bluuebunny/crossref_metadata_2025_split huggingface dataset:
History of cerebrovascular events is associated with a higher risk of significant left anterior descending artery stenosis
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
Acute coronary syndrome (ACS) remains a frequent cause of hospital admission, with its prognosis depending on many factors, one being the location of the culprit lesion. It is established that anterior myocardial infarction, caused mostly by left anterior descending artery occlusion is associated with a worse prognosis and higher morbimortality. Therefore, identifying patients at a higher risk of significant LAD lesions could potentially impact outcomes.

Purpose
We aim to identify if having personal history of cerebrovascular events could be related to more severe LAD stenosis.

Methods
We retrospectively analysed a population of 988 patients (L) admitted with ACS and divided them into two groups: those who had significant stenosis of the left anterior descending artery (LAD) documented in coronary angiography, defined as a stenosis above 50% (L1), and those who had no significant stenosis of the LAD (L2), which included those with no stenosis or stenosis under 50%. We then compared the prevalence of previous cerebrovascular events, defined as stroke or TIA, between both groups. Age, sex, personal history of smoking, hypertension, dyslipidaemia and diabetes mellitus were also documented.

Results
L1 was comprised of 553 patients (56,0% of the population). When comparing between groups, results show that L1 had a significantly higher prevalence of previously documented stroke or TIA (1,4% vs 0,2%, p=0,026; odds ratio: 7,628, 95% CI [0,922; 63,120]) than L2. Regarding age, sex and history of hypertension, dyslipidaemia and diabetes, there were no relevant differences and no impact on the severity of the LAD stenosis.

Conclusions
Patients with ACS and previous history of cerebrovascular events have a sevenfold-increased risk of having significant LAD stenosis on coronary angiography. This could potentially impact pre-procedure risk stratification and timing of percutaneous intervention.
In patients with acute coronary syndromes, left ventricular dysfunction is associated with an increased risk of cardiac arrest
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
In patients with acute coronary syndromes (ACS), the occurrence of intra-hospital cardiac arrest is a medical emergency with a challenging approach, especially when it is unpredictable, and remains associated with higher morbimortality. The correct identification of patients at a greater risk and closer monitoring could potentially improve outcomes.

Purpose
This study aims to characterise if the establishment of left ventricular (LV) dysfunction after ACS is related with a higher incidence of intra-hospital cardiac arrest.

Methods
We analysed a population of 894 patients (D) admitted with ACS and divided them into two groups: those who had LV systolic dysfunction, defined as left ventricular ejection fraction (LVEF) under 50% (D1), and those who had no systolic dysfunction (D2). We then compared the incidence of cardiac arrest between both groups. Age, sex, personal history of smoking, hypertension, dyslipidaemia, diabetes mellitus, stroke/TIA and myocardial infarction were also documented.

Results
D1 consisted of 398 patients (44,5% of the population). There were no statistically relevant differences regarding age, sex and prevalence of hypertension, dyslipidaemia, diabetes, previous stroke/TIA or myocardial infarction between the groups. However, D1 had a significantly higher incidence of intra-hospital cardiac arrest (4,5% vs 1,2%, p=0,002; odds ratio: 3,868, 95% CI [1,521;9,840]) than D2.

Conclusions
The development of LV dysfunction in patients with ACS seems to be a better predictor of cardiac arrest, contrasting with age, sex and personal history of smoking, hypertension, dyslipidaemia, diabetes mellitus, stroke/TIA and myocardial infarction, which have no significant impact on this outcome. Further characterizing if there is a correlation between decreasing LVEF and increasing rates of cardiac arrest could be of interest.
The effectiveness of different educational interventions in reducing the prehospital delay of patients with coronary artery disease: a systematic review
Authors: Idyan Z , Lai Y H , Lin Y J , Chen M R 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
Recognizing symptoms of coronary artery disease (CAD) is important and challenging for CAD patients. Failure in detecting the related symptoms may lead to prehospital delay and decelerate the golden time of ischemic reperfusion.

Purpose
The purpose of the systematic review aims to evaluate types of education programs (through randomized control trial) of their effectiveness on reducing prehospital delay regarding CAD.

Method
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was adopted to proceed this review. We searched from Pubmed, Cochrane Library, Scopus, CINAHL and EMBASE using a combination of free text words and Medical Subject Headings guided by the PICO framework. The abstracts and full-text screening were peer-reviewed by two reviewers.

Results
A total of 722 records were identified through database searching of which 11 randomized controlled trials were finally included into this review (n = 38773). The Cochrane Risk of Bias assessment tool 2.0 was utilized to examine the methodological quality of the included studies. Eight out of 11 studies conducted one by one individualized-educational intervention program (n = 11007); two studies used mass media campaign for the general public education program (n = 24753), and one study used the community-based educational intervention model (n = 3031). Of the three types of education models, the one to one individualized-educational intervention was found to be the most effective model to have reduce prehospital delay time shorter ranged from 30-60 minutes in the experimental groups while comparing to the control groups.

Conclusion
Individualized-educational program is found to be the most effective intervention to reduce prehospital delay for CAD patients. Health care providers are encouraged to apply one to one educational program in term of reducing prehospital delay for CAD patients both in clinical and community setting. Moreover, family members of high-risk patients are suggested to be included in a step-by-step action plan that eliminates the wait and see approach to reach medical support.
Exercise hemodynamics and metabolisms in (very) sportive patients after orthotopic heart transplantation
Authors: Schmidt T , Bjarnason-Wehrens B , Mommertz S , Hannig M , Brand P , Predel H G , Reiss N 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Purpose
After orthotopic heart transplantation (HTX), patients benefit with improved survival and quality of life, but exercise physiology becomes complicated and exercise capacity usually remains limited at 60-70% of predicted values. However, there are also patients who return to demanding or competitive sports even after HTX. For these patients, optimal exercise hemodynamics and metabolisms are crucial. It was the aim of this study to investigate this question more closely in (very) sportive patients after HTX.

Methods
6 patients after orthotopic HTX (1 female, 54±16 yrs old, BMI 23.6±2.8, 11±7 yrs post-transplant) from different sports disciplines (Cycling [2x], Triathlon, Hockey, Table-Tennis, Scuba Diving) could be included (Table 1). We performed cardiopulmonary exercise test (CPET) on a bicycle ergometer using a ramp protocol (15 watts/minute) and consecutive inertgas rebreathing (IGR) on different exercise steps (rest, light, moderate, heavy) of each 4-5 minutes. The hemodynamic measurements and blood gas analysis were conducted at the last minute of each IGR step. The study was approved by the local ethics committee.

Results
For CPET: one patient reached extraordinary exercise capacity with a peak load of 345 watts (182% of pred.) and a peak VO2 of 58.9 ml/kg/min (163% of pred.). Corresponding values at first ventilatory threshold (VT1) were 280 watts and 44.1 ml/kg/min. The results of the other patients showed a more homogenic profile: Mean peak load was 172±44 watts (104±14% of pred.) and peak VO2 was mean 25.6±4.5 ml/kg/min (91±14% of pred.). Values at VT1 were 108±27 watts and 18.0±2.5 ml/kg/min.
Selected IGR results for all patients are displayed in Table 2. The hemodynamic measurements revealed a steadily increase in cardiac output (CO), cardiac index (CI), arteriovenous oxygen difference (avDO2), heart rate and systolic blood pressure from rest to the different exercise steps. However, an increase in stroke volume (SV) beyond light to moderate exercise often remained limited (peak SV 101±14 ml/beat). Also, peak CO (13.9±1.8 l/min) remained slightly below predicted values (89% of pred.).

Conclusion
Hemodynamic measurements revealed satisfying exercise adaptions and adequate prerequisites for intensive physical activities in selected patients even after HTX. However, compared to healthy athletes, SV was clearly limited to normal values (&lt;120 ml/beat). The deficit in CO occurs with moderate to heavy exercise levels could be partially compensated by increased avDO2 due to excellent peripheral function. Therefore, regular exercise training is crucial for this target group.
High risk dyslipidemia: can we predict early coronary disease?
Authors: Cortez Quiroga G A , Rus Mansilla C , Duran Torralba M C , Cruz Romero L , Eliche Mozas P , Cubillas Quero A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The AHA/ACC guidelines on the management of blood cholesterol (2013 and 2018) classified the LDL-c &gt;190 mg/dL as high-risk patients, with the indication of high-intensity statins (c-LDL reduction greater than 50%). Recently the 2019 ESC guidelines(1) also classify these patients as high cardiovascular (CV) risk.

Objective
Determine factors associated with the development of early coronary disease (ECD) in patients with high-risk dyslipidemia (HRD).

Methods
Observational retrospective cohort of 160 patients with historical maximum LDL-c ≥190 mg/dL without secondary cause. We compared the clinical characteristics, the baseline blood test with maximum LDL-c (BT1), and the effects of lipid-lowering treatment on the last blood test (BT2), between patients with ECD (53 patients Group A) and patients without cardiovascular events (107 patients Group B).

Results
Group A, presented maximum LDL-c at a younger age, had dyslipidemia of longer evolution time, had a higher proportion of men, smokers, diabetics, and had a higher number of associated risk factor's (Table 1).
In the BT1 they presented greater proportion of HDL-c values below 45 mg/dL (35.3% vs 12.3%, p=0.001), and a higher proportion of remnant cholesterol (Non HDLc - LDLc = &gt;30 mg/dL, 51% vs 33.3%, p=0.037). Patients with ECD received high-intensity lipid-lowering treatment, statin + ezetimibe (73.6% vs 29.8%, p&lt;0.0001), IPCSK9 (7.5% vs 2.9%, p=0.18), and achieving LDL-c goals (32.1% vs 13.6%, p=0.006) and Non HDL-c (47.2% vs 14.6%, p&lt;0.0001) according to cardiovascular risk. There were no variation between BT1 and BT2 in HDL-c levels in both groups.
In the Cox regression model, male sex (HR 2.8 (1.4-5.7), p=0.003), tobacco (HR 2.5 (1.3-4.7), p=0.005), and the relation between Non HDL-c/HDLc (&gt;4.5 male, &gt;4 female, in primary prevention) in BT1 (HR 1.65, (1.15-1.86) p=0.02) increase independently the risk of ECD in patients with HRD.

Conclusion
In patients with HRD the presence of male sex, tobacco, increase relation between Non HDLc/HDLc, diabetes, a greater number of cardiovascular risk factors, most atherogenic blood test (HDLc &lt;45 mg/dL and remnant cholesterol) have been associated with the development of ECD. We have had some apreciated 5.45 (± 4) years since the BT1 to prevent ECD.
Semi-supervised deep neural networks for left atrial segmentation from cardiac MRI
Authors: Qiu Y , Meng J 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Left atrium size and function is an important but less studied prognostic marker for many cardiovascular diseases [1]. Cardiac Magnetic Resonance Imaging (MRI) can capture atrial structure with a high temporal and spatial resolution. However, diagnoses and accurate measurement of volumes from MRI often rely on time-consuming manual processing, or needs correction of software segmentation error by clinicians. Robust, automated methods are highly desirable to assist morphological analysis of dynamic changes in the heart. Ultimately this facilitates the wider application of cardiac MRI in early identification and prevention of potential cardiovascular disease.

Purpose
To introduce a semi-supervised teacher-student deep neural networks (requiring less labelled data) for accurate segmentation of left atrium from cardiac MRI images, and compare their performance with conventional supervised learning.

Methods
The basic structure for a mean teacher deep neural network is shown in Fig.1. Network training starts in a supervised manner. At each MRI batch input, both the student and the teacher model evaluate the images with applied noise. The student network is updated by gradient descent and segmentation loss is obtained by comparing its prediction with the label. The exponential moving average (EMA) of the student weight is then migrated to update the teacher network. Consistency loss between the student’s and teacher’s prediction (filtered by uncertainty map in Uncertainty-Aware Mean Teacher, UA-MT [2]) is obtained to jointly update the student. Unlabeled images continually improve the network without using supervised loss.
We compared three semi-supervised teacher-student networks UA-MT, Hierarchical Consistency Regularized Mean Teacher (HCR-MT) and Semi-supervised Contrastive Consistency model (SCC), with the supervised network TransUNnet [3], using benchmark cardiac MRI dataset from MICCAI 2018 Atrial Segmentation Challenge [4]. Out of 20 MRI scans (1760 images), 16 scans were used for training, and 4 scans for testing. For semi-supervised learning, 75% of the training set was used as labelled data and 25% was assumed to be unlabeled. In the supervised learning, all labels were enabled.

Results
Example segmentation results from three semi-supervised models are shown in Fig 2. For comparison, the fully supervised TransUNnet produced an accuracy of 76%. Benefiting from effective teacher-student learning, the semi-supervised models achieved a superior accuracy of 89%, while also requiring less labelled data.

Conclusion
The proposed teacher-student deep neural network facilitates effective semi-supervised learning, and outperforms supervised TransUNet in segmenting the left atrium in cardiac MRI. Our semi-supervised approach uses less training data, reducing tedious and time-consuming manual labelling tasks, ultimately unlocking the ability to effectively utilise the full power of deep learning in medical applications.
Family history of cardiovascular disease in athletes: 2 sports medicine clinics, 4 systems of preparticipation screening, 7 years of work. Is it time for a change?
Authors: Jiravska Godula B , Pesova P , Sovova M , Moravcova K , Ozana J , Sovova E , Jiravsky O 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): IGA-internal grant agency Palacky University,Olomouc.

Introduction
Searching for a positive family history (FH) of cardiovascular disease (CVD) or sudden cardiac death (SCD) is a standard part of preparticipation screening (PPS) of athletes. This is despite the fact that there is no evidence to support either a mortality or cost-effective benefit of this practice.
It is generally accepted that the use of a questionnaire method of family history investigation will expedite and refine the process of obtaining adequate responses required for the PPS.
There are a number of PPS systems currently in use around the world, of which four standardized PPS systems are very commonly used (AHA; 5thPPE; IOC = Lausanne Questionnaire; FIFA), each with its own questionnaire that is distinct from the other systems.
A positive finding of a family history of CVD/SCD in an athlete during PPS is an accepted indication for (sports) cardiology investigation. However, there is no evidence to define the scope of this examination and validate the mortality or cost-effective benefit of this practice.

Purpose
1. To determine the number of athletes with positive FH in the entire cohort using questionnaires from the four PPS systems mentioned above.
2. Evaluate differences in frequency analysis of each questionnaire.
3. To identify question wording issues and to highlight overly "soft" criteria in each PPS system.
4. Propose optimization of FH data collection and follow-up.

Methods and file
Between 2015 and 6/2022, 14083 patients were screened at 2 centers. There were 13879 athletes with traceable FH (3768 females -27.1%), aged 14 (IQR 5) years.

Results
180 athletes (1.3%) had positive FH according to at least one PPS system. The IOC system generated the fewest positive responses, followed by the AHA and FIFA, and the 5thPPE system clearly generated the most positive responses (by 80% compared to IOC). See Table 1. Clearly the "softest" question is the query about any heart disease/heart problems/ in 5thPPE, this alone is responsible for the majority of positive responses above the response levels of the other systems.

Conclusion
Investigating positive FH CVD/SCD is an established part of the athlete's PPS. There is up to 80% variation when using the 4 globally accepted PPS questionnaires. The lack of evidence for their use, as well as the lack of evidence for other cardiac retrospective investigations, coupled with their complexity and difficulty for patients to understand, is a challenge to research in this field.
Temporal trends in cardiac rehabilitation participation and its core components: a nationwide study from the Netherlands
Authors: Bakker E A , Vonk T , Maessen M F H , Hopman M T E , Snoek J A , Aengevaeren V L , Franklin B A , Eijsvogels T M H 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiac rehabilitation (CR) is an important secondary prevention strategy for individuals with cardiovascular diseases (CVD)(1). Nevertheless, CR participation rates remain low(2). In the past decade, more attention has been given to CR referral and participation following the development and implementation of (inter)national multidisciplinary CR guidelines(1).

Purpose
To assess time trends in Dutch CR participation rates between 2013-2019, as well as its distinct components (e.g., admission session, exercise training, nutrition counselling, and psychological help).

Methods
CVD patients with a clinical indication for CR were enrolled in this observational study. Health insurance claim data was used to identify CR participation and its components. Temporal trends were analysed using logistic restricted cubic spline regression.

Results
106,212 CVD patients were included, of which 38,954 patients (37%) participated in CR. Participation rates significantly increased from 28% in 2013 to 41% in 2016 but stabilized thereafter. The time trends of participation to CR were mostly similar across different subgroups of age, (Figure 1A), sex (Figure 1B), CVD diagnosis (Figure 1C), and cardiothoracic surgery/procedure (Figure 1D). Participation rates were the highest in younger patients (&lt;50 years; 52%, and 50-65 years; 50%), men (48%), patients with an ST-segment elevation myocardial infarction (73%), and coronary artery bypass grafting (82%). In contrast, participation rates were the lowest in older patients (≥85 years; 8%), women (30%) and in patients with heart failure (11%). Most CR participants received an admission session (97%) and exercise training (82%) during their CR program, whereas nutrition counselling (14%) and psychological help (10%) were underutilized (Figure 2).

Conclusion
CR participation rates increased, but stabilized after 2016. Age, sex, CVD diagnosis and cardiothoracic surgery/procedures affected CR participation rates. Future research and renewed implementation strategies are needed to increase CR referrals, enrolment and participation in specific CVD subgroups and to enhance its potential effectiveness by a higher utilization of modules related to dietary and psychosocial counselling.
Gender difference in the association between prediabetes and post-myocardial infarction prognosis
Authors: Chattopadhyay S , George A , Soman B , John J , Sathyapalan T 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Higher incident coronary heart disease in females with prediabetes compared to males is seen in the general population. This interaction in post-MI patients for recurrent events is largely unexplored.

Purpose
Explore the interaction between sex and newly diagnosed glycaemic abnormalities in terms of its association with recurrent cardiovascular events.

Methods
Retrospective analysis of a cohort of MI-survivors without known diabetes who had pre-discharge OGTT. MACE (death and non-fatal MI) had fasting (FPG) and 2-hour post-load plasma glucose (2h-PG), were recorded. Cox regression models adjusted for confounders were used. The modifying effect of sex on the association between MACE and, glycaemic groups or fasting or post-load glucose levels was tested by adding an interaction term combining gender and glycaemic category prediabetes (pDM) and new diabetes (NDM) (pDM*sex and NDM*sex) or glucose levels (FPG*sex and 2h-PG*sex) to the base model to additionally adjust for sex-specific confounding.

Results
Crude MACE was higher in women with pDM (35.8% v 16.7%, p=0.001) and men with NDM (29.6% v 17.3%, p=0.003) compared to normal glucose tolerance (NGT). Adjusted MACE was higher only in women with pDM (HR 2.15, 95% CI 1.24 to 3.72, p=0.007) and only in men with NDM (HR 1.57, 95% CI 1.01 to 2.42, p=0.044) compared to NGT. In pDM group, risk of MACE was higher in women compared to men (HR 1.72, 95% CI 1.13 to 2.60, p=0.011), (p for interaction=0.040) but not NDM (HR 0.83, 95% CI 0.43 to 1.60, p=0.575), (p for interaction=0.378). Increasing 2h-PG, but not FPG, was associated with MACE in both sexes with no sex interaction. Compared to NGT, IGT, not IFG, predicted MACE in women, (HR 2.08, 95% CI 1.21 to 3.57, p=0.008) but not in men, (p for interaction=0.043). 2h-PG determined NDM predicted MACE in men (HR 1.59, 95% CI 1.04 to 2.44, p=0.034) but not in women without sex interaction, (p for interaction=0.365) (Fig 2).

Conclusion
Female sex adversely modifies the association between 2h-PG determined pDM and post-MI MACE.