bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of long-term cardiovascular outcomes of COVID-19. Artificial Intelligence model for risk evaluation
Authors: Hovornyan A , Ilashchuk T O 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The COVID-19 pandemic has caused a serious worldwide health crisis with wide-reaching consequences. According to current studies, COVID-19 may contribute to the emergence of various problems, including cardiovascular disorders [1-3]. However, there are currently no strategies for predicting the cardiovascular post-acute COVID-19 consequences, nor is there any scientific examination of these effects [3]. This knowledge gap must be filled in order to improve post-acute COVID-19 care [4].

Purpose
To conduct a 12-month follow-up longitudinal observation study to explore potential long-term cardiovascular outcomes of COVID-19 and develop an AI-based model to predict them.

Methods
We included 328 COVID-19 patients who were admitted to the hospital between February and April 2021. The average age of the studied population was 56.1, while 51% of the population was male. Patients with severe comorbidities, major adverse cardiovascular events (MACE) in anamnesis, and intra-hospital mortality were not included. After discharge, patients were monitored for 12 months. The data were randomly divided into derivation (n=201), validation (n=81), and external cohort (n=47). The obtained data include clinical data, results of laboratory and instrumental investigations, and medical records during the 1-year period. Our AI model is a convolutional neural network (CNN) consisting of sigmoid-activation-function neurons, trained by using outcome results, received in follow-ups, and evaluated on the external cohort.

Results
Due to the analysis of clinical data, higher levels of C-reactive protein, D-dimer, neutrophil/lymphocyte ratio, and lower levels of thyrotropin were associated with a higher 12-month risk of cardiovascular consequences. The longitudinal study showed that 16.4% of patients experienced MACE (8.5% - myocardial infarction, 5.2% - cerebrovascular disorders, 2.7% - pulmonary embolism) leading to cardiovascular death in 2.4% of the studied population. The total count of cardiovascular complications was 25.9% including first-detected hypertension, arrhythmias, heart failure etc.
The derivation and validation datasets were used for the training of the CNN. The ROC analysis indicated that our AI model had a high predictive value for cardiovascular events during follow-up (AUC=0.891, 95% CI=0.869–0.913, p&lt;0.001, sensitivity 92.4%, specificity 90.1%). The external cohort data analysis showed accurate results in 41/47 patients (87.2% accuracy), which significantly outperformed any other known methods of cardiovascular outcomes prediction during 12 months after COVID-19.

Conclusions
Cardiovascular health in COVID-19 survivors needs special attention since COVID-19 is linked to an elevated risk of post-acute cardiovascular consequences. Long-term outcomes for COVID-19 can be predicted using AI-driven models.
Effect of cardiac telerehabilitation as standard care on quality of life
Authors: Van Mierlo R F R , Houben V , Rikken A O F , Van 'T Hof A W J 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): EIT Health education grant.

Background
Cardiac telerehabilitation (CTR) is a continuously developing cardiac rehabilitation (CR) format that might offer a solution to some of the challenges centre-based CR programs face. CR centres continue to face suboptimal participation in their provided CR program. The COVID-19 pandemic encouraged CR centres to implement their own CTR program to tackle practical challenges and to improve participation in CR. Multiple centres have since then developed a CTR program in accordance to (inter)national guidelines. CTR aims to improve the quality of life of patients, therefore analyses of quality of life is essential.

Purpose
Our study aims to analyse quality of life changes over a period of three months after program initiation for patients choosing to participate in either centre-based CR or CTR.

Methods
Our study included (N)STEMI patients eligible for CR between November 2021 and November 2022. Patients were invited by the cardiac rehabilitation nurse during intake to participate in CR. Patients were offered the choice between centre-based CR and CTR. The centre-based CR exercise program typically lasted for 6-8 weeks and the CTR program for a total of 48 weeks. CTR offers remote-access, digital platform for patients to interact with their healthcare professionals. The digital platform monitors physical activity and progress, which can be access by both patients and coaches. Coaches provide remote-access feedback. The SF-36 questionnaire was send out right after the CR intake procedure (T0) and three months after the CR intake procedure (T1). We only analysed data from participants who completed both T0 and T1 questionnaires, using the paired sample T-test for both CTR and centre-based CR.

Results
Until now, 173 patients have been included in the study of which 42 patients (24%) participated in CTR. 143 patients reached T1. 84 (59%) participants completed both T0 and T1 questionnaires, of which 24 (29%) participate in CTR (92% male, mean age 60) and 60 (71%) participate in centre-based CR (80% male, mean age 64). Participants from the centre-based CR program improved on both physical (score: +11,12; p &lt; 0,001) and emotional (score: +9,30; p = 0,028) role functioning over a three month period. Participants in the CTR program improved on physical role functioning (score: +18,75; p = 0,002) and social functioning (score: + 13,54; p = 0,019).

Conclusion
Our preliminary show that patients were able to improve quality of life in both CTR and centre-based CR. Therefore, CTR can be used as an alternative to centre-based CR as standard care. Future research should focus on long term effects on quality of life.
Nursing protocol for heart failure remote monitoring in patients with ICD/CRT with a 5 variable multiparametric tool
Authors: Flores Soler J , Garcia-Torrent M , Casas De La Cal L , Herreros Gil M , Garcia Gonzalez F , Canadas-Godoy V , Salgado Aranda R , Perez-Villacastin Dominguez J , Perez-Castellano N 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Many patients with heart failure (HF) suffer from decompensation that sometimes leads to hospitalizations, harming prognosis and quality of life. Some cardiac implantable electronic devices (CIEDs) allow the transmission of clinical data online, providing helpful information without the patient having to go to a face-to-face consultation, which usually takes no less than 25 minutes. Moreover, a 5-variable multiparametric tool (S1 and S3 heart sounds, pulmonary congestion through a thoracic impedance, volume and respiratory rate, night heart rate) expresses a heart failure index (HM-5) incorporated into some CIEDs, capable of predicting 34 days before HF decompensation episodes when the reported index is ≥16, with a sensitivity of 70%. According to this warning, transmissions with a potential risk of HF exacerbation should be classified. Ideally, reviewing these warnings should not take more time than is invested in the face-to-face follow-up.

Purpose
Create a protocol with a risk classification according to the heart failure index and compare the duration of face-to-face and remote online follow-up performed by the same nursing staff in patients with CIEDs with a heart failure index activated in the arrhythmia consultation in a tertiary hospital.

Methods
First, we created a colour scale protocol (red alert: urgent event, yellow alert: important event and green alert: normal state) classifying heart failure index alerts during one year (January – December 2021) (See figure 1). Patient clinical characteristics, and duration of face-to-face & remote monitoring follow-ups were registered, quantifying the time spent reviewing each patient.

Results
Twenty-two patients with CIEDs and HM-5 tool activated were included; 28% were female, 72% had hypertension, 40,9% had diabetes mellitus, 22,7% had chronic kidney disease, and the mean left ventricle ejection fraction was 36,18%, half of them has ischaemic cardiomyopathy. The annexed protocol was followed with the help of the medical health record platform that classified the transmissions according to a colour scale. The rate of alerts/patient-year was 0.97; 22% of yellow alerts were related to HF. The mean time nursing review face-to-face versus remote was 16.55 min vs 3.05 min (p&lt;0.001) (table 1).

Conclusion
Remote follow-up by the nursing staff of patients with HF and ICD provided with a 5-variable multiparametric tool is strict and protocolized in our hospital. It requires less time compared to face-to-face review.
Atrial fibrillation is an independent risk factor for heart failure progression and pump failure mortality in HFpEF:: a propensity score matched analysis of the TOPCAT Americas study
Authors: Nagarakanti R , Slee A , Shah D , Lewalter T , Karcnik J , Galgocy S , Rochotte M , Saksena S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial fibrillation (AF) is associated with excess mortality and cardiovascular (CV) hospitalizations in HF patients (pts) with preserved systolic function (pEF) but the contributing factors to these outcomes are not known..

Purpose
To analyze the independent impact of AF on clinical outcomes of HFpEF pts in the TOPCAT AMERICAS study using propensity score matched (PSM) cohorts to account for confounding by other comorbidities.

Methods
Study cohorts were PSM matched for 20 clinical, demographic & ECG variables. 3 matched cohorts based on baseline rhythm status at study entry were compared viz. subjects in sinus rhythm (SR), subjects in AF on baseline ECG & subjects with Any AF event by history or ECG. We analyzed CV mortality, adjudicated modes of death & morbidity during a mean follow up period of 2.9 yrs.

Results
418 subjects in SR (SR cohort) were PSM with 418 subjects in AF on baseline ECG (AF on ECG cohort) & 418 pts with any AF event by history or ECG (Any AF cohort) at study entry. Any AF increased the risk of CV death (D), pump failure death (PFD), CV and HF hospitalization (H) and HF progression. AF on ECG increased risk of CVD, CVH, HFH and PFD (Tables). Neither AF cohort increased risk of sudden death (SD) {Figure}.

Conclusion
1. AF is an independent risk factor for worsening CV outcomes in HFpEF.
2. This increased risk is due to a selective increase in symptomatic HF progression from early to advanced HF, HFH and PFD in advanced HF rather than SD.
3. Loss of AV synchrony & rate control in AF can independently impact HF progression in HFpEF with consequent HFH and PFD. Restoration of SR may offer benefits for CV outcomes in HFpEF & warrants evaluation.
QT prolongation-related ventricular arrhythmia associated with atrial fibrillation electrical cardioversion
Authors: Rav Acha M , Tovia-Brodie O T B , Bayya F B , Michowitz Y M , Glikson M G 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Atrial fibrillation (AF) is the most common arrhythmia, a leading cause of strokes, and associated with an increased mortality. Although electrical cardioversion of AF is considered a relatively safe procedure, post cardioversion QT prolongation-related ventricular arrhythmias (VA) may appear due to the combination of QT-prolonging anti-arrhythmic drugs, acute heart rate change from rapid AF into sinus bradycardia, electrolyte imbalance, etc. To date, there is still no consensus regarding the actual prevalence of this complication. Given the global tendency for early discharge during the same day of AF cardioversion, there is a crucial need to define the true prevalence of this phenomenon and the characteristics of these patients.

Purpose
Evaluate the prevalence of post AF cardioversion prolonged QT-related VA, and describe the characteristics of patients developing this complication.

Method
Single center retrospective analysis of all AF electrical cardioversions, during the last 3 years, which were followed by documented prolonged QT-related VA or sudden cardiac death (SCD) within 72 hours from cardioversion. Post cardioversion VA was detected by a computerized search of hospitalization records, 24-hour Holter recordings, and EMS strips.

Results
Out of 950 AF electrical cardioversions performed at our hospital during the last 3 years there were 4 cases with Torsades de Pointes (TdP) and 1 case of SCD occurring within 72 hours from cardioversion (5/950; 0.5%). All five patients were females, 3/5 with low LVEF and 4/5 on class III anti-arrhythmic drug (Amiodarone or Sotalol). Electrolyte abnormalities (including hypokalemia, hypomagnesemia, and hypocalcemia) were found in 3/5 patients and post cardioversion sinus bradycardia in 2/5 patients.

Conclusion
The incidence of post-AF cardioversion life threatening VA is low although non-negligible. Prolonged ECG monitoring and cautious follow-up of QTc should be recommended among patients, especially females with low LVEF, treated by class III anti-arrhythmic drugs. Post AF cardioversion same day discharge should be discouraged in these patients.
Timing of clinically relevant recurrence or true blanking period?
Authors: Mendsaikhan P , Park Y J , Kim D , Yu H T , Kim T H , Uhm J S , Joung B , Lee M H , Pak H N 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Ministry of Health and Welfare of Korea
The National Research Foundation of Korea (NRF) which is funded by the Ministry of Science, ICT & Future Planning (MSIP)

Background
Although early recurrence (ER) within 3 months after atrial fibrillation catheter ablation (AFCA) is reportedly considered as a reliable predictor of late recurrence (LR), those ERs are still counted as benign events. There is no large-scale study showing the time limit of true blanking period, nor the potential mechanisms of clinically relevant recurrences within 3 months.

Purpose
To explore temporal association of ERs with LRs and the presence of extra-pulmonary vein (ExPV) triggers.

Methods
This retrospective, single center study included 2,788 patients undergoing de novo AFCA (median 60 years old, 37.4% persistent AF [PeAF]) with isoproterenol provocation at the procedures. ER and LR were defined as any documented atrial arrhythmia &gt;30s occurring (≤3 months), (&gt;3months) after AFCA respectively. We evaluated the risk factors for ER and LR and compared the risk for LR and existence of ExPV triggers according to different timing of ER.

Results
ER was detected in 783 (28.1%) patients. During a median follow-up of 40 months, LR occurred in 945 (33.9%) patients. PeAF (OR 1.79, 95% CI 1.36-2.34), a larger left atrial (LA) diameter (OR 1.03 per 1 mm increase, 95% CI 1.00-1.05), and the existence of ExPV-triggers (OR 3.02, 95% CI 2.08-4.38) were independently associated with ER. ER (HR 2.55, 95% CI 2.15-3.03); the existence of ExPV-triggers (HR 1.63, 95% CI 1.28-2.08), PeAF (HR 1.39, 95% CI 1.16-1.66), and a larger LA diameter (HR 1.02 per 1 mm increase, 95% CI 1.01-1.04) were independent predictors for LR. When stratified according to the days of ER occurrence, ER occurring earlier showed trends toward higher rates of LR (P for trend=0.047) (Figure 1A). Patients with ER occurring within 1 month after AFCA had a higher incidence of LR than those with ER occurring between 2 and 3 months after AFCA (57.5% vs. 49.6%; log-rank P=0.020) (Figure 2B). ER occurring within 1 month after AFCA, compared with no ER, was independently associated with the existence of ExPV triggers (OR 3.99, 95% CI 2.65-6.02) whereas ERs occurring at different timing were not (Figure 1B).

Conclusions
ER, regardless of the timing, and the existence of Ex-PV triggers were independently associated with long-term AF recurrence. Especially, ER occurring earlier within 1 month after AFCA, which was associated with Ex-PV triggers, had the worst rhythm outcome.
Temporal relation of disease onsets in patients with acute myocardial infarction and atrial fibrillation - results from a nationwide registry study
Authors: Karlsson E , Kiviniemi T , Halminen O , Lehtonen O , Haukka J , Mustonen P , Putaala J , Linna M , Hartikainen J , Airaksinen K E J , Lehto M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Helsinki and Uusimaa Hospital District TYH2019309 and The Finnish Foundation for Cardiovascular Research

Background/Introduction
Acute myocardial infarction (AMI) and atrial fibrillation (AF) are commonly seen in a same patient. It is not unusual that patients are diagnosed with new-onset AF as a complication of AMI. Nevertheless, little is known about the temporal relations of these two diagnoses.

Purpose
We evaluated the temporal relations of AMI and new-onset AF in the Nationwide Finnish Anticoagulation in Atrial Fibrillation (FinACAF) comprising all patients with AF during 2004-2018 in Finland.

Methods
Patients with AF and AMI in Finland during 2010 to 2017 were analyzed, and individual patient data from the different registries were merged.

Results
Of the 157,658 patients with new-onset AF, a total of 16,971 (10.8%) patients were diagnosed with AMI at any point. The mean-age was 77.5 years (SD 10.6) and 72.3 years (SD 13.2), and the proportion of females 7,864 (46.3%) and 70,873 (50.4%) in AF patients with and without AMI, respectively.
Altogether 8,889 (52.4%) of the AMI-AF patients had a history of established AMI diagnosis; whereas 4,278 (25.2%) were diagnosed with AMI during the same hospitalization period as new-onset AF or within 30 days; and 3,804 (22.4%) over 30 days after new-onset AF. A total of 6,928 (40.83%) of all AMI diagnoses were diagnosed within 1 year from new-onset AF. The temporal relation between new-onset AF and AMI are described in the Figure.

Conclusions
AMI-AF patients are older than AF patients without AMI at the time of new-onset AF. The diagnoses of AMI and AF tend to accumulate close to one another. One fourth of all AMI-AF patients were diagnosed with both diseases occurring same hospitalization period or within 30 days from new-onset AF.
Left atrial dimensions and left atrial appendage morphology: differences in paroxysmal versus persistent atrial fibrillation patients
Authors: Pongratz J , Riess L , Dorwarth U , Wankerl M , Straube F , Hoffmann E 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulmonary vein isolation (PVI) is an effective treatment strategy in symptomatic atrial fibrillation (AF) patients. However, this approach shows worse long-term results in individuals suffering from persistent compared to the paroxysmal type.

Purpose
The objective was to investigate differences of left atrial (LA) as well as left atrial appendage (LAA) anatomy in persistent AF (persAF) and paroxysmal (PAF) and patients.

Methods
An observational single center study with a blinded retrospective analysis of cardiac computed tomography angiography (CCTA) images was conducted. Dimensions of LA, posterior wall box, pulmonary veins (PV) as well as LAA size and morphology were assessed and statistically analyzed. All important measures are depicted in the attached figure.

Results
From 2012 to 2016 a total of 1.103 patients underwent second generation cryoballoon PVI. Prior to PVI, CCTA was available for 725 (65.7%) patients with sufficient quality for measuring in 473 (65.2%). Mean age was 66.3±9.5 years; PAF was present in 277 (58.6%) participants. In persAF LA volume [mL] (111.8; 128.8; p&lt;0.001), posterior wall box area [cm2] (11.9; 13.3; p&lt;0.001) and pulmonary vein ostial dimensions were significantly larger compared to PAF. LAA volume [mL] (9.0; 10.0; p=0.01) and LAA ostial perimeters (66.5; 70.0; p=0.003) were also identified to be larger in persAF. However, there was no difference in LAA morphology (overall distribution: "windsock" 51%; "chicken-wing" 20%; "cauliflower" 15% and "cactus" 13%).

Conclusion
Compared to PAF, persAF patients had significantly larger LA volumes, posterior wall box areas, PV ostial dimensions as well as LAA volumes and LAA ostial perimeters. LAA morphological types were distributed equally in both groups.
The role of biomarkers, sleep apnea and echocardiography as predictors of atrial fibrillation in a pacemaker population
Authors: Santos Sanchez A , Roldan Sevilla A , Gonzalez Recio P , Garcia Fernandez J 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Sleep apnea, dilated left atrial has been related to a higher possibility to develop atrial fibrillation (AF). Some pacemakers are able to detect periods of apnea during the sleeping time obtaining a respiratory disturbance index (RDI) related to sleep apnea (SA), as well as atrial high rate episodes (AHREs) that are also predictors of AF. Another possible predictor of AF is galectin-3, a biomarker related to fibrotic phenomena.
This study aims to evaluate the relationship between ARI and AHRE detection, as well as the relationship between left atrial size measured by echocardiography and some biomarkers with the development of AHREs.

Methods
This is a single-centre, prospective, non-randomized, descriptive study carried out in a tertiary hospital, including patients with dual-chamber pacemaker able to detect SA, initially in sinus rhythm. Patients were included at the implantation date, between November 2015 and November 2018, and medium follow-up was 2 years. Those with a previous diagnosis of AF were not included. In a baseline visit, clinical, anthropometric characteristics, as well as echocardiography and analytical parameters were obtained, including NTproBNP, galectin-3 and ST-2. In addition to the baseline visit, device interrogation visits at six months, one year and tho years in order to obtain atrial activity and SA registers were performed. Those whose apnea recordings were illegible were excluded from the analysis.
We performed a descriptive statistical analysis with Microsoft Excel.

Results
102 patients with dual chamber pacemaker were included. 79 of the pacemakers provided legible apnea and atrial activity recordings. 22 of them showed an RDI&gt;20 in more than 75% of the nights, and 38 of them recorded AHRE longer than 6 minutes in 24 hours. Tables 1 and 2 show baseline characteristics and the AHRE (episodes with duration &gt;6 minutes) and RDI recordings suggestive of severe SA (RDI&gt;20 in more than 75% of the nights). Differences in AHRE between both RDI groups did not reach statistical significance. After univariate analysis, the multivariate analysis showed significant relationship between AHRE &gt;6 minutes and the galectin-3 level at baseline as well as between AHRE&gt;6 minutes and the left atrial indexed volume at baseline.

Conclusion
In our study, 48% of the pacemakers registered AHRE longer than 6 minutes in 24 hours. No statistical relationship between RDI and AHRE was found. Baseline galectin-3 level and left atrial indexed volume appeared to be related to the development of AHRE in the follow-up.