bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of Physiological Electrocardiographic Findings in a Brazilian Cohort of Young Football Players: B-Pro Foot ECG Pilot Study
Authors: Stein R , Ferrari F , Helal L , Emed LGM , Dilda GD , Aleixo HC , Bassan F , Martins VM , Da Silveira AD 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Hospital de Clínicas de Porto Alegre Research and Event Incentive Fund (FIPE-HCPA)

Introduction
The 12-lead electrocardiogram (ECG-12) is a useful tool in the assessment of athletes, and it may present findings compatible with physiological adaptations to regular exercise. ECG-12 findings in Brazilian soccer players are unknown.

Purpose
To describe the prevalence of physiological ECG-12 findings in young Brazilian soccer players based on the "2017 International Criteria for Electrocardiographic Interpretation in Athletes".

Methods
Continuous variables were displayed as mean and standard deviation or median and interquartile range, while prevalence’s with 95% confidence intervals, and stratified by race. Intra-group differences were estimated by linear models or binomial and multinomial logistic regressions. Type I error was set to set a at 0.05. An additional margin of 0.025 was considered at the discretion of the statistician conditioned to the quality of the model. All analysis were running in Stata version 16.0.0.

Results
2,581 athletes from 27 clubs (mainly first division), aged 15-35 years (median: 18 years) were evaluated. 1,268 (49.1%) were Caucasians, 796 (30.8%) Mixed-race (MR) and 517 (20.1%) Afro-Brazilians (AB). In this sample from across the country, we identified the following findings and its respective prevalence: sinus bradycardia (50%), ectopic atrial rhythm (1.4%), junctional rhythm (0.3%), incomplete right bundle branch block (23.7%), first-degree atrioventricular (AV) block (3.0%), Mobitz type I AV block (0.1%), and increase QRS voltage for left or right ventricular hypertrophy (35.2% and 17.3%, respectively). The mean PR interval was 153.9±28.7 ms, corrected QT interval 399.2±28.0 ms, and QRS duration 96.0±14.0 ms. ST elevation followed by T-wave inversion in leads V1–V4 was identified in 11/517 (2.1%) of AB athletes. Early repolarization was present in 828 athletes (32.1%), being more prevalent in AB when compared to MR and Caucasians (P = 0.003). Likewise, AB had a greater PR interval in comparison to MR and Caucasians (P &lt;0.001 and P = 0.007, respectively). On the other hand, Caucasians had a significant longer QRS duration compared to AB. For all remaining variables there was no difference among races.

Conclusions
To the best of our knowledge, this is the first large study to describe the prevalence of physiological electrocardiographic finding in young Brazilian soccer players, according to "2017 International Criteria for Electrocardiographic Interpretation in Athletes". Future studies comparing the frequency of these findings with the prevalence observed in other cohorts are welcome.
Cardiac screening in police and armed forces: a pilot project
Authors: Yamagata K , Yamagata LM , Abela M 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Most international bodies now recommend cardiac screening for all individuals undertaking high intensity physical activity. The sensitivity and specificity of the ECG in cardiac screening is undisputed.
Study Objective
Two major national institutions (Police Force and the Armed Forces) have now recognized the importance of having a cardiac screening program. As of 2020, the department of Cardiology has been offering remote ECG interpretation for all new recruits. The aim of the study was to retrospectively review this service, specifically looking at the diagnostic yield.

Methodology
All reported ECGs were retrospectively evaluated. ECG changes were labelled as training related, borderline or pathological ECG patterns as depicted in the 2017 International Recommendations for ECG interpretation in athletes. Demographic, symptom and ECG data were tabulated. The clinical outcomes of those referred were also recorded. Categorical data was presented as percentages. Statistical analysis was performed using SPSS v23.

Results
318 recruits were screened, mean age 31.42 ± 13.2 years. The majority (n=196, 61.6%) were younger than 35 years. It was a predominant male population (n=262, 82.4%), all being Caucasian. Armed forces and police force recruits were equally represented (n=154, 48.4% vs n=164, 51.6%). No one reported symptoms (0.0%). The commonest training related changes included early repolarisation (22.3%), left ventricular hypertrophy (15.4%), sinus bradycardia (14.2%) and partial right bundle branch block (7.5%). Some had pathological ECG patterns (Anterior T Wave Inversion n=6 [1.9%], ST segment depression n=6 [1.9%], pathological Q waves n=5 [1.6%], ventricular ectopics n=3 [0.9%], pre-excitation n=2 [0.6%], inferior T Wave inversion n=1 [0.3%], Short QT n=1 [0.3%]).
Most were cleared at the initial assessment (n=292, 91.5%). 26 (8.2%) were referred for further evaluation. 14 (4.4%) needed a repeat ECG. Most (n=6, 23.1%) were cleared after secondary evaluation. Another 4 (15.4%) needed surveillance. 6 (23.1%) had a clinical diagnosis, equating to 1 in 53 individuals screened (1.9% of initial cohort). Two patients were already under the care of a cardiologist (n=1 sinus venosus defect with PAPVD, n=1 ischaemic cardiomyopathy). 4 were newly diagnosed cardiac patients (n=1 HCM, n=2 WPW, n=1 Aortopathy). Age did not have any significant impact on the diagnostic yield (&lt;35 [50%] vs ≥35 [50%] years, p=0.244).

Conclusion
8.2% were referred for further evaluation (1 in 12). 1.9% (1 in 53) had a clinical diagnosis. This highlights the importance of an ECG based screening algorithm in close liaison with experts in cardiac screening. A clinical diagnosis in law enforcement and army personnel may have important lifelong career implications.
The prevalence of risk factors and pattern of obstructive coronary artery disease in young indians (&lt; 45 years) undergoing percutaneous coronary intervention: a gender-based multi-center study
Authors: Jariwala PVJ , Jadhav KARTIK , Patil RR , Chawla KK 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
In a retrospective study, we aimed to explore the prevalence of risk factors and trends of obstructive coronary artery disease (CAD) in Indian females under 45 years old compared to males of the same age group who underwent percutaneous coronary intervention (PCI).

Purpose
With changing lifestyles, the onset of traditional risk factors at the early stages of life is the major culprit for developing CAD at an early age. For several years, the significance of CAD in young women was underestimated. There are some sex-related variations in CAD, and symptoms of CAD in women, regardless of age, have low specificity even in the absence of risk factors.

Materials and Methods
This was a retrospective, observational, multi-centre study of young Indian females and males (&lt; 45 years) who underwent PCI as per the guidelines at three high-volume centres of India. The study evaluated the prevalence of risk factors, clinical and angiographic patterns of obstructive CAD in young Indian women compared to men.

Results
In a cohort of 3656 patients who underwent PCIs, 113 young females comprised 3.1% of those with obstructive CAD, while 254 young males constituted 6.9%. Traditional risk factors such as hypertension, diabetes, and family history of premature CAD were the most common in both genders, whereas dyslipidaemia, obesity, smoking, and alcoholism were more common in young males. The acute coronary syndrome was the most common clinical presentation. The single-vessel disease was common with the involvement of the left anterior descending artery as a most common angiographic feature. The prevalence of cardiogenic shock was 4.4% in females and 4.1% in males while the in-hospital mortality rate was 1.77% in young females and 2% in young males.

Conclusion
CAD in young Indians is on the rise, and frequent screening for obstructive CAD should be done, especially in those with symptoms and risk factors.
The incidence of cardiac arrhythmias during exercise stress testing among patients with obesity undergoing sleeve gastrectomy
Authors: Vecchiato M , Quinto G , Mazzucato B , Gasperetti A , Neunhaeuserer D , Ermolao A , Battista F 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Obesity is associated with higher rate of cardiovascular morbidity and mortality, anatomical and functional cardiac alteration.(1) In particular, several studies found an association between increased body weight and arrhythmic events.(2) Sleeve Gastrectomy (SG) is recognized as significant treatment option for obesity, with beneficial effect in both weight loss and comorbidities.(3) Moreover, this treatment results in positively decrease in some basal parameters currently associated with increased risk of arrhythmic events, even if little is known about real incidence of cardiac arrhythmias, especially during exercise, before and after bariatric surgery.(4)

Purpose
To investigate the prevalence of arrhythmic events during maximal exercise testing in patients with moderate-severe obesity and to evaluate how SG affects the number of arrhythmic events.

Methods
All patients with moderate or severe obesity who were considered suitable candidates for SG after multidisciplinary evaluations were consecutively included in this study. Each patient underwent an incremental, maximal, ECG-monitored cardiopulmonary exercise testing (CPET) before and 6-months after SG. Presence and complexity of atrial premature beats (APBs) and ventricular premature beats (VPBs) has been evaluated at rest, during exercise and during recovery phase.

Results
318 patients with morbidly obesity (BMI 44.20±6.79 kg/m2, age 48.9±10.7 years) were included in the study. After SG, patients presented lower heart rate at rest (80.75±12.60 versus 64.84±9.89 bpm, p&lt;0.001) and an increased exercise time (831.30±195.32 versus 941.13±222.16 s, p&lt;0.001). The analysis of the arrhythmic events during the complete test showed a slight significant difference between pre-SG and post-SG, only regarding number of patients presenting APBs (p=0.038). However, the incidence of arrhythmic events was significantly increased during the recovery phase in post-SG evaluation, both by number of patients with at least one arrhythmic episode and by number of arrhythmic events per minute (Table I). Patients affected by severe obesity had a higher risk occurrence of arrhythmias during CPET, notably atrial premature beats (p=0.038), when compared to patients with moderate obesity. No differences were found among post-SG patients. Men presented more frequently VPBs compared to women, both in pre-SG (p=0.048) and post-SG evaluation (p&lt;0.001). No gender differences were observed in APBs (Figure 1).

Conclusion
Patients affected by severe obesity show an increased prevalence of atrial premature beats, even if no episode of exercise-induce atrial fibrillation has been described. In the early post-surgical phase, the risk of exercise-induced arrhythmias may be higher during the recovery phase, although SG does not seem to increase the occurrence of life-threating arrhythmias.
Effectiveness of empiric cardioprotective therapy in patients receiving cardiotoxic chemotherapies: systematic review & bayesian network meta-analysis
Authors: Abdelfattah OM , Sayed AS , Munir M , Shazly O , Awad AK , Ghaith HS , Gerew M , Guha A , Barac A , Fradley MG , Abela GS , Addison D 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardioprotective therapies represent an important avenue to reduce these limiting toxicities, including serious heart failure (HF) events. However, due to conflicting isolated reports, the true efficacy and optimal cardioprotective therapy at the time of anticancer treatment initiation is unclear. Therefore, we undertook a network meta-analysis to elucidate the most effective therapies at cardiotoxic HF prevention.

Purpose
To determine the efficacy, and optimal cardioprotective strategy in patients receiving cardiotoxic chemotherapies.

Methods
Leveraging the MEDLINE/Pubmed, CENTRAL, and clinicaltrials.gov databases, we identified all randomized controlled trials (RCTs) investigating cardioprotective therapies from inception to November 2021. Eligible cardioprotective classes included ACEIs, ARBs, Beta-blockers, dexrazoxane (DEX), statins, and mineralocorticoid receptor antagonists (MRA). The primary endpoint was the prevention of new-onset HF. The secondary outcomes were the mean difference in left ventricular ejection fraction (LVEF) change, the incidence of hypotension, and all-cause mortality. Network meta-analyses were used to assess the cardioprotective effects of each therapy to deduce the most effective therapies. Both analyses were undertaken using a Bayesian random-effects model to estimate risk ratios (RR) and 95% credible intervals (95% CrI).

Results
Overall, from 726 articles, 39 studies evaluating 5,931 participants (38.0±19.1 years, 72.0% females) were identified. Over a median follow-up of 6 months, use of any cardioprotective strategy was associated with a significant reduction in new-onset HF (RR:0.32; 95% CrI:0.19-0.55), improved LVEF (mean difference: 3.92%; 95% CrI:2.81-5.07), and increased hypotension (RR:3.27; 95% CrI:1.38-9.87); there was no difference in mortality (RR:1.03; 95% CrI:0.84-1.22). Based on the median risk of incident HF in the control groups being 3.28%, the number need to treat (NNT) for "any" cardioprotective therapy to prevent one incident HF event was 45 patients. For dexrazoxane and neurohormonal agents, the median NNT was 36 and 53 patients, respectively. In this network analysis, dexrazoxane was most effective at HF prevention [Surface Under the Cumulative Ranking curve (SUCRA): 81.47%] and MRA most effective at preserving LVEF (SUCRA: 99.22%). ARBs most greatly increased hypotension (RR:7.20; 95% CrI:2.46-26.94).

Conclusion
Cardiotoxicity remains a challenge for cancer patients requiring life-saving cancer therapies. The initiation of a cardioprotective strategy reduces incident HF. Additional head-to-head trials are needed to confirm the optimal preventative strategy.
An artificial intelligence model to predict 12-month mortality among patients with myocardial infarction
Authors: Hovornyan AV , Ilashchuk TO 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Ischemic heart disease and acute myocardial infarction (AMI) are the number one causes of death and disability, affecting around 126 million individuals worldwide [1]. About 30% of all cases of AMI lead to death. According to different sources, 8-20% of people with AMI die within 1 year of the event, and every second patient is rehospitalized [1-2]. Thus, it is necessary to assess the risk and to predict the outcomes during the first admission to the hospital, in order to guide the management and treatment after AMI [2]. Conventional risk rating scales and methods have a lot of drawbacks, so novel approaches such as artificial intelligence (AI) and deep learning (DL) methods have the potential to provide an accurate risk assessment and share decision-making in patients who experienced AMI [3-4].

Purpose
To develop and validate a deep-learning-based risk stratification model to predict the 12-months mortality in patients with AMI.

Methods
A cohort of 250 AMI patients with Killip class I-IV was enrolled in the study. The data was collected on the admission day and a year after the event and included anamnesis as well as the results of the physical and laboratory-instrumental examination (72 values). All patients were randomly divided into 2 groups: the derivation cohort, which consisted of 215 individuals, and the validation cohort consisted of 35 patients. Our model was created using the Python programming language in GoogleColab and it is a convolutional neural network (CNN) with 1 input layer, 4 hidden layers, and 1 output layer consisting of neurons with a sigmoid activation function (Fig. 1). We used MaxAbsScaler for data normalization and Adam for optimization. Also, we calculated the GRACE risk score and compared the performance of the models only for the validation cohort that was not used for the model development.

Results
We developed our DL-based model using the derivation data during the 30 cycles of work, receiving the maximum value of training accuracy of 96.7%. The mortality risk, calculated by our model for the validation group was compared with real 12-months mortality, and the CNN "lied" only 2 times (Table 1). The test of the validation cohort showed such results of our DL-based model: 94% - accuracy, 71% - sensitivity, 100% - specificity, 100% - positive, and 93% - negative prognostic value. These results significantly outperformed the GRACE scale, which showed 63%, 71%, 54%, 26%, and 94% respectively.

Conclusions
In summary, we develop and validate a DL-based risk stratification model to predict the 12-months mortality in patients with AMI. The accuracy of the created model is significantly higher than conventional risk scales (GRACE score). Thus, it is proved that algorithms based on deep learning may be more effective to predict mortality and guide the management of cardiac patients.
Cardiovascular risk factor insights into the Tesco 1.0 Dataset
Authors: Pimenta D , Taubel J 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Tesco published an open-source dataset containing area-aggregated product purchase information from 420m transactions across 16m individual Clubcard users in the Great London area, at a borough level. This dataset is presented as a ‘typical product’ purchase for each borough, divided into 220 individual datapoints.

Purpose
We wanted to explore dietary correlates with cardiovascular outcomes including age-standardised mortality rates for myocardial infarct, stroke, cardiac arrhythmia and COVID-19.

Methods
The Tesco 1.0 dataset was accessed on 1/11/21 and a sample of traditional dietary clinical risk and protective factor datapoints for each London borough were selected. Data for age-standardised mortality rates (ASMR) in each London borough were downloaded from the Office of National Statistics for 2019 for myocardial infarction, stroke, cardiac arrhythmia and 2020 COVID-19 deaths (March-July 2020). To explore for relevant associated factors, the average deprivation index (IMD) for each borough was accessed from Public Health England, and demographic data accessed from the Greater London Authority database.
Statistics using Spearman’s Rho calculator were derived in Excel and calculated using a web-based statistics calculator.

Results
Myocardial infarction (MI) ASMR closely correlated with increased levels of salt (g), fat and oils (% of total product), and weight of purchase (g). Increased fibre (g) was correlated with lower MI mortality. An important associated risk factor was the deprivation index, a important co-variable to consider when assessing diet-health relationships.
Stroke ASMR was more closely correlated with typical product constituents, significant risk factors were weight (g) of fat, carbohydrate, sugar and ready meals (%) and sweets (%), while % of fish and both % and total weight (g) of fruit and veg were protective factors. Importantly salt content was NOT a statistically significant factor.
Cardiac arrhythmia ASMR did not correlate with any dietary constituents reviewed.
COVID ASMR was closely correlated with myocardial infarction ASMR risk factors (salt, % of fat and oils and total weight of purchase) and total fibre (g) was again a protective factor. Interestingly, the % of ready meals was a protective factor for COVID ASMR, possibly associated with cultural and ethnicity-related behaviours, with higher BAME communities less likely to purchase ready meals.

Conclusions
This unique dataset offers a Big Data insight into the relationship between diet and health but is limited by a lack of individual granularity and heterogenous intra-borough populations. This research offers a starting point to further exploring in-depth food purchasing habits with healthcare outcomes, and further partnership in the future may unlock this.
Israel's first national remote cardiac rehabilitation program - patient response and potential factors affecting successful completion
Authors: Nabutovsky I , Heller A , Breitner D , Klemphner Y , Nachshon A , Yeshayahu S , Gang N , Klempfner R 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Sheba Medical Center

Introduction
Cardiac rehabilitation is an essential program for the reduction of future cardiac events and improve quality of life. However, many vulnerable individuals do not achieve this desired outcome due to the restrictive nature of institution-based rehabilitation. With this in mind was developed the Remote Cardiac Rehabilitation Program (RCRP). Our aim was to create the optimal conditions so that our patients are guided and stimulated in order to successfully complete the program.

Material and method
This study involved 306 patients with established CHD who underwent a six-month RCRP, three months of which were subsidized by health insurance. RCRP involves regular exercise, monitored by a smart sports watch and transferred to both the medical operations center as well as the mobile application on the patient’s smartphone. We built models to get predictors for the best patient performance in the last (third) month. Predictions were made based on their performance in the first month and some demographical data. Age and gender were taken as base features to all the models.

Results and discussion
The study involved patients, 81.5% men, aged 57.59 (±10.62), who were admitted to the RCRP mainly after myocardial infarction or coronary interventions (49%). The median minutes per week that patients performed aerobic exercise was 164, a median of 92 minutes at target HR (established by exercise physiologist), and the median percent of heart rate reserve was 76 % across exercise training. The median number aerobic sessions per week was 4, while the median daily steps was 8,370. Values had no significant differences across the 24 weeks. Following the 24-weeks of intervention, there was a significant improvement in exercise capacity, assessed by estimated METS using pre and post exercise stress tests from 9.95±2.57 to 11.71±3.43 (p&lt;0.001). The most significant predictors of program adherence were older age and the number of weekly aerobic minutes and sessions in the first weeks of training (p&lt;0.005). There is a direct relationship between the patient's age and the program compliance - the older the patient, the higher the compliance.

Conclusion
Adherence and the performance achieved by patients in the RCRP is well within guideline recommendations, leading to a significant improvement in exercise capacity. Older age, as well as early program adherence were significant factors which led to better program completion.