bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medication adherence and antithrombotic therapy outcomes: insights from a post-hoc analysis of the AFIRE trial
Authors: Chiba N , Noda T , Nochioka K , Kaikita K , Akao M , Ako J , Matoba T , Nakamura M , Miyauchi K , Hagiwara N , Kimura K , Hirayama A , Matsui K , Ogawa H , Yasuda S 
Published: October 2024

Abstract

Background
The AFIRE (Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease) trial established noninferiority in efficacy and superiority in safety endpoints of rivaroxaban monotherapy over rivaroxaban plus antiplatelet therapy (combination therapy) in patients with atrial fibrillation (AF) and stable coronary artery disease (CAD). However, the impact of medication adherence to rivaroxaban on AFIRE study outcomes remains unclear.

Purpose
This post-hoc analysis aimed to explore the influence of medication adherence on AFIRE trial results.

Methods
Among 2,120 patients, participants were classified into adherent and non-adherent groups based on self-reported measures, which were further verified through on-site visits to the facilities. Adherent patients were defined as those who reported consistently taking their medication as prescribed. The primary efficacy endpoint comprised stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularization, or all-cause death, including cerebral events. Analysis also examined differences in the primary efficacy endpoint between adherent and non-adherent patients.

Results
Of the 2,120 patients, 2,012 (94.9%) were adherent to rivaroxaban, while 108 (5.1%) were non-adherent. Among adherent patients, rivaroxaban monotherapy showed significantly better efficacy outcomes compared to combination therapy (hazard ratio [HR] 0.73; 95% confidence interval [CI] 0.54–0.98; p=0.04, Figure 1A). However, primary efficacy outcomes did not significantly differ among non-adherent patients (HR 0.64, 95% CI 0.23–1.81, p=0.40, Figure 1B). Adherent patients exhibited improved outcomes relative to non-adherent patients, though this difference was not statistically significant (HR 1.68; 95% CI 0.99–2.85; p=0.05, Figure 2A). In clinically high-risk patients with a history of angina pectoris, those who demonstrated adherence to medication (n=1281) exhibited significantly better efficacy outcomes compared to non-adherent patients (n=68) (HR 1.97; 95% CI 1.09–3.56; p=0.03, Figure 2B).

Conclusions
Rivaroxaban monotherapy versus combination therapy showed favorable efficacy outcomes in patients with good adherence, consistent with the overall AFIRE trial. However, these benefits were not observed in non-adherent patients. Adherence to rivaroxaban is crucial for achieving its maximum therapeutic effect as monotherapy.Figure1Figure2
Effect of sodium-glucose cotransporter-2 inhibitor (SGLT2-i) in patients with LVAD: a systematic review and meta-analysis
Authors: Hasabo E A , Isik B , Elgadi A , Eljack M M F , Yacuob M S , Alzomor H , Sawabi R , Sultan S , Caliskan K , Soliman O 
Published: October 2024

Abstract

Introduction
Sodium-glucose cotransporter-2 inhibitor (SGLT2-i) have been shown to reduce risks of clinical events in patients with heart failure (HF). However, data on the use of SGLT2-i in patients with left ventricular assist devices (LVAD) are scarce. We thought to assess the efficacy and safety of SGLT2-i in patients with LVAD

Methods
A systematic search was done in PubMed, Scopus, Web of Science, Embase, and Cochrane from inception to December 2023. We used all relevant words for "SGLT2-i" and "LVAD" to search in databases and we included studies and published abstracts in peer-reviewed journals of studies assessed SGLT2-i in patients with LVAD. The efficacy and safety data were extracted across the studies. RevMan 5.4.1 was used for meta-analysis.

Results
Three studies and eight abstracts totaling 209 patients using SGLT2-i were included. Empagliflozin, Dapagliflozin, and Canagliflozin were the used SGLT2-i across the included studies. SGLT2-i effectively decreased hemoglobin A1c (HbA1c) (Mean = -0.44, 95% CI [-0.79, -0.09], p = 0.01) and diuretic dose (Mean=-2.54, 95% CI [-3.56, 1.51], p&lt; 0.00001) from baseline. No significant improvement was found for glomerular filtration rate (GFR), B-type natriuretic peptide (BNP), or mean pulmonary artery pressure (MPAP). Regarding safety, the pooled percentage of people with driveline infection was 9.33%, 95% CI [2.05, 16.60], p=0.01.

Conclusion
SGLT2-i effectively improves HbA1c and diuretic dose in patients using LVAD. Further randomized studies with a large number of participants may be warranted.
Torsemide versus furosemide in patients with heart failure: a systematic review and meta-analysis
Authors: Mohamed A E , Ramadan S , Afify R , Ellaban M , Ishak J , Shafiek F A M , Abdelwahab A , Abdelaziz A , Elnady M I , Abdelazeem B , Lavie C J , Slipczuck L 
Published: October 2024

Abstract

Introduction
Loop diuretics are essential agents in the management of fluid overload conditions, heart failure and renal dysfunction. Despite their widespread use, there is ongoing debate regarding the relative efficacy, safety, and clinical outcomes associated with furosemide and torsemide. By systematically analyzing existing literature, this study seeks to provide a comprehensive evaluation of the comparative effectiveness and safety profiles of these two medications , Helping to inform clinical decision-making and contribute to the optimization of diuretic therapy in patients with heart and kidney diseases.

Methods
We searched PubMed, Scopus, WOS, and Cochrane until February 2024 for relevant studies comparing the torsemide and furosemide in Heart failure patients. Outcomes of interest were all-cause mortality, cardiovascular mortality, all-cause hospitalization, hospitalization for HF, and improvement of ≥ 1 in NYHA functional class.

Results
16 studies were included in this meta-analysis with a total of 12545 patients, There were no significant results between the two drugs in all-cause mortality, cardiovascular mortality or all-cause hospitalization, torsemide showed a reduction in hospitalization from heart failure (RR 0.85, 95% CI [0.71 to 1.02]), torsemide showed a significant improvement of ≥ 1 in NYHA functional class (OR 1.60, 95% CI [1.18, 2.17]).

Conclusion
There was no difference between torsemide and furosemide when it comes to all-cause and cardiovascular mortality, but torsemide showed better results in reducing hospitalization rates and and improving quality of life.Hospitalization from heart failureImprovement ≥ 1 in NYHA class
Differences in symptoms of anxiety and depression among out-of-hospital cardiac arrest survivors and their relatives, paired results from the DANCAS survey
Authors: Bekker-Jensen D , Sofie Hermansen A , Moesgaard Bruvik S , Joshi V , Wieghorst A , Zwisler A , Borregaard B 
Published: October 2024

Abstract

Background
It is well known that out-of-hospital cardiac arrest (OHCA) survivors, as well as their relatives, struggle with symptoms of anxiety and depression, but less is known about the potential differences in paired outcomes.

Purpose
To describe differences in symptoms of anxiety and depression among OHCA survivors and their relatives (paired) and to investigate characteristics associated with these symptoms among both groups.

Methods
A national cross-sectional survey (DANCAS) was conducted with OHCA survivors combined with a survey for their closest relatives. The Hospital Anxiety and Depression Scale (HADS) was included in both surveys. Paired t-tests were used to examine potential differences in HADS mean scores among survivors and relatives. Associations between characteristics (demographic and other self-reported outcomes) and symptoms of anxiety (HADS-A ≥8) and depression (HADS-D ≥8) were examined using multivariable logistic regression models, presented as odds ratios (OR) with 95% confidence intervals (CI), adjusted for potential confounders.

Results
In total, 526 pairs of OHCA survivors and their relatives both responded, with 447 (85%) of the survivors being men, a median age of 67 years (IQR 59-75) and 462 (88%) of the relatives being women with a median age of 64 years (IQR 55-70). Most relatives (85%) were spouses or unmarried partners. In the paired analyses, relatives had significantly higher scores of anxiety compared to survivors (mean 5.6 SD 4.0 vs 3.5 SD 3.8; p&lt;0.001). On the contrary, survivors had significantly worse scores of depression (mean 3.1 SD 2.8 vs 2.4 SD 3.2; p&gt;0.001). Several characteristics (demographic and self-reported) were associated with symptoms of anxiety and depression among both survivors and relatives, Table 1 & 2.

Conclusion
Following OHCA, relatives report worse scores of anxiety while, in contrast, survivors report worse scores of depression, indicating psychological interventions should be tailored differently for the two groups. Further investigation of the reasons for these findings are needed, including whether fatigue might be a symptom of depression or a confounder.
Determinants of adherence among patients with hypertension
Authors: Lomper K , Wleklik M , Chudiak A , Mazur G , Uchmanowicz I 
Published: October 2024

Abstract

Background
Poor adherence to pharmacological treatment among patients with hypertension (HTN) is common. Approximately half of HTN patients do not use their medications as prescribed. Multiple barriers can influence adherence to antihypertensive medications. HTN patients may be characterized by the presence of frailty syndrome (FS) and cognitive impairment (CI). FS and CI may adversely affect the course of the disease and adherence to therapeutic recommendations.

Purpose
To assess the adherence and its determinants among patients with hypertension.

Methods
The study included 129 patients diagnosed with hypertension (81 men, 48 women; mean age M±SD=69.98±11.67) hospitalized in the Department of Occupational Diseases and Hypertension. Medical record analysis, the author's sociodemographic questionnaire, the Tilburg Frailty Idicator (TFI) to determine the presence of frailty syndrome, the Montreal Cognitive Assesment (MoCa) questionnaire to assess cognitive function, and the Adherence to Medication Scale (ARMS) to assess adherence were used.

Results
The majority of respondents were male (62.79%), living in large cities (31.78%), in a relationship (61.24%), with a high school education (68.22%), and retired (67.44%). Analysis of medical records among comorbidities showed diabetes (59.69%) and other cardiovascular diseases (58.91%) to be the most common. Hospitalizations due to hypertension within the past year in the range of 1-2 were reported in 72.09% of the subjects, 3-5 hospitalizations in 17.05%, and more than 5 hospitalizations in 10.85% subjects. The surveyed patients mostly kept self-monitoring diaries (61.24%), measured their blood pressure values 2-3 times a day (58.15%) with an upper arm blood pressure monitor (64.34%). In terms of self-care behaviors, respondents most often indicated following a diet with a restriction of unhealthy fats (52.71%), following a low-sodium diet (44.19%) and being physically active (33.33%). The mean blood pressure values in the study group were M±SD=139.73±16.73 mmHg for SBP and M±SD=81.48±13.25 mmHg for DBP, respectively. On the basis of the TFI, 99.22% of patients showed the presence of FS (M±SD =10.66±2.82), the MoCa questionnaire indicated abnormal values in cognitive function in 79.07% (M±SD =18.16±8.3). The average adherence ARMS score was M±SD 17,6±6,72 pcts. (higher the ARMS score the worse adherence).
Univariate analysis as determinants of adherence showed unemployment (b=9.391;p=0.001), smoking (b=6.701;p=0.001), duration of illness (b=-0.153;p=0.003), 3-5 hospitalizations in the past year (b=3.891;p=0.014). Multivariate analysis among determinants of adherence showed unemployment (b=7.556;p=0.022), duration of illness (b=-0.167;p=0.002) and 3-5 hospitalizations (b=5.011;p=0.001).

Conclusion
Hypertensive patients are characterized by optimal adherence. Despite expectations, cognitive impairment and frailty syndrome did not determine adherence to medications.
Differential effects of heat-not-burn, electronic cigarettes and conventional cigarettes on endothelial glycocalyx
Authors: Ikonomidis I , Katogiannis Κ , Kourea K , Kostelli G , Pavlidis G , Thymis J , Katsanaki H , Vlachomitros D , Maratou E , Vlastos D , Lambadiari V 
Published: October 2024

Abstract

Background
Heat-not-burn cigarette (HNBC) and electronic cigarette (Ecig) constitute non-combustible smoke products. Their effect on endothelial glycocalyx has not been investigated so far.
Patients and Methods: Out of 100 subjects attending smoking cessation clinic: α) 50 smokers were randomized to usage of HNBC (n=25) or Ecig (n=25) and β) 50 smokers were used as control group. Participants randomized to the newer tobacco products had similar clinical and demographic characteristics to the control group. Smoking status was verified by measuring the concentration of exhaled carbon monoxide [(e CO) (ppm), Bedfont Scientific, Maidstone, Kent UK]. Perfused Boundary Region (PBR), which is inversely related to endothelial glycocalyx thickness in sublingual arterioles (range 5–25 μm) and blood levels of cotinine, a stable metabolite of nicotine, was assessed in all participants. Exhaled CO, endothelial glycocalyx, and blood cotinine were assessed at baseline and after 1 month.

Results
Conventional cigarette smokers were aged: 48 ± 5 years, 53% female and used 27 ± 9 cigarettes/day, 29 ± 9 pack-years. HNBC users were aged: 46 ± 14 years, 55% female and used 26 ± 8 cigarettes/day, 30 ± 8 pack-years. Ecig users were aged: 45 ± 8 years, 51% female and used 27 ± 10 cigarettes/day, 28 ± 10 pack-years. Compared to baseline, switching to HNBC for 1 month improved only PBR20-25 (2.55±0.49 vs 2.34±0.34 μm, p=0.002). Ecig use did not alter endothelial glycocalyx in any range of microvessels throughout the study (p&gt;0.05). In contrast, Tcig smoking for one month further worsened endothelial glycocalyx in all microvessels ranges compared to baseline (p&lt;0.05). Blood cotinine levels were similar at baseline and after 1 month using HNBC (p=0.432), Ecig (p=0.535) or conventional cigarette (p=0.489). Compared to baseline, exhaled CO decreased in HNBC or Ecig users (mean percent change: -55% and -58% respectively p&lt;0.001), while remained unchanged in Tcig smokers (p=0.312) at 1 month. Thus, Tcig smokers had higher CO than those who switched to HNBC or E-cig after one month (p&lt;0.01).

Conclusion
Conventional cigarette users further worsened endothelial glycocalyx after continuing to smoke for one month. In contrast, smokers who switched to Ecig maintained glycocalyx integrity, while those who switched to HNBC showed modest improvement in glycocalyx integrity in microvessels ranging from 20 to 25 μm. Cotinine levels, which reflect nicotine exposure, were similar between the Tcig, HNBC and Ecig groups. Thus, endothelial glycocalyx impairment in the conventional cigarette group was independent of nicotine consumption and possibly related to greater exposure to toxic emissions, such as CO, after Tcig use than after switching to HNBC or Ecig.
The introduction of a dedicated cardiology clinic including a clinical scientist led pathway for women with turner's syndrome
Authors: Macrae R , Von Klemperer K , Zemrak F , Wong H Y C , Stoicescu C N 
Published: October 2024

Abstract

Background
There are more than 15,000 women living with Turner’s Syndrome (TS) in the UK, over 700 of whom are cared for within our linked Endocrinology services. Mortality is predominantly related to cardiovascular disease therefore close cardiology review with a focus on aortopathy is essential (1). However appropriate surveillance is challenging with growing pressures on all aortopathy services across the United Kingdom.

Purpose
To audit our current practise according to current international guidelines (2) and seek methods to improve the pathway for our growing population of TS patients including the feasibility of a Clinical Scientist led clinic, aiming to improve capacity and efficiency of our service.

Methods
A quality improvement project was conducted over a three-year period, piloting a dedicated clinical scientist-led clinic under close Cardiology Consultant supervision. Patients selected were deemed lower risk for cardiovascular complications according to American Heart Association (AHA) recommendations (2) (figure 1). Follow-up intervals of patients under both consultant-led and clinical scientist led pathways were analysed.

Results
Among a total of 226 patients analysed, 103 (46%) fell into the lowest risk category and therefore deemed suitable for prospective Clinical Scientist led pathway (figure 2).
Analysis of all patients demonstrated that 60% had appropriate follow-up intervals according to guidelines, while 37% were too short and 3% were too long. A five-year projection indicated a consequential 96 unnecessary additional appointments for patients that were being seen too frequently. Further analysis showed that the time frame for follow up was too short in 25% of patients seen in the clinical scientist led clinic compared to 41% in the Consultant-led clinic.
There were no aortic dissections in patients under surveillance during this period. In the last 10 years 1 patient on the waiting list for surgery (having presented with a type B dissection but requiring workup for liver cirrhosis) had a retrograde type A dissection (indexed aortic root dimension 2.4cm/m²). No other adverse events were recorded.

Conclusion
Auditing our service revealed safe management and improved adherence to guidelines in the clinical scientist-led clinic, identifying opportunities to optimize follow-up and enable physicians to focus upon high-risk patients. This pilot demonstrates the feasibility of a clinical scientist-led clinic in managing low risk TS patients, suggesting scalability to other conditions involving aortopathy to address capacity issues and improve pathways.
Fully automated detection of anomalous aortic origin of the coronary arteries in coronary CT images: a novel artificial intelligence-based screening tool
Authors: Shiri I , Mohammadi Kazaj P , Bigler M , Stark A , Kakizaki R , Siepe M , Valenzuela W , Raber L , Giannopoulos A , Ralf Buechel R , Graeni C 
Published: October 2024

Abstract

Background
Anomalous Aortic Origin of the Coronary Artery (AAOCA) is a rare congenital disease that can be easily overlooked during contrast-enhanced Coronary Computed Tomography Angiography (CCTA) image analysis.

Objective
In this study, we aimed to develop a novel artificial intelligence-based screening tool to automate the detection of AAOCA in CCTA images.

Method
We enrolled 127 patients from the coronary artery anomaly registry from two centers with AAOCA diagnosis based on CCTA as well as 413 normal cases. A deep learning model was developed to automatically segment the aorta and the left ventricle (LV), after which the images were automatically cropped to the aortic root and LV intersection with a box size of 6 cm3. The images were then clipped to Hounsfield Units ranging from -400 to 750 and normalized to -1 to1. These cropped regions were fed into different residual convolutional neural networks (ResNet, with different depths 10, 18, 34 and 50) to detect AAOCA. Model development (parameter and hyperparameters optimization) was performed on the training and validation sets (70/10%), and finally, it was tested on the 20% untouched test set. Various classification metrics were reported for the detection of AAOCA.

Results
ResNet-10 achieved an AUC of 0.91 (sensitivity: 0.89, specificity: 0.86), while ResNet-18 showed improved performance with an AUC of 0.95 (sensitivity: 0.89, specificity: 0.95). ResNet-34 achieved an AUC of 0.94 (sensitivity: 0.83, specificity: 0.96), and ResNet-50 excelled with the highest AUC of 0.96 (sensitivity: 0.89, specificity: 0.95), indicating its superior capability in accurately identifying AAOCA.

Conclusion
We developed a high-performance AI tool for the fully automated detection of AAOCA using CCTA images. This tool can be used to evaluate large patient cohorts and detect AAOCA in extensive databases. Moreover, it can operate seamlessly alongside clinical assessments of CCTA scans, providing real-time alerts to medical personnel about potential AAOCA findings. This enhances diagnostic efficiency and supports early intervention in cardiovascular care.
Using deep learning to detect atherosclerotic plaques on carotid ultrasound images in the UK Biobank
Authors: Omarov M , Jorshery S D , Malik R , Raghu V K , Dichgans M , Anderson C D , Georgakis M K 
Published: October 2024

Abstract

Background
Atherosclerosis is the main underlying cause of cardiovascular disease (CVD). Existing CVD risk assessment tools do not consider the burden of subclinical atherosclerosis. The presence of carotid plaques on carotid ultrasound is a well-known marker of subclinical atherosclerosis. The accumulation of population-scale data on the presence of atherosclerotic plaques, along with deep phenotyping, can allow not only to address the effectiveness of carotid ultrasound in routine clinical practice, but to shed light on the biology of atherosclerosis development.

Purpose
To develop an effective deep learning model for plaque detection in carotid ultrasound images in the UK Biobank.

Methods
We used 680 carotid ultrasound images with manually annotated plaques to train a deep learning model employing the YOLOv8 architecture. Different augmentation techniques were used to increase the generalizability of the model. The developed model was applied to automatically detect plaques in raw ultrasound images from 19,507 UK Biobank participants. Logistic and Cox regression were used to explore the associations of plaque presence and number as predicted by the model with conventional CVD risk factors and the risk of future CVD events over follow-up. To explore the genetic architecture of subclinical atherosclerosis, we conducted a genome-wide association study (GWAS) on plaque presence, followed by meta-analysis with data from the CHARGE Consortium.

Results
Our plaque detection model achieved high classification metrics of accuracy, sensitivity, and specificity (89.3%, 89.5%, and 89.2%, respectively) and detected atherosclerotic plaques in 44% of UK Biobank participants. As expected, plaques were more common among men than women and their prevalence increased linearly with age. Both plaque presence and number of plaques were correlated with conventional CVD risk factors including diabetes, hypertension, and hyperlipidemia, and showed strong associations with future risk of incident CVD events (Hazard Ratio for plaque presence: 1.48 [95%CI: 1.21-1.82], for 2 plaques or more: 1.65, [95% CI: 1.28-2.13]). Incorporating plaque-derived phenotypes minimally altered the C-index of the time-to-event model. GWAS meta-analysis of carotid plaque presence revealed 5 previously known loci, as well as a significant locus including the LPA gene that had not previously been associated with carotid plaque.

Conclusion
We have developed and implemented an efficient plaque detection model to data from the UK Biobank, which holds significant promise for studying atherosclerosis at a population-wide scale through integration with multiomics data and electronic health records.