bluuebunny/crossref_metadata_2025_split huggingface dataset:
GDF-15: a novel biomarker of heart failure predicts 30-day all-cause mortality and 30-day HF rehospitalization in patients with acute heart failure syndrome
Authors: Kosum P , Mattanapojanat N , Kongruttanachok N , Ariyachaipanich A 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Ratchadapiseksomphotch Fund, Faculty of Medicine, Chulalongkorn University

Background
Growth Differentiation Factor-15 (GDF-15) is a distant member of the transforming growth factor-β (TGF-β) cytokine super family. The increased expression of GDF-15 has been observed during various cardiac diseases include heart failure (HF) and may associated with worse outcomes. However, the relationship is still not well understood, and evidences are not existed in Thai patients.

Purpose
To study association between biomarker (GDF-15, NT-proBNP and hs-Troponin T) at the time of admission and discharge in patient with AFHS and their association with 30-day all-cause mortality and 30-day heart failure rehospitalization

Methods
This is a prospective, single center study of patients admitted for acute HF syndrome regardless of ejection fraction between December 2018 to June 2019. GDF-15 were measured within 24 hours after admission and at the time of discharge. Patient characteristics, orthoedema congestion score, biomarkers, treatment and outcome including 30-day, all-cause mortality and rehospitalization were collected. Logistic regression analysis was used to evaluate the relationship between GDF-15 level and outcomes.

Results
Total of 103 patients were screened and 84 patients were enrolled (mean age of 69 ± 14 years, 52.4% females). Ischemic heart diseases were reported in 38.1% and 23.1% of patients had history of HF with reduced ejection fraction. The orthoedema congestion score at the time of admission and discharge were 2.29 ± 0.1 and 0.38 ± 0.8, respectively (score from 0 to 4, with lower scores are less congestion). The GDF-15 level was significantly decrease during admission (at the time of admission 9118 ± 6010 pg/mL, at time of discharge 7107 ± 4787 pg/mL, mean differences 1528 ± 4469; p = 0.006). The 30-day all-cause mortality was 5.95%. The 30-day rehospitalization occurred in 22 (26.1%) patients (13 HF rehospitalization and 9 non-HF rehospitalization). Univariate analysis showed that the admission GDF-15 level, but not troponin or NT-proBNP, was associated with 30-days all-cause mortality (p = 0.029) and multivariate analysis showed reduction in GDF-15 level from admission to discharge was associated with lower 30-days rehospitalization (p = 0.023).

Conclusion
In this single center study, the rate of mortality and rehospitalization is very high in patient discharge after acute HF hospitalization. the GDF-15 levels were elevated during acute HF and improving by the time of discharge. This novel biomarker may offer additional value in predicting the risk of outcomes in patient with acute HF.
Machine learning based diagnosis of heart failure with preserved ejection fraction among South Asian patients
Authors: Cherukupalli R , Achanta A , Cherukupalli A , Potukuchi S 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Diagnosis of Heart Failure with preserved Ejection Fraction (HFpEF) remains challenging even for an astute clinician with the current diagnostic tests, algorithms and scoring systems. The use of Machine Learning (ML) in cardiovascular research has expanded exponentially in recent years.

Purpose
In this study we studied the predictive accuracy of a machine-learning model for the diagnosis of HFpEF in South Asian patients.

Methods
A single centre retrospective data of 1068 admitted patients with a clinical diagnosis of HF were obtained. From this data outliers were removed based on box-and-whisker plot study. This data was then segregated into three: without HF, HF with reduced ejection fraction and HFpEF. Finally, we arrived at 530 patients’ data with left ventricular ejection fraction (LVEF) values of &gt;45%. This data set was randomly divided into two parts: 80% as Training dataset and 20% as Test dataset. Two ML techniques such as Logistic Regression and Neural Networks were chosen to build the prediction models. Orange Data Mining Software version 3.28 was used to build these models. The overall performance of the ML methods has been reported using Precision, Recall and F1 scores of precision and recall; measure that combines precision and recall.

Results
The table summarizes precision, recall and F1 score of both models. The predicted results from the ML models are compared with HFA PEFF score.

Conclusion
ML based diagnosis using two different models showed acceptable predictive accuracy for HFpEF. Limitations of using LVEF as a predictor for the diagnosis of HF by ML and discussion on how the combination of an expert clinician opinion with ML further improves the diagnostic ability will be made. Abstract Figure.
Predictors of elevated follow-up high sensitivity troponin after an initial normal value during acute exacerbations of chronic obstructive pulmonary disease
Authors: Yew M S , Abisheganaden J A , Xu H Y 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
BACKGROUND
Elevation of cardiac troponin (cTn) may be seen in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and is both diagnostic for myocardial injury and confers a poorer prognosis. Serial cTn testing after an initial normal value is often performed even though the yield is low.
PURPOSE
We aim to investigate factors predicting an abnormally elevated cTn after an initial normal cTn value.
METHODS
Retrospective data analysis of patients with AECOPD admitted between 1st January 2017 to 30th June 2017 with at least 2 serial high sensitivity cTn I (HScTnI) performed within 24 hours of presentation. Binary logistic regression was used to explore predictors of abnormally elevated (&gt;40 ng/L) serial HScTnI after an initial normal value.
RESULTS
There were 240 cases with an initial normal HScTnI (mean age 74 years, 92.1% male). Amongst these, 97 cases had another follow-up HScTnI performed within 24 hours of presentation. Patients in the groups with or without follow-up HScTnI were similar in terms of demographics, COPD stage, cardiovascular risk factors, history of coronary disease and vital parameters. Significantly more patients in the group with follow-up HScTnI had ischaemic electrocardiographic changes (10.3 vs 2.1%, p = 0.006). There were 22/97 (22.7%) cases with abnormally elevated follow-up HScTnI. The mean time interval between the initial and follow-up HScTnI was not significantly different between the groups with or without elevated HScTnI (12.8 vs 10.4 hours, p = 0.858). Cases with elevated follow-up HScTnI had significantly higher heart rate (109 vs 97bpm, p = 0.007), initial HScTnI (24 vs 17ug/L, p = 0.009), C reactive protein (43.1 vs 7.6mg/L, p = 0.004) and procalcitonin (0.16 vs 0.07ug/L, p = 0.014) levels. They also had a greater proportion of chest radiographs showing consolidation (15 vs 9%, p = 0.046). On univariate analysis, heart rate (OR 1.037 [1.009 - 1.066], P = 0.009), temperature (OR 1.897 [1.119 - 3.217], p = 0.017), initial HScTnI value (OR 1.063 [1.014 - 1.115], p = 0.012) and neutrophil counts (OR 1.039 [1.000 - 1.078], p = 0.049) were significant predictors of an abnormally elevated follow-up HScTnI. Only heart rate remained as a significant predictor (Adj OR 1.050 [CI 1.015 - 1.086] p = 0.005) after multivariate analysis.
CONCLUSIONS
Less than a quarter of AECOPD patients with an initial HScTnI had an elevated level on serial testing. A higher heart rate is a significant predictor of a subsequent elevated HScTnI after an initial normal value and may identify patients for selective serial cTn testing. Larger studies are needed to identify predictors that can reliably risk stratify patients for serial cTn testing.
Predictions of arrhythmic, heart failure and mortality outcomes in pericarditis using automatic electrocardiogram analysis: a retrospective cohort study
Authors: Lakhani I , Zhou J Z , Li A L , Lee S L , Liu T L , Zhang Q Z , Tse G T 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Pericarditis is a relatively rare disease with a global burden. Despite its strong association with adverse cardiovascular outcomes, identification of patients at risk of future heart failure or arrhythmic events is difficult. In the following study, automated electrocardiogram (ECG) variables were used to predict new onset ventricular tachycardia/fibrillation (VT/VF), atrial fibrillation (AF) and heart failure with reduced ejection fraction (HF) in an Asian cohort of pericarditis patients.

Purpose
Assessing the use of automated ECG parameters to predict prognosis in pericarditis patients.

Methods
Consecutive patients admitted to a single tertiary center in China, for a diagnosis of pericarditis between 1st January 2005 and 31st December 2019, were included. Patients with existing AF or HF were excluded. The follow-up period was until the 31st December 2020, or death. Cox regression was applied to identify significant predictors of the incident VT/VF, AF or HFrEF.

Results
A total of 874 patients were included. The cohort was 57% male and had a median age of 59 (IQR: 50-70) years old. During follow-up, 57 patients (6.5%), 156 (17.8%) and 168 (19.2%) suffered from VT/VF, AF and HF, respectively. Cox regression identified baseline VT/VF, terminal angle of the QRS vector in the transverse plane, mean QRS duration and mean QTc intervals as significant predictors of incident VT/VF events, with only the foremost maintaining significance in multivariate analysis. In contrast, baseline age, prior diagnoses of hypertension, malignancy and atrial flutter, initial angle and magnitude of the QRS vector in the transverse plane, P-wave and QRS axis in the frontal plane, ST segment axis in the frontal and horizontal planes, mean PT interval, mean PR segment duration and QTc intervals were all univariate predictors of incident AF, albeit only baseline age and initial angle of the QRS vector in the transverse plane retained significance after multivariate adjustment. As it pertains to new-onset HFrEF, several clinical and electrocardiographic parameters demonstrated an association in univariate analysis, with history of hypertension, history of sudden cardiac death (SCD), initial QRS angle in transverse plane, initial 40ms QRS complex axis, ST-segment axis in the horizontal plane, T-wave frontal axis and atrial rate all showcasing significant relationships in multivariate analysis.

Conclusions
AF and HFrEF are relatively common complications, whilst VT/VF occurs less frequently in the context of pericarditis. Different clinical and ECG predictors of these outcomes were identified. Future studies are still needed to evaluate their use for risk stratification in the clinical setting.
Clinical manifestation of coronary pulmonary arterial fistula diagnosed by cardiac computed tomography
Authors: Funabashi N , Kobayashi Y 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Coronary pulmonary arterial fistula (CPAF) may cause enlargement of an aneurysm, which may rupture or compress other organs, or occurrence of steal phenomenon of coronary arterial (CA) blood flow. We hypothesize that there are various clinical characteristics of CPAF including patient age at diagnosis, method of diagnosis, observed symptoms, complications, and surgical interventions

Methods
From a total of &gt;17,000 patients undergoing CT from 2000-2019 in our institute, 11 patients diagnosed as having CPAF were analyzed retrospectively. One was treated surgically prior to analysis, and the remaining 10 (3 males; 56 ± 12 years) were followed for a mean of 52 ± 64 months.

Results
5 were diagnosed as having CPAF through cardiac CT and 2 were diagnosed by invasive coronary angiograms. One was diagnosed by TTE and another patient was diagnosed by TTE and cardiac CT to differentiate from a mediastinal tumor. 4 had dyspnea, 2 had chest pain, and 1 had palpitation. 5 showed other cardiovascular disease (1 with left ventricular non-compaction, and persistent left superior vena cava; 1 with vascular type Ehlers-Danlos syndrome; 1 with hypertrophic cardiomyopathy; 1 with aortic valve regurgitation (AR); and 1 with vasospastic angina pectoris). The occurrence of steal phenomenon of CA blood flow was diagnosed in 4. CA aneurysm was observed in 5. 2 had abnormal flow from descending aorta to pulmonary arteries through CA. Pulmonary arterial systolic pressure &gt;30 mmHg was observed in 2. During the observed periods, 4 underwent surgical procedure to eliminate CA aneurysm (N = 2), or for significant steal phenomenon of CA blood flow (N = 1). A patient with AR underwent CPAF elimination simultaneously with aortic valve replacement. The mean periods between initial diagnoses and surgical intervention was 27 ± 36 months. The remaining 6 were followed without surgical intervention for a mean of 69 ± 76 months without any cardiac events.

Conclusion
CPAF was diagnosed at a mean age of 56 years and half were diagnosed incidentally by cardiac CT. Five of the 11 patients (45%) underwent a surgical procedure. Patients with CPAF showed various symptoms due to complicating diseases, anatomical configurations, and outcomes. Abstract Figure. Typical CT images of CPAF
Randomized comparison of proximal and distal radial access for coronary angiography and interventions
Authors: Dadarwal A , Garg N , Kapoor A , Tewari S , Kumar S , Khanna R , Sahu A , Goel P K 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Vascular access for coronary procedures is of paramount important not only for successful procedure but also to prevent complications. In comparison to femoral access, proximal radial artery (PRA) access at wrist is associated with decreased bleeding complications and mortality. The most important complication of PRA access is radial artery occlusion Use of the proximal radial artery (PRA) approach at wrist has several limitations: the need to supinate the hand, which can exacerbate chronic joint pain, the depth of the radial artery in large arms, which could make arterial puncture challenging even under ultrasound guidance, the risk of sporadic bleeding in the forearm, and the risk of radial artery occlusion. All above limitations can be overcome by distal radial artery (DRA) access in anatomical snuff box. Randomized Studies are lacking for the comparison between DRA and PRA approach in coronary procedures.

Aims and objective
To compare safety, efficacy and feasibility between PRA and DRA approach in randomized fashion.

Material and methods
This was single center randomized controlled trial. 320 patients were randomized in PRA and DRA groups. PRA approach was in wrist and DRA approach was in anatomical snuff box. Primary endpoint was cannulation failure (failure to achieve radial access) and transradial failure (failure to complete procedure after successful access). Secondary safety outcome includes major (compartment syndrome, need for vascular surgery, hand dysfunction, nerve palsy ,arteriovenous fistula, hematoma requiring blood transfusion, proximal radial artery occlusion) and minor (radial artery spasm, hematoma not requiring transfusion or causing compartment syndrome, ecchymosis, local edema, paresthesia, pseudoaneurysm) complications; secondary efficacy outcome were puncture attempts, cannulation time, procedure time, radiation dose, hemostasis time and quality of life endpoint was pain score .

Results
Each group was having 160 patients. In DRA group 73.9 % were CAG and 26.1 % were PCI; in PRA group and 75.7 were CAG and 24.3 were PCI. Cannulation failure was more in DRA group (7.5 % vs 2.5 %, P &lt; 0.001) without difference in transradial failure (n = 3 vs 4, p =0.764). There were no major complications in both groups except PRAO which was significantly less in DRA group (0 % vs 5.2 %, p= 0.007). Puncture attempts, cannulation time, pain score were more in DRA (1.65 vs 1.29, P &lt; 0.001;3.23 vs 2.62 minutes, p &lt; 0.001;25.5 vs 21.6 minutes, p = 0.039 respectively). There was no significant difference for minor complications in both groups.

Conclusion
DRA approach is as safe and feasible as PRA approach and causes significantly less PRAO. DRA approach may be advocated as default approach where radial access is chosen for coronary procedures. Abstract Figure. primary outcome Abstract Figure. Procedural characteristic
Platinum chromium everolimus-eluting stent versus cobalt chromium zotarolimus-eluting stent in very late stent thrombosis: a meta-analysis of randomized controlled trials
Authors: Baterna J J , Susanto A , Cheng F 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Very late stent thrombosis is a rare but potentially lethal outcome for drug-eluting stents used in percutaneous coronary intervention. There is limited research currently on the occurrence of very late stent thrombosis as a complication of two most used second-generation drug-eluting stents, i.e. platinum chromium everolimus-eluting stent (PtCR-EES) and cobalt chromium zotarolimus-eluting stent (CoCr-ZES).

Purpose
The study provides comparative information on the formation of very late stent thrombosis as a long-term outcome of PtCr-EES and CoCr-ZES. Results of this study may guide interventional cardiologists in decision-making regarding the choice of stent.

Methods
Randomized controlled trials (RCTs) which compared stent thrombosis end point of PtCr-EES and CoCr-ZES were identified through Pubmed.

Results
Data from three RCTs analyzed a total of 7,911 participants, with 4,574 in the PtCr-EES and 3,324 in the CoCr-ZES. Treatment with either stent showed no significant difference in the incidence of very late stent thrombosis.

Conclusion
Both stents showed comparable incidence of very late stent thrombosis. Additional RCTs are recommended to further establish the results for very late stent thrombosis. Longer follow-up is also suggested to discover more long-term outcomes.
Association of body mass index with systolic and diastolic blood pressure in rural Indians
Authors: Inamdar Aniket 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Body mass index (BMI) is positively and independently associated with morbidity and mortality from hypertension, cardiovascular disease, type II diabetes mellitus, and other chronic diseases. In Caucasian and Asian populations, a strong association has been depicted between BMI and mortality. Globally, high blood pressure is estimated to cause 7.1 million deaths, about 13% of the total. About 62% of cerebrovascular disease and 49% of ischemic heart disease are attributable to suboptimal BP (systolic &gt; 115 mm Hg). Overweight and obesity increase the risks of high BP, coronary heart disease, ischemic stroke, type II diabetes mellitus, and certain cancers. Worldwide, about 58% of diabetes mellitus and 21% of ischemic heart disease are attributable to BMI above 21 kg/m2. The combination of blood pressure and Body Mass Index (BMI) contribute more than 60% cases of cardiovascular disease.

Purpose
The main objective was to determine the correlation between BMI and systolic and diastolic blood pressure of rural Indian patients.

Materials and Methods
310 patients who visited our hospital in rural India from January 15,2021 to February 15,2021 were included in this study and their systolic and diastolic blood pressure, weight and height were measured. BMI was calculated by weight in kilograms divided by square of height in meters. Using this, the patients were categorized as underweight (&lt;18.5 kg/m2), normal or lean BMI (18.5–22.9 kg/m2), overweight (23.0 –24.9 kg/m2) and obese (≥25 kg/m2) based on the revised consensus guidelines for India. Descriptive analysis and Spearman correlation test were used to analyze the data.

Results
The results of the bivariate analysis using Spearman correlation test showed that there is significant relationship between BMI and systolic blood pressure (p &lt; 0.001, r = 0.375) as well as BMI and diastolic blood pressure (p &lt;0.001, r = 0.432). This study shows that as BMI increases both systolic and diastolic blood pressure increases.

Conclusion
This study shows statistically significant relationship between Body Mass Index (BMI) and systolic and diastolic blood pressure in rural Indian patients. Weight gain seems to be an important risk factor for development of hypertension. Weight loss has been recommended for obese hypertensive patients and has been shown to be most effective non pharmacological treatment approach. Physical activity and caloric restriction should be promoted to control the obesity epidemic which will significantly reduce global cardiovascular disease burden.
A survey-based comparison of cardiovascular health risk behaviours in Indian men and women during the pandemic
Authors: Chockalingam P , Natarajan V , Sekar T 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiovascular disease (CVD), the leading cause of mortality globally, is caused by a combination of behavioral, clinical and genetic risk factors. The rising prevalence of unhealthy diet, inadequate exercise, psychosocial factors and tobacco use in urban and rural populations of India has posed a major epidemiological and healthcare threat in the recent past.

Purpose
This study aims to understand the cardiovascular health risk behaviors in Indian men and women during the pandemic.

Methods
A survey-based study was conducted at different time points between April 2020 and August 2021. A pre-tested anonymized self-administered questionnaire was distributed online as a pre-program assessment of participants registering for the health awareness webinars conducted by our team. Demographic data and CVD risk behaviors pertaining to dietary consumption, exercise routine, sedentary behavior, psychosocial factors, sleep pattern, tobacco use and alcohol consumption were collected. Not meeting daily intake of whole grains and at least 4 portions of vegetables and fruits, non-performance of at least 150 minutes of brisk aerobic exercise per week, chronic stress and use of tobacco were considered risky behaviors, as per the international guidelines.

Results
Of the 573 subjects, 305 (53%) were women and 236 (41%) were 15-30 years old. Majority of subjects were not meeting their requirements pertaining to whole grains (76%) and fruits/vegetables (72%). Inadequate exercise (48%), chronic stress (31%) and tobacco use (5%) were noted. Significantly more women than men (p = 0.0001) were falling short in their exercise requirement. Significantly more men than women (p = 0.0001) were using tobacco products (Figure).

Conclusion
Cardiovascular risk behaviors are highly prevalent in Indian men and women during the pandemic calling for a coordinated effort to increase awareness and modify to a healthy behavior. Abstract Figure. Risk behaviors in study subjects Abstract Figure. Comparison of risk behaviors