bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transcatheter aortic valve implantation improves endothelial and autonomic function
Authors: Vitez L , Starc V , Jug B , Bunc M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Degenerative aortic stenosis is the leading native valve pathology in developed countries. Its degeneration process is affected by aging, common cardiovascular risk factors and an atherosclerotic-like process preceded by endothelial and autonomic dysfunction. With the increasing integration of transcatheter aortic valve implantation (TAVI) in the treatment of aortic stenosis in the elderly, research is being intensively oriented into its beneficial effect on the cardiovascular system. Measurements of vascular function with flow mediated dilatation (FMD) and autonomic cardiac function using heart rate variability parameters represent a validated method for treatment evaluation at different time-points.

Purpose
The purpose of our study was to assess whether haemodynamic and structural changes after TAVI will have a positive impact on endothelial and autonomic cardiac function on early and late follow-up.

Methods
50 patients with severe aortic stenosis destinated to TAVI were prospectively included. Data was collected at baseline (24 hours before the procedure), on early follow-up (48 hours after the procedure) and on late follow-up (6 months after the procedure). While different heart rate variability parameters were obtained using a high-resolution electrocardiogram, FMD was assessed using a standardized ultrasound-based process with induced forearm hyperaemia.

Results
43 patients completed the study (mean age 81 (75-85); 60% women). FMD measurements significantly changed from baseline to early follow-up (2.8 ± 1.5 % to 4.7 ± 2.7 %, p &lt; 0.001). Improvement was persistent on late follow up (4.8 ± 2.7 %, p = 0.936). Moreover, heart rate variability parameters remained unchanged on early follow-up and improved 6 months after. Late follow-up statistical significance was reached by HF, a frequency-domain parameter (5231 ± 1783 to 6507 ± 1789 ms2; p = 0.029) and two Poincare diagram parameters: RR ecc (682 to 906 ms2; p &lt; 0.001) and SDRR (9.6 to 23.9 ms; p = 0.001). Significant predictors of FMD change were as following: baseline maximal aortic valve velocity (R = 0.415; p = 0.011), mean aortic gradient (R = 0.373; p = 0.018), indexed stroke volume (R = 0.503; p = 0.006) and NT-proBNP (R = 0.491; p = 0.001).

Conclusions
Both endothelial and autonomic function improved after TAVI. While FMD seems to change early due to acute haemodynamic changes attributed to aortic valve stenosis resolution, autonomic cardiac functions remain stable and ameliorate late after procedure, likely reflecting left ventricular reverse remodelling.
Insomnia in patients with myocardial infarction with and without obstructive coronary arteries: prevalence and prognosis
Authors: Izquierdo Coronel B , Lopez Pais J , Martin Munoz M , Nieto Ibanez D , Olsen Rodriguez R , Abad Romero R , Perela Alvarez C , Alvarez Bello M , Galan Gil D , Espinosa Pascual M J , Ceballo Silva J F , Fraile Sanz A , Mata Caballero R , Awamleh Garcia P , Alonso Martin J J 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Spanish Society of Cardiology.

Introduction
Although some studies suggest a relationship between insomnia and cardiovascular disease, the initial approach of patients with myocardial infarction does not usually include the evaluation of sleep disorders as a contributing factor to cardiovascular disease.
This study aims to compare the prevalence of insomnia between patients with obstructive coronary artery disease (MICAD) and those without significant coronary obstruction (MINOCA) and its impact on prognosis.

Methods
During a five-year period (July 2017-July 2022), all consecutive patients with myocardial infarction and coronarography were included. This study was conducted in a university hospital which covers a population of 220,000 people.
Insomnia severity index (ISI) questionnaire was completed by each patient during admission. Follow-up analysis included major adverse cardiovascular events (MACE: cardiovascular readmission, myocardial reinfarction, stroke, and death from any cause).

Results
Among 533 patients, 56 had MINOCA, and 477 had MICAD. There were no significant differences in the prevalence of insomnia between both groups: insomnia median value (M) in MINOCA: M=7 (3-11) vs MICAD M=7 (3-12), p=0.95. Analysing it by sex, the score remained similar: MINOCA women M=9 (3.5-11.5) vs MICAD M=8.5 (3.2-15), p=0.6. MINOCA men M=5.5 (3-9.7) vs MICAD M=7 (3-11), p=0.77. (Figure 1)-
At the three-year follow-up, there was a relationship between the insomnia levels and survival (IC [1.1-6.6], p=0.03). When ISI score was over 7 points (subclinical insomnia, moderate insomnia, or severe insomnia) there was a relationship with more mortality: number of events under the median value =7; number of events over the median value =16; (IC [1.1-6.6], p=0.03); whereas MACE remained similar (IC [0.6-1.5], p=0.89).

Conclusions
In this study, the prevalence of insomnia was similar between MINOCA and MICAD patients. A higher score in the ISI questionnaire was related to a worse prognosis at the three-year follow-up.
Effect of a home-based inspiratory muscle training program on functional capacity in post-discharged patients with long COVID: The InsCOVID trial
Authors: Albiach C , Dominguez E , Lopez L , Sastre C , Minguez S , Nunez J , Palau Sampio P 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Sociedad Española de Cardiología.

Background
Fatigue and exercise intolerance are the most common symptoms in patients with long COVID.

Purpose
This study aimed to evaluate whether a home-based inspiratory muscle training (IMT) program improves maximal functional capacity in patients long COVID after a previous admission due to SARS-CoV-2 pneumonia.

Methods
This study was a single-centre, blinded assessor, randomised controlled trial. Twenty-six patients with long COVID and a previous admission due to SARS-CoV-2 pneumonia were randomly assigned to receive either a 12-week program of IMT or usual care alone. The physiotherapist and participants were not blinded. Patients allocated to the IMT arm were instructed to train at home twice daily using a threshold inspiratory muscle trainer and to maintain diaphragmatic breathing during the training session. The usual care arm received no intervention.
The primary endpoint was changes in peak oxygen consumption (peakVO2). Secondary endpoints were changes in quality of life (QoL), ventilatory efficiency and chronotropic response during exercise (evaluated by chronotropic index-CIx- formula). We used linear mixed regression analysis for evaluating changes in primary and secondary endpoints.

Results
The median (interquartile range) age of the sample and time to first visit after discharge were 52 (42-59) years and 405 (301-435) days, respectively. A total of 11 (42.3%) were female. At baseline, the median of peakVO2, ventilatory efficiency and CIx were 17.4 (15.6-21.1) mL/kg/min, 29 (24.5-33.3), and 0.64 (0.54-0.87), respectively. The IMT arm improved their peakVO2 significantly compared to usual care (+Δ 4.46 mL/kg/min, 95% CI 3.10 to 5.81; p&lt;0.001). Similar positive findings were found when evaluating changes for CIx and some QoL dimensions. We did not find significant changes in ventilatory efficiency.

Conclusion
In long COVID patients with a previous admission due to SARS-CoV-2 pneumonia, IMT was associated with marked improvement in exercise capacity and QoL.
The incorporation of repeated measurements of risk factors at current and previous visits improves the accuracy of cardiovascular risk assessment: an analysis of the EXSCEL trial
Authors: Oulhaj A , Aziz F , Suliman A , Iqbal N , Coleman R L , Holman R R , Sourij H 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Risk prediction tools play an important role in cardiovascular risk stratification. One major limitation of most of these tools is their use of only single values of each risk factor, measured usually at a particular clinical visit, ignoring measurements made at previous visits.

Purpose
The aim of this study is to demonstrate the gain in predictive performance when CVD risk prediction tools incorporate repeated, rather than only single, measurements of risk factors.

Methods
We used data from the Exenatide Study of Cardiovascular Event Lowering (EXSCEL) randomized controlled trial to compare the quality of predictions of future major adverse cardiovascular events (MACE) in the Cox proportional hazards model that uses single values of risk factors, compared to the Bayesian joint model that uses repeated measures of risk factors. The risk of MACE was calculated in patients with type 2 diabetes with and without established CVD. We assessed the predictive ability of the following cardiovascular risk factors: glycated haemoglobin (HbA1c), high-density lipoprotein cholesterol (HDL-C), non-HDL-C, triglycerides, estimated glomerular filtration rate, low-density lipoprotein cholesterol (LDL-C), total cholesterol, and systolic blood pressure (SBP) using the time-dependent area under the receiver operating characteristic curve (aROC) for discrimination and the time-dependent Brier score for calibration.

Results
In participants without history of CVD, the aROC of systolic blood pressure increased from 0.62 to 0.69 when repeated, rather than only single, measurements of SBP were incorporated into the predictive model. Similarly, the aROC increased from 0.67 to 0.80 when repeated, rather than only single, measurements of both SBP and LDL-C were incorporated into the predictive model. For all other investigated cardiovascular risk factors, the measures of discrimination and calibration both improved when using the joint model as compared to the Cox proportional hazards model. The improvement was evident in participants with and without history of CVD but was more pronounced in the latter group.

Conclusion
This analysis demonstrates that the joint modeling approach, considering trajectories of cardiovascular risk factors, provides superior predictive performance of CVD risk stratification compared to standard risk prediction tools, using only a single time point.
Identification of ICD-code misclassifications in cardiac disease using natural language processing
Authors: Falter M , Godderis D , Scherrenberg M , Kizilkilic S E , Xu L , Tukanov E , Neven F , Dendale P 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): FWO - Flanders Research Foundation.

Background/Introduction
The international classification of disease (ICD) codes are used worldwide for classification of hospitalisations. The codes are used for administrative, financial and research purposes. It is known however that errors occur in the coding process.

Purpose
To investigate methods for automatic classification of disease in unstructured medical records using natural language processing (NLP) and to compare these to conventional ICD-10 coding.

Methods
Two datasets were used: the open-source Medical Information Mart for Intensive Care (MIMIC)-III dataset (n=40.000) for algorithm testing and a dataset from a hospital in Belgium (n = 8041). In the Belgian dataset automated pseudonymization was performed prior to further analysis. A training, validation and test set was used in all methods. Automated searches using NLP algorithms were performed for the diagnoses "atrial fibrillation" and "heart failure". The information extraction methods that were used were: rule-based search, logistic regression, term frequency-inverse document frequency (TF-IDF), XGBoost and bio-bidirectional encoder representations from transformers (BioBERT). All algorithms were tested on the MIMIC-III dataset. Precision (or positive predictive value), recall (or sensitivity) and accuracy were calculated for each model. The best performing algorithm was then deployed on the Belgian dataset.

Results and discussion
Results for the different NLP models are depicted in Table 1. Non-compatible results in NLP versus ICD-coding often indicated errors in ICD-coding. NLP algorithms could thus be used to improve the ICD-coding process in hospitals.

Conclusion
A high accuracy can be achieved when using NLP algorithms for diagnostic classification of patient records. Also, NLP algorithms can be used to identify ICD-coding errors and optimise the ICD-coding process.
ST-segment elevation is associated with a higher risk of cardiac arrest in patients with acute coronary syndromes
Authors: Paralta De Figueiredo M , Carias M , Picarra B , Rocha De Almeida A , Claudio F , Rocha R , Trinca M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiac arrest is a feared complication of cardiovascular disease, even in inpatient context, and requires swift and precise management to avoid increasing morbimortality. Identifying which patients are at greater risk could potentially improve outcomes.

Purpose
We aim to identify if ST-segment elevation is related with a higher incidence of intra-hospital cardiac arrest.

Methods
We analysed a population of 940 patients (C) admitted with ACS and divided them into two groups: those who had a myocardial infarction (MI) with ST-segment elevation on ECG (C1), and those who had no ST-segment elevation (C2), which included those with MI with no ST-segment elevation, undetermined location MI and unstable angina. We then compared the incidence of cardiac arrest between both groups. Age, sex, personal history of smoking, hypertension, dyslipidaemia, diabetes mellitus, and previous stroke/TIA and myocardial infarction were also documented.

Results
C1 was comprised of 379 patients (40,3% of the population). When comparing age, sex and prevalence of hypertension, dyslipidaemia, diabetes, and previous stroke/TIA or myocardial infarction between the groups, there were no relevant differences and no impact regarding risk of cardiac arrest was documented. Nonetheless, C1 had a significantly higher incidence of intra-hospital cardiac arrest (6,1% vs 0,5%, p=0,0001; odds ratio: 12,017, 95% CI [3,582;40,316]) than C2.

Conclusions
Patients with ST-segment elevation on admission have a 12-time higher risk of intra-hospital cardiac arrest than other ACS and thus may require more careful and regular monitoring.
Identifying predictors of coronary stent restenosis
Authors: Carias M , Paralta De Figueiredo M , Picarra B , Rocha De Almeida A , Claudio F , Rocha R , Trinca M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Despite advancements in stent technology, such as the appearance of the drug-eluting stents, stent restenosis remains a common post-procedure complication and is associated with a higher morbimortality. These patients frequently need repeat revascularisation and pose a therapeutic challenge.

Purpose
This study aims to characterise if it is possible to identify clinical predictors of stent restenosis.

Methods
We retrospectively observed a population of 9815 patients (D) admitted with acute coronary syndrome (ACS) and divided them into two groups: those who had stent restenosis (D1), and those who did not (D2). We then compared both groups regarding age, sex, personal history of smoking (both current or former smokers), hypertension, dyslipidaemia, diabetes mellitus, stroke/TIA, chronic kidney disease and stent location.

Results
D1 consisted of 2,9% of the population. Both groups had similar age (D1: 67,95±10,35 years vs. D2: 68,56±11,57years) and were predominantly of the male sex (75,9% vs. 73,3%). D1 had a significantly higher prevalence of diabetes (3,1% vs 2,7%, p=0,008; odds ratio: 1,183, 95% CI [1,044;1,340]); dyslipidaemia (72,4% vs 59,0%, p&lt;0,001; odds ratio: 1,821, 95% CI [1,586;2,092]); hypertension (86,4% vs 80,8%, p&lt;0,001; odds ratio: 1,507, 95% CI [1,259;1,805]); smoking (38,1% vs 33,6%, p=0,003; odds ratio: 1,215, 95% CI [1,069;1,381]); and chronic kidney disease (12,1% vs 10,0%, p=0,003; odds ratio 1,235, 95% CI [1,020;1,495]) than D2. When comparing stent location, restenosis was more frequently observed in the right coronary artery (4,5% vs 2,3%, p&lt;0,001; odds ratio 2,016, 95% CI [1,775;2,289]), with no significant differences in relation to other segments. There were no statistically relevant differences regarding stroke/TIA between the groups.

Conclusions
In patients with ACS, stent restenosis seems to be associated with a significantly higher prevalence of diabetes, hypertension, dyslipidaemia, history of smoking and chronic kidney disease. Right coronary artery stenting also seems to be associated with a higher rate if restenosis when compared to other revascularised segments. These characteristics could help predict which patients are at a higher risk and need closer monitoring, potentially improving outcomes. Further developing a score with these predictors could be of interest.
Adherence to free and single-pill combination of rosuvastatin/ezetimibe: findings from a real-world analysis in italy
Authors: Zambon A , Liberopoulos E , Dovizio M , Veronesi C , Degli Esposti L , Perez De Isla L 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Servier.

Background/Introduction
Several studies have shown that simplifying cardiovascular drug treatment by alleviating pill burden leads to better treatment adherence.

Purpose
This real-world analysis aimed to evaluate characteristics and change in adherence in patients treated with rosuvastatin and ezetimibe (ROS/EZE) as free combination who switched to ROS/EZE as single-pill combination, in Italy.

Methods
A retrospective analysis was performed using administrative databases covering approximately 7 million health-assisted Italian subjects. Adults prescribed with ROS/EZE as a single-pill from January 2010 up to June 2021, were selected. The index date corresponded to the first prescription date of ROS/EZE as single-pill combination; all patients with at least 1 year of data availability before and after the index date were selected. Among selected patients, users of ROS/EZE as a free combination during 1 year before the index date were included in this analysis (patients switching from free to single-pill combination). Baseline demographic and clinical characteristics of these patients were evaluated during the year before index date. Adherence to free or single-pill combination was evaluated as the proportion of days covered (PDC), during 12 months before and after index date (PDC&lt;25% non-adherence; PDC=25-75% partial adherence; PDC&gt;75% adherence).

Results
A total of 1,219 patients (61.1% male, mean age 66.2 ±10.4 years) met the inclusion criteria. Among them, 83.3% had cardiovascular (CV)-related comorbidities, 26.4% of patients had diabetes mellitus and 16.2% of patients presented a combination of CV disease and diabetes mellitus. A significantly higher percentage of patients were adherent to single-pill compared to free combination (75.2% vs 51.8%, p&lt;0.001). Moreover, the proportion of partially adherent patients (16.4% vs 37.4%, p&lt;0.001) and non-adherent patients (8.4% and 10.7%, p&lt;0.05) was significantly lower with the single-pill combination compared to free combination.

Conclusions
This analysis provides real-world evidence on adherence of patients to ROS/EZE in free or in single-pill combination, suggesting that switching from multiple to single-pill combination could positively impact the level of adherence to lipid-lowering medications.
Impact of chronic obstructive pulmonary disease in patients with myocardial infarction
Authors: Paralta De Figueiredo M , Carias M , Picarra B , Rocha De Almeida A , Claudio F , Rocha R , Trinca M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Chronic obstructive pulmonary disease (CPOD) is a common comorbidity in patients admitted with myocardial infarction (MI) and needs to be considered since it can condition therapeutic approach and potentially negatively impact their prognosis.

Purpose
We aim to evaluate the impact of CPOD in therapeutic approach, clinical course and in-hospital mortality in patients admitted with MI.

Methods
We retrospectively analysed a population of 2797 patients admitted with MI (C). We divided them into two distinct groups: those with an established diagnosis of CPOD (C1) and those without it (C2). Age, sex, personal history, in-hospital therapeutic, left ventricular ejection fraction (LVEF), electrocardiographical presentation and angioplasty were documented. We defined the following as complications: heart failure (HF), need for invasive and non-invasive mechanical ventilation, reinfarction, newly onset atrial fibrillation, high-grade atrioventricular block and need for temporary cardiac pacing. Mortality, incidence of complications and a combined outcome of both mortality and any of the previous complications were compared between groups. We applied a multivariate analysis to adjust the effect of CPOD to the presence of other potential predictors.

Results
C1 consisted of 6,3% of the population (N=173). These patients were older (69,8±10,6 vs 65,5±13,5 years; p&lt;0,001), had a higher prevalence of hypertension (76,3% vs 68,7%; p=0,036) and chronic kidney disease (13,7% vs 5,6%; p&lt;0,001). They presented less frequently with ST-segment elevation MI (38,3 % vs 47,4%; p=0,019), but more often with depressed LVEF (57,9% vs 47,2%, p=0,008). They received less beta-blockers (63,4% vs 80,2%; p&lt;0,001) and had fewer rates of drug-eluting stents application (63,4% vs 80,2%; p&lt;0,001); on the other hand, they were more frequently medicated with calcium-channel blockers (16,7% vs 8,1%; p&lt;0,001) and diuretics (50,0% vs 31,6%; p&lt;0,001) and more bare-metal stents were utilised (52,8% vs 37,4%; p=0,002). The diagnosis of CPOD was not associated with higher mortality in patients with MI, however C1 presented with an increased incidence of complications (33,1% vs 26,0%; OR =1,413 [1,019-1,959]; p=0,037) and of the combined outcome (34,3% vs 26,5%; OR=1,447 [1,046-2,000]; p=0,02). Though multivariate analysis, CPOD tends to be an independent predictor of mortality and/or development of complications, although it narrowly misses to achieve statistical significance (p=0,056); only age, medication with beta-blockers and depressed LVEF were statistically independent predictors.

Conclusions
The comorbid diagnosis of CPOD conditions the choice of medication in patients with MI and tends to be an independent predictor of mortality and/or development of in-hospital complications.