bluuebunny/crossref_metadata_2025_split huggingface dataset:
The diagnostic role of myocardial work indices in stable coronary disease - global wasted work as a novel important non-invasive parameter?
Authors: Szigyarto I , Fabian A , Ladanyi Z S , Csernak A , Martincsevics I , Lakatos B , Szilveszter B , Sayour A A , Kovacs A , Edes I F , Merkely B , Olah A 
Published: October 2024

Abstract

Introduction
Although the non-invasive diagnostic tools for stable coronary artery disease (CAD) have developed significantly over the past years, there is no resting parameter available to recognize functionally significant CAD. The role of the novel myocardial work index (myocardial work index - MWI) calculated by the pressure-strain loop created with the help of speckle-tracking analysis and blood pressure measurement in the diagnosis of ischemic heart disease is not yet fully clarified. In our research, we examined the parameters of myocardial work analysis in stable coronary disease patients.

Purpose
Clarification of the diagnostic role of the myocardial work analysis, in patients with stable coronary artery disease.

Methods
In our prospective, single-center study, we examined 13 patients who had at least moderate stenosis (≥50%) in one main coronary branch detected on coronary CTA. A fractional flow reserve (FFR) test was performed for functional coronary assessment. Based on this measurement, we divided our patients into FFRneg (FFR value&gt;0.8) and FFRpos groups. Echocardiography was performed before coronary angiography in all patients. In addition to the standard echocardiographic parameters, global myocardial work index (GWI), global constructive work (GCW) and global wasted work (GWW) were calculated. In the case of the FFRpos group, we performed the above examination both before and after revascularization (2 months).

Results
Our results show that neither the standard parameters (GLS, EF), nor the GWI and GCW showed any difference between the FFRpos and FFRneg groups. However, there was a significant difference regarding GWW (172.3±21.8 FFRneg vs. 258.2±38.4 FFRpos, p=0.048) at baseline. In the case of the FFRpos group, the analysis of our data showed that there was no significant difference in EF, GLS, GWI and GWE parameters before and after revascularization. However, global wasted work (GWW) showed a significant improvement after revascularization (preGWW 258.2±38.4 vs. postGWW 139.5±14.5, p=0.041). NT-proBNP levels were normal in our patient population and we could not detect.

Conclusion
Based on our results, the GWW may be suitable for non-invasive assessment of the functional significance of stable coronary disease, as it showed a significant difference in the case of functionally significant and non-significant stenosis and improved after revascularization in patients with single-vessel CAD.
Prognostic significance of plasma molecular lipid species in coronary artery disease patients: A prospective cohort study
Authors: Veiga-Fernandes Mira J , Meuleman V , Akkerhuis M , Oemrawsingh R , Daemen J , Van Mieghem N M , Serruys P , Van Geuns R J , Laaksonen R , Boersma E , Kardys I 
Published: October 2024

Abstract

Background
Circulating plasma lipids are vital indicators for quantifying coronary artery disease (CAD) risk, yet traditional biomarkers like LDL, HDL, and triglycerides often exhibit limited predictive capacity. Advancements in lipidomics have identified novel molecular constituents with the potential to improve prognostication in CAD patients. However, the prognostic value of lipidomics for long-term mortality has not yet been investigated.

Objective
In our study, which was part of the European Collaborative Project on Inflammation and Vascular Wall Remodeling in Atherosclerosis (ATHEROREMO), we aimed to investigate the predictive value of specific molecular lipid species for long-term mortality.

Methods
We utilized data from the 581 CAD patients enrolled in the ATHEROREMO clinical imaging study, who were admitted for either diagnostic coronary angiography or percutaneous coronary intervention. We measured a series of serum lipid species, comprising ceramides (Cer) and cholesteryl esters (CE), by mass spectrometry-based shotgun lipidomics. Long-term all-cause mortality follow-up was conducted in 2022 via the Civil Registry. We used the Kaplan-Meier method and multivariable Cox-proportional hazards regression (correction for age, sex, cardiac risk factors, statin use, hypercholesterolemia, and angiography indication) to assess survival distributions and associations with all-cause mortality.

Results
Mean age was 61.5 years (IQR: 53.5-61.5), 75% were male. A total of 55% patients were diagnosed with acute coronary syndrome (ACS) and 45% with stable angina pectoris (SAP). During a median follow-up of 11 years (IQR: 10.1-13.4) 179 patients died. Five molecular lipid species (two cholesteryl esters, one ceramide and two ceramide ratios) correlated with mortality (see Table). As an example, Figure 1 demonstrates a clear survival difference between patients with Cer(d18:1/16:0)/Cer(d18:1/24:0) ratio below versus above the median. Findings were consistent for ACS and SAP.

Conclusion
Our study demonstrates the prognostic value of specific cholesteryl esters, ceramides and ceramide ratios for 11-year mortality in patients with CAD. To the best of our knowledge, this is the longest follow-up study so far within this domain.Table.Lipid molecule and Mortality 11-yFig.1 Kaplan Meier Ceramide ratio
Triggers of type 2 myocardial infarction: implications for long-term prognosis
Authors: Marinelli V , Ryabenko K , Cavallo D , Casuso Alvarez M , Suma N , Impellizzeri A , Bodega F , Fedele D , Pastore G , Bergamaschi L , Angeli F , Sansonetti A , Rinaldi A , Paolisso P , Pizzi C 
Published: October 2024

Abstract

Background
Type 2 myocardial infarction (T2MI) is characterized by a mismatch between myocardial oxygen supply and demand, unrelated to acute coronary thrombosis.
This discrepancy arises from triggers, which may or may not be of cardiac origin. Common cardiac triggers include coronary artery spasm, coronary embolism, and arrhythmias, whereas non-cardiac triggers encompass factors such as anemia, hypertension/hypotension, sepsis, renal damage, and respiratory failure. However, identifying these triggers isn't always straightforward.

Aim
Our study aimed to identify, whenever possible, the triggers contributing to the oxygen supply-demand mismatch in T2MI cases, as defined by the Fourth Universal Definition of Myocardial Infarction. Additionally, we sought to explore the correlation between these triggers and patient prognosis.

Methods
We enrolled all consecutive patients diagnosed with non-ST-segment elevation myocardial infarction (NSTEMI) who met the criteria for T2MI and underwent coronary angiography within 72 hours of diagnosis. Patients were categorized into three groups based on the trigger causing T2MI: cardiac, non-cardiac, and unidentified. The primary endpoint was the occurrence of major adverse cardiovascular events (MACEs), including all-cause mortality, new myocardial infarction, hospitalization for heart failure, and ischemic stroke, during long-term follow-up. We estimated MACE-free survival using Kaplan-Meier curves and compared it among the three groups using the log-rank test. Multivariable logistic regression analysis was performed to identify independent predictors of MACE.

Results
The final cohort comprised 598 T2MI patients, with 308 having a cardiac trigger, 147 having a non-cardiac trigger, and 143 with an unidentified trigger. The mean age of the overall population was 69.6±13.1 years, with a median follow-up time of 25 (13-49) months.
Kaplan-Meier curves demonstrated statistically significant differences in MACEs based on the trigger causing T2MI (p&lt;0.001). Specifically, patients with an unidentified trigger exhibited a better prognosis, while those with a non-cardiac trigger had a worse prognosis during long-term follow-up. Multivariable logistic regression analysis confirmed that not having an identified trigger is an independent protective factor for MACEs (HR 0.63, 95% CI 0.45-0.89, p=0.009, unidentified trigger vs cardiac + non-cardiac trigger).

Conclusions
T2MI is prevalent in clinical practice, yet reliable outcome predictors remain elusive. Our findings indicate a relationship between the type of trigger precipitating T2MI and patient prognosis, notably demonstrating that the absence of a specific identifiable trigger is linked to a more favorable long-term outcome. Further studies are needed to better define the prognostic stratification of these patients.MACE-free survival Kaplan Meier
An ensemble machine learning approach for predicting heart failure risk in acute coronary syndrome patients: heartguardai
Authors: Petretto G , Porcheddu T , Isgender M , Merella P , Talanas G , Casu G , Navarese E P , Bilotta F 
Published: October 2024

Abstract

Background
Heart failure (HF) constitutes a major post-event morbidity in patients experiencing Acute Coronary Syndrome (ACS), underscoring the imperative for precise risk stratification methodologies. Traditional prognostic models, although beneficial, are limited by their reliance on a narrow scope of variables, thereby overlooking the comprehensive analytical potential afforded by extensive clinical datasets.

Aims
To develop "HeartGuardAI," an ensemble machine learning model that predicts HF risk in ACS patients. By incorporating a wide array of variables including ejection fraction (EF), glomerular filtration rate (GFR), body mas index(BMI), male sex, this model seeks to offer a more practical tool for clinical decision-making.

Methods
We queried ACTION-ACS a large-scale multicenter database of 3335 patients at 10-year follow-up. We employed a feature selection process informed by Random Forest Classifier to identify the most predictive variables. An ensemble model combining the strengths of Random Forest and Gradient Boosting methodologies was then developed. The model's predictive performance was validated through Stratified K-Fold cross-validation, focusing on Area Under the Curve (AUC) and confidence intervals to assess its efficacy. The model's predictive performance was validated through Stratified K-Fold cross-validation, focusing on Area Under the Curve (AUC) and confidence intervals to assess its efficacy.

Results
Demonstrating a mean AUC of 0.76 ± 0.036, "HeartGuardAI" showed a high capability to predict HF risk in post-ACS patients and emphasizes the significance of incorporating multifactorial clinical assessments

Conclusions
HF risk can be predicted by a handy tool developed with advanced machine learning methods. Future studies are needed to prospectively validate this algorithm.Graphic 1Graphic 2
Prognostic implications of N-terminal pro-brain natriuretic peptide in patients with Non-ST segment elevation myocardial infarction
Authors: Kim C , Lee S H , Lee J M 
Published: October 2024

Abstract

Background
Limited data exist regarding prognostic implications of N-terminal pro-Brain Natriuretic Peptide (NT-proBNP) in patients with non-ST segment elevation myocardial infarction (NSTEMI) who underwent percutaneous coronary intervention (PCI).

Objectives
The current study sought to evaluate the prognostic implications of NT-proBNP in patients with NSTEMI who underwent PCI.

Methods
Among a total of 13,104 patients from a nationwide, multicenter, and prospective registry of the Korea Acute Myocardial Infarction Registry-National Institutes of Health (KAMIR-NIH), a total of 3,083 patients with NSTEMI who underwent PCI were selected. The selected patients were classified according to the initial NT-proBNP value (cut-off value of NT-proBNP, 700 pg/ml). Primary endpoint was major adverse cardiovascular events (MACE) at 3 years, a composite of all-cause death, recurrent myocardial infarction (MI), unplanned repeat revascularization, and admission for heart failure.

Results
Among the study population, 1,813 patients (58.8%) were in the low NT-proBNP group (&lt;700 pg/ml) and 1,270 patients (41.2%) were in the high NT-proBNP group (≥700 pg/ml). The high NT-proBNP group showed significantly higher risk of MACE than the low NT-proBNP group (29.5% vs 12.3%; adjusted hazard ratio [HR], 1.69; 95% confidence interval [CI], 1.39-2.07; P&lt;0.001), mainly driven by higher risk of cardiac death or admission for heart failure (15.6% vs. 2.2%; adjusted HR, 2.98; 95% CI, 2.03-4.40; P&lt;0.001). These results were consistent after confounder adjustment by propensity score matching (HR, 1.56; 95% CI, 1.21-2.02; P=0.001) and inverse probability weighting analysis (HR, 1.54; 95% CI, 1.19-2.00; P=0.001).

Conclusion
In patients with NSTEMI who underwent PCI, elevated initial NT-proBNP level was associated with higher risk of MACE at 3 years, mainly driven by the higher risk of cardiac death or admission for heart failure. The current results suggest that the initial NT-proBNP level may have a clinically significant prognostic value in NSTEMI patients undergoing PCI.
Artificial intelligence-guided screening of under-recognized cardiomyopathies adapted for point-of-care echocardiography
Authors: Oikonomou E K , Holste G , Coppi A , Mcnamara R L , Nadkarni G N , Krumholz H M , Wang Z , Miller E J , Khera R 
Published: October 2024

Abstract

Background
Point-of-care ultrasonography (POCUS) enables access to cardiac imaging directly at the bedside but is limited by brief acquisition, variation in acquisition quality, and lack of advanced protocols.

Purpose
To develop and validate deep learning models for detecting underdiagnosed cardiomyopathies on cardiac POCUS, leveraging a novel acquisition quality-adapted modeling strategy.

Methods
To develop the models, we identified transthoracic echocardiograms (TTEs) of patients across five hospitals in a large U.S. health system with transthyretin amyloid cardiomyopathy (ATTR-CM, confirmed by Tc99m-pyrophosphate imaging), hypertrophic cardiomyopathy (HCM, confirmed by cardiac magnetic resonance), and random controls from the same period enriched for the presence of severe AS. In a sample of 290,245 TTE videos, we used novel augmentation approaches and a customized loss function to weigh image and view quality to train a multi-label, view agnostic video-based convolutional neural network (CNN) to discriminate the presence of ATTR-CM, HCM, and/or AS+ and AS- controls. Models were tested across 3,758 real-world POCUS videos from 1,879 studies in 1,330 independent emergency department (ED) patients from 2011 through 2023 (A).

Results
Our multi-label, view-agnostic classifier demonstrated state-of-the-art performance in discriminating ATTR-CM (AUROC 0.98 [95%CI: 0.96-0.99]) and HCM (AUROC 0.95 [95% CI: 0.94-0.96]) on standard TTE studies. Automated metrics of anatomical view correctness confirmed significantly lower quality in POCUS vs TTE videos (median view classifier confidence of 0.63 [IQR: 0.44-0.88] vs 0.93 [IQR: 0.69-1.00], p&lt;0.001). When deployed to POCUS videos, our algorithm effectively discriminated ATTR-CM and HCM with AUROC of up to 0.94 (parasternal long-axis (PLAX)), and 0.85 (apical 4 chamber (A4C)) (B), corresponding to positive diagnostic odds ratios of 46.7, and 25.5, respectively. In total, 18/35 (51.4%) of ATTR-CM and 32/57 (41.1%) of HCM patients in the POCUS cohort had a positive AI screen in the year before their eventual confirmatory imaging (C).

Conclusions
We define and validate an AI framework that enables scalable, opportunistic screening of under-diagnosed cardiomyopathies using POCUS.
Relation of plasma neuropeptide-Y with myocardial function and infarct severity in acute ST-elevation myocardial infarction
Authors: Tiller C , Reindl M , Holzknecht M , Lechner I , Oberhollenzer F , Von Der Emde S , Kremser T , Mayr A , Bauer A , Reinstadler S J , Metzler B 
Published: October 2024

Abstract

Background
Acute myocardial infarction is associated with high levels of cardiac sympathetic stimulation, which leads to the release of the co-transmitter neuropeptide-Y (NPY). NPY acts as a potent vasoconstrictor and an association with increased risk for heart failure and microvascular dysfunction after acute ST-elevation myocardial infarction (STEMI) has been suggested.

Purpose
This study aims to comprehensively evaluate the association of plasma NPY with myocardial function and infarct severity, visualized by cardiac magnetic resonance (CMR) imaging, in STEMI patients revascularized by primary percutaneous coronary intervention (PCI).

Methods
In this observational study, we included 260 STEMI patients treated with primary PCI. Plasma NPY concentrations were measured by an immunoassay 24h after PCI from peripheral venous blood samples. Left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), infarct size (IS) and microvascular obstruction (MVO) were determined using CMR imaging 4 days and 4 months after PCI.

Results
Median plasma concentrations of NPY were 70 [interquartile range (IQR): 35-115] pg/ml. NPY levels above median were significantly associated with lower LVEF (48% vs. 52%, p=0.004), decreased GLS (-8.8% vs. -12.6%, p&lt;0.001) and larger IS (17% vs. 13%, p=0.041) in the acute phase after infarction as well as in the chronic stage (LVEF: 50% vs. 52%, p=0.030, GLS: -10.5 vs. -12.9, p&lt;0.001, IS: 13% vs. 10%, p=0.011). In addition, NPY levels were significantly related to presence of MVO (58% vs. 52%, p=0.041). Moreover, in multivariable linear regression analysis, NPY remained significantly associated with all investigated CMR parameters (LVEF: p&lt;0.001, GLS: p&lt;0.001, IS: p=0.003, MVO: p=0.042) independent of other established clinical variables including high-sensitivity cardiac troponin T, pre-interventional TIMI flow 0 and left anterior descending artery as culprit lesion location.

Conclusion
High plasma levels of NPY, measured 24h after STEMI, were independently associated with lower LVEF, decreased GLS, larger IS as well as presence of MVO, indicating plasma NPY as a valuable biomarker for optimized risk stratification.
Cardiac myosin-binding protein-C: assessing fragmentation patterns to differentiate between forms of myocardial injury
Authors: Mcgrath S , Alaour B , Marber M 
Published: October 2024

Abstract

Background
Cardiac myosin-binding protein-C (cMyC) is a novel biomarker of myocardial injury. We hypothesize that fragmentation of cMyC differs according to aetiology of myocardial injury. Assessing the fragmentation pattern of the protein may aid diagnosis of these conditions.

Purpose
This work represents an examination of cMyC fragmentation in human serum, and studies its utility in differentiating between forms of myocardial injury.

Methods
Patients who were admitted to a hospital during October-November 2023 with acute myocardial injury were recruited. Acute myocardial injury was defined as a dynamic troponin rise above the 99th centile (Abbott Alinity: cTnI&gt;34ng/L male, cTnI &gt;16ng/L female).
Following collection, samples were left at room temperature for 30 minutes and then centrifuged. Serum was separated for cMyC measurement, frozen in liquid nitrogen and stored at -80 °C. Recruited patients were followed up during their inpatient journey. Their final diagnosis was defined using the 4th universal definition of MI by two cardiologists, with a third cardiologist acting as adjudicator, if required.
The serum samples were analysed using two separate electrochemiluminescence sandwich ELISA assays detecting different portions of cMyC. One assay formulated for total concentration of cMyC using high affinity mouse N-terminal monoclonal antibodies (mAb) targeting epitopes in close proximity (Limit of Detection (LoD) = 9.0ng/L). The other assay uses a N-terminal and a C-terminal mouse mAb which straddle the major proteolytic cleavage site of cMyC. This assay detects the intact (fuller-length) cMyC (LoD= 14.2ng/L). Both assays perform with good sensitivity, low variability and are capable of detecting cMyC at concentrations well below the 99th centile.

Results
11 patient samples were collected with final diagnoses of; type 1 MI (STEMI n=3, NSTEMI n=4), type 4 MI (alcohol septal ablation n=1), acute myocardial injury (myocarditis n=2) and type 2 MI (chest sepsis with known coronary disease n=2).
Figure one details the percentage of intact cMyC relative to total cMyC measured in serum for each patient, and is split into their adjudicated diagnosis. The bars display the median and interquartile range (IQR).
Our findings suggest that the fragmentation pattern of cMyC could help differentiate between forms of myocardial injury. The ratio of intact: total cMyC was higher in the type 2 MI than any other condition. The results did not reach statistical significance (p = 0.06) due to the small sample size.

Conclusions
The fragmentation pattern of cMyC is dependent on the type of myocardial injury and could aid in the differentiation between type 2 MI and other forms of myocardial injury.Figure One
Myocarditis prognostic score: a new risk assessment tool in patients with myocarditis
Authors: Di Lisi D , Madaudo C , Macaione F , Scelfo D , Alaimo C , Gargano M , Marotta A , Giardina O , Novo G 
Published: October 2024

Abstract

Background
Myocarditis is an inflammatory disease of the myocardium with multiple causes and evolutions. The aim of our study was to design a prognostic multiparametric score in patients with myocarditis, to identify those at higher risk of adverse cardiovascular events (AE).

Methods
A prospective study was performed enrolling 98 patients with myocarditis: 72 M, 26 F; median age 27 [IQR 20–40]. Patients were divided into 2 groups: complicated (CM) and uncomplicated myocarditis (UM). Six months after hospital admission, cardiac magnetic resonance (CMR) and cardiological consultation were repeated. AE (death, hospitalization for heart failure, heart transplant, ICD implantation, heart failure development) were evaluated at 6 months and after 3 years.

Results
We found 67 UM and 31 CM. AE were significantly higher in patients with complicated myocarditis. We found a significant correlation between AE and reduced left ventricular ejection fraction (LVEF) at hospital admission, increased GLS, septal LGE at CMR, longer persistence time of increased troponin, LGE extension progression or persistence 6-month CMR. A myocarditis prognostic score was developed on the basis of these parameters. A score ≥ 5 showed higher sensitivity (100%) and specificity (87%) - AUC 1, to identify AE in patients with myocarditis. A score between 3 and 4 showed high sensitivity but low specificity. A score ≤ 2 was associated with low probability of events.

Conclusion
Our study confirms the high probability of AE in patients with CM and it suggests a myocarditis prognostic score to identify patients at higher risk of AE.