bluuebunny/crossref_metadata_2025_split huggingface dataset:
No need for a cardiologist for AMI diagnosis – progress of transforming a behemoth telemedicine program with artificial intelligence
Authors: Mehta S , Vieira D , Zerpa D , Guillen V , Carrasquel M , Ramadan S , Martinez F , Rossitto F , Carrera K , Fleming M , Pinos D , Brena-Pastor L , Ozair S , Gonzalez A , Barco A 
Published: October 2022

Abstract

Background
The Latin American Telemedicine Infarct Network (LATIN) Telemedicine is a mammoth hub and spoke model that provides an umbrella of AMI protection for 100 million patients. In the program, 826,043 patients had a telemedicine encounter; 7,400 with AMI were diagnosed; 4,332 of them managed with guidelines-based strategies. We have gradually begun implementing a system for using Artificial Intelligence (AI) algorithms embedded into EKGs for rapid and accurate STEMI detection and validated the results with a cardiologist's interpretations.

Purpose
To test whether an AI-driven EKG algorithm can effectively substitute a cardiologist for STEMI telemedicine protocols.

Methods
The AI algorithm construction was in the following fashion. Sample: a selection of 8,511 EKG and 90,592 classified heartbeats. Pre-processing: segmentation of each EKG into individual heartbeats. Training & testing: 90% and 10% of the total dataset, respectively. Classification: 1-D Convolutional Neural Network; the study constructed classes for each heartbeat. The algorithm was next deployed on a consecutive series of LATIN EKG records to diagnose STEMI. We afterwards compared the algorithm's results with eight expert cardiologists' interpretations of the same sample.

Results
This study achieved a concordance of 91% between the AI algorithm and cardiologist interpretation (Figure 1).

Conclusions
The initial results with AI algorithms for STEMI diagnosis are encouraging and may provide the base work for new tools for cardiologists to improve their efficiency. Moreover, implementing this innovative tool may overcome current limitations associated with the telemedical management of this disease.

Funding Acknowledgement
Type of funding sources: None.
Including measures of chronic kidney disease to improve cardiovascular risk prediction by SCORE2 and SCORE2-OP
Authors: Matsushita K , Kaptoge S , Hageman S H J , Visseren F L J , Pennells L , Coresh J 
Published: October 2022

Abstract

Background
The 2021 ESC guideline on cardiovascular disease (CVD) prevention qualitatively categorizes moderate and severe chronic kidney disease (CKD) as high and very-high CVD risk status regardless of other factors like age and does not include estimated glomerular filtration rate (eGFR) and albuminuria in its algorithms, SCORE2 and SCORE2-OP, to predict CVD risk.

Purpose
To develop and validate an “Add-on” to incorporate CKD measures into these algorithms, using a validated approach.

Methods
In 3,054,840 participants from 34 datasets, we developed three Add-ons (eGFR only, eGFR + urinary albumin-to-creatinine ratio [ACR] [the primary Add-on], and eGFR + dipstick proteinuria) for SCORE2 and SCORE2-OP. We validated c-statistics and net reclassification improvement (NRI), accounting for competing risk of non-CVD death, in 5,995,067 participants from 33 different datasets.

Results
In the target population of SCORE2 and SCORE2-OP without diabetes, the CKD Add-on (eGFR only) and CKD Add-on (eGFR + ACR) improved c-statistic by 0.006 (95% CI 0.005–0.008) and 0.018 (0.012–0.024), respectively, for SCORE2 and 0.012 (0.009–0.015) and 0.023 (0.013–0.032), respectively, for SCORE2-OP. Similar results were seen when we included individuals with diabetes and tested the CKD Add-on (eGFR + dipstick). In 57,485 European participants with CKD, SCORE2 or SCORE2-OP with a CKD Add-on showed a significant NRI (e.g., 0.100 [0.062–0.138] for SCORE2) compared to the qualitative approach in the ESC guideline.

Conclusion
Our Add-ons with CKD measures improved CVD risk prediction beyond SCORE2 and SCORE2-OP. This approach will help clinicians and patients with CKD refine risk prediction and further personalize preventive therapies for CVD.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): US National Kidney Foundation funding as well as US NIDDK
Potential impact of replacing SCORE with SCORE-2 on risk classification and statin eligibility – a coronary calcium score correlation study
Authors: Paiva M , Gomes D , Freitas P , Santos R , Presume J , Lopes P , Matos D , Guerreiro S , Santos A , Saraiva S , Mendes M , Ferreira A 
Published: October 2022

Abstract

Background
Recently, the European Society of Cardiology issued new algorithms to estimate the 10-year risk of atherosclerotic cardiovascular disease (ASCVD), along with new age-specific thresholds to classify individuals as low-to-moderate, high, or very-high risk.
The aim of this study was to compare the latest SCORE-2 model with the older SCORE (Systematic COronary Risk Evaluation) in their ability to identify individuals with high coronary artery calcium score (CACS), and assess the relationship between potential eligibility for statin therapy and CACS.

Methods
Individuals 40–69 years old without diabetes or known ASCVD were identified in a single center registry of patients undergoing CACS and coronary CT angiography for suspected coronary artery disease. SCORE and SCORE-2 were calculated and used with each patient's untreated LDL-C values to assess eligibility for statin therapy. High CACS was defined as an Agatston score ≥100.

Results
A total of 389 pts (46% men, mean age 58±8 years) were included, of which 15% (n=60) were active smokers. The mean systolic blood pressure and untreated LDL-C values were 136±17 mmHg and 155±65 mg/dL, respectively.
The proportion of patients classified as low-to-moderate risk, high risk, and very high risk was 93%, 6% and 1% using the SCORE algorithm, and 42%, 44%, and 14% using SCORE-2, respectively. Overall, 218 patients (56%) would have their risk category revised upwards, while no patients would be downgraded.
The median CACS was 5 (IQR 0–71 AU), with 166 patients (43%) having CACS = 0, and 81 (21%) presenting CACS values ≥100.
SCORE and SCORE-2 showed similar discriminative power to identify patients with CACS ≥100 (C-statistic 0.77, 95% CI 0.71–0.82, vs. 0.75, 95% CI 0.69–0.80, P=0.109 for comparison]. The up-reclassification of risk conveyed by SCORE-2 affected patients across all categories of CACS (Fig. 1).
The proportion of patients in whom statin therapy would generally be indicated was higher with the SCORE-2 criteria vs. the SCORE algorithm (61% vs. 29%, respectively, p&lt;0.001). The broadening of potential indication for statin therapy spanned all categories of CACS, including patients with CACS = 0 (Fig. 2).

Conclusion
Even though the discriminative power of SCORE-2 is similar to the older SCORE, the introduction of age-specific thresholds results in the up-reclassification of risk in roughly half of the patients. The application of SCORE-2 will broaden statin eligibility overall, not only in patients with high atherosclerotic burden, but also in those with CACS = 0. These findings support the use of risk modifiers in selected patients to improve the effectiveness of statin therapy.

Funding Acknowledgement
Type of funding sources: None.
Impact of metabolic syndrome and its components on the progression of coronary artery calcification in statin-naive young adults: results from the KOICA registry
Authors: Ahn H J , Lee H S , Han S M , Park H E , Choi S Y 
Published: October 2022

Abstract

Background
Metabolic syndrome (MetS) is known to be associated with the progression of coronary artery calcification (CAC). However, the relative risks of CAC progression according to the presence of MetS and individual components of MetS in young adults are unknown.

Purpose
We investigated the impact of MetS, the number of meeting MetS components (metabolic burden), and each component of MetS on CAC progression in statin-naïve young adults. Also, we evaluated the association between the change of metabolic burden and CAC progression.

Methods
From the KOrea Initiatives on Coronary Artery calcification (KOICA) registry, we included 2,151 asymptomatic adults aged between 20 and 45 years who underwent serial coronary artery calcium scans as a part of health examination. The difference of ≥2.5 between the square roots of coronary artery calcium score at the baseline and follow-up measured by Agatston units was defined as CAC progression. We estimated the risk of CAC progression according to the presence of MetS, individual components of MetS, and metabolic burden using Cox proportional-hazards models. Among young adults with MetS, the impact of the metabolic burden decrement on CAC progression was evaluated by a logistic regression model.

Results
Of 2,151 young adults (mean age 41.3±3.8 years, male 85.4%), 488 (22.7%) adults had MetS at baseline health examination. During a median follow-up of 2.1 years, CAC progression was observed in 325 (15.1%) adults. MetS was significantly associated with an increased risk of CAC progression after adjusting for other cardiovascular risk factors: adjusted hazard ratio (aHR) 2.59, 95% confidence interval (CI): 1.97–3.42, p&lt;0.001. There was a positive linear correlation between metabolic burden and the risk of CAC progression with an approximately 7-fold higher risk in the group having metabolic burden of 4–5 (aHR 7.22, 95% CI: 4.10–12.72, p&lt;0.001) than in the group without. Among each component of MetS, elevated blood pressure (BP), impaired fasting glucose (IFG), and elevated triglycerides (TG) were associated with the risk of CAC progression, demonstrating the strongest contribution of elevated BP (aHR 2.67, 95% CI: 2.00–3.56, p&lt;0.001). Of note, a decrease of more than one metabolic burden in the follow-up examination was associated with the reduced risk of CAC progression in MetS adults than the others: odds ratio (95% CI), 0.46 (0.22–0.98), p=0.044.

Conclusions
In statin-naïve young adults, the metabolic burden is associated with CAC progression in a dose-response relationship. Elevated BP, TG, and IFG are metabolic derangements requiring special attention to care, and an improvement in metabolic imbalance might have a preventive effect on CAC progression.

Funding Acknowledgement
Type of funding sources: None.
Prognostic role of adding a genetic risk score to the new European SCORE2 in a cardiovascular events prediction, in a moderate-risk region
Authors: Temtem M , Palma Dos Reis R , Serrao M , Sa D , Santos M , Soares C , Sousa A C , Rodrigues M , Freitas S , Henriques E , Borges S , Guerra G , Ornelas I , Drumond A , Mendonca M I 
Published: October 2022

Abstract

Introduction
The new SCORE2 provides risk estimates for the combined outcome of fatal and non-fatal cardiovascular disease (CVD) events, in contrast with SCORE's use for CVD mortality only. Genetic predisposition to CVD is not considered in SCORE2 for prevention and treatment.

Purpose
Evaluate the impact of adding a Genetic Risk Score (GRS) to the new European SCORE2 in MACE prediction and estimate the additional value in cardiovascular risk stratification in an asymptomatic Portuguese population.

Methods
A prospective study was performed in a population-based cohort of 1,100 individuals without known CVD and diabetes (mean age 53.3±6.9 years). For all included participants, SCORE2 was calculated and three risk categories were considered: low-, moderate- and high-risk. A 33-SNP GRS was constructed and two groups were analyzed: lower and higher than the GRS median. Kaplan-Meier survival curves were created and a Cox regression model was performed with the two scores to assess MACE risk. C-statistic methodology compared the model between SCORE2 solely and SCORE2 plus GRS.

Results
After Kaplan-Meier analysis for MACE occurrence, the high categories of SCORE 2 and GRS showed worst survival when compared to the lower categories (p&lt;0.0001). Cox regression presented an HR of 8.528 (p=0.001) for high-risk SCORE2 and an HR of 4.520 (p&lt;0.0001) for GRS higher than the median. C-statistic demonstrated that the SCORE2 predictive value was 0.678, increasing to 0.792 when GRS was included (p=0.0005).

Conclusions
In this work, combining SCORE2 with multiple genetic loci gathered into a GRS, improved the identification of patients with the worst prognosis. This new tool may be of great utility in risk stratification in primary prevention. Larger prospective multicenter cohorts with longer follow-up should reproduce and validate these findings.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): SESARAM EPERAM
Prognostic impact of adding Coronary Calcium Score to European SCORE2 in an asymptomatic Portuguese population
Authors: Temtem M , Mendonca M I , Serrao M , Santos M , Sa D , Soares C , Sousa A C , Henriques E , Rodrigues M , Freitas S , Borges S , Ornelas I , Drumond A , Palma Dos Reis R 
Published: October 2022

Abstract

Introduction
The new European SCORE2 estimates the combined risk of fatal and non-fatal cardiovascular (CV) events, in contrast with SCORE's use for CV mortality only. Although controversial, several studies point out that Coronary Artery Calcification (CAC) scoring could improve CV risk stratification in primary prevention.

Purpose
Assess the impact of including CAC score to the new SCORE2 in MACE prediction and CV risk stratification in an asymptomatic Portuguese population.

Methods
The new SCORE2 was calculated in a population-based cohort of 1,014 individuals (mean age 58.6±8.5 years) without known CV disease and diabetes. Population was stratified into three SCORE2 risk categories (low-, moderate- and high-risk). According to the Hoff's nomogram, CAC score was categorized into: low CAC (0≤CAC&lt;100 or P&lt;50); moderate CAC (100≤CAC&lt;400 or P50–75) and high or severe CAC (CAC≥400 or P&gt;75). Kaplan-Meier survival curves were estimated and a multivariate regression analysis predicted the MACE risk for both scores. C-statistic methodology evaluated the ability of CAC when added to the SCORE2 model in MACE prediction.

Results
Kaplan-Meier curves showed that the highest categories of both scores presented a worst survival. Cox regression analysis showed that the highest categories of both CAC and SCORE2 remained in the equation with an increased MACE risk (HR) of 3.69 (p=0.008) and 9.87 (p=0.005), respectively, when compared with the lowest categories. C-statistic demonstrated that the predictive value for MACE increased from 0.668 (SCORE2 model) to 0.787 when CAC was included (p=0.012), showing a better predictive and discriminative capacity for MACE.

Conclusions
Our results highlight the importance of adding CAC score to SCORE2 in primary prevention to improve cardiovascular risk stratification and MACE risk prediction. Larger prospective multicenter cohorts with longer follow-up should reproduce and validate these findings.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): SESARAM EPERAM
Development and validation of the HARMS2-AF lifestyle risk score to predict incident AF
Authors: Segan L , Canovas R , Nanayakkara S , Chieng D , Prabhu S , Ling L H , Voskoboinik A , Sugumar H , Lee G , Morton J , Kalman J , Kistler P 
Published: October 2022

Abstract

Background
Lifestyle risk factors (RFs) are a modifiable target in atrial fibrillation (AF) management. However, the relative contribution of individual lifestyle RFs to AF incidence has not been described.

Purpose
Development and validation of a novel AF-lifestyle risk score to determine AF risk in the general population.

Methods
The UK Biobank (UKB) is a large prospective cohort with outcomes measured &gt;10 years. In the UKB, we performed regression analysis of AF lifestyle RFs which were then evaluated in a multivariable model and a weighted score was developed. Next, the risk score was externally validated in the Framingham Heart Study (FHS) population. Kaplan-Meier estimates ascertained the 10-year risk of AF development.

Results
In the UKB, AF incidence was 5.3% among 302,926 participants, with a median time to AF 7.3 years (IQR 4.3–9.8). Hypertension, sleep apnoea, male sex, age, obesity (BMI&gt;30 kg/m2), alcohol and smoking were predictive variables (all p&lt;0.001); physical inactivity (OR 1.02,95% CI 0.97–1.10, p=0.3), diabetes (OR 0.98,95% CI 0.91–1.06, p=0.2) and BMI 27–30 kg/m2 (OR 1.02, 95% CI 0.97–1.07, p=0.424) were not significant. The HARMS2-AF score (Figure 1) had similar predictive performance (AUC=0.782, LogLoss 0.178, Brier Score 0.046) to the unweighted regression model (AUC 0.808) in the UKB. Validation in the FHS (AF incidence 6.7% of 7206 participants) maintained excellent predictive performance with an AUC of 0.747 (95% CI 0.724–0.769, Figure 2). A higher HARMS2-AF score (&gt;5 points) was associated with a heightened 10-year AF risk (score 5–9: OR 9.35, score 10–14: OR 33.34).

Conclusions
The HARMS2-AF score is a novel lifestyle risk score which may help identify individuals at risk of AF and assists in general population screening.

Funding Acknowledgement
Type of funding sources: None.
Have the ESC guidelines improved the identification and prevention of individuals at risk of premature myocardial infarction?
Authors: Zeitouni M , Sulman D , Silvain J , Kerneis M , Guedeney P , Barthelemy O , Procopi N , Collet J P , Montalescot G 
Published: October 2022

Abstract

Background
Over the last 20 years, the proportion of young patients admitted for MI has increased. It is unknown whether the 5-year changes in ESC/EAS guidelines and the new SCORE2 can improve the detection and treatment of individuals at risk of premature MI.

Purpose
To determine how consecutive changes in the ESC/EAS guidelines affected the identification and treatment of young adults premature STEMI.

Methods
Patients admitted for a first STEMI in the ePARIS between 2010 and 2018 were included (n=2757) and stratified by age categories (&lt;55 y-o; 55–65 y-o; &gt;65 y-o). Using baseline characteristics, we evaluated whether patients in each age group would have been detected as high risk and treated with primary prevention statins before their first STEMI based on the 2021 EAS/ESC guidelines versus 2019 and 2016 guidelines (class I, IIA and IIB recommandations). Eligibility for intensive lipid-lowering therapy in secondary prevention according to age was also assessed.

Results
Among the 2757 individuals admitted for a first STEMI, 1253 (45,7%) were &lt;55 y.o, 633 (22.9%) were [55–65] and 871 (31.4%) were &gt;65. Only 17% and 18% of young individuals would have been considered as high risk and eligible for primary prevention statins prior to their first STEMI according to 2016 and 2019 EAS/ESC guidelines respectively, compared with individuals aged 55–65 years (41% and 35%) and &gt;65 years old (21% and 72%), p&lt;0.01. Following 2021 ESC guidelines, 62.5% of individuals aged &lt;55 y.o would have been detected as eligible for primary prevention statins, without difference with individuals aged 55 to 65 years old (61.7%) and &gt;65 y.o (62.1%) (figure). At discharge, based on the expected reduction of baseline LDL-C with maximal dose statins and ezetimibe, 47% of patients with premature STEMI would be eligible for PCSK9i compared with 50% and 37% in individuals aged 55–65 y-o and &gt;65 y-o, respectively.

Conclusions
While 2016 and 2019 ESC guidelines poorly detected young individuals at risk of premature MI, the 2021 ESC guidelines using the new SCORE2 allowed a much better detection of young individuals at risk for a first STEMI. Young patients were also more likely to be eligible for intensive lipid-lowering therapy after their first premature STEMI.

Funding Acknowledgement
Type of funding sources: None.
Plasma hydroxyanthranilic acid as a predictor of stress induced myocardial ischemia in non-obstructive coronary artery disease
Authors: Karaji I , Lonnebakken M T , Storesund S , Khan I , Ueland P M , Vikenes K , Nygard O K , Pedersen E R 
Published: October 2022

Abstract

Background
The tryptophan catabolite hydroxyanthranilic acid (HAA) has potent immunomodulatory and vasoactive effects. HAA is also a precursor in the synthesis of nicotinamide adenine dinucleotide (NAD), a crucial cofactor in energy-metabolism. We have previously demonstrated that elevated plasma HAA predicted risk of myocardial infarction.

Purpose
To explore if plasma HAA is associated with stress induced myocardial ischemia in non-obstructive coronary artery disease (CAD).

Methods
In 132 patients with chest pain and non-obstructive CAD by coronary computed tomography angiography (CCTA), plasma HAA was analyzed by gas chromatography tandem mass spectrometry. All participants underwent myocardial contrast stress echocardiography. Myocardial ischemia was assessed as delayed contrast replenishment at peak dobutamine stress during real-time low mechanical index imaging and destruction replenishment. The extent of ischemia was defined as the number of segments with delayed contrast enhancement using a 17-segment left ventricular model. Associations of plasma HAA with myocardial ischemia was evaluated in a multivariate adjusted linear regression model.

Results
Mean (SD) age at inclusion was 63 (8) years and 56% were women. At CCTA, the median (25th, 75th percentile) coronary artery calcium (CAC) score was 42 (13–107) Agatston units, whereas the mean (SD) segment involvement score (SIS) was 2.6 (1.6). Myocardial ischemia was found in 52% of patients with on average 5 (3) ischemic segments per patient. Serum HAA did not correlate with the CAC score or SIS (p&gt;0.29). After multivariate adjustment including age, sex, body mass index, systolic blood pressure, diabetes, current smoking, and LDL cholesterol, the odds ratio and 95% confidence interval for myocardial ischemia was 1.55 (1.04–2.32), P=0.03, per SD increment of plasma HAA levels (log transformed). Plasma HAA was also associated with the extent of myocardial ischemia with a multivariate adjusted β of 0.26, P=0.004.

Conclusion
Plasma HAA is associated with the extent of myocardial ischemia in non-obstructive CAD. Potential roles of this metabolite in atherogenesis, vascular dysfunction and as a predictor of myocardial ischemia should be further elucidated.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Western Norway Regional Health Authority