifying and analysing risk factors for PAD progression and holds potential to refine management algorithms.KM curves of CLTI-free survival (DM)
Factors affecting in-hospital clinical outcomes in patients with acute limb ischemia undergoing endovascular therapy or fogarty thrombectomy: a large-scale analysis based on the JROAD-DPC database
Authors: Ozawa T , Yanishi K , Yoshimura J , Goto D , Kawamata H , Fujioka A , Seki T , Zen K , Matoba S 
Published: October 2024

Abstract

Background
The etiology of acute limb ischemia (ALI) involves embolism as well as atherosclerotic thrombosis. Although endovascular therapy (EVT) or Fogarty thrombectomy (Fogarty TE) is the recommended revascularization method for ALI, treatment choice based on patient characteristics remains controversial.

Purpose
This study aimed to evaluate the differences in clinical outcomes between primary treatments and identify predictive factors affecting clinical outcomes in patients with ALI.

Methods
This retrospective study used data from the Japanese Registry of All Cardiac and Vascular Diseases-Diagnosis Procedure Combination (JROAD-DPC) database, from April 2012 to March 2020. We analyzed 18,701 patients with ALI and categorized them into medication and invasive treatment groups (EVT alone, Fogarty TE alone, bypass surgery alone, and hybrid treatment). The EVT-alone and Fogarty TE-alone groups were compared after propensity score matching, considering 19 clinically relevant covariates. The primary outcomes were in-hospital mortality, major amputation, and bleeding complications (anemia requiring transfusion or endoscopic hemostasis). The secondary outcomes were major adverse cardiovascular events (myocardial infarction, coronary intervention, heart failure, stroke, and cerebral hemorrhage), major amputation and/or death, hospitalization duration, and total cost during hospitalization.

Results
The EVT-alone group had more patients at a higher risk of atherosclerotic disease, including peripheral artery disease (PAD), chronic kidney disease (CKD), or hemodialysis. The Fogarty TE-alone group had more patients at a higher risk of embolism, including AF or AFL. After propensity score matching, in-hospital mortality (odds ratio [OR]: 1.58, 95% confidence interval [CI]: 1.29–1.92, p&lt;.0001), bleeding complications (OR: 1.28, 95% CI: 1.12–1.46, p=0.0002), and major amputation rates (OR: 1.44, 95% CI: 1.17–1.76, p=0.0004) were significantly higher in the EVT-alone group than in the Fogarty TE-alone group. Major amputation and/or death rates and total hospitalization costs were higher in the EVT-alone group than in the Fogarty TE-alone group. In interaction analyses, EVT demonstrated a favorable trend of lower risks of death and/or major amputation in patients with PAD, CKD, and diabetes mellitus (all risk factors for atherosclerotic disease), especially in those with PAD and CKD.

Conclusions
Fogarty TE may be the preferred primary treatment for patients with ALI, particularly those without PAD or CKD.Study flowchartForest plot analyzing interaction effect
Echocardiographic signs of atrial cardiopathy and MRI-detected silent brain infarcts in a middle-aged cohort: the Akershus Cardiac Examination 1950 Study
Authors: Ihle-Hansen H , Magnar Gangas Solberg M G S , Marte Meyer Walle-Hansen M M W H , Thea Vigen T V , Trygve Berge T B , Guri Hagberg G H , Hege Ihle-Hansen H I H , Bente Thommessen B T , Kjetil Steine K S , Mona Kristiansen Beyer M K B , Helge Rosje H R , Ole Morten Ronningen O M R , Arnljot Tveit A T , Magnus Nakrem Lyngbakken M N L , Peter Selmer Ronningen P S R 
Published: October 2024

Abstract

Background
Atrial fibrillation (AF) is linked to clinical stroke and silent brain infarction (SBI). In the majority of AF patients, there exists a recognized form of atrial cardiopathy, and it is suggested that atrial cardiopathy, even in the absence of AF, may serve as a risk factor for stroke. However, existing evidence is limited, and it remains unclear whether atrial cardiopathy indeed poses a risk for stroke and SBI.

Purpose
We aimed to investigate the association between echocardiographic signs of atrial cardiopathy and the detection of SBI through magnetic resonance imaging (MRI) in a middle-aged cohort from the general population.

Methods
In the prospective Akershus Cardiac Examination (ACE) 1950 Study conducted within the general population in Norway, cardiovascular risk assessment including transthoracic echocardiography, was undertaken at study inclusion between 2012 and 2015. We assessed body surface area-indexed left atrial (LA) maximum and minimum volume, as well as LA reservoir and contractile strain. Subsequently, brain MRI was conducted in a subset of the cohort between 2017 and 2023. SBI was defined as presence of neuroimaging sign of infarcts, including lacunes, in individuals without a history of stroke. Logistic regression analyses were performed to explore the associations between echocardiographic measures of atrial cardiopathy and SBI on MRI, adjusting for sex, age, hypertension, and diabetes.

Results
A total of 397 out of 3706 (10.7%) participants in the ACE 1950 study underwent MRI examination and were included in this analysis. At the time of MRI, the mean age was 70.0±2.2 years, with 157 (40%) women, 248 (62%) with hypertension, and 36 (9%) with diabetes at study inclusion. SBI was present in 51 (13%), of which only 1 (2%) had known AF. After excluding 18 participants with pre-existing AF, no significant difference were observed in LA volumes or LA strain between participants with or without SBI (Figure 1). In unadjusted and adjusted logistic regression analyses, neither LA volume nor LA strain were associated with SBI (Table 1).

Conclusion
Echocardiographic signs of atrial cardiopathy were not associated with silent brain infarcts in a middle-aged cohort from the general population.
Cardiovascular outcomes in patients with newly diagnosed atrial fibrillation and previous stroke: a plausible impact of stroke-heart syndrome using longitudinal data from the GLORIA-AF registry
Authors: Lam S H M , Romiti G F , Olshansky B , Chao T F , Huisman M V , Lip G Y H 
Published: October 2024

Abstract

Background
Patients with new onset atrial fibrillation (AF) and previous stroke events (PS) represent a high-risk cohort and may represent a particular manifestation of the so-called stroke-heart syndrome. Whether the long-term risks of cardiovascular (CV) outcomes and mortality are different among AF patients with different number of PS remain uncertain.

Purpose
To evaluate if the risks of cardiovascular outcomes are different among AF patients with different number of PS.

Methods
Data from phase III of the prospective GLORIA-AF (Global Registry on Long-Term Oral Anti-thrombotic Treatment in Patients With Atrial Fibrillation) were used. The risks of Major Adverse Cardiovascular Events (MACE), CV death, and all-cause mortality were analysed with COX proportional hazard regression.

Results
A total of 17482 AF patients [median age: 71.0 (IQR: 64.0 – 78.0) years; 45.3% female] were included in the analysis. At baseline, 1840 (10.5%) AF patients had previous strokes. Among them, 1694 (9.7%) and 170 (0.97%) patients had one (1 PS) and ≥2 previous strokes (≥2 PS) respectively. There were 1111 MACE, 562 CV deaths, and 1266 all-cause mortality after a median follow-up of 3.0 (IQR: 2.9 – 3.1) years. Multivariate Cox regression showed that patients with 1 PS and ≥2 PS had higher risks of MACE (HR: 1.50, 95% CI : [1.26 – 1.78] for 1 PS; HR: 2.65, 95% CI: [1.83 – 3.85] for ≥2 PS), and all-cause mortality (HR: 1.36, 95% CI: [1.13 – 1.58] for 1 PS; HR: 2.16, 95% CI: [1.48 – 3.16] for ≥2 PS) compared to patients without PS (table 1), with the risk of CV death (HR: 2.88, 95% CI: [1.71 – 4.84]) only higher in patients with ≥2 PS. In the subgroup analysis where only patients with PS were included, patients with ≥2 PS had higher risks of MACE, CV death, and all-cause mortality compared to patients with 1 PS.

Conclusion
AF patients with 1 PS or ≥2 PS events had significantly higher risks of MACE and all-cause mortality compared to AF patients without PS. Moreover, AF patients with ≥2 PS had significantly higher risks of MACE, CV death and all-cause mortality compared to AF patients with only 1 PS.
Revisiting risk stratification in hypertrophic cardiomyopathy after the recent guidelines - LGE remains tough to beat
Authors: Amador R , Pereira J C , Freitas P , Lima R , Paiva M S , Gomes D , Rochite C , Arteaga E , Carmo P , Cavaco D , Adragao P , Ferreira A M 
Published: October 2024

Abstract

Background and Objectives
Over the last decades, the recommendation for ICD implantation for the primary prevention of sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM) has been evolving. Late gadolinium enhancement (LGE) has been incorporated in the guidelines as a risk factor to be considered for ICD implantation.
The aims of this study were: 1) assess the evolution of accuracy and discriminative ability of the different guidelines (ESC 2014, ESC 2022, ESC 2023, ACC 2011 and ACC 2020) in predicting SCD; and 2) to understand whether LGE can further help in the risk stratification of SCD.

Methods
We conducted an international multicentric retrospective analysis of HCM patients undergoing cardiac magnetic resonance (CMR) for diagnostic confirmation and/or risk stratification. Eligibility criteria for ICD according to the ESC 2014 (HCM), ESC 2022 (Ventricular arrhythmias VAs), ESC 2023 (Cardiomyopathies), ACC 2011 and ACC 2020 (both HCM guidelines) was determined for each patient. Our primary endpoint was a composite of SCD, appropriate ICD discharge and sustained VT.

Results
We included a total of 530 patients (median age was 49 (IQR 35-61), 57% male). Over a median follow-up of 3.8 (IQR 1.6 – 7.0) years, 27 events occurred (13 SCDs, 8 appropriate ICD discharges and 6 sustained VAs). The diagnostic accuracy statistics of the European and the American societies guidelines have evolved similarly over time: sensitivity and PPV increased, NPV remained high and discriminative ability also increased (see Figure). However, the concordance in risk assessment is only moderate between the ESC 2022 and ACC 2020 (κ = 0.60 (95%CI: 0.54–0.67); p &lt; 0.001) or the ESC 2023 and ACC 2020 guidelines (κ = 0.56 (95%CI: 0.49–0.62); p &lt; 0.001).
LGE was present in 80% of patients. Median LGE% was 3.2% (IQR 0.5 – 8.4%) and remained an independent predictor of arrhythmic events after adjustment to known confounders (aHR of 1.09 per 1% increase in LGE% [95% CI 1.05 – 1.12; p &lt; 0.001]). The Youden test showed a best cut-off for LGE burden of 7.1%. Further risk stratification could be reached by employing LGE% as an arbiter. Irrespectively of the guideline publisher, in patients with any recommendation for ICD (classes IIa and IIb), the absence of LGE identified patients with no arrhythmic events during follow-up (see Figure).

Conclusions
Current guidelines have shown increased sensitivity, PPV and discriminative power when compared with older counterparts. LGE burden remains an independent risk factor for arrhythmic events and although extensive LGE burden has been included in the risk stratification for ICD implantation, further stratification can be accomplished for ICD recommendation, since this seems to be a predictor stronger than clinical parameters.
Relationship between triglyceride-to-glucose index in addition to waist circumference as a marker of insulin resistance and mean arterial pressure
Authors: Takami H 
Published: October 2024

Abstract

Background
Blood pressure is one of the criteria for detecting metabolic syndrome in Japan as follows: systolic blood pressure(SBP) ≥ 130mmHg or diastolic blood pressure (DBP) ≥ 85mmHg, and mean arterial pressure(MAP) is related to atherosclerosis of small artery and insulin resistance is the risk facor of it. Recent experts propose that triglyceride-to-glucose (TyG) index and in addition to waist circumference (WC) are alternative method to predict insulin resistance.

Methods and Results
27939 individuals under 65 years old who received health check-up were eligible for the present study. MAP is calculated as follow: (SBP - DBP)/3 + (DBP). TyG index is calculated as follow: Ln(triglyceride x glucose/2). TyG-WC index is calculated as follow: (TyG index) x (WC). Mean triglyceride, glucose, TyG index and TyG-WC index were 103.9, 94.2, 9.02 and 733.6, respectively. Receiver operating characteristics (ROC) curve showed the cut-off value of MAP ≥ 96.33mmHg as high blood pressure. Using this cut-off value, ROC curves of TyG index and TyG-WC index for predicting high MAP shows 9.06 (AUC 0.66) and 734.8 (AUC 0.70), respectively.

Conclusions
TyG index and TyG-WC index as markers of insulin resistance were significantly correlated with MAP. TyG-WC index was better marker of insulin resistance then TyG index and it might be useful for predicting hypertension and metabolic syndrome.
Lipoprotein(a) and atherosclerotic cardiovascular disease in a Brazilian tertiary hospital population
Authors: Zorzanelli Rocha V , Viana I , Mizuta M , Miname M H , Chacra A P M , Raupp P , Santos R D 
Published: October 2024

Abstract

Background/Introduction
Elevated levels of lipoprotein(a) [Lp(a)] are a strong risk marker of atherosclerotic cardiovascular disease (ASCVD), including myocardial infarction (MI), ischemic stroke, and peripheral arterial disease, as well as of aortic valve calcification and stenosis. However, few studies have assessed the prevalence of high Lp(a) levels in patients followed at a tertiary hospital specialized in cardiovascular diseases (CVD). In addition, there is scant information about Lp(a) concentrations in Brazilian individuals.

Purpose
The aim of the study was to describe the demographic characteristics and comorbidities of patients with at least one measure of Lp(a) at a tertiary treatment center for CVD in our city – Brazil.

Methods
Patients treated at a heart institute had their data extracted between the years 1999 and 2021. Data were obtained through direct electronic extraction of patients' medical records. The patients were categorized according to different Lp(a) cutoff levels (&gt; 50 and &lt; 70, &gt; 70 and &lt; 90, and &gt; 90 mg/dL) and by quartiles.

Results
Of 4,970 unique patients included in the study, the mean age at baseline was 59.9 years (SD ± 14.5), 2,634 (53%) were male, and the median Lp(a) was 23.2 mg/dL (interquartile range 8.9 - 56.8 mg/dL). In the whole cohort, 460 (9.3%) had Lp(a) &gt; 50 and &lt; 70, 344 (6.9%) &gt; 70 and &lt; 90, 612 (12.3%) &gt; 90 mg/dl and 138 (2.8%) &gt; 150 mg/dL. Established ASCVD was reported in 1,223 (24%) of the individuals, with a progressively higher prevalence across the Lp(a) categories above (31.2%, 33.8%, 34.2%, respectively) (table 1). Moreover, the Lp(a) median (interquartile range) in mg/dL was significantly higher in those with baseline history of ASCVD (31.4 [10.8-71.2] vs 21.2 [8.3-52]), MI (27.8 [10.6-65.9] vs 22.3 [8.5-54.7]) and stroke (24.9 [10-69.5] vs 23.1 [8.9-56.5]), all p &lt; 0.05 (table 2). Lp(a) was also significantly higher among those with LDL-C ≥ 100 mg/dL relative to LDL-C &lt; 100 mg/dl (25.5[9.5-63.2] vs 21.4[8.4 vs 52.2] p &lt; 0.05).

Conclusions
In this cohort of patients followed at a tertiary center specialized in CVD, approximately a third had Lp(a) levels above 50 mg/dL, a cutoff robustly associated with ASCVD. This finding likely represents an important source of cardiovascular residual risk, particularly in those with established ASCVD, exposing the need of further therapies.
Failure of primary prophylaxis: statin use, risk profile, and outcomes in contemporary patients treated with PCI for first atherosclerotic event
Authors: Anjum H , Lahchich S , Kristensen A T , Bojer A S , Lauridsen B K , Olsen N T 
Published: October 2024

Abstract

Background
Atherosclerosis and coronary artery disease (CAD) are potentially preventable through lifestyle modifications and the use of medical cholesterol-lowering drugs in individuals at risk. However, guidelines for optimal use of statins are debated, and not enough is known about the real-world barriers to effective CAD-prevention. Understanding the mechanisms of prophylactic treatment failure in patients who undergo PCI for their first atherosclerotic event could help improve primary prevention strategies.

Purpose
To 1) examine the relative contribution of failure mechanisms of medical prophylaxis in patients undergoing PCI for their first atherosclerotic event, 2) examine how clinical characteristics differ between patients with different failure mechanisms, and 3) examine whether long-term outcomes after PCI differ depending on the mechanism of prophylactic failure.

Methods
A retrospective study was conducted to study electronic healthcare records for all patients ≥18 years treated with PCI at Gentofte Hospital, Denmark in 2019. Data was extracted from electronic health care records. Patients with first atherosclerotic event were divided into cardiovascular risk groups based on the ESC/EAS guidelines and further into four different prophylactic failure mechanism groups based on cardiovascular risk, statin indication, statin use and whether the risk-based LDL-C treatment goals were reached.

Results
507 patients were treated with PCI for their first atherosclerotic event. 54% were categorized as low-moderate cardiovascular risk. 41% were not on statin and did not have class I indication for statin treatment (strategy failure). 26% were not on statin treatment despite class I indication for statin treatment (implementation failure). 18% were on statin treatment but had not reached their LDL-C target (efficiency failure), and 16% were on statin treatment, and had reached the LDL-C target (efficacy failure). Patients with strategy failure, were more likely to be younger, mostly males, and often had a smoking history. Patients with implementation failure, were typically elderly, with relatively few comorbidities. The frequency of death, myocardial infarction, stroke, or repeat revascularization over 4 years was 15.3%, with no statistically difference between the groups (p =0.3).

Conclusion
In this cohort study, patients treated with PCI for first atherosclerotic event were often classified as low or intermediate risk, and a majority had not been on statin treatment before. Improved primary prevention should focus on at-risk groups that are either not included in current recommendation for statin treatment, especially young smokers, or patients not receiving treatment despite recommendations, especially older patients with few medical contacts.Cardiovascular risk & failure mechanismKaplan-Meier MACE
Assessment of impact of left ventricular flow state on myocardial blood flow using positron emission tomography and echocardiography
Authors: Chen B , Travin M , Rodriquez C J , Zhang L , Garcia M , Slipczuk L , Labit A , Pu M 
Published: October 2024

Abstract

Background
The relationship between left ventricular (LV) mass and myocardial blood flow (MBF) has been recognized as an important physiological measure of myocardial perfusion to match global metabolic demand. However, there is little information on the association between LV flow state and MBF.

Purpose
To investigate impact of LV flow state on MBF.

Methods
The study included 104 patients undergoing cardiac positron emission tomography (PET) and echocardiography for chest pain and/or dyspnoea. CT attenuation corrected rest/regadenoson stress 13N-ammonia myocardial perfusion imaging was acquired with a PET CT camera. All images were acquired in 3-D list mode. Sixteen dynamic frames were reconstructed and analyzed with QPET software to obtain rest quantitative MBF measurements adjusted for rate-pressure product in ml/min/g, with a myocardial flow reserve (MFR) derived as the ratio of stress MBF/resting MBF. All patients had no ischaemia or infarction with LV ejection fraction ≥55%. Echocardiography was performed within 6 months of PET in clinically stable conditions allowing for. SV was measured by Doppler echocardiography using the continuity equation and was indexed by body surface area (SVi). The patients were divided to normal flow group (NFS: SVi &gt; 35 ml/m2) and low flow group (LFS: SVi≤35 ml/m2).

Results
The mean SVi was 40 ml/m2 for NFS and 29 ml/m2 for LFS (p&lt;0.001). LFS group was younger (57 ± 11 vs. 67 ± 11 years, p&lt;0.001) with higher body mass index (43±8 vs. 37±8 kg/m2, p&lt;0.001) and lower resting MBF (0.84±0.22 vs. 1.02±0.34 ml/min/g, p&lt;0.01) than NFS groups. There were no significant differences of hypertension (81% vs. 82%, p&gt; 0.05), LV mass index (82±21 vs. 88±82 g/m2, p&gt;0.05), LVEF (63% vs. 65%, p&gt;0.05) between LFS and NFS groups. SVi was positively associated with MBF as a whole group (r= 0.38, p&lt;0.01). However, this significant association was only observed in NFS group (r=0.62, p &lt;0.001), but not in LFS group (r=0.048, p= 0.46, Figure).

Conclusion
LFS expressed low MBF and the dissociation between SVi and MBF in comparison with NFS group suggesting potential alterations in relationships between myocardial work (SV) and oxygen consumption (MBF) in LFS. Further studies are warranted to investigate the pathophysiology behind the findings and to correlate with a long-term clinical outcome.