bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of a systematic referral model to primary care health interventions for patients with atrial fibrillation. a delphi study
Authors: Elnegaard C , Risom S , Borregaard B , Tveskov C , Brandes A , Zwisler A D 
Published: October 2024

Abstract

Background
The European Society of Cardiology (ESC) guidelines for the management of atrial fibrillation (AF) recommend integrated care in AF, combining medical treatment with lifestyle modifications and psychosocial management in a multi-disciplinary set-up. Research show that patients with AF can benefit from lifestyle interventions and psychosocial management, like patient education. According to World Health Organization recommendations, these health interventions are moving from hospitals to primary healthcare settings. Therefore, patients with AF should be systematically referred to these interventions. Yet, an evidence-based referral model that can support this transition is lacking.

Purpose
The purpose is to develop a systematic referral model for primary care health interventions for patients with AF.

Methods
We used the Delphi-technique with three rounds of questionnaires (figure 1). International and national clinical experts in AF across disciplines and health sectors were invited to participate. In the first round, the expert panel evaluated items that could be part of a referral model on relevance, improvability and self-reporting. In the second round, the expert panel evaluated each item as either an inclusion or exclusion criteria, important knowledge to have, or not relevant. In the third round, the expert panel evaluated the items according to data source and outcome status. A final model was drawn based on items reaching consensus. The study was reported according to the guidance on conducting and reporting Delphi studies (CREDES).

Results
In total, 69 of 139 invited experts accepted to participate (50%). These were mostly academics or clinicians (90%), stemming from primary sector (16%), secondary sector (35%) and research (32%). Most were medical doctors (36%) and nurses (35%). However physiotherapist, psychologists, dieticians, and other disciplines along with six patients with AF were also represented. The expert panel (60% females) had a mean age of 50 years, and 65% were from Denmark. For the final referral model (figure 2), AF symptom burden and impaired health-related quality of life, anxiety and poor medicine compliance combined with a risk factor profile were the main inclusion criteria. Furthermore, it was important to know about the patients’ mental well-being, self-management abilities and comorbidities.

Conclusion
Consensus was reached for a generic referral model, which can be further adjusted in the appropriate clinical context. The model includes inclusion criteria which closely correlate with guidelines for AF management focusing on reducing the patients’ symptom and risk factor burden. The referral model is expected to increase the number of patients with AF referred to primary care health interventions, which could lead to better quality of life, fewer hospital admissions and lowered health care costs in AF.
Exploring LGE areas in the atria: Insights from electroanatomical voltage mapping in AF patients
Authors: Ali S Y , Mohsen Y , Mao Y , Sakata K , Prakosa A , Yamamoto C , Kholmovski E , Sinha S , Marine J , Sommer P H , Sohns C H , Stoeckigt F , Spragg D , Trayanova N 
Published: October 2024

Abstract

Introduction
Late gadolinium enhancement MRI (LGE MRI) is a common method for the evaluation of the atrial substrate in atrial fibrillation (AF) patients. The extent of LGE is associated with atrial cardiomyopathy and ablation outcomes. However, previous studies have yielded inconsistent results in detecting low voltage areas (LVA) using bipolar electroanatomical mapping (EAM) in LGE regions.

Objective
Conduct a thorough analysis of the bipolar and unipolar voltage in LGE areas and its relationship with the voltage in non-LGE areas, utilizing high-density (HD) EAM generated by a multipolar HD-mapping catheter.

Methods
In this study, 20 patients undergoing AF ablation were examined using LGE-MRI. A 3D mesh integrating LGE data was generated. HD-EAM (&gt; 4000 points) was performed in sinus rhythm. The EAM map and MRI mesh underwent manual alignment and registration. Using a nearest neighbor algorithm, EAM points nearest to LGE areas were identified, and the corresponding unipolar and bipolar voltage values, along with LGE voxel intensity, were exported for analysis.

Results
LGE areas exhibited a median bipolar voltage amplitude of 0.93 mV, median unipolar voltage of 1.73 mV. In contrast, areas without enhancement displayed median bipolar voltage of 2.33 mV, unipolar voltage of 3.58 mV. We observed a variation in voltage amplitudes across the different LGE areas: bipolar voltage ranged from 0.04 to 2.51 mV and unipolar voltage from 0.22 to 3.75 mV. This variation strongly correlated with voxel intensity in LGE areas (correlation coefficient r = -0.86 [p &lt;0.001]). Irrespective of the voltage amplitude in the examined LGE areas, a significant voltage drop was observed, with an average reduction of 54% in bipolar and 51% in unipolar voltages, compared to the amplitudes in non-LGE areas within the same atria.

Conclusion
Variations in bipolar and unipolar voltage within LGE areas are significantly correlated with local voxel intensity. Despite the inconsistent overlap with the predefined bipolar threshold for LVA, LGE regions exhibit a pronounced and consistent reduction in both bipolar and unipolar voltage compared to non-LGE areas. This pattern suggests notable electrophysiological changes in these areas. These insights underscore the need for further investigation to better understand the implications and mechanisms underlying these alterations in LGE regions.
Patients vaccinated against COVID-19 present better coronary flow, myocardial work and NTproNP levels than non-vaccinated at 4 months post COVID infection
Authors: Ikonomidis I , Kountouri A , Katogiannis K , Pavlidis G , Thymis J , Kostelli G , Katsanaki E , Thomas K , Antoniadou A , Tsiodras S , Frogoudaki A , Vrettou A R , Parissis J , Lambadiari V 
Published: October 2024

Abstract

Introduction
COVID-19 affected patients present impaired subclinical markers of cardiovascular and endothelial function post resolution of infection. Whether vaccination impedes impairment of myocardial and vascular function has not been clarified.

Purpose
We investigated the effect of COVID-19 infection on markers of endothelial, vascular and myocardial function in vaccinated and non-vaccinated subjects at four months after the infection.

Methods
We recruited 60 vaccinated and 60 non-vaccinated patients with similar clinical characteristics, who were examined in a dedicated post-COVID-19 outpatient clinic during a scheduled follow-up visit at four months after a confirmed COVID-19 infection. We measured (i) perfused boundary region (PBR) of the sublingual arterial (increased PBR indicates reduced endothelial glycocalyx thickness), (ii) flow-mediated dilatation (FMD), (iii) coronary flow reserve (CFR) by Doppler echocardiography, (iv) pulse wave velocity (PWV) and central systolic blood pressure (cSBP), (v) global left and right ventricular longitudinal strain (GLS), (vi) myocardial global work index (GWI) global constructive work (GCW), global wasted work (GWW) and the myocardial global work efficiency (GWE) and v) NTproBNP blood levels.

Results
Among vaccinated patients 54,2% had mild disease, 33,3% had moderate disease and 12,5% had severe disease, while among non-vaccinated 29,1% had mild disease, 32,9% had moderate disease and 38% had severe disease(p&lt;0.05).
At four months, vaccinated patients presented with higher LVGLS, GCW values and CFR compared to non-vaccinated (p&gt;0.05 table), while GWI, GWW and GWE were similar between the two groups(p&gt;0.5). Moreover, in vaccinated patients RVGLS and RV FWLS were significantly higher than in non-vaccinated patients (p&gt;0.05). Also, NTproBNP leves were significantly lower in vaccinated than in non-vaccinated patients (p&lt;0.05).
At four months, in vaccinated patients , we observed a marginally lower brachial and central systolic blood pressure compared with non-vaccinated (p=0.045, p=0.048 respectively.) Vaccinated patients displayed similar FMD and PWV values compared to non-vaccinated (p&gt;0.05 for all the comparisons).

Conclusion
Patients vaccinated against COVID-19 suffered from milder disease resulting to better cardiac function and lower NTproNP levels than non-vaccinated 4 months post COVID infection.
Serum proteomic profiling reveals potential inflammatory biomarkers in long-COVID patients: a comparative analysis with healthy controls
Authors: De Angelis M , Togni G , Praderio A , Fioretti F , Sammartino A , Rizziello A , Calzoni A , Nodari S 
Published: October 2024

Abstract

Background
Long-COVID (also known as post-acute sequelae of SARS-CoV-2 infection, PASC), is defined as the persistence, or the new onset, of symptoms after recovery from the acute phase of COVID-19.
It consists of a multiorgan syndrome expressing itself with a wide variety of cardiovascular and non-cardiovascular symptoms such us chest pain, fatigue, shortness of breath, autonomic dysfunction, cognitive impairment and sleep disorders even in the absence of a clear evidence of organ dysfunction.
Some previous studies have suggested the potential role of an abnormal inflammatory response after SARS-CoV-2 infection, however the specific underlying mechanisms remain unclear.
In this study we performed a proteomic analysis of the serum of 80 long-COVID patients to identify potential biomarkers that may act as indicators or therapeutic targets for long COVID.

Methods and results
We compared the levels of the proteins in both long-COVID group and a control group using multivariate and univariate analysis. Both PLS-DA and PCA analysis showed a clear distinction between the two groups; clustering analysis also clearly separated control from long-COVID patients. Proteins were then filtered based on (a) statistical analysis, considering proteins with a VIP&gt;1 (PLSDA) and p&lt;0.05 (t-test); (b) coefficient of variation (CV), where only proteins with CV&lt;10 were considered; (c) and fold change (FC), for which proteins with FC&lt;0.67 or FC&gt;1.5 were selected for further analysis.
The selected proteins were then subjected to a ROC curve analysis to identify antithrombin as a potential biomarker with an area under the curve (AUC) near 1. Other proteins, displaying an AUC &gt; 0.98, were also identified as potential biomarkers (Sirtuin 1, NatriureticPeptide B, Hemopexin Arachidonate 5-Lipoxygenase). In addition, a multivariate ROC method, using linear SVM as classification method, identified that a combination of ten proteins would also result in an AUC near 1.
Finally, a correlation analysis between the proteins of interest and the clinical manifestations was performed. A positive correlation (above 0.5) was found between dyspnea and Glucocorticoid Receptor and between memory deficit and Antithrombin. Arachidonate 5-Lipoxygenase was negatively correlated (below -0.5) with tremors and hair loss, MannoseBinding Lectin 2 was found to be positively linked to asthenia, Antithrombin with concentration deficit and Endothelin-2 with muscles aches.

Conclusions
The identified biomarkers are associated with inflammatory processes, corroborating literature evidence that long-COVID patients develop an inflammatory state that damages many tissues. Further studies are needed to validate this data in larger cohorts to identify specific biomarkers, and guide future preventive strategies or treatments to address long COVID and its cardiovascular and non-cardiovascular sequelae.
Prognostic evaluation with cardiac magnetic resonance in patients with systemic sclerosis
Authors: Fernandez J R , Guillen Del Castillo A , Airale L , Giustiniani A , Valente F V , Illuminato F , Simeon C P , Rodriguez Palomares J F 
Published: October 2024

Abstract
Systemic sclerosis (SSc) is an autoimmune disease with multiorgan involvement. Cardiac involvement is common and impact in prognosis. Cardiac magnetic resonance (CMR) allows an evaluation in ventricular and atrial function and hemodynamics forces.
Our study aimed to assess RVD prevalence in SSc patients and analyze its impact on cardiovascular events.

Methods
In this retrospective study, we included patients diagnosed with SSc and followed-up in a specialized unit. We collected clinical, hemodynamic, and imaging data, including baseline CMR studies. Pulmonary function tests were also performed.
RVD was defined as a right ventricular ejection fraction ≤52% in men and ≤51% in women.
Patients were monitored for a composite endpoint consisting of cardiovascular death and/or admissions due to heart failure (HF). We assessed the predictors of this endpoint using Cox regression analysis.

Results
The study included 74 patients with SSc, most were female (81 %) with a mean age of 60±12 years. RVD prevalence was 32 %. Patients with RVD had greater ventricular volumes (160±44.9 vs 130±36.2; p=0.003), lower right ventricular global strain (-18 % vs. -26 %; p &lt;0.001) and lower right atria strain (19% vs 29%; p=&lt;0.001). We don’t found differences in presence of LGE of both ventricles.
In the multivariate analysis RVEF (HR 2.9.; p = 0.022), pulmonary trunk dilatation (HR 1.15; p= 0.004, pulmonary hypertension at baseline (HR 2.98; 0.09); RV GLS (HR 1.08; p = 0.03) and RA GLS (HR 0.96; p = 0.024) were predictors of composite outcome of cardiovascular death and/or heart failure hospitalization. During a mean follow-up of 46 months, patients with RVD had higher rates of heart failure admissions (38% vs. 12%; p = 0.01) and cardiovascular mortality (29% vs. 6%; p 0.01). No ventricular arrhythmias occurred.

Conclusion
RVD is common among SSc patients. RVEF and pulmonary hypertension are the strongest variables linked to increased adverse cardiovascular clinical events and decreased survival in these patients.
Are novel ASCVD risk factors more prevalent in young middle eastern women who have classical risk factors
Authors: Alkhawaldeh M , Al-Akhras A , Abedal- Kareem K , Baker M , Abu Dayah S , Alsahan M , Almansi J , Eid S , Hammoudeh A , Ibdah R , Shehadeh J , Mahmoud S , Asfour H , Ababneh A 
Published: October 2024

Abstract

Introduction
Urbanization is an important contributor to atherosclerotic cardiovascular disease (ASCVD) in the Middle East, especially in the younger age groups. There is a scarcity of data on clinical profiles and cardiovascular risk factors (RFs) in urban young women compared with those who reside in rural areas in this region.

Purpose
To study the demographic and clinical profiles and prevalence of traditional and novel CV RFs in a cohort study of young urban Middle Eastern women compared with those in rural areas.

Methods
The prevalence of 19 traditional and novel cardiovascular RFs were compared in urban vs. rural young women residents (18-50 years of age), who were enrolled in 12 centers (August 2020 to October 2023).

Results
Of 627 young women enrolled (mean age 44.2 ± 5.1 years old), 463 (74%) were urban residents and 164 (26%) were rural residents. ASCVD was diagnosed in 32% of urban and 37.3% of rural young women. Table shows the prevalence of traditional and novel, sex-specific RFs with significant differences in the 2 groups. Other RFs with no significant differences included hypertension, diabetes and gestational diabetes, preterm delivery, persistent weight gain after delivery, radiation for breast cancer, and polycystic ovary syndrome.

Conclusion
In this cohort of Middle Eastern young women, despite heterogeneity, those who were urban residents had worse clinical profiles with higher prevalence of certain classical and sex-specific risk factors.
Sex sifferences in lifes essential eight and its association with mortality among adults without known CVD
Authors: Kobo O , Kaur G , Gulati M , Mamas M 
Published: October 2024

Abstract

Background
The American Heart Association’s Life’s Essential 8 (LE8) score is a helpful tool to quantify cardiovascular health (CVH) metrics. Sex differences in relation to LE8 and its association with mortality are not known.

Methods
The National Health and Nutrition Examination Survey (NHANES) between 2009 and 2018 was utilized to evaluate the prevalence of health metrics included in LE8 among adult patients, stratified by sex. Health metrics were further subdivided into health behaviors (diet, physical activity, nicotine exposure, and sleep) and health factors (body mass index, non–high density lipoprotein cholesterol, blood glucose, and blood pressure). LE8 scores were also evaluated based on age, race/ethnicity, and socioeconomic status. Cox proportional hazard models were used to evaluate the association between the levels of CVH and risk of all-cause and cardiovascular mortality.

Results
Among 22,761 participants, 52% were female. Overall CVH score was similar in both females and males (65.8 vs. 65.9). Females had higher health factors score (64.3 vs. 63.1, p &lt;0.001) and lower health behaviors score (67.2 vs 68.6, p &lt;0.001). Amongst individual metrics, blood pressure score was higher in females (73.2 vs. 67.7, p &lt;0.001) while males had higher physical activity score (70.6 vs. 54.9, p &lt;0.001). For individuals under 65 years of age, overall CVH and health factors scores were higher in females while in those age 65 or older, males had higher scores. The most prominent sex differences were noted in non-Hispanic Black females who had significantly lower CVH scores than Black males. High or moderate LE8 scores vs. low LE8 scores demonstrated lower all-cause and CV mortality in both sexes (p-interaction 0.98 and 0.9). High or moderate health behaviors scores also demonstrated a significant association with lower all-cause and CV mortality, with the reduction in mortality being more prominent in females (p-interaction 0.01 and 0.03).

Conclusions
We demonstrate important sex differences in CVH metrics along with notable variations based on age and race/ethnicity. Furthermore, we highlight sex differences in the association of CVH metrics with mortality. These findings underscore the importance of designing and implementing effective strategies for both sexes, aimed at targeting these specific factors.
Sex-differences in the clinical features, managements and outcomes of early-onset atherosclerotic coronary artery disease in China
Authors: Shali S , Yao K , Luo L F , Xu L L , Huang M G , Shi F , Li J X , Qian J Y , Zheng Y , Dai Y X , Ge J B 
Published: October 2024

Abstract

Background/Introduction
There is an alarming rise in the incidence of atherosclerotic coronary artery disease (CAD) among young adults, particularly in young women. Sex disparities of early-onset CAD in the context of contemporary cardiovascular practice are not well understood.

Purpose
We aimed to delineate the differences in clinical profiles and prognosis between young men and women with established early-onset CAD.

Methods
This is a nationwide, hospital-based, longitudinal prospective cohort study. Young patients (aged ≥18 years and ≤ 45 years) with angiographically confirmed severe atherosclerotic obstructive coronary arteries (luminal narrowing ≥ 70%) were included from 38 hospitals across China between May 2017 and May 2020. Coronary risk factors, clinical features and treatments were compared between men and women at baseline. Participants were followed for 3 years. The outcome was major adverse cardiovascular events (MACE), a composite of cardiovascular death, non-fatal myocardial infarction (MI), unplanned revascularization, and ischemic stroke. The Cox regression analyses were used to estimate hazard ratios (HR) with 95% confidence intervals (CIs) for outcome.

Results
There were 1524 patients (female: 4.4%) included in this study. The female patients were older than the male patients (41.1±4.0 years for females vs. 39.6±4.4 years for males, p=0.006). They showed a lower prevalence of hypertension, lipid disorders, and smoking or drinking (all p&lt;0.01). The female patients were less likely to have at least 1 modifiable risk factors (female: n=45 (67.2%) vs. male: n=1382 [94.6 %], p&lt;0.001); they showed more favorable laboratory results at baseline, including lipids, serum creatinine and uric acid (all p&lt;0.05) as compared to male patients. Besides, young females presented more often with stable angina on admission, whereas young males tended to present with acute MI (p&lt;0.001). There was no significant sex difference in Gensini Score (p=0.15). Female patients were less likely to undergo revascularization procedures than male patients (73.1% vs. 85.3%, p=0.01). During the 3 years of follow-up, female patients were at a significantly higher risk of MACE compared to their male counterparts (13.4% vs. 5.8%, adjusted HR: 3.07, 95% CI:1.36–6.94, p=0.007) after adjusting for age, smoking, drinking, body mass index, hypertension, diabetes, dyslipidemia, diagnosis and revascularization.

Conclusions
Distinct sex disparities, unfavorable to young females, were documented among patients with early-onset CAD, with the largest gaps noted in the treatment and prognosis. Despite more favorable baseline profiles, young female patients had insufficient care and 3-fold greater risk for MACE compared to young males. These results highlight the need for strengthening the treatment strategies for this vulnerable disease entity.Figure 1