bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of ultrasound-assisted thrombolysis and mechanical thrombectomy in patients with intermediate-high-risk pulmonary embolism
Authors: Pinsdorf D , Knuschke R , Petrikhovich O , Messiha D , Janosi A , Rassaf T , Rammos C 
Published: October 2024

Abstract

Background
Pulmonary embolism (PE) can cause right heart failure and is associated with a high mortality. Early risk stratification is critical for individualized management. In patients with intermediate-high-risk PE, guidelines recommend to consider a percutaneous catheter-directed treatment (CDT). While different techniques are available, comparisons between treatments regarding right heart function and outcome are still scarce.

Purpose
To compare changes in right heart function as well as outcome in patients with intermediate-high-risk PE after catheter-directed treatment with ultrasound-assisted thrombolysis as compared to mechanical thrombectomy.

Methods
This is a retrospective, single-center study in intermediate-high-risk PE. According to the ESC guidelines, all patients had PESI class III-V, RV dysfunction and elevated cardiac troponin levels, but were hemodynamically stable. PE was confirmed by CT angiography. All patients underwent a catheter-directed treatment. One group received an ultrasound-assisted thrombolysis (USAT), while the other had a large-bore mechanical thrombectomy (MT). Right heart function (RV-Diameter, RV-/LV-Ratio, TAPSE) assessed via transthoracic echocardiography before and after CDT as well as interventional characteristics and postinterventional hospital stay were compared.

Results
From June 2022 to January 2024, 27 patients (43% female; aged 62 ± 14 years) were diagnosed with pulmonary embolism with intermediate-high-risk and underwent a catheter-directed treatment. Most patients (89%) had bilateral pulmonary embolisms. 15 patients (55%) received an ultrasound-assisted thrombolysis. 12 patients (45%) had a mechanical thrombectomy via a large-bore aspiration system. The mean procedural time was 41 ± 19 minutes for USAT and 106 ± 33 minutes for MT (p &lt; 0.001). Right ventricular / left ventricular ratio reduction was -0.48 ± 0.25 in the USAT group (p &lt; 0.001) and -0.34 ± 0.14 in the MT group (p &lt; 0.001) (between group difference p = 0.2). TAPSE increased by 8 mm ± 4.4 mm in the USAT group (p &lt; 0.001) and by 8.7mm ± 3.8 mm in the MT group (p &lt; 0.001) (between group difference p = 0.7). The median postinterventional hospital stay was 7 days for the USAT patients and 7 days for the MT patients (between group difference p = 1).

Conclusions
In patients with intermediate-high-risk PE both ultrasound-assisted thrombolysis and large-bore mechanical thrombectomy lead to an improved right heart function with both interventions leading to a similar length of postprocedural hospital stay. Further randomized data have to discriminate differential impact of novel tools for the treatment of intermediate risk PE.
Evaluation of naples prognostic score to predict long-term mortality in patients with pulmonary embolism
Authors: Pay L , Cetin T , Keskin K , Dereli Ş , Tezen O , Yumurtas A , Kolak Z , Eren S , Saylik F , Cinar T , Hayiroglu M 
Published: October 2024

Abstract

Background/Introduction
APE mortality rates are still not satisfactory despite new diagnosis and treatment methods (1). Thus, risk classification is crucial due to the wide range of clinical presentations. Several risk stratifications have been developed such as simplified Pulmonary Embolism Severity Index (sPESI) (2). Nonetheless, there remains a need for an optimal indicator that can be conveniently measured with a high degree of precision to predict clinical outcomes. Naples prognostic score (NPS) is a newly defined index that is developed to determine the prognosis of cancer patients and reflects the inflammatory and nutritional status of the patients (3).

Purpose
The aim of our study was to determine the long-term prognostic value of NPS in APE patients.

Methods
Two hundred ninety-three patients diagnosed with APE between November 2016 and February 2022 were included in the study. NPS consists of 4 parameters: serum albumin, total cholesterol (TC) concentration, neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR). Naples scores of all patients were calculated and the patients were divided into 2 groups according to their NPS and their long-term mortality was compared. The primary endpoint of the study was long-term mortality.

Results
The long-term mortality was observed in 38 patients out of 293 patients in the mean follow-up of 24 (16-42) months. In the low-Naples risk group (group 1), there were 215 patients, while the high-Naples risk group (group 2) had 78 patients. Multivariate analysis showed that NPS as a categorical parameter (HR: 3.458, 95%CI:1.734-6.896, p&lt;0.001), NPS as a numerical parameter, (HR:1.651, 95%CI:1.217-2.241, p=0.001) and simplified pulmonary embolism severity index (sPESI) (HR:1.887, 95%CI:1.223-2.911), p=0.004) score were independent predictors of long-term mortality. The receiver operating characteristic curve analysis showed that the model 2 with NPS as continuous had higher discriminative ability than the baseline model for detecting patients with mortality (Area under curve (AUC) values = 0.791 vs. 0.723, respectively, p=0.04) (Figure 1A). The long-term predictive capability of NPS was non-inferior than the sPESI score (Figure 1B).

Conclusions
The current study highlights that NPS, which reflects systemic inflammation and nutritional status may have potential to predict long-term mortality in APE patients. To our knowledge, this is the first study to show the relationship between long-term mortality and NPS in APE patients.
Right ventricular dysfunction parameters at echocardiography in patients with acute pulmonary embolism: meta-analysis of individual participant data
Authors: Cimini L A , Pruszczyk P , Jimenez D , Weekes A , Zuin M , Vanni S , Ciurzynski M , Kostrubiec M , Khemasuwan D , Yuriditsky Y , Bahloul M , Rajagopal S , Pieralli F , Monreal M , Becattini C 
Published: October 2024

Abstract

Background & Aim
Echocardiography has a crucial role for decision making on management of patient with acute pulmonary embolism (PE) according to current international guidelines. However, the definition of right ventricle dysfunction (RVD) at echocardiography requires standardization. We performed an Individual patient data meta-analysis (IPDMA) to assess the role of individual parameters of RVD and of combinations of parameters for the prediction of short-term all-cause mortality and PE-related death.

Methods
A systematic search was run to identify clinical studies reporting on RVD at echocardiography and on short-term clinical outcome in patients with acute PE. Individual patient data from the original studies were pooled to perform a meta-analysis (IPDMA). The study outcomes were short-term death defined as death occurring within 30 days from PE diagnosis and PE-related death. Multiple imputation was used for the management of missing data. The odds ratio for all cause and PE related mortality were calculated using generalized linear mixed effects model.

Results
Individual data from 9,233 patients with acute PE from 16 studies were pooled in a unique database. All cause short-term mortality occurred in 9% of patients (95% CI 0.06-0.13, I2 93%). The IPDMA was feasible for the following parameters: tricuspid anulus systolic excursion (TAPSE), estimated pulmonary artery pressure (PAP) &gt;30mmHg, right to left ventricle diameter ratio (RV/LV)&gt;1, hypokinesia, paradoxical septal motion, RV diameter&gt;30 mm and McConnel sign. All these parameters, except for PAP&gt;30mmHg and RV diameter&gt;30 mm, were predictors of short-term all cause death in the overall population and in hemodynamically patients (table). All the assessed RV findings, except for the McConnell’s sign, were predictors of PE-related death (Table). The presence of one RVD parameter only was not associated with increased risk of all cause death (OR 1.22, 95% CI 0.97-1-54), while the presence of two parameters or ≥ three parameters were (OR 1.63, 95% CI 1.24-2.15; OR 2.07 95% CI 1.59-2.69, respectively).

Conclusion
In patients with acute PE, the majority of RVD parameter at echocardiography are predictors of short-term death and of PE-related death. The higher the number of RVD parameters the worst the prognosis. These results claim for standardization in RVD definition to guide decision making for patient management.
A novel dynamic risk score to predict venous thromboembolism (VTE) recurrences after 3 months of anticoagulation in patients with incident VTE and without active cancer
Authors: Cohen A , Choudhuri S , Khan I , Pollock K , Bober-Irizar M , Galias Z , Irizar A , Bober M 
Published: October 2024

Abstract

Background
Predicting the risk of recurrent venous thromboembolism (rVTE) during and following anticoagulation is complex. Current models lack the ability to adapt to changing patient conditions over time and fail to account for the direct impact of anticoagulation in real-world clinical settings.

Purpose
To develop a dynamic risk prediction model for rVTE to help clinicians decide on the duration of anticoagulant therapy in conjunction with a model for bleeding (also submitted to the conference).

Methods
UK Clinical Practice Research Datalink data (2001-2020) was used to generate a retrospective cohort with first VTE who had received 3 months of anticoagulation. Patient episodes of rVTE were evaluated. Covariates were collected at baseline and subsequently as time-varying data to capture changes post-VTE. Hazards with 95% confidence intervals (CI) were estimated and covariates included in a Fine & Gray model used as predictors of rVTE. An additive (logarithmic) scoring scheme was developed from subdistribution hazard ratios, discrimination (expressed by the C-statistic) estimated from 10-fold cross-validation.

Results
51,465 patients with a first VTE were included; 4041 rVTE were identified in 200,698 person-years of observation. Incidence rates for rVTE were 2.01 per 100 person-years. Nineteen independent predictors of rVTE (recorded before or after the VTE diagnosis) were included in the model, 13 associated with increased risk and 6 with decreased risk, Table 1. Patients recognised as lower-risk, medium and higher-risk (10.5%, 37% and 52.5% of the population, respectively, at 90 days after first VTE, assuming no anticoagulation treatment) had an annualised rVTE incidence rate of 2.20, 3.84, and 7.44 per 100 person-years. The C-statistic for rVTE was 0.65 (95%CI, 0.64-0.66). The points scored can be added or subtracted to predict risk (Table 2).

Conclusions
Our dynamic risk score effectively identifies patients at risk of rVTE three months post their initial VTE diagnosis. It allows for continuous monitoring of risk, and modelling of treatment impact, providing clinicians with a pragmatic tool to help determine treatment duration, and adapt their strategies in response to evolving patient conditions.Table 1:Predictors for VTE recurrenceTable 2:VTE recurrence risk score
Mini nutritional assessment is a predictor of mortality and morbidity in patients with pulmonary arterial hypertension
Authors: Wieteska-Milek M , Szmit S , Florczyk M , Betkier-Lipinska K , Kusmierczyk-Droszcz B , Zielinski P , Krzesinski P , Hoffman P , Kurzyna M 
Published: October 2024

Abstract

Background
Malnutrition has been demonstrated as a predictor for unfavorable clinical outcomes in chronic heart failure, and may affect patients with pulmonary arterial hypertension (PAH). The Mini Nutritional Assessment (MNA) is a reliable indicator for nutritional status assessment, but its relationship with mortality risk and hospitalization in PAH patients has not yet been investigated.

Purpose
The study aimed to determine whether the MNA has prognostic value in stable patients with PAH.

Methods
A prospective multicenter study was performed. All patients completed the MNA at study entry in outpatient clinic or during planned hospitalization. The primary endpoint was all-cause mortality. Secondary end-point was the composite end-point of all cause death or PAH-related hospitalizations. Patients with malnutrition (MNA ≤17 points) or at risk of malnutrition (MNA 18-23,5 points) were considered as having abnormal nutritional status for statistical analysis.

Results
182 PAH patients were included to the study (mean age 60 ± 17 years; 73% females; 57% idiopathic PAH). Abnormal nutritional status was identified in 68 (37%) patients. Median and the range of follow up period was 23 months and 0–32 months, respectively. 34 (18.7%) patients died, 53 (29.1%) were hospitalized due to PH, and 57 (31.3%) achieved the composite secondary end-point.
Kaplan-Meier survival curves revealed significant differences in overall survival between patients with abnormal MNA and normal MNA, p &lt;0.0001, and significant differences in composite risk of death and PAH-related hospitalization, p=0.02.
In the multivariate Cox regression analysis including age, sex, and main risk factors (COMPERA 2.0 score, TAPSE/PASP, right atrial pressure, cardiac index, mix oxygen saturation), abnormal MNA remained significantly associated with all-cause mortality (HR 2.86 [95%CI: 1.29–6.38], p=0.01) and the composite end-point HR 2.39 [95% CI: 1.05–5.42], p=0.04) in PAH patients.

Conclusions
Using MNA as a routine screening tool allowed the detection of abnormal nutritional status in more than one third of PAH patients. Nutritional status assessed by the MNA was an independent predictor of all-cause death and the composite end-point of all-cause death and PAH-related hospitalization in patients with PAH.
Improved prognosis prediction of idiopathic pulmonary arterial hypertension using targeted plasma proteomics in disease management
Authors: Yang Y , Shu S R , Sun B , Wang P Z , Zeng Q X , Wang C S , Xiong C M 
Published: October 2024

Abstract

Background
Idiopathic pulmonary arterial hypertension (IPAH), a special subgroup of PAH with unclear etiology, is characterized by rapid progression and poor prognosis underscoring the need for optimization of IPAH management and the accurate prediction of prognosis. However, it is disappointing that specific plasma biomarkers for IPAH management and prognosis are lacking in clinical practice. Up to date, the plasma biomarkers used for assessment of IPAH severity and prognosis are relied solely on indicators such as N-terminal prohormone of brain natriuretic peptide, or brain natriuretic peptide, which could reflect cardiac function but fail to promptly response to the dynamic change of disease condition due to the complexity of IPAH pathogenesis.

Purpose
We evaluated the prognostic value of plasma proteins in addition to current clinical predictors for prognosis prediction of IPAH.

Methods
Olink Immune-Response panel was used to measure 92 plasma proteins in a prospective IPAH cohort with 169 patients and a mean follow-up period of 2.4 ± 0.9 years. Six machine learning methods were used to construct predictive models, including plasma proteins-based Olink models, clinical parameters-based clinical models, and integrative models.

Results
A total of 18 proteins showed differential expression between patients with or without adverse clinical outcomes. Three proteins (STC1, CXADR, and IL6) were strongly correlated with clinical indicators of IPAH severity and their concentrations showed upward trends along with increased risk stratification. Elevated levels of STC1, CXADR, and IL6 are all associated with an increased risk of adverse clinical events, indicated by survival analysis, restricted cubic splines, and multivariable Cox regression analysis (STC1 HR=3.474, 95%CI: 1.129-10.692, P=0.030; CXADR: HR=1.602, 95%CI: 1.074-2.387, P=0.021; IL6: HR=1.883, 95%CI: 1.376-2.576, P&lt;0.001). The inclusion of these three proteins into the predictive model could significantly increase the predictive power on the basis of the clinical model (AUC: 0.746 vs 0.626).

Conclusions
High levels of STC1, CXADR, and IL6 in plasma were associated with severe clinical phenotype and increased risk of adverse clinical events in patients with IPAH. These plasma proteins could significantly improve the prognostic performance of pre-existing clinical models, facilitating the clinical management of IPAH patients.The predictive efficient of models
Genome wide association studies on three-dimensional aortic geometric indices measured with magnetic resonance imaging
Authors: Beeche C , Dib M J , Azzo J D , Maynard H , Salman O , Witschey W , Chirinos J 
Published: October 2024

Abstract

Introduction
To date, three-dimensional properties of the aorta have not been comprehensively quantified in a population level dataset, nor has there been a genome-wide association study (GWAS) to identify significant single nucleotide polymorphisms (SNPs) associated with geometric properties of the aorta.

Methods
We segmented the thoracic aorta of 48,045 subjects in the UK Biobank using a U-Net convolutional neural network. We then computed geometric measurements (centerline length, arch height, arch width, arch height-width ratio, curvature, and mean, minimum and maximum diameter) across six subsegments of the aorta. Centerline length was allometrically indexed to body height. Using generalized linear models, we performed GWAS on each geometric phenotype adjusted for the following covariates: (1) age, (2) sex, and (3) ten genetic principal components. SNPs with a minor allele frequency &lt; 0.05 were excluded. We performed LD-based clumping with an r2 threshold of 0.001 to identify significant loci and used LDSC to compute the genetic heritability of each geometric phenotype.

Results
After performing LD clumping, we identified 457 significant(P&lt;5e-8) SNPs across 36 aortic geometric parameters. GWAS-based heritability analyses showed a mean heritability of 13.8 (9.9) % across all aortic geometric parameters, with all intercepts being close to 1, suggesting minimal genomic inflation. Maximum aorta diameter exhibited the highest observed heritability of 34.5 (3.0) %. Allometric centerline length showed a heritability of 13.6 (1.5) %. Similarly, arch height and width showed heritability of 14.6 (1.5) %, and 13.64 (1.5) % respectively. Aortic curvature showed limited heritability at 8.54 (1.2) %, with arch curvature being further reduced to 7.6 (1.20) %.

Conclusion
To our knowledge, this was the first study that investigated the genetic architecture of aortic centerline length, aortic curvature, and aortic tortuosity. These results suggest that aortic remodeling associated with aging and pathological conditions has important genetic contributions. SNPs associated with aortic geometry may identify therapeutic targets to prevent aortic remodeling, which should be the focus of future work.significant_snpsheritability
Efficacy of beta blockers in patients with thoracic aortic aneurysm: meta-analysis of randomized controlled trials
Authors: Tanriverdi L H , Barrett A , Kalyanasundaram A , Zafar M A , Ziganshin B A , Elefteriades J A 
Published: October 2024

Abstract

Studies investigating the efficacy of β-blocker agents on patients with thoracic aortic aneurysm have produced heterogeneous and conflicting results. This study was aimed to assess protective effects of β-blockers in terms of aortic events (dissection, rupture) and mortality in patients with thoracic aortic aneurysm. A systematic literature search was performed through Ovid MEDLINE, EMBASE, Web of Science, Pubmed and The Cochrane Central Register of Controlled Trials (Cochrane CENTRAL), all from inception to May 10, 2022. Randomized controlled trials exploring the efficacy of β-blocker agents in patients with thoracic aortic aneurysm were considered for inclusion with no population restriction. Two independent reviewers performed the literature search. Two reviewers independently extracted all available prespecified relevant data in accordance with the International Prospective Register of Systematic Reviews protocol. Summary effect measures of the primary outcomes were obtained by pooling the data with an inverse variance–weighted random-effects model. The overall risk of bias assessment was conducted by using the Cochrane Risk of Bias 2 tool A sensitivity analysis was performed regarding whether the conclusions reached might differ substantially if a single study was omitted. The primary outcome was aortic events (aortic dissection/rupture). Secondary outcomes were death (all-cause mortality) and aortic dissection. Two independent reviewers identified 4 RCTs presented in 5 reports from 1494 unique studies screened. Three trials involving 129 eligible participants compared β blockers (propranolol and celiprolol) with no treatment. One trial involving 32 eligible participants compared β blocker (atenolol) with placebo. This systematic review and meta-analysis included 161 patients with thoracic aortic aneurysm (mean age, 27.6 years; 80 [49.7%] male, mean follow-up 6.7 years). The pooled risk ratio in the β-blocker arm for aortic events was 0.74 [95% CI (0.20; 2.71), I2: 0%, p=0.64] when comparing to the placebo or no treatment in patients with thoracic aortic aneurysm. The pooled risk ratio for death (all-cause mortality) and aortic dissection in the β-blocker arm were 0.45 [95% CI (0.10; 1.98), I2: 0%, p=0.29] and 0.58 [95% CI (0.15; 2.24), I2: 0%, p=0.43], respectively. The risk of aortic dissection, rupture, or death were essentially identical, regardless of treatment group and subgroup analysis. A sensitivity analysis revealed that none of the studies significantly influenced the pooled risk estimate to any great extent. We found no evidence of benefit from β-blocker treatment. More robust data regarding β-blocker use in patients with thoracic aortic aneurysms from randomized controlled trials are needed to establish evidence based recommendations and to determine whether current evidence comes from absense of evidence or evidence of absense.Forest plot for death (all-cause)