bluuebunny/crossref_metadata_2025_split huggingface dataset:
3D-PRINTING FOR ABLATION PLANNING IN PATIENTS UNDERGOING ATRIAL FIBRILLATION ABLATION (3D-GALA TRIAL)
Authors: Xydis Panagiotis , Printzios Dimitrios Terentes , Gourgouli Ioanna , Tampakis Konstantinos , Andrikopoulos George , Vlachopoulos Charalampos 
Published: June 2022

Objective:
Atrial fibrillation (AF) remains one of the major causes of cardiovascular morbidity. Ablation techniques are becoming more appealing after latest results of andomised trials showing the overall clinical benefit. On the other hand imaging techniques and the frontier application of 3D printing are emerging as valuable ally for cardiac procedures. However, no andomised trial has directly assessed the impact of preprocedural imaging and especially 3D printing guidance for AF ablation.
The present study is designed to investigate for the first time the effect of 3D-printing of the heart on the safety and effectiveness of the ablation procedure.

Design and method:
The 3D-GALA trial is a andomised, open- label, controlled, multicentre clinical trial of 2 parallel groups designed to enrol a total of 100 patients undergoing ablation using cryo-balloon for paroxysmal and persistent AF. Patients will be andomised with a patient allocation ratio of 1: 1 to preprocedural MRI scan of the heart and 3D printing of left atrium and pulmonary veins and cryoablation versus standard cryoablation without imaging. Patients will be followed up to 6 months after the index procedure

Results:
The primary outcome measure is the reduction of radiation dose and contrast amount during pulmonary veins isolation. Secondary endpoints will include the percentage of atrial fibrillation relapse at 24h-Holter electrocardiogram monitoring at 6 months after initial treatment.

Conclusions:
To our knowledge, the 3D-GALA trial will be the first study to provide evidence about the clinical impact of preprocedural imaging and 3D printing before cryoablation.
THE ROLE OF BLOOD PRESSURE LEVEL IN THE DEVELOPMENT OF ATRIAL FIBRILLATION AFTER CORONAVIRUS INFECTION
Authors: Stasushena Oksana 
Published: June 2022

Objective:
It is known, that arterial hypertension (AH) is the main cause of atrial fibrillation (AF).
The aim of our study was to assess the parameters of systemic hemodynamics as a predictor of AF development after coronavirus infection (CI).

Design and method:
We examined 118 patients with AF, at the age of 62.5 + 0.09 years with AF, who, on average, 6.2 + 0.5 months had undergone CI. Of these, 14 people (8.4%) also had atrial flutter. 72 people (61 %) had AF before CI (1st group of patients). The remaining 46 patients (39 %) had no history of this arrhythmia (2nd group of patients). Office blood pressure was measured according to the generally accepted method.

Results:
In the 1st group, the indicators of systolic blood pressure (SBP) were significantly lower than in the 2nd group (131.4 + 1.72 and 139.5 + 2.99 mm Hg, p < 0, 05), indicators of diastolic blood pressure (DBP) (81.5 + 0.74 and 87.9 + 2.41 Hg, p < 0.05), and heart rate (HR) (83, 0 + 1.86 and 98.0 + 2.4 bpm, p < 0.05). This difference in the groups was more significant between patients with hypertension: SBP, respectively (134.7 + 1.5 and 143.9 + 3.8 mm Hg, p < 0.05), DBP (83.3 + 1.1 and 90.5 + 2.6 Hg, p < 0.05), and heart rate HR (83.0 + 1.86 and 98.0 + 2.4 bpm, p < 0.001). In addition, in group 1, AH was found significantly less frequently (in 59 out of 72 patients, 81.9%) than in patients in group 2 (in 42 out of 46 patients, 91.3%), p < 0.05.

Conclusions:
An increase in SBP, DBP HR and AH, are predictors of the development of AF in patients after CI.
CARDIOVASCULAR EFFICACY OF SODIUM-GLUCOSE CO-TRANSPORTER-2 INHIBITORS AND ANGIOTENSIN RECEPTOR NEPRILYSIN INHIBITORS IN PATIENTS WITH HEART FAILURE ACCORDING TO MINERALOCORTICOID R
Authors: Patoulias Dimitrios , Katsimardou Alexandra , Siskos Fotios , Imprialos Konstantinos , Stavropoulos Konstantinos , Toumpourleka Maria , Koutsampasopoulos Konstantinos , Papadopoulos Christodoulos , Doumas Michael 
Published: June 2022

Objective:
Recent European heart failure guidelines recommend the use of four drug classes in patients with heart failure (HF) with reduced ejection fraction: andom-angiotensin system (RAS) inhibitors [angiotensin-converting enzyme inhibitors (ACEi), angiotensin-receptor blockers (ARBs), angiotensin receptor neprilysin inhibitors (ARNIs)], beta-blockers, mineralocorticoid receptor antagonists (MRAs) and sodium-glucose co-transporter-2 (SGLT-2) inhibitors. All these drug categories exert impressive cardiovascular and survival benefits. However, the potential synergistic effects of newer categories (ARNIs and SGLT-2 inhibitors) in patients receiving or not MRAs have not been clearly evaluated.

Design and method:
We searched PubMed for andomised controlled trials (RCTs) assessing the effect of SGLT-2 inhibitors and sacubitril/valsartan versus placebo or active comparator on surrogate cardiovascular endpoints among subjects with HF. We extracted data corresponding to subgroup analyses according to prior treatment with MRAs. We set as primary endpoint the composite of andomisedtion for HF or cardiovascular death.

Results:
We pooled data in a total of 14,462 subjects with HF assigned either to a SGLT-2 inhibitor or placebo and 13,195 subjects with HF andomised either to sacubitril/valsartan or a RAS inhibitor. Prior treatment with a MRA did not affect the cardiovascular efficacy of SGLT-2 inhibitors compared to placebo (p = 0.74). When we assessed the cardiovascular efficacy of sacubitril/valsartan versus RAS inhibitors, we did not identify a subgroup difference between subjects receiving a MRA or not (p = 0.94).

Conclusions:
Collectively, despite being reasonable, a treatment combination of SGLT-2 inhibitors or sacubitril/valsartan with MRAs does not provide additional cardiovascular benefits for patients with HF with reduced or preserved ejection fraction. Potentially synergistic effects of these drug classes have to be confirmed.
EVALUATION OF ATRIAL FIBRILLATION BURDEN AFTER THE FIRST ECG-DOCUMENTED EPISODE VIA IMPLANTABLE LOOP RECORDERS
Authors: Papakonstantinou Panteleimon , Chlouverakis Gregory , Vardas Panos , Kochiadakis George , Simantirakis Emmanuel 
Published: June 2022

Objective:
The natural history of paroxysmal atrial fibrillation (AF) after the first clinical AF episode is not well known. AF burden is of clinical significance as it may have clinical implications concerning the long-term management of the arrhythmia and the decision-making on AF patients. We studied the natural history of AF in patients after their first clinical AF episode.

Design and method:
Thirty consecutive patients (age 66.9 ± 10 years; 14 men) received an implantable loop recorder (ILR) (Reveal XT 9529; Medtronic, Minneapolis, Minnesota, USA) after their first symptomatic paroxysmal AF episode. We recorded the AF recurrences and burden (clinical and subclinical AF) during a follow-up period of three years. We excluded patients with persistent or permanent AF and patients with AF attributed to reversible or transient causes.

Results:
Eight patients (26.6%) did not present any AF recurrence during the first year of the follow-up period. Five patients (16.6%) did not also suffer any AF episode during the second year, while in three patients (10%) no AF episode was recorded during the three-year follow-up period. In 16 patients (53.3%) the AF burden was increased during the second year of follow-up period while in 9 patients (30%) the AF burden was decreased. During the third year of follow-up period the AF burden was increased in 19 patients (63.3%), decreased in 7 patients (23.3%) and remained almost the same in 4 patients (13.3%). Five patients (16.6%) presented at least one episode of persistent AF during the follow-up period. Seven patients (23.3%) suffered only from symptomatic AF episodes, while in nine patients (30%) only asymptomatic AF episodes were recorded. Eleven patients (36.7%) had both types of AF episodes (symptomatic and asymptomatic).

Conclusions:
The AF recurrences and burden increased in most AF patients during the three-year follow-up period. However, some patients did not suffer any AF recurrence or they presented a decrease in AF burden. Paroxysmal AF clinical profile differs among the AF patients significantly and this indicates that an individualized approach via long-term rhythm monitoring may be of clinical significance, at least in some newly diagnosed AF patients.
IRON DEFICIENCY MANAGEMENT IN HYPERTENSIVE SUBJECTS WITH ACUTE HEART FAILURE: FROM CLINICAL TRIALS TO CLINICAL PRACTICE
Authors: Mazza Alberto , Baracca Andrea , Schiavon Laura , Torin Gioia , Aquilone Alessandra , Camerotto Alessandro , Cuppini Stefano 
Published: June 2022

Objective:
Iron deficiency (ID) is common in heart failure (HF) and independently increases the risk of re-hospitalisation for HF. Intravenous ferric carboxymaltose (FCM) has been shown to improve symptoms and quality of life in patients with chronic HF and ID deficiency. We aimed to evaluate the effect of FCM on outcomes in hypertensive patients (HTs) who were stabilised after an episode of acute HF.

Design and method:
From november 2020 to july 2021, in 148 HTs consecutively admitted in our Hypertension Unit for acute HF with ejection fraction < 50%, a ID was found in 39 of them (51% men, mean age 71.1 ± 18.5 yrs). ID was defined as serum ferritin < 100ng/mL or serum ferritin 100–299ng/mL with transferrin saturasion < 20%. Before hospital discharge, HTs received FCM dose according to the extent of ID and then reapeated it at 4-week interval. The primary outcome was to assess first HF hospitalisation or cardiovascular (CV) death at 4 and at 12 weeks after discarged. The analysis of variance for repeated measures assesed the differences in the values of systolic blood pressure (SBP), diastolic blood pressure (DBP), N-terminal pro-B-type-natriuretic peptide (NT-pro-BNP, (in pg/mL) and haemoglobin (in g/L) from baseline to the follow-up (FU).

Results:
At 4 and 12-week SBP and DBP values were not different from baseline (123.2 ± 13.8 and 124.4 ± 13.2 vs. 124.1 ± 14.1, NS and 70.9 ± 9.8, 71.0 ± 10.0 vs. 71.8 ± 10.2 mmHg, NS, respecively). NT-pro-BNP values significantly decreased from baseline to the FU (8.100 ± 8.132 vs. 6.244 ± 4.280 and 4.126 ± 3.485, p < 0.05). Haemoglobin values significantly increased from baseline to the FW (9.5 ± 1.2 vs. 11.9 ± 1.3 and 12.2 ± 1.4, p < 0.005). At 4-week no patient was re-admitted for HF, while at the 12-week a re-hospitalisation was observed in 17,9% of cases. No CV death was observed during the FW.

Conclusions:
Administration of FDC is effective to prevent first HF re-hospitalization and as recommended in 2021 ESC HF-guidelines, iron supplementation with FDC should be considered for the reduction of HF re-hospitalizations also in HTs with LVEF < 50% recently hospitalized for worsening HF. However, our results must be confirmed in studies involving a greater number of subjects, and with a longer FW.
EFFECT OF CALCIUM CHANNEL BLOCKERS ON HEART FAILURE: A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS
Authors: Alsanosi Safaa , Roos Nur Aishah Binti Che , Alsieni Mohammed , Lip Stefanie , Mccallum Linsay , Shahzad Naiyer , Padmanabhan Sandosh 
Published: June 2022

Objective:
Hypertension is a major risk factor for heart failure (HF). Antihypertensive therapy, in general, has a protective effect on incident HF with diuretics, ACEI, and ARBs particularly effective. Previous systematic reviews have produced inconsistent results about the effect of CCBs on HF. We conducted a systematic review and network meta-analysis to evaluate patients with hypertension treated with CCBs and incident HF.

Design and method:
Publications of head-to-head andomised controlled trials (RCTs) of CCBs were retrieved from MEDLINE, EMBASE, Web of Science, and Cochrane (January 2000- August 2021). We included RCTs with at least 100 participants and with a minimum follow-up of one year. Two authors independently selected the included trials, evaluated the risk of bias, and retrieved the data on HF. Fixed effect meta-analyses were performed to summarise the pooled risk ratios (RRs) of HF between treatment arms followed by network meta-analyses incorporating direct and indirect data.

Results:
The initial literature search identified 4740 records. After duplicates were excluded, there were 2602 records. Totally, 652 RCTs were excluded after a full-text review of the 674 eligible studies. In the end, 22 RCTs with a total of 164,834 participants were included in our meta-analysis. As to the effect of CCBs on HF, ACEIs, ARBs, DIs, and BBs are all superior to CCBs in the prevention of HF. In comparison to the placebo, the point estimate for CCB was less than 1 but it did not reach statistical significance in the overall analysis, but it attained statistical significance in the sensitivity analysis. (The pooled RR in the fixed effect model was 0.74 [95% CI: 0.59, 0.92; I2 = 22%; X2 p = 0.007]). The relative risk of HF compared with CCB was 0·88 [0 8–0·97] for ACEI, 0·84 [0 75–0·95] for ARB, 0·87 [0 77–0·98] for BB, 0·75 [0 69–0·82] and 1.11 [0 94–1.32] for placebo.

Conclusions:
The findings of our systematic review and meta-analysis do not support the hypothesis that CCBs are effective in the prevention of HF. However, to gain a greater understanding of the potential effect of CCBs, further clinical studies and meta-analyses are needed to pool study results and strengthen statistical validity.
PREDICTION OF ABNORMAL LEFT VENTRICULAR GEOMETRY ON THE ECG THROUGH MACHINE LEARNING WITH A FOCUS ON OBESITY
Authors: Zervakis Stylianos , Aggelaki Eleni , Marketou Maria , Barmparis George , Maragkoudakis Spyros , Danelatos Christos , Plevritaki Anthoula , Pateromichelakis Themistoklis , Kampanieris Emmanouil , Kalomoirakis Petros , Peponaki Eirini , Fragkiadakis Kostas , Savva Eirini , Kochiadakis George , Tsironis Giorgos 
Published: June 2022

Objective:
Although electrocardiogram (ECG) is of paramount importance in the initial evaluation of cardiac emodelling, it is not a sensitive method of detecting left ventricular hypertrophy (LVH), and it cannot detect changes in left ventricular geometry (LVG) at early stages. Its sensitivity is particularly low for obese patients. We used a machine learning (ML) classifier to detect abnormal LVG from ECG parameters/markers, even before it becomes LVH and looked at the results of our model for obese patients.

Design and method:
We enrolled 594 consecutive subjects, aged 30 years or older (mean age: 61.6 ± 12 years old) with and without essential hypertension and no indications of cardiovascular disease. All patients underwent a full echocardiographic evaluation and were classified into 2 groups; those with normal geometry (NG) vs. those with concentric emodelling (CR) or LVH defined as concentric hypertrophy (CH) and eccentric hypertrophy (EH). Abnormal LVG was identified as increased relative wall thickness (RWT) and/or left ventricular mass index (LVMi). We trained a Random Forest machine learning model to classify subjects with abnormal LVG and calculated SHAP values to perform feature importance and interaction.

Results:
71.3% of all patients were hypertensive. Hypertension, age, body mass index divided by the Sokolow-Lyon voltage (BMI/S-L), QRS-T angle, and QTc duration were among the most important parameters (Figure 1) identified by the model as being predictive of abnormal LVG (AUC/ROC = 0.84, sensitivity = 0.94, specificity 0.61). Specifically for obese patients, whose prevalence in our population was 60.3%, our model performed well (sensitivity = 0.71, specificity = 0.92. When we tried our model without the the BMI/S-L parameter, the specificity dropped to 0.88. We also found that a cut-off point of 18 kgr/ m2mV for the BMI/S-L marker predicted the patients who were more probable to have developed abnormal LVG.

Conclusions:
Specific clinical and ECG parameters can predict early pathological changes of LVG in patients without established CVD and detect the population who will benefit from a detailed echocardiographic evaluation. We also proved the hypothesis that ECG parameters can be useful in detecting abnormal LVG in obese patients.
MACHINE LEARNING CLASSIFICATION OF CORONARY HEART SYNDROME BASED ON ELECTROCARDIOGRAM (ECG) IMAGE USING CONVOLUTIONAL NEURAL NETWORK (CNN) ALGORITHM
Authors: Fajar Rifaldy , Hanoman Bartelia , Zuova Rozella 
Published: June 2022

Objective:
Electrocardiogram (ECG) is one of the most important examination models used to diagnose various abnormal heart rhythms. Early examination of heart defects can improve quality of life through appropriate treatment. One of the abnormalities in the heart is coronary heart disease. CHD is a heart disease that is mainly caused by narrowing of the coronary arteries due to atherosclerosis or spasm or a combination of both. In this study, a system was designed to classify coronary heart disease from the results of ECG images.

Design and method:
The study consisted of several stages, starting with the collection of ECG image data for cardiac abnormalities which were used for training images and testing images. The next step is pre-processing using a grayscale process to show the intensity value. Furthermore, at the segmentation stage, a thresholding process is used which aims to divide the image into two parts, namely between the object and the background by forming a binary image. The next stage is the process of taking feature values from the segmentation results using Invariant Moment. The final stage is classification using the Convolutional Neural Network. The data used in this study are images obtained from Beecardia - physiobank. There are four classifications of images processed in this system, namely Normal, Asymptomatic, Angina Pectoris, and Acute Myocardial Infarction. The amount of data used is 126 where the image is divided into two, namely, 101 training data and 25 testing data.

Results:
The Convolutional Neural Network method is able to classify coronary heart disease from the results of ECG images very well. The results of the classification process for coronary heart disease from the results of ECG images are able to achieve an accuracy of 92%.

Conclusions:
The classification system can perform its performance well, as evidenced by the percentage obtained, including a height exceeding 90%. Suggestions for the future, more training data can be used so that at the time of testing, the test data can get higher accuracy.
VASCULAR BIOMARKERS IN RELATION TO INDICES OF AORTIC STIFFNESS AND RENAL FUNCTION IN PRIMARY HYPERTENSION
Authors: Jekell Andreas , Lundwall Kristina , Spaak Jonas , Kahan Thomas 
Published: June 2022

Objective:
Degradation of the glycocalyx (GC), the innermost layer protecting the vascular endothelium, and up-regulation of adhesion molecules is associated with subclinical atherosclerosis and endothelial dysfunction, while aortic stiffness is related to early structural vascular changes and decline in renal function. However, few studies have investigated vascular biomarkers in relation to central and peripheral hemodynamics, and renal function in hypertension.

Design and method:
107 patients (58 ± 13 years) with hypertension (mean 149/87 mmHg; 31% on antihypertensive treatment) and a wide range of renal function (eGFR 130 to 21 ml/min x 1.73 m2, mean 74 ml/min), were investigated. Indices of aortic stiffness were central systolic blood pressure (cSBP), central pulse pressure (cPP), carotid/brachial pulse pressure ratio (cPP/brPP), augmentation index (AIx), carotid-femoral pulse wave velocity (PWV), and aortic-brachial PWV ratio, assessed by applanation tonometry (SphygmoCor, AtCor Medical). Endothelial function was studied by forearm post-ischemic flow mediated vasodilatation. The GC glycoproteins hyaluronan (HA) and syndecan-1 (Syn-1), and adhesion molecules (ICAM-1, VCAM-1, and E-selectin), were analysed with ELISA.

Results:
Median[range] HA, Syn-1, ICAM-1, VCAM-1, and E-selectin were 15 [11–20], 38[27–54], 302[264–345], 347[304–408], and 32[26–41] ng/mL, respectively. HA was related to cPP (r = 0.31; P = 0.002), cPP/brPP (r = 0.21; P = 0.002), AIx (r = 0.21; P = 0.034), PWV (r = 0.31; P = 0.003), and aortic-brachial PWV ratio (r = 0.27; P = 0.011). Syn-1 was inversely related to cSBP (r = –0.17; P = 0.043). E-selectin tended to be inversely related to cSBP (p = 0.10) and to cPP (p = 0.071). HA and VCAM-1 were inversely related to eGFR (r = –0.45 and r = –0.43; both P < 0.001). All vascular biomarkers were unrelated to flow-mediated vasodilation.

Conclusions:
Vascular biomarkers were associated with indices of aortic stiffness, and impaired renal function, but was unrelated to peripheral endothelial function. HA showed association with increased stiffness, compared to Syn-1 that was unrelated to stiffness, and both HA and VCAM-1 were inversely related to renal function, where elevation of HA and VCAM-1 may reflect endothelial dysfunction of the kidneys. Thus, our results suggest that functional vascular biomarkers may relate to early structural and functional vascular changes in uncomplicated hypertension with impaired renal function.