bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic value of machine learning for acute heart failure
Authors: Shimizu M , Miyazaki H , Cho S , Misu Y , Tateishi R , Yamaguchi M , Yamakami Y , Shimada H , Manno T , Isshiki A , Kimura S , Fujii H , Suzuki M , Nishizaki M , Sasano T 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
At onset of acute heart failure (AHF), various clinical fundamental parameters including vital sign, laboratory data, or initial treatment were investigated, and we can roughly estimate the prognosis. However, machine learning method for prediction of the prognosis was not studied.

Purpose
To elucidate prognostic value of machine learning for AHF comparing conventional statistical model.

Methods
We enrolled consecutive 300 patients with AHF (79.5 ± 12.1 years, 158 Males). Patients with acute coronary syndrome, mechanical circulatory support cases, and cardio-pulmonary arrest cases were excluded. The patients were randomly divided into 80% (240 cases) and 20% (60 cases), and the former was used as train data, and the latter as validation data. Objective variable was set as cardiac death in one year. First, logistic regression analysis with Akaike’s information criterion (AIC) was performed, and extracted predictive parameters. The predictive model for the cardiac prognosis was constructed by cut-off value of ROC curve analysis of propensity score was calculated. Next, machine learning (random forest method and deep learning) to build predictive model was performed with the predictors. Finally, accuracy of each predictive model was compared.

Results
Thirty cases showed cardiac death in one year. Logistic regression with AIC extracted 8 predictors, and the cut off-value of propensity score with the 6 parameters was 0.110. The accuracy was 0.714 and area under ROC (AUROC) was 0.836. Conversely, random forest method demonstrated the accuracy as 0.927, AUROC 0.860. On deep learning, the accuracy was 0.937 and AUROC 0.901.
The top 4 high feature importance of random forest were Cl/red blood cell count/pH/Anion Gap. However, accuracy of those predictors was lower than that of machine learning.

Conclusion
Machine learning was a powerful tool to predict cardiac prognosis of AHF, comparing with conventional statistical model. Abstract Figure. Statistical model
Prevalence and characteristics of non-ST-segment elevation in acute myocardial infarction with insignificant coronary artery disease
Authors: Sricholwattana S , Chaipromprasit J , Kosum P 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): King Chulalongkorn Memorial Hospital

Background
Acute myocardial infarction is mostly associated with obstructive coronary artery disease. 8% to 12% of patients have insignificant coronary artery disease. Prognosis for patients with insignificant coronary artery disease is better than patients with obstructive coronary artery disease who presented with non-ST elevation myocardial infarction (NSTEMI). Prevalence of patients with non-ST elevation myocardial infarction (NSTEMI) related insignificant coronary artery disease in Thailand remains unknown.

Method
A retrospective cohort analysis was performed in all patient who admitted for NSTEMI and underwent coronary angiography presenting to our hospital in admission (January 2018 to October 2020). The primary end point was to study the prevalence of insignificant coronary artery disease in NSTEMI patients, the secondary end point was to find associated factors of the insignificant coronary artery disease and create new scoring system for predicting insignificant coronary artery disease.

Result
A total 522 subjects were enrolled. 74 patients (14.2%) had insignificant coronary artery disease. The median age was 68.37 years (female 37.4%), smoking 14%, diabetes 46.7%, hypertension 85.1%, dyslipidemia 78%, history of stroke 8.4% and ESRD 7.3%. There are many predictors of insignificant coronary artery disease in NSTEMI patients: Absence of regional wall motion abnormalities from echocardiogram had the strongest association with insignificant coronary artery disease (OR = 5.057, 95% CI, 2.54-10.06 ; p-value &lt; 0.001). Other variables were; no ST segment deviation in the ECG (OR = 4.29, 95% CI, 2.16-8.52 ; p-value &lt; 0.001), female sex (OR = 3.43, 95% CI, 1.77-6.66 ; p-value &lt; 0.001) and the absence of dyslipidemia (OR = 2.48, 95% CI, 1.23-4.97 ; p-value = 0.01). By using multivariate analysis, a scoring system was made to predict insignificant coronary artery disease, which consist of 2 points for female, 2 points for not having history of dyslipidemia, 3 points for no ST segment deviation form the ECG and 3 points for no regional wall motion abnormalities from the echocardiogram. As shown in the ROC curve, the AUC = 0.804 and 5 is the cut point score with 72.1% sensitivity, 72.3% specificity and 72.3% accuracy.

Conclusion
Prevalence of non-ST-segment elevation acute myocardial infarction with insignificant coronary artery disease is 14.2%. Absence of regional wall motion abnormalities from echocardiogram, no ST segment deviation in the ECG, female sex and absence of dyslipidemia were all statistically associated with insignificant coronary artery disease. With the predicting score ≥5, the patient may be considered not to proceed the coronary angiogram.
Aspirin vs. Clopidogrel as a Chronic maintenance monotherapy after PCI in patients with high ischemic risk and high bleeding risk: Subgroup analysis of the HOST-EXAM trial
Authors: Park K W , Kang J , Koo B K , Rhee T M , Yang H M , Won K B , Rha S W , Bae J W , Lee N H , Hur S H , Han J K , Shin E S , Kim H S 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

OnBehalf
on behalf of the HOST-EXAM investigators

Background
The HOST-EXAM randomized clinical trial recently performed a comparison of clopidogrel monotherapy vs. aspirin monotherapy in patients requiring indefinite antiplatelet monotherapy after percutaneous coronary intervention (PCI). This study randomized 5,438 patients who maintained dual antiplatelet therapy without clinical events for 6–18 months after PCI with drug-eluting stents (DES) to receive a monotherapy agent of clopidogrel 75 mg once daily or aspirin 100 mg once daily for 24 months. During the 24-month follow-up, the primary outcome (a composite of all-cause death, non-fatal myocardial infarction, stroke, readmission due to acute coronary syndrome, and Bleeding Academic Research Consortium (BARC) bleeding type 3 or greater) rate was significantly lower in the clopidogrel group (hazard ratio [HR] 0.73 [95% CI 0.59–0.90]; p = 0.0035). However, it is uncertain whether the beneficial effect of clopidogrel will be consistent in patients with high ischemic risk or those with high bleeding risk.

Methods
This is a post-hoc analysis of the HOST-EXAM trial. A high ischemic risk was defined as those who had at least 1 of the following procedural features: 3 vessels treated, ≥3 stents implanted, ≥3 lesions treated, bifurcation PCI, total stent length &gt;60 mm, or left main PCI. Patients with high bleeding risk were defined according to the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria. The co-primary outcome were thrombotic endpoints (a composite of cardiac death, non-fatal myocardial infarction, ischemic stroke, readmission due to acute coronary syndrome, and definite or probable stent thrombosis) and bleeding endpoints (BARC type ≥2 bleeding events) at 24-month follow-up.

Results
Among the total population, 22.1% had high ischemic risk and 21.4% had high bleeding risk. Complex PCI was not associated with a higher risk of thrombotic endpoints, nor bleeding endpoints. For patients with a high bleeding risk, these patients had a higher risk of both thrombotic endpoints (HR 1.545, 95% CI 0.141-2.092, p = 0.005) and bleeding endpoints (HR 3.418, 95% CI 2.413-4.840, p &lt; 0.001). The primary results focusing on the interaction between high ischemic risk, high bleeding and the antiplatelet regimen will be presented.

Conclusion
The current post-hoc analysis of the HOST-EXAM trial will evaluate the efficacy of clopidogrel monotherapy vs. aspirin monotherapy during the chronic maintenance period after PCI, in patients with high ischemic risk or those with high bleeding risk.
Comparison of VWF-ADAMTS13 axis involvement in atrial fibrillation and sinus rhythm in patients with ST-elevation myocardial infarction
Authors: Osawa T , Ito Y , Nakano K , Yamada Y , Abe Y , Tabata F , Koizumi T 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Previous studies have shown that von Willebrand factor (VWF) increases, and a disintegrin-like and metalloproteinase with thrombospondin type-1 motifs 13 (ADAMTS13) decreases in myocardial infarction. Few studies have examined the involvement of the VWF-ADAMTS13 axis in ST-elevation myocardial infarction (STEMI) patients with atrial fibrillation (AF).

Purpose
Our aim was to investigate VWF-ADAMTS13 axis involvement in atrial fibrillation in STEMI.

Methods
The subjects of this study were participants in an observational study for investigating the difference in the pathology of thrombus retrieved from infarct-related artery between AF and sinus rhythm (SR). From June 2019 to August 2020, patients who underwent thrombus aspiration for STEMI at our hospital. Only subjects whose thrombus could be confirmed were enrolled. They were divided into two groups, the AF group, and the SR group. Serum biomarkers, including ADAMTS13 activity, and VWF were evaluated.

Results
34 patients with STEMI who were able to aspirate thrombus were enrolled in the study. They were divided into two groups: 6 patients with AF (AF group, mean age 72.5 years, 100% male) and 28 patients with SR (SR group, mean age 63.0 years, 100% male). ADAMTS13 activity was significantly lower in AF group than SR group (AF: 0.63 ± 0.14 vs. SR: 0.77 ± 0.13 U / mL, p = 0.037). There was no significant difference in VWF antigen between the two groups (AF: 251 ± 56 vs. SR: 204 ± 69%, p = 0.170). VWF/ADAMTS13 activity in AF group were significantly higher than in SR group.

Conclusion
Our study suggests an association between the VWF-ADAMTS13 axis and atrial fibrillation in STEMI. Abstract Table. Comparison of serum biomarkers
Influence of ST2 level on the development of acute arrhythmias in NSTEMI
Authors: Maslovskyi V I , Mezhiievska I A 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Purpose
To determine the structure and relationship of cardiac arrhythmias in NSTEMI patients based on plasma ST2 level.

Methods
We studied 90 patients with NSTEMI aged from 35 to 79 years (mean 60.7 ± 0.8, median - 61, interquartile range 54 and 69). Plasma ST2 level was determined and analyzed in the NSTEMI patients group, the gradations of the ST2 level and the correlation with cardiac arrhythmias.
All of the research corresponds to the principles of the Declaration of Helsinki of the World Medical Association.
Results. Using the variation statistics method, the ST2 level gradations group were selected. Thus, the relatively low (RL) corresponded to less than 25, and the relatively high (RH) level of ST2 to more than 75 persons in the group, respectively. For patients in the main group, these levels were &lt;26 and&gt; 56 ng / ml, respectively. Instead, the relatively moderate (or intermediate) ST2 level (RM) for these patients was 26-56 ng / ml.
It has been determined that the most frequent rhythm disturbances were observed in the RM and RH risk groups, and more often in the RM risk group, probably due to a larger number of observations (Tab. 1). At that time, the total duration of ventricular tachycardia (VT) episodes, regardless of the number of patients, was at RH risk group. The same was observed with episodes of ST-depression.
Conclusions. Despite the number of observations, the risk of VT and ST-depression is significantly higher in patients at RH risk group. This should be taken into account when predicting the risk of complications in patients with NSTEMI. Abstract Figure. Tab. 1
Coronary atherosclerotic burden and trimethylamine N-oxide in non-ST-segment myocardial infarction patients: SZ-NSTEMI cohort
Authors: Bin Waleed K , Wang LILI , Chang JUNLEI , Tse GARY , Xia Y L , Wu SHULIN , Ding L G 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Trimethylamine N-oxide (TMAO) is reported to accelerate atherosclerosis and adverse cardiac outcomes. Relationship between coronary atherosclerotic burden and TMAO has linked in stable coronary artery disease and ST-segment elevation myocardial infarction, but not in non-ST-segment elevation myocardial infarction (NSTEMI).

Objective
We examined an association of TMAO with coronary atherosclerosis burden in NSTEMI.

Methods
In this prospective cohort, two groups including NSTEMI (n = 73) and age-sex matched Healthy (n = 35) individuals were enrolled between 2019 and 2020. The number of diseased coronary vessels and clinical risk scores including SYNTAX and GENSINI were used to stratify coronary atherosclerotic burden. Fasting plasma TMAO was measured by isotope dilution high-performance liquid chromatography.

Results
The median plasma TMAO levels (0.59 mM; [interquartile range [IQR]: 0.43-0.78) versus (0.42 mM; IQR: 0.33-0.64) were significantly higher in NSTEMI group versus Healthy group, respectively (P = 0.006). Among the patients with NSTEMI group, the plasma TMAO levels were significantly higher in the multivessel disease (MVD) versus single vessel disease (P = 0.002), and intermediate-high risk (score³23) versus low risk (score &lt; 23) of SYNTAX (P = 0.003) and GENSINI (P = 0.005). TMAO levels remained independently associated with MVD (odds ratio [OR]: 5.94, P = 0.005), and intermediate-high risk SYNTAX (OR: 3.61, P = 0.013) and GENSINI scores (OR: 4.60, P = 0.008) following traditional risk factors adjustment. Area under receiver operating characteristic curves (AUC) for TMAO also predicted MVD (AUC: 0.73, 95% confidence interval [Cl]: 0.60-0.86, P = 0.002), and intermediate-high SYNTAX score (AUC: 0.70, 95%Cl: 0.58-0.82, P = 0.003) and GENSINI score (AUC: 0.70, 95%Cl: 0.57-0.83, P = 0.005).

Conclusions
TMAO levels are independently associated with high coronary atherosclerotic burden in NSTEMI. Abstract Figure. Abstract
Short- and long-term outcomes in patients with right ventricular infarction according to modalities of reperfusion strategies in China: data from China Acute Myocardial Infarction (CAMI) Registry
Authors: Mengjin H , Yuejin YANG , Xiaojin G A O 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Twelfth Five-Year Planning Project of the Scientific and Technological Department of China
Purpose We sought to investigate the short- and long-term outcomes in patients with right ventricular infarction in China.
Methods Data from China Acute Myocardial Infarction (CAMI) Registry for patients with right ventricular infarction between January 2013 and September 2014 were analyzed.
Results Of the 1,988 patients with right ventricular infarction, 733 patients did not receive reperfusion therapy, 281 patients received thrombolysis therapy, and 974 patients underwent primary PCI. Primary PCI and thrombolysis were all associated with lower risks of in-hospital (3.1% vs 12.6%; adjusted OR: 0.48; 95% CI: 0.27–0.87; P = 0.0151 and 5.7% vs 12.6%; adjusted OR: 0.43; 95% CI: 0.22–0.85; P = 0.0155, respectively) and two-year all-cause mortality (6.3% vs 20.9%; adjusted HR: 0.50; 95% CI: 0.34–0.73; P = 0.0003 and 11.0% vs 20.9%; adjusted HR: 0.59; 95% CI: 0.38–0.92; P = 0.0189, respectively) compared with no reperfusion therapy. Meanwhile, primary PCI was superior to thrombolysis in reducing the risks of in-hospital atrial-ventricular block (4.2% vs 8.9%; adjusted OR: 0.46; 95% CI: 0.23–0.91; P = 0.0257), cardiogenic shock (5.3% vs 13.9%; adjusted OR: 0.43; 95% CI: 0.23–0.83; P = 0.0115), and heart failure (8.5% vs 23.5%; adjusted OR: 0.35; 95% CI: 0.22–0.56; P &lt; 0.0001). Primary PCI could reduce the risk of two-year major adverse cardiac and cerebrovascular event (19.1% vs 33.3%; adjusted HR: 0.72; 95% CI: 0.56–0.92; P = 0.0092) relative to no reperfusion therapy, whereas thrombolysis may increase the risk of two-year revascularization (15.5% vs 8.7%; adjusted HR: 1.90; 95% CI: 1.15–3.16; P = 0.0124) compared with no reperfusion therapy.
Conclusions Timely reperfusion therapy is essential for patients with right ventricular infarction. Primary PCI should be considered as the default treatment strategy for patients with right ventricular infarction in the contemporary primary PCI era.
The effect of remote ischemic post-conditioning on left ventricular ejection fraction in STEMI patients undergoing primary percutaneous coronary intervention
Authors: Fadil M 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background/Introduction
Primary Percutaneous Coronary Intervention (PPCI) in ST-Segment Elevation Myocardial Infarction (STEMI) is an effective method to limit the infarct area, reduce clinical symptoms, and improve clinical prognosis. However, it has the potential to creates an acute reperfusion injury which will result in worsening of left ventricular ejection fraction and eventually worsen the prognosis. Remote ischemic post-conditioning (RIPostC) is an additional, non-invasive, and inexpensive protective strategy that has been proved to play an important role in preventing worsening of reperfusion injury and left ventricular ejection fraction.
Purpose
The aim of this study was to evaluate whether PPCI combined with RIPostC improves the left ventricular ejection fraction of STEMI patients
Methods
This study used a post test only approach with control group design with an experimental research design. From June 2019 to June 2020, Fifty STEMI patients who underwent PPCI were randomized into PPCI with RIPostC (n = 24) and PPCI-only group (n = 26). After crossing wire or crossing balloon, RIPostC group was given 5 minutes inflating and 5 minutes deflating of cuff for 4 cycles. Furthermore, both groups were subjected to echocardiography follow up at 1 day and 6 months after PPCI. A bivariate analysis was performed to determine the effect of RIPostC on left ventricular ejection fraction in both groups.
Results
Based on baseline characteristics, beta-blocker therapy was found to be statistically more significant in PPCI with RIPostC than the control group (18 vs 7; p = 0.001). There was no statistically significant increase in left ventricular ejection fraction after 1 month and 6 months after PPCI in RIPostC group (p&gt; 0.05) and the control group (p&gt; 0.05). There was no significant difference in the changes of LVEDV, LVESV, and LVEF between 1 day and 6 months after PPCI between both groups. However, there was a different result in delta LVEF between RIPostC and without RIPostC, 6.21 ± 9.316 and 2.81 ± 8.079 respectively.
Conclusion(s)
The effect of RIPostC on echocardiography results in 1 day and 6 months after PPCI, as well as changes in echocardiography values in 1 day and 6 months did not appear to be statistically significant between the two groups. Abstract Figure. Baseline characteristics
Optimal landmark for chest compression during cardiopulmonary resuscitation derived from a chest computed tomography in arms-down position
Authors: Usawasuraiin P , Wittayachamnankul B , Euathrongchit J , Phinyo P , Tangsuwanaruk T 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Private hospital(s). Main funding source(s): The Faculty of Medicine, Chiang Mai University Fund

Background
Recently evidence, compression at the maximal left ventricular diameter on sternum (LVmax) maximises cardiac output, stroke volume and rate of return of spontaneous circulation. However, there is insufficient evidence for the specific landmark on the chest for high-quality chest compression. Although cardiac arrest patients are usually in the arms-down position, previous studies used chest computed tomography (CCT) of the patient with arms-up position. It might alter the left ventricular position.

Purpose
This study aimed to identify the landmark of LVmax and to propose the new hand placement to optimise the chest compression by using CCT in arms-down position.

Methods
A retrospective, cross-sectional study conducted at a university-based, tertiary care hospital between September 2016 and November 2020. We included adult patients who underwent CCT in arms-down position. We measured healthcare providers’ hand heel width and the cardiothoracic parameters in CCT to establish a new optimal landmark of chest compression. We defined the sternal notch as a reference point and measured the distance from the sternal notch to LVmax (DLVmax), to the lower half of sternum (DLH), and to the point of maximal force of hand which placed the palmar margin of the reference hand at the xiphisternal junction (lower end of the sternum).

Results
A total of 39 patients were enrolled to measure the cardiothoracic parameters. There were 22 male (56.4%) and the median age was 67 years. DLVmax was neither different in inspiratory-hold nor expiratory-hold (mean ± standard deviation: 12.1 ± 1.9 cm and 12.9 ± 2.7 cm, p = 0.386). LVmax was located lower than the lower half of the sternum (Figure 1); the median of DLVmax and DLH were 12.6 cm (interquartile range: 10.6, 13.5 cm) and 10.0 cm (9.5, 11.0 cm), respectively (p &lt;0.001). We found that the distance from the sternal notch to the point of maximal force of the left hand which the ulnar border located at the xiphisternal junction (DLU) was not significantly different from DLVmax (Figure 2); the median of DLVmax and DLU were 12.6 cm (10.6, 13.5 cm) and 11.3 cm (10.6, 12.5 cm), respectively (p 0.076).

Conclusions
The maximal left ventricular diameter on sternum (DLVmax) in the arms-down position was located lower than the lower half of the sternum (lower than the standard guideline recommendation). We propose that the new hand placement for chest compression is placing the left hand down and the hand’s border located at the xiphisternal junction while approach at left side of the patient. Abstract Figure. Abstract Figure.