bluuebunny/crossref_metadata_2025_split huggingface dataset:
Young patients with acute myocardial infarction: early screening is warranted
Authors: Lagoas Pohle C , Silva Ferreira J , Antunes Coelho R , Quintal J , Bernardes P , Esteves A F , Sa C , Seixo F 
Published: June 2024

Abstract

Background
Acute Myocardial Infarction (AMI) remains a significant cause of morbidity and mortality in young individuals, although relatively under-studied, with no consensus on a cutoff value for this definition.

Purpose
The purpose of this study was to compare the cardiovascular risk factors and characteristics of acute coronary events in a population of younger versus older AMI patients.

Methods
A retrospective analysis of consecutive AMI patients admitted to the Cardiology Department from November 2021 to October 2022 was conducted.
The population was evaluated according to basal characteristics. We divided the population in two groups: young AMI patients (YAMI) (defined as ≤50 years) and older AMI patients (defined as &gt;50 years), which were compared according to demographic and index-hospitalization variables, co-morbidities, analytical and echocardiographic data and adverse events.

Results
A total of 390 patients (71.3% males) with a mean age of 66.6 ± 12.3 years were included.
The characteristics of the two groups are described in Table 1.
The YAMI group (n=38) had a median age of 46.0 years (IQR 43-48) and 86.8% were male. In this group of patients, 42.1% had a known diagnosis of hypertension, 39.5% had dyslipidemia, 39.5% had type 2 diabetes, 26.3% were obese and 76.3% were smokers. ST-elevation myocardial infarction (STEMI) presentation occurred in 68.4% and multivessel disease was observed in 31.6% of the YAMI group.
Patients in the YAMI group were predominantly male (p = 0.026), smokers (p &lt; 0.001) and with a family history (FH) of AMI (p = 0.007). STEMI was more likely in the YAMI group (p = 0.007), which had higher LDL-cholesterol (p = 0.007) and total cholesterol levels (p = 0.003), but lower glycosylated hemoglobin values (p = 0.005).

Conclusion
This study emphasizes that YAMI patients in this population exhibit greater metabolic dysregulation, evidenced by higher LDL, and total cholesterol levels, highlighting the importance of early screening and intervention in younger patients with cardiovascular risk factors (namely smokers) and with a family history of AMI.
Cardiac rehabilitation versus percutaneous coronary intervention for stable angina pectoris: effects on major adverse cardiovascular events and associated healthcare costs
Authors: De Koning I , Heutinck J M , Vromen T , Bakker E A , Maessen M F H , Smolders J , Eijsvogels T M H , Grutters J P C , Kemps H M C , Thijssen D H J 
Published: June 2024

Abstract

Background
Stable angina pectoris is commonly treated with percutaneous coronary intervention (PCI), but cardiac rehabilitation (CR) may represent a potential alternative effective treatment.

Purpose
The purpose of the study was to compare the effects of CR versus PCI on major adverse cardiovascular events (MACE), new revascularisations (PCI and coronary artery bypass grafting), chest pain and associated healthcare costs over a period of 24-months in patients with stable angina pectoris.

Methods
We performed a retrospective cohort study using a database from a Dutch health insurance company. Patients diagnosed with stable angina pectoris between January 2013 and July 2018 who received a treatment of PCI only or CR only were included. To create comparable groups, propensity score matching based on age, sex, respiratory diseases, dementia, diabetes and use of cardiovascular medication was used. Post-treatment MACE (ischemic events, acute heart failure and mortality), new revascularizations (PCI and coronary artery bypass grafting) and chest pain were recorded during 24-month follow-up, whilst we also calculated healthcare costs associated to cardiovascular events and stable angina pectoris treatment.

Results
Of 4,724 eligible patients, 1,682 patients were matched and included in the analysis. Following propensity score matching, the CR (n=841) and PCI (n=841) group did not differ regarding patient characteristics. We found significantly fewer MACE following CR (n=239 (28.4%)) compared to PCI (n=367 (43.7%), p&lt;0.001) within 24-month follow-up (hazard ratio 0.54; 95% confidence interval, 0.46-0.64). Following CR, significantly fewer PCIs and coronary artery bypass grafts were performed than following PCI (PCI: hazard ratio 0.71, 95% confidence interval: 0.79-1.01; CABG: hazard ratio 0.18, 95% confidence interval: 0.04-0.81 ). Prevalence of chest pain did not significantly differ between both groups. Healthcare costs, including treatment and cardiovascular events during follow-up, were significantly higher in PCI (€7386; 95% confidence interval, €7067-€7704) compared to CR (€4468; 95% confidence interval, €4221-€4715, p&lt;0.001).

Conclusion
We found that CR in patients with stable angina pectoris was associated with significantly fewer MACE and lower healthcare costs compared to PCI during a 24-month follow-up. These findings indicate that in a selection of patients with stable angina pectoris, CR might be a cost-effective alternative to PCI.
Unlocking the mystery. Exploring the relationship between PFO anatomical features and the right to left shunt size
Authors: Kalesi A E , Karakosta M , Maritsa D , Ntiloudi D , Gardikioti V , Archontikis A , Karaminas N , Ntalekou K , Plaitis A , Arnas N , Kasinos N , Destounis A , Zachos P , Patsourakos N , Theodosis - Georgilas A 
Published: June 2024

Abstract

Introduction
The contributory role of a patent foramen ovale (PFO) in stroke pathogenesis remains a subject of debate. This study endeavors to elucidate a potential association between the anatomical characteristics of PFOs and the size of right-to-left (R-L) shunt.

Material and methods
This retrospective investigation was performed in a tertiary center and included individuals aged 18 to 65 who presented with cryptogenic stroke between January 2018 and June 2023, and in whom a transesophageal echocardiogram was conducted as part of the comprehensive assessment for stroke etiology, revealing the presence of a PFO.
PFO dimensions, including length (overlap between septum primum and septum secundum), maximum atrial septal displacement (towards both the left and right atrium), and height (maximal separation between septum primum and septum secundum), were measured. Additionally, the size of the right-to-left shunt (classified as small or moderate with &lt;30 bubbles and large with &gt;30 bubbles) was assessed.
Statistical analysis was performed using non-parametric tests (Mann-Whitney test), and the predetermined level of statistical significance was set at p &lt; 0.05.

Results
Among the 250 patients subjected to transesophageal echocardiography, 76 individuals (58 males) were identified with a PFO, accounting for 30.4% of the cohort. The median age of patients with PFO was 52 years (range 20-65 years). Of these 76 patients, 44 (57.9%) exhibited a large PFO, while 32 (42.1%) had a small or moderate shunt. In those with a small-moderate shunt, the mean values for PFO length, maximal atrial septal displacement, and PFO height were 10.8±4.7, 10.3±4.2, and 3.8±1.2, respectively. In the sub-group of patients with large R-L shunt, the mean values for PFO length, maximal atrial septal displacement and PFO height were 11.8±4.1, 10.5±3.6, and 4.8±1.5, respectively. In the subset of patients exhibiting large shunts, the measured PFO height values were statistically significantly higher compared to the other subgroup (p=0.001) (figure 1). While PFO length and maximal atrial septal displacement values in the large shunt subgroup were numerically greater, no statistically significant differences were observed between the two groups (figure 2).

Conclusions
The PFO height seems promising as a potential predictor for the size of the right-to-left shunt. Nonetheless, comprehensive epidemiological studies are warranted to further explore the correlation between PFO characteristics and infarct size.
Differences in left atrial functionality between individuals with ischemic stroke and healthy controls: a comparative analysis
Authors: Kalesi A E , Karakosta M , Maritsa D , Ntiloudi D , Vasiliadou A , Tzinieris T , Kalivi A , Konstantara A , Zampelis D , Skantzikas P , Kapsokoli C , Theodosis - Georgilas A , Destounis A , Patsourakos N , Kasinos N 
Published: June 2024

Abstract

Introduction
Recent findings highlight the critical involvement of atrial cardiomyopathy in the pathophysiology of embolic strokes of unidentified source (ESUS). Newer echocardiographic indices, such as the left atrium (LA) peak reservoir strain (LARS), present promising tools for evaluating left atrial (LA) function and gaining insights into the role of atrial myopathy in this specific patient population. The objective of this study was to compare left atrial strain values between patients with ischemic stroke and healthy individuals.
Material/methods
This retrospective study was conducted at a tertiary center and included individuals aged 18 to 65 with stroke and no prior history of atrial fibrillation or carotid artery disease who underwent a transesophageal echocardiogram between January 2018 and June 2023.
Fifty patients were excluded due to insufficient data. Gender and age-matched healthy individuals were also enrolled. The left atrial strain was quantified using the speckle-tracking method in the apical four-chamber view.
Statistical analysis was performed using non-parametric tests (Mann-Whitney test), and the predetermined level of statistical significance was set at p &lt; 0.05.

Results
A total of 197 patients with stroke were included in the study, comprising 128 men (65.1%) and 83 healthy individuals, of which 52 were men (62.7%). Among the stroke patients, 64 individuals (32.5%) were identified to have a patent foramen ovale (PFO). The median age for both sub-groups of stroke patients (with and without PFO) was 52 years (range 20-65 years), while the healthy individuals had a median age of 49 years (range 19-63 years).
The left atrial strain (LARS) values exhibited a statistically significant difference (p=0.032) between the healthy individuals’ group (mean rank 156.5) and the stroke patients group (mean rank 133.8), with higher values observed in the healthy cohort (Figure 1). Within the stroke patient group, those with PFO had significantly elevated LARS values (mean rank 117.25) compared to those without PFO (mean rank 91.63), demonstrating a notable difference with a p-value of 0.003 (Figure 2).

Conclusions
Our study reveals a noteworthy distinction in left atrial strain (LARS) values between stroke patients and healthy individuals, with stroke patients demonstrating significantly lower LARS values. Additionally, within the stroke group, individuals with a patent foramen ovale (PFO) present higher LARS values compared to those without PFO.
Accuracy of nine artificial intelligence chatbots in replying in accordance with the 2023 ESH guidelines for the management of arterial hypertension
Authors: Ioannidis A , Tsounis D , Bouras G , Pantelas N , Pechlevanis A , Gkavoudi K , Stravodimou N , Sidera C , Markidou E , Kafkia T 
Published: June 2024

Abstract

Background/Introduction
The emergence of artificial intelligence (AI) models has created new opportunities in the medical field. The potential of AI chatbots to deliver timely, reliable medical information is one of its promising features.

Purpose
Our goal was to assess how well online AI chatbots could respond in accordance with the 2023 ESH Guidelines for the management of arterial hypertension.

Methods
We structured 20 questions covering issues that have been included in the recommendations of the 2023 ESH Guidelines. Fifteen questions required simple answers (e.g. What is the systolic blood pressure threshold for initiation of drug therapy in patients ≥80 years? Should we use cuffless blood pressure devices for the evaluation of hypertension in clinical practice?). The questions were fed to nine free online chatbots. The responses were recorded and evaluated by three experienced cardiologists with special interest in hypertension. To assess consistency, each question was asked three times, though only the first response was included in the accuracy analysis. All questions were preceded by "According to the 2023 ESH Guidelines for the management of arterial hypertension". A response was considered "accurate" if it included all essential information, "inaccurate" if it was not in accordance with the guidelines, and "incomplete" if any essential information was missing.

Results
In total there were 180 responses recorded. A total of 82 (45.6%) responses were deemed accurate, ranging from only 4 out of 20 (20% for deepai.org) to 16 out of 20 (80% for Google-PaLM) (see Figure). Eighty (44.4%) of the responses were judged as inaccurate and 18 (10%) as incomplete. Only one question got accurate responses from all nine chatbots and there were three questions with accurate replies from only one chatbot (different chatbot for each question). Moreover, 293 out of the 360 regenerated responses were consistent with the initial answer (81.1%). No chatbot would have replied accurately to every question even if the regenerated responses were to be considered.

Conclusion(s)
The study resulted in a variation in the accuracy of the responses generated by nine popular online AI chatbots when asked about issues covered in the recommendations of the 2023 ESH Guidelines on arterial hypertension. While the use of chat-based AI in medicine is still in its early stages and current models are not intended for medical use, the potential for such technology is significant. The debate is still ongoing about what level of accuracy is thought to be acceptable.
Long-term cardiovascular risk in post-cardiac rehabilitation patients after one year follow-up using a smartphone application: 4-year post intervention follow-up of a randomized controlled trial
Authors: Lunde P , Bye A , Grimsmo J , Pripp A H , Ritschel V , Jarstad E , Nilsson B B 
Published: June 2024

Abstract

Background
Adherence to healthy behaviour adapted in cardiac rehabilitation (CR) is challenging for many patients. In 2020, we demonstrated that one year of individualized follow-up using a smartphone-application (app) is effective to promote adherence to healthy behaviour post-CR (1). However, long-term data evaluating the effect of mobile health (mHealth) intervention regarding adherence to healthy behaviour are sparse.

Purpose
The purpose of the present study was to assess the effects of individualized follow-up with an app for one year in patients post-CR, four-year post intervention.

Methods
A single-blinded randomized controlled trial lasting for one year with follow-up four-year post-intervention. The intervention group (IG) received follow-up enabled with an app for one year, while the control group (CG) received usual care. After the intervention period, all patients received usual care for the next four years. The primary outcome was difference in peak oxygen uptake (VO2peak). In addition, exercise performance (time to exhaustion at cardiopulmonary exercise test), cardiac events, cholesterol, body weight, quality of life and health status were evaluated. Data were analysed in accordance with the intention-to-treat principle. Linear mixed models for repeated measurements were used to analyse for differences between groups. All tests were two-sided, and p-values ≤0.05 were considered as statistically significant.

Results
A total of 113 patients completing CR (88 med/25 women, mean age 59±8.7 years, 73.4% with coronary artery disease, 16.8 after valve surgery and 9.8% with other heart diseases) were randomly allocated to the IG or CG post-CR (Table 1). As previously reported (1) and presented at ESC Preventive Cardiology 2020, there were statistically significant differences between the groups in favour of the IG in VO2peak and exercise performance at the end of the intervention period (one-year post-CR). At four-year post intervention, 102 patients were assessed. There were no statistically significant differences between the groups in any outcomes evaluated (Table 2). In total, 33 patients experienced a new cardiac event post-CR, 12 (5 in the CG and 7 in the IG) during the first year, and 21 (11 in the CG and 10 in the IG) during the four-year post intervention period.

Conclusion
Individualized follow-up enabled with an app for one year is effective to improve VO2peak, exercise performance and exercise habits in patients post-CR. Despite the positive effects observed one-year post-CR, these benefits have ceased to exist four years post intervention. Results from this study is of significant clinical importance for the future implementation of technology to promote lifelong adherence to healthy behaviour post lifestyle interventions, such as CR.
Non-invasive multiparameter monitoring for detection of decompensated heart failure: an exploratory study
Authors: Herkert C , Van Leunen M , Tang J , Raschella F , Saeed A , Spee R F , Lu Y , Kemps H M C 
Published: June 2024

Abstract

Aims
Telemonitoring strategies in heart failure (HF) patients are often based on manual readings of multiple parameters by the healthcare professional (HCP). In order to improve early prediction of decompensated HF, and to reduce the workload for both the HCP and the patient, there is a need for multiparameter predictive models. These models should preferably be based on parameters measured with a single, non-invasive, easy-to-use device. This exploratory study aimed to evaluate whether a multiparameter prediction model, using a wrist-worn device supplied with a photoplethysmography sensor and a triaxial accelerometer, can be helpful to detect decompensated HF and death in patients with unstable HF.

Methods
17 patients who were admitted to the hospital with acute decompensated HF, regardless of etiology or left ventricular ejection fraction, were provided a with wrist-worn device at the moment of discharge. The device measured heart rate (HR)-related data, respiration rate (RR), activity and sleep stages. Participants were asked to wear the device 24 hours a day for 3 consecutive months. A decision-tree model was developed with the collected data. The combined endpoint of interest was hospital readmission due to decompensated HF, decompensated HF treated at the outpatient clinic by increasing loop diuretic dose, or death as was expected due to HF.

Results
During follow-up, the compliance with wearing the device was 78 (interquartile range 55-81)%. The parameters that were based on accelerometry (energy expenditure and activity counts) performed best with respect to data quality: 72% and 79% of the data was of high quality respectively. For HR 46% of the data was of high quality, whereas only 14% of the RR data was of high quality. Sleep data was lacking in almost all participants. The best model to predict the combined endpoint showed a specificity of 98% and a sensitivity of 4% in the 2 weeks prior to an event (area under the curve: 0.5).

Conclusion
A multi-parameter, non-invasive model using a single device measuring HR, RR, activity and sleep, showed high specificity, but low sensitivity in predicting decompensated HF and death. An important reason for the low sensitivity could be low data quality (specifically HR, RR sleep stages) in a real-life setting in the HF population. Future studies should address this issue and should include larger populations.
Branched chain amino acids and anthropometry: body mass index and waist circumference are oldies, but goldies
Authors: Liu K , Borreggine R , Gallart-Ayala H , Ivanisevic J , Marques-Vidal P 
Published: June 2024

Abstract

Background
Branched chain amino acids (BCAAs, Valine, Leucine, and Isoleucine) are indispensable for skeletal muscle metabolism. However, the association between BCAA and anthropometry is still controversial.

Aims
To assess the associations between BCAA levels and different anthropometric markers, including leptin and adiponectin levels, in a sample of healthy, non-obese participants.

Methods
Cross-sectional study using data from the CoLaus|PsyCoLaus study in our city. Anthropometric markers included conicity index (CI), Body roundness index (BRI), A Body shape index (ABSI), body mass index (BMI), and waist circumference, among others. Grip strength was used as a proxy for muscle mass.

Results
Data from 1929 participants (845 men, 53.2±8.5 years old, BMI&lt;30 kg/m2) Using bivariate analysis, most anthropometric markers were positively correlated with BCAA, while adiponectin levels were negatively correlated with BCAA. The correlations were stronger in men compared to women, except for Conicity index, ABSI, and adiponectin. After multivariable analysis, weight and BMI had the strongest association with BCAA in men, while in women the strongest associations were found for waist and waist to height ratio (table). No significant associations were found between the ABSI and BCAA levels in men, and between grip strength and BCAA levels in women. Stepwise linear regression identified BMI in men and waist in women as the anthropometric markers most associated with BCAA.

Conclusion
We found a significant gender difference in the anthropometric markers associated with BCAA levels. BMI was the anthropometric marker most associated in men, and waist was the anthropometric marker most associated in women.
Branched chain amino acids and body composition in healthy, non-obese women
Authors: Liu K , Borreggine R , Gallart-Ayala H , Ivanisevic J , Marques-Vidal P 
Published: June 2024

Abstract

Background
Branched chain amino acids (BCAAs, Valine, Leucine, and Isoleucine) are indispensable for skeletal muscle metabolism. However, the association between BCAA and body composition (lean and fat mass) have been seldom studied.

Aims
To assess the associations between BCAA levels and body composition as assessed by Dual Energy X-ray Absorption (DEXA) in a sample of healthy, non-obese women.

Methods
Cross-sectional study using data from the OsteoLaus study in our city. Whole body, gynoid, android and appendicular lean and fat mass and percentages were assessed.

Results
Data from 388 women (mean age 58.4±6.4 years, BMI 23.4±2.9 kg/m2) were analysed. After multivariable analysis, the strongest associations were found for all BCAAs with the android %fat/gynoid %fat ratio (beta coefficient=0.263, 0.228 and 0.219 for Valine, Leucine and Isoleucine, respectively) and the trunk fat mass/limb fat mass ratio (beta coefficient=0.257, 0.254 and 0.249 for Valine, Leucine and Isoleucine, respectively), and between Valine with android fat mass and visceral fat mass (table). Stepwise linear regression identified the android %fat/gynoid %fat ratio as the body composition marker most associated with valine levels, and the trunk fat mass/limb fat mass ratio as the body composition marker most associated with leucine and isoleucine.

Conclusion
In healthy middle-age woman, blood BCAAs levels were mainly associated with fat mass and not with lean mass, suggesting that BCAAs might be more related to fat than to muscle metabolism.