Pub Date : 2024-09-03DOI: 10.3389/fcvm.2024.1398963
Pingping Jie, Min Fan, Haiyi Zhang, Oucheng Wang, Jun Lv, Yingchun Liu, Chunyin Zhang, Yong Liu, Jie Zhao
BackgroundArtificial intelligence (AI) has increasingly been applied to computed tomography angiography (CTA) images to aid in the assessment of atherosclerotic plaque. Our aim was to explore the diagnostic accuracy of AI-assisted CTA for plaque diagnosis and classification through a systematic review and meta-analysis.MethodsA systematic literature review was performed by searching PubMed, EMBASE, and the Cochrane Library according to PRISMA guidelines. Original studies evaluating the diagnostic accuracy of radiomics, machine-learning, or deep-learning techniques applied to CTA images for detecting stenosis, calcification, or plaque vulnerability were included. The quality and risk of bias of the included studies were evaluated using the QUADAS-2 tool. The meta-analysis was conducted using STATA software (version 17.0) to pool sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) to determine the overall diagnostic performance.ResultsA total of 11 studies comprising 1,484 patients were included. There was low risk of bias and substantial heterogeneity. The overall pooled AUROC for atherosclerotic plaque assessment was 0.96 [95% confidence interval (CI) 0.94–0.97] across 21 trials. Of these, for ≥50% stenosis detection, the AUROC was 0.95 (95% CI 0.93–0.96) in five studies. For identifying ≥70% stenosis, the AUROC was 0.96 (95% CI 0.94–0.97) in six studies. For calcium detection, the AUROC was 0.92 (95% CI 0.90–0.94) in six studies.ConclusionOur meta-analysis demonstrates that AI-assisted CTA has high diagnostic accuracy for detecting stenosis and characterizing plaque composition, with optimal performance in detecting ≥70% stenosis.Systematic Review Registrationhttps://www.crd.york.ac.uk/, PROSPERO, identifier (CRD42023431410).
背景人工智能（AI）越来越多地应用于计算机断层扫描血管造影（CTA）图像，以帮助评估动脉粥样硬化斑块。我们的目的是通过系统综述和荟萃分析，探讨人工智能辅助 CTA 对斑块诊断和分类的诊断准确性。方法根据 PRISMA 指南检索 PubMed、EMBASE 和 Cochrane 图书馆，进行系统文献综述。纳入的原始研究评估了应用于 CTA 图像的放射组学、机器学习或深度学习技术在检测狭窄、钙化或斑块脆弱性方面的诊断准确性。使用 QUADAS-2 工具对纳入研究的质量和偏倚风险进行了评估。使用 STATA 软件（17.0 版）进行荟萃分析，汇总灵敏度、特异性和接收者操作特征曲线下面积（AUROC），以确定总体诊断性能。偏倚风险较低，异质性较大。在21项试验中，动脉粥样硬化斑块评估的总合AUROC为0.96[95%置信区间（CI）0.94-0.97]。其中，对于≥50%狭窄的检测，5项研究的AUROC为0.95（95% CI 0.93-0.96）。在识别≥70%狭窄方面，6项研究的AUROC为0.96（95% CI 0.94-0.97）。结论我们的荟萃分析表明，AI辅助CTA在检测狭窄和描述斑块组成方面具有很高的诊断准确性，在检测≥70%的狭窄方面具有最佳性能。系统综述注册https://www.crd.york.ac.uk/，PROSPERO，标识符（CRD42023431410）。
{"title":"Diagnostic value of artificial intelligence-assisted CTA for the assessment of atherosclerosis plaque: a systematic review and meta-analysis","authors":"Pingping Jie, Min Fan, Haiyi Zhang, Oucheng Wang, Jun Lv, Yingchun Liu, Chunyin Zhang, Yong Liu, Jie Zhao","doi":"10.3389/fcvm.2024.1398963","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1398963","url":null,"abstract":"BackgroundArtificial intelligence (AI) has increasingly been applied to computed tomography angiography (CTA) images to aid in the assessment of atherosclerotic plaque. Our aim was to explore the diagnostic accuracy of AI-assisted CTA for plaque diagnosis and classification through a systematic review and meta-analysis.MethodsA systematic literature review was performed by searching PubMed, EMBASE, and the Cochrane Library according to PRISMA guidelines. Original studies evaluating the diagnostic accuracy of radiomics, machine-learning, or deep-learning techniques applied to CTA images for detecting stenosis, calcification, or plaque vulnerability were included. The quality and risk of bias of the included studies were evaluated using the QUADAS-2 tool. The meta-analysis was conducted using STATA software (version 17.0) to pool sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) to determine the overall diagnostic performance.ResultsA total of 11 studies comprising 1,484 patients were included. There was low risk of bias and substantial heterogeneity. The overall pooled AUROC for atherosclerotic plaque assessment was 0.96 [95% confidence interval (CI) 0.94–0.97] across 21 trials. Of these, for ≥50% stenosis detection, the AUROC was 0.95 (95% CI 0.93–0.96) in five studies. For identifying ≥70% stenosis, the AUROC was 0.96 (95% CI 0.94–0.97) in six studies. For calcium detection, the AUROC was 0.92 (95% CI 0.90–0.94) in six studies.ConclusionOur meta-analysis demonstrates that AI-assisted CTA has high diagnostic accuracy for detecting stenosis and characterizing plaque composition, with optimal performance in detecting ≥70% stenosis.Systematic Review Registration<jats:uri>https://www.crd.york.ac.uk/</jats:uri>, PROSPERO, identifier (CRD42023431410).","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142221625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-03DOI: 10.3389/fcvm.2024.1419496
Xinyuan Zhang, Yingkun Guo, Huayan Xu
BackgroundCardiovascular complications are the leading cause of death among individuals with Duchenne muscular dystrophy (DMD). However, due to the difficulty in evaluating individuals with inactive DMD, acute myocardial injury may be overlooked.Case presentationAn 11-year-old boy with DMD presented to the emergency department with a 5-day history of persistent nasal congestion, runny nose, and cough. He was regularly taking prednisolone acetate, angiotensin-converting enzyme (ACE) inhibitors, and β-blockers for suspected DMD-associated cardiomyopathy. Upon presentation, a substantially elevated cardiac troponin I (cTnI) level of 19.8 μg/L and abnormal electrocardiogram (ECG) results were detected. Further cardiac magnetic resonance imaging (CMR) showed myocardial inflammation with localized T2 hyperintensity from the basal to middle lateral and inferior walls, as well as late gadolinium enhancement (LGE) from the basal to apical inferior lateral walls, supporting a diagnosis of acute myocarditis. Subsequently, the patient showed clinical improvement in response to combination treatment with intravenous immunoglobulin, oral prednisolone acetate, potassium chloride sustained-release tablets, anti-heart failure medication, and broad-spectrum antibiotics.ConclusionsWe report a rare case of acute myocarditis in a patient with DMD, potentially due to upper respiratory tract infection. This case highlights the importance of early myocarditis recognition and treatment in patients with DMD.
{"title":"Case Report: Acute myocarditis in a patient with Duchenne muscular dystrophy","authors":"Xinyuan Zhang, Yingkun Guo, Huayan Xu","doi":"10.3389/fcvm.2024.1419496","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1419496","url":null,"abstract":"BackgroundCardiovascular complications are the leading cause of death among individuals with Duchenne muscular dystrophy (DMD). However, due to the difficulty in evaluating individuals with inactive DMD, acute myocardial injury may be overlooked.Case presentationAn 11-year-old boy with DMD presented to the emergency department with a 5-day history of persistent nasal congestion, runny nose, and cough. He was regularly taking prednisolone acetate, angiotensin-converting enzyme (ACE) inhibitors, and β-blockers for suspected DMD-associated cardiomyopathy. Upon presentation, a substantially elevated cardiac troponin I (cTnI) level of 19.8 μg/L and abnormal electrocardiogram (ECG) results were detected. Further cardiac magnetic resonance imaging (CMR) showed myocardial inflammation with localized T2 hyperintensity from the basal to middle lateral and inferior walls, as well as late gadolinium enhancement (LGE) from the basal to apical inferior lateral walls, supporting a diagnosis of acute myocarditis. Subsequently, the patient showed clinical improvement in response to combination treatment with intravenous immunoglobulin, oral prednisolone acetate, potassium chloride sustained-release tablets, anti-heart failure medication, and broad-spectrum antibiotics.ConclusionsWe report a rare case of acute myocarditis in a patient with DMD, potentially due to upper respiratory tract infection. This case highlights the importance of early myocarditis recognition and treatment in patients with DMD.","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142221623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BackgroundIn recent years, septic shock remains a common fatal disease in the intensive care unit (ICU). After sufficient fluid resuscitation, some patients still experience tachycardia, which may lead to adverse effects on cardiac function. However, the use of β-blockers in the treatment of septic shock remains controversial. Thus, the purpose of this study is to evaluate the efficacy of β-blockers in the treatment of patients with septic shock and explore the most appropriate patient subgroups for this treatment.MethodsThis retrospective observational study enrolled septic shock patients from the Medical Information Mart for Intensive Care (MIMIC)-IV and used propensity score matching (PSM) to balance some baseline differences between patients with and without β-blockers treatment. The primary outcome was the 28-day mortality. Length of stay (LOS) in the ICU and hospital, and the degree of support for organs such as circulatory, respiratory and renal systems were also assessed. Subgroup analysis and multivariate logistic regression were performed to determine the relationship between β-blockers therapy and 28-day mortality in different patient groups.ResultsA total of 4,860 septic shock patients were enrolled in this study and 619 pairs were finally matched after PSM. Our analysis revealed that β-blocker therapy was associated with a significant improvement in 28-day mortality (21.5% vs. 27.1%; P = 0.020) and led to a prolonged LOS in both the ICU and hospital. Subgroup analysis indicated that there was an interaction between cardiovascular diseases and β-blocker therapy in patients with septic shock. Patients with pre-existing heart disease or atrial arrhythmias were more likely to derive benefits from β-blocker treatment.ConclusionWe found β-blockers therapy was effective to improve 28-day mortality in patients with septic shock. Patients in the subgroup with cardiovascular diseases were more likely to benefit from β-blockers in mortality.
{"title":"Effectiveness of β-blockers in improving 28-day mortality in septic shock: insights from subgroup analysis and retrospective observational study","authors":"Ling Zhang, Yue Yu, Tong Wu, Tingting Pan, Hongping Qu, Jingyi Wu, Ruoming Tan","doi":"10.3389/fcvm.2024.1438798","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1438798","url":null,"abstract":"BackgroundIn recent years, septic shock remains a common fatal disease in the intensive care unit (ICU). After sufficient fluid resuscitation, some patients still experience tachycardia, which may lead to adverse effects on cardiac function. However, the use of β-blockers in the treatment of septic shock remains controversial. Thus, the purpose of this study is to evaluate the efficacy of β-blockers in the treatment of patients with septic shock and explore the most appropriate patient subgroups for this treatment.MethodsThis retrospective observational study enrolled septic shock patients from the Medical Information Mart for Intensive Care (MIMIC)-IV and used propensity score matching (PSM) to balance some baseline differences between patients with and without β-blockers treatment. The primary outcome was the 28-day mortality. Length of stay (LOS) in the ICU and hospital, and the degree of support for organs such as circulatory, respiratory and renal systems were also assessed. Subgroup analysis and multivariate logistic regression were performed to determine the relationship between β-blockers therapy and 28-day mortality in different patient groups.ResultsA total of 4,860 septic shock patients were enrolled in this study and 619 pairs were finally matched after PSM. Our analysis revealed that β-blocker therapy was associated with a significant improvement in 28-day mortality (21.5% vs. 27.1%; <jats:italic>P</jats:italic> = 0.020) and led to a prolonged LOS in both the ICU and hospital. Subgroup analysis indicated that there was an interaction between cardiovascular diseases and β-blocker therapy in patients with septic shock. Patients with pre-existing heart disease or atrial arrhythmias were more likely to derive benefits from β-blocker treatment.ConclusionWe found β-blockers therapy was effective to improve 28-day mortality in patients with septic shock. Patients in the subgroup with cardiovascular diseases were more likely to benefit from β-blockers in mortality.","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142221624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-02DOI: 10.3389/fcvm.2024.1425534
Eng Leng Saw, Martin Fronius, Rajesh Katare, Yoshihiko Kakinuma
Diabetic heart disease remains the leading cause of death in individuals with type-2 diabetes mellitus (T2DM). Both insulin resistance and metabolic derangement, hallmark features of T2DM, develop early and progressively impair cardiovascular function. These factors result in altered cardiac metabolism and energetics, as well as coronary vascular dysfunction, among other consequences. Therefore, gaining a deeper understanding of the mechanisms underlying the pathophysiology of diabetic heart disease is crucial for developing novel therapies for T2DM-associated cardiovascular disease. Cardiomyocytes are equipped with the cholinergic machinery, known as the non-neuronal cardiac cholinergic system (NNCCS), for synthesizing and secreting acetylcholine (ACh) as well as possessing muscarinic ACh receptor for ACh binding and initiating signaling cascade. ACh from cardiomyocytes regulates glucose metabolism and energetics, endothelial function, and among others, in an auto/paracrine manner. Presently, there is only one preclinical animal model – diabetic db/db mice with cardiac-specific overexpression of choline transferase (Chat) gene - to study the effect of activated NNCCS in the diabetic heart. In this mini-review, we discuss the physiological role of NNCCS, the connection between NNCCS activation and cardiovascular function in T2DM and summarize the current knowledge of S-Nitroso-NPivaloyl-D-Penicillamine (SNPiP), a novel inducer of NNCCS, as a potential therapeutic strategy to modulate NNCCS activity for diabetic heart disease.
{"title":"Mini Review: the non-neuronal cardiac cholinergic system in type-2 diabetes mellitus","authors":"Eng Leng Saw, Martin Fronius, Rajesh Katare, Yoshihiko Kakinuma","doi":"10.3389/fcvm.2024.1425534","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1425534","url":null,"abstract":"Diabetic heart disease remains the leading cause of death in individuals with type-2 diabetes mellitus (T2DM). Both insulin resistance and metabolic derangement, hallmark features of T2DM, develop early and progressively impair cardiovascular function. These factors result in altered cardiac metabolism and energetics, as well as coronary vascular dysfunction, among other consequences. Therefore, gaining a deeper understanding of the mechanisms underlying the pathophysiology of diabetic heart disease is crucial for developing novel therapies for T2DM-associated cardiovascular disease. Cardiomyocytes are equipped with the cholinergic machinery, known as the non-neuronal cardiac cholinergic system (NNCCS), for synthesizing and secreting acetylcholine (ACh) as well as possessing muscarinic ACh receptor for ACh binding and initiating signaling cascade. ACh from cardiomyocytes regulates glucose metabolism and energetics, endothelial function, and among others, in an auto/paracrine manner. Presently, there is only one preclinical animal model – diabetic db/db mice with cardiac-specific overexpression of choline transferase (<jats:italic>Chat</jats:italic>) gene - to study the effect of activated NNCCS in the diabetic heart. In this mini-review, we discuss the physiological role of NNCCS, the connection between NNCCS activation and cardiovascular function in T2DM and summarize the current knowledge of S-Nitroso-NPivaloyl-D-Penicillamine (SNPiP), a novel inducer of NNCCS, as a potential therapeutic strategy to modulate NNCCS activity for diabetic heart disease.","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142221628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-02DOI: 10.3389/fcvm.2024.1425159
Dominika Bernáth-Nagy, Melek Sükran Kalinyaprak, Evangelos Giannitsis, Pál Ábrahám, Florian Leuschner, Norbert Frey, Jona Benjamin Krohn
Cardiovascular disease (CVD) ranks among the primary contributors to worldwide mortality. Hence, the importance of constant research on new circulating biomarkers for the improvement of early diagnosis and prognostication of different CVDs and the development and refinement of therapeutic measures is critical. Extracellular vesicles (EV) have a great potential as diagnostic and prognostic markers, as they represent their parent cell by enclosing cell-specific molecules, which can differ in quality and quantity based on cell state. Assuming that all cell types of the cardiovascular system are capable of releasing EV into circulation, an emerging body of evidence has investigated the potential role of serum- or plasma-derived EV in CVD. Comprehensive research has unveiled alterations in EV quantity and EV-bound cargo in the form of RNA, proteins and lipids in the context of common CVDs such as coronary artery disease, atrial fibrillation, heart failure or inflammatory heart diseases, highlighting their diagnostic and prognostic relevance. In numerous in vitro and in vivo models, EV also showed promising therapeutic potential. However, translation of EV studies to a preclinical or clinical setting has proven to be challenging. This review is intended to provide an overview of the most relevant studies in the field of serum or plasma-derived EV.
心血管疾病（CVD）是造成全球死亡的主要原因之一。因此，不断研究新的循环生物标志物对于改善不同心血管疾病的早期诊断和预后以及开发和完善治疗措施至关重要。细胞外囊泡（EV）具有作为诊断和预后标志物的巨大潜力，因为它们通过包裹细胞特异性分子来代表其母细胞，而这些分子的质量和数量会因细胞状态而不同。假设心血管系统的所有细胞类型都能向血液循环中释放EV，新出现的一组证据已对血清或血浆中的EV在心血管疾病中的潜在作用进行了研究。全面的研究揭示了在冠心病、心房颤动、心力衰竭或炎症性心脏病等常见心血管疾病的背景下，EV 数量和以 RNA、蛋白质和脂质形式存在的 EV 结合货物的变化，突出了它们在诊断和预后方面的相关性。在许多体外和体内模型中，EV 也显示出良好的治疗潜力。然而，将 EV 研究转化为临床前或临床环境已被证明具有挑战性。本综述旨在概述血清或血浆衍生 EV 领域最相关的研究。
{"title":"Circulating extracellular vesicles as biomarkers in the diagnosis, prognosis and therapy of cardiovascular diseases","authors":"Dominika Bernáth-Nagy, Melek Sükran Kalinyaprak, Evangelos Giannitsis, Pál Ábrahám, Florian Leuschner, Norbert Frey, Jona Benjamin Krohn","doi":"10.3389/fcvm.2024.1425159","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1425159","url":null,"abstract":"Cardiovascular disease (CVD) ranks among the primary contributors to worldwide mortality. Hence, the importance of constant research on new circulating biomarkers for the improvement of early diagnosis and prognostication of different CVDs and the development and refinement of therapeutic measures is critical. Extracellular vesicles (EV) have a great potential as diagnostic and prognostic markers, as they represent their parent cell by enclosing cell-specific molecules, which can differ in quality and quantity based on cell state. Assuming that all cell types of the cardiovascular system are capable of releasing EV into circulation, an emerging body of evidence has investigated the potential role of serum- or plasma-derived EV in CVD. Comprehensive research has unveiled alterations in EV quantity and EV-bound cargo in the form of RNA, proteins and lipids in the context of common CVDs such as coronary artery disease, atrial fibrillation, heart failure or inflammatory heart diseases, highlighting their diagnostic and prognostic relevance. In numerous <jats:italic>in vitro</jats:italic> and <jats:italic>in vivo</jats:italic> models, EV also showed promising therapeutic potential. However, translation of EV studies to a preclinical or clinical setting has proven to be challenging. This review is intended to provide an overview of the most relevant studies in the field of serum or plasma-derived EV.","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142221630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-02DOI: 10.3389/fcvm.2024.1357305
Ranel Loutati, Yotam Kolben, David Luria, Offer Amir, Yitschak Biton
BackgroundThe traditional classification of left ventricular hypertrophy (LVH), which relies on left ventricular geometry, fails to correlate with outcomes among patients with increased LV mass (LVM).ObjectivesTo identify unique clinical phenotypes of increased LVM patients using unsupervised cluster analysis, and to explore their association with clinical outcomes.MethodsAmong the UK Biobank participants, increased LVM was defined as LVM index ≥72 g/m2 for men, and LVM index ≥55 g/m2 for women. Baseline demographic, clinical, and laboratory data were collected from the database. Using Ward's minimum variance method, patients were clustered based on 27 variables. The primary outcome was a composite of all-cause mortality with heart failure (HF) admissions, ventricular arrhythmia, and atrial fibrillation (AF). Cox proportional hazard model and Kaplan-Meier survival analysis were applied.ResultsIncreased LVM was found in 4,255 individuals, with an average age of 64 ± 7 years. Of these patients, 2,447 (58%) were women. Through cluster analysis, four distinct subgroups were identified. Over a median follow-up period of 5 years (IQR: 4-6), 100 patients (2%) died, 118 (2.8%) were admissioned due to HF, 29 (0.7%) were admissioned due to VA, and 208 (5%) were admissioned due to AF. Univariate Cox analysis demonstrated significantly elevated risks of major events for patients in the 2nd (HR = 1.6; 95% CI 1.2–2.16; p < .001), 3rd (HR = 2.04; 95% CI 1.49–2.78; p < .001), and 4th (HR = 2.64; 95% CI 1.92–3.62; p < .001) clusters compared to the 1st cluster. Further exploration of each cluster revealed unique clinical phenotypes: Cluster 2 comprised mostly overweight women with a high prevalence of chronic lung disease; Cluster 3 consisted mostly of men with a heightened burden of comorbidities; and Cluster 4, mostly men, exhibited the most abnormal cardiac measures.ConclusionsUnsupervised cluster analysis identified four outcomes-correlated clusters among patients with increased LVM. This phenotypic classification holds promise in offering valuable insights regarding clinical course and outcomes of patients with increased LVM.
背景传统的左心室肥厚（LVH）分类依赖于左心室的几何形状，但与左心室质量（LVM）增大患者的预后并不相关。方法在英国生物库参与者中，男性左心室质量指数≥72 g/m2，女性左心室质量指数≥55 g/m2，即为左心室质量增大。从数据库中收集了基线人口统计学、临床和实验室数据。采用沃德最小方差法，根据 27 个变量对患者进行分组。主要结果是全因死亡率与心力衰竭（HF）入院率、室性心律失常和心房颤动（AF）的复合结果。结果在 4255 人中发现 LVM 增加，平均年龄为 64 ± 7 岁。在这些患者中，有 2447 人（58%）为女性。通过聚类分析，确定了四个不同的亚组。中位随访期为 5 年（IQR：4-6 年），其中 100 名患者（2%）死亡，118 名患者（2.8%）因心房颤动入院，29 名患者（0.7%）因视网膜病变入院，208 名患者（5%）因房颤入院。单变量 Cox 分析显示，与第一分组相比，第二分组（HR = 1.6; 95% CI 1.2-2.16; p < .001）、第三分组（HR = 2.04; 95% CI 1.49-2.78; p < .001）和第四分组（HR = 2.64; 95% CI 1.92-3.62; p < .001）患者发生重大事件的风险明显升高。对每个群组的进一步研究发现了独特的临床表型：结论无监督聚类分析在 LVM 增大的患者中发现了四个结果相关的聚类。这种表型分类有望为 LVM 增大患者的临床过程和预后提供有价值的见解。
{"title":"AI-based cluster analysis enables outcomes prediction among patients with increased LVM","authors":"Ranel Loutati, Yotam Kolben, David Luria, Offer Amir, Yitschak Biton","doi":"10.3389/fcvm.2024.1357305","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1357305","url":null,"abstract":"BackgroundThe traditional classification of left ventricular hypertrophy (LVH), which relies on left ventricular geometry, fails to correlate with outcomes among patients with increased LV mass (LVM).ObjectivesTo identify unique clinical phenotypes of increased LVM patients using unsupervised cluster analysis, and to explore their association with clinical outcomes.MethodsAmong the UK Biobank participants, increased LVM was defined as LVM index ≥72 g/m<jats:sup>2</jats:sup> for men, and LVM index ≥55 g/m<jats:sup>2</jats:sup> for women. Baseline demographic, clinical, and laboratory data were collected from the database. Using Ward's minimum variance method, patients were clustered based on 27 variables. The primary outcome was a composite of all-cause mortality with heart failure (HF) admissions, ventricular arrhythmia, and atrial fibrillation (AF). Cox proportional hazard model and Kaplan-Meier survival analysis were applied.ResultsIncreased LVM was found in 4,255 individuals, with an average age of 64 ± 7 years. Of these patients, 2,447 (58%) were women. Through cluster analysis, four distinct subgroups were identified. Over a median follow-up period of 5 years (IQR: 4-6), 100 patients (2%) died, 118 (2.8%) were admissioned due to HF, 29 (0.7%) were admissioned due to VA, and 208 (5%) were admissioned due to AF. Univariate Cox analysis demonstrated significantly elevated risks of major events for patients in the 2nd (HR = 1.6; 95% CI 1.2–2.16; <jats:italic>p</jats:italic> &lt; .001), 3rd (HR = 2.04; 95% CI 1.49–2.78; <jats:italic>p</jats:italic> &lt; .001), and 4th (HR = 2.64; 95% CI 1.92–3.62; <jats:italic>p</jats:italic> &lt; .001) clusters compared to the 1st cluster. Further exploration of each cluster revealed unique clinical phenotypes: Cluster 2 comprised mostly overweight women with a high prevalence of chronic lung disease; Cluster 3 consisted mostly of men with a heightened burden of comorbidities; and Cluster 4, mostly men, exhibited the most abnormal cardiac measures.ConclusionsUnsupervised cluster analysis identified four outcomes-correlated clusters among patients with increased LVM. This phenotypic classification holds promise in offering valuable insights regarding clinical course and outcomes of patients with increased LVM.","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142221639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-02DOI: 10.3389/fcvm.2024.1440636
Letizia Spinelli, Antonio Bianco, Eleonora Riccio, Antonio Pisani, Guido Iaccarino
Anderson–Fabry disease (AFD) is a lysosomal storage disorder, depending on defects in alpha galactosidase A activity, due to a mutation in the galactosidase alpha gene. Cardiovascular involvement represents the leading cause of death in AFD. Cardiac imaging plays a key role in the evaluation and management of AFD patients. Echocardiography is the first-line imaging modality for the identification of the typical features of AFD cardiomyopathy. Advanced echocardiography that allows assessment of myocardial deformation has provided insights into the cardiac functional status of AFD patients. The present review highlights the value and the perspectives of advanced ultrasound imaging in AFD.
{"title":"Cardiac involvement in Anderson–Fabry disease. The role of advanced echocardiography","authors":"Letizia Spinelli, Antonio Bianco, Eleonora Riccio, Antonio Pisani, Guido Iaccarino","doi":"10.3389/fcvm.2024.1440636","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1440636","url":null,"abstract":"Anderson–Fabry disease (AFD) is a lysosomal storage disorder, depending on defects in alpha galactosidase A activity, due to a mutation in the galactosidase alpha gene. Cardiovascular involvement represents the leading cause of death in AFD. Cardiac imaging plays a key role in the evaluation and management of AFD patients. Echocardiography is the first-line imaging modality for the identification of the typical features of AFD cardiomyopathy. Advanced echocardiography that allows assessment of myocardial deformation has provided insights into the cardiac functional status of AFD patients. The present review highlights the value and the perspectives of advanced ultrasound imaging in AFD.","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142221629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-02DOI: 10.3389/fcvm.2024.1456360
Min Liu, Jixiang Liu, Shen Chen, Xiaoyan Gao, Jinnan Zhong, Lu Sun, Fajiu Li, Chenghong Li
Bronchial artery embolization (BAE) is currently the first-line treatment for massive hemoptysis. Previous studies have proven its safety and efficacy, with mild, transient, and reversible complications. This case described a patient with congenital multiple bronchopulmonary fistulas who underwent BAE due to massive hemoptysis. However, due to an overlooked and misdiagnosed atypical fistula, the patient experienced an ectopic pulmonary embolism and subsequently secondary pulmonary infarction. He eventually exhibited a full postoperative recovery following percutaneous catheter-directed embolectomy. This case revealed a type of occult fistula masked by multiple bronchial artery branches, which may be a potential risk factor for an ectopic pulmonary embolism during BAE. We propose that it is crucial to identify abnormal anastomosis, especially atypical fistula, and select appropriate embolization materials during BAE.
{"title":"Case Report: Ectopic pulmonary embolism as a complication of bronchial artery embolization","authors":"Min Liu, Jixiang Liu, Shen Chen, Xiaoyan Gao, Jinnan Zhong, Lu Sun, Fajiu Li, Chenghong Li","doi":"10.3389/fcvm.2024.1456360","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1456360","url":null,"abstract":"Bronchial artery embolization (BAE) is currently the first-line treatment for massive hemoptysis. Previous studies have proven its safety and efficacy, with mild, transient, and reversible complications. This case described a patient with congenital multiple bronchopulmonary fistulas who underwent BAE due to massive hemoptysis. However, due to an overlooked and misdiagnosed atypical fistula, the patient experienced an ectopic pulmonary embolism and subsequently secondary pulmonary infarction. He eventually exhibited a full postoperative recovery following percutaneous catheter-directed embolectomy. This case revealed a type of occult fistula masked by multiple bronchial artery branches, which may be a potential risk factor for an ectopic pulmonary embolism during BAE. We propose that it is crucial to identify abnormal anastomosis, especially atypical fistula, and select appropriate embolization materials during BAE.","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142221641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-31DOI: 10.3389/fcvm.2024.1441241
Yao Li, Wei Zhang, Keping Chen, Zhexun Lian
BackgroundLeft bundle branch area pacing (LBBAP) has become an alternative method for cardiac resynchronization therapy. Various modes of LBBAP have been determined, including left bundle trunk pacing (LBTP), left anterior branch pacing (LAFP) and left posterior branch pacing (LPFP). However, whether the outcomes of various pacing modes differ in heart failure (HF) patients is still unclear. This study aimed to compare the electrophysiological characteristics and echocardiographic response rate among those distinct modes of LBBAP.MethodsHF patients undergoing successful LBBAP were retrospectively included. Distinct modes of pacing were determined based on paced QRS morphology. The fluoroscopic images were collected to compare the lead tip position between the groups. The electrocardiograms (ECG) before and after LBBAP were used to measure the depolarization (QRS duration [QRSd] and the interventricular delay [IVD]), and the repolarization parameters [QTc, TpeakTend(TpTe), and TpTe/QTc]. The left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) of patients were also recorded. In addition, the lead parameters and certain complications were compared.ResultsA total of 64 HF patients were finally included, consisting of 16 (25.0%) patients in the LBTP group, 22 (34.4%) patients in the LAFP group, and 26 (40.6%) patients in the LPFP group. The distribution features of LBBAP lead tips were significantly related to pacing modes: LBTP was more likely to be in zone 4 while LAFP or LPFP was prone to locate in zone 5. After LBBAP, the ventricular ECG parameters were significantly improved, regardless of pacing modes. Besides, the LVEF of the patients was significantly increased (P < 0.001), and LVEDD was significantly decreased (P < 0.001). There was no difference in the response rate and super-response rate among groups (P > 0.05). In addition, the lead parameters remained stable and no significant difference was observed among groups.ConclusionLPFP was the main pacing mode among HF patients after LBBAP. The paced QRS morphology was significantly related to the position of lead tips. After LBBAP, the ventricular depolarization synchronization and repolarization stability were both significantly improved, regardless of pacing modes. There was no significant difference in the echocardiographic response rate among distinct LBBAP modes.
{"title":"Comparison of electrocardiogram parameters and echocardiographic response between distinct left bundle branch area pacing modes in heart failure patients","authors":"Yao Li, Wei Zhang, Keping Chen, Zhexun Lian","doi":"10.3389/fcvm.2024.1441241","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1441241","url":null,"abstract":"BackgroundLeft bundle branch area pacing (LBBAP) has become an alternative method for cardiac resynchronization therapy. Various modes of LBBAP have been determined, including left bundle trunk pacing (LBTP), left anterior branch pacing (LAFP) and left posterior branch pacing (LPFP). However, whether the outcomes of various pacing modes differ in heart failure (HF) patients is still unclear. This study aimed to compare the electrophysiological characteristics and echocardiographic response rate among those distinct modes of LBBAP.MethodsHF patients undergoing successful LBBAP were retrospectively included. Distinct modes of pacing were determined based on paced QRS morphology. The fluoroscopic images were collected to compare the lead tip position between the groups. The electrocardiograms (ECG) before and after LBBAP were used to measure the depolarization (QRS duration [QRSd] and the interventricular delay [IVD]), and the repolarization parameters [QTc, TpeakTend(TpTe), and TpTe/QTc]. The left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) of patients were also recorded. In addition, the lead parameters and certain complications were compared.ResultsA total of 64 HF patients were finally included, consisting of 16 (25.0%) patients in the LBTP group, 22 (34.4%) patients in the LAFP group, and 26 (40.6%) patients in the LPFP group. The distribution features of LBBAP lead tips were significantly related to pacing modes: LBTP was more likely to be in zone 4 while LAFP or LPFP was prone to locate in zone 5. After LBBAP, the ventricular ECG parameters were significantly improved, regardless of pacing modes. Besides, the LVEF of the patients was significantly increased (<jats:italic>P </jats:italic>&lt; 0.001), and LVEDD was significantly decreased (<jats:italic>P </jats:italic>&lt; 0.001). There was no difference in the response rate and super-response rate among groups (<jats:italic>P </jats:italic>&gt; 0.05). In addition, the lead parameters remained stable and no significant difference was observed among groups.ConclusionLPFP was the main pacing mode among HF patients after LBBAP. The paced QRS morphology was significantly related to the position of lead tips. After LBBAP, the ventricular depolarization synchronization and repolarization stability were both significantly improved, regardless of pacing modes. There was no significant difference in the echocardiographic response rate among distinct LBBAP modes.","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142221640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-30DOI: 10.3389/fcvm.2024.1385108
Magdalena I. Rufa, Adrian Ursulescu, Juergen Dippon, Dincer Aktuerk, Ragi Nagib, Marc Albert, Ulrich F. W. Franke
IntroductionThe safety and efficacy of minimally invasive direct coronary artery bypass (MIDCAB) surgery has been confirmed in numerous reports. However, minimally invasive multi-vessel off-pump coronary artery bypass grafting (MICS CABG) has lower uptake and has not yet gained widespread adoption. The study aimed to investigate the non-inferiority of MICS CABG to MIDCAB in long-term follow-up for several clinical outcomes, including angina pectoris, major adverse cardiac and cerebrovascular events (MACCE) and overall survival.MethodsThis is an observational, retrospective, single center study of 1,149 patients who underwent either MIDCAB (n = 626) or MICS CABG (n = 523) at our institution between 2007 and 2018. The left internal thoracic artery and portions of the radial artery and saphenous vein were used for the patients’ single-, double-, or triple-vessel revascularization procedures. We used gradient boosted propensity-score estimation to account for possible interactions between variables. After propensity-score adjustment, the two groups were similar in terms of preoperative demographics and risk profile. Long-term follow-up (mean 5.87, median 5.6 years) was available for 1,089 patients (94.8%).ResultsA total of 626, 454 and 69 patients underwent single, double and triple coronary revascularization, respectively. The long-term outcomes of freedom from angina pectoris, acute myocardial infarction, and revascularization rate were similar between the two groups. During follow-up, there were 123 deaths in the MIDCAB group and 96 in the MICS CABG group. The 1-, 3-, 5-, and 10-year survival rates were 97%, 92%, 85%, and 69% for the MIDCAB group and 97%, 93%, 89%, and 74% for the MICS CABG group, respectively. The hazard ratio of overall survival for patients with two or more bypass grafts compared to those with one bypass graft was 1.190 (p-value = 0.234, 95% CI: 0.893–1.586). This indicates that there was no significant difference in survival between the two groups. Furthermore, if we consider a hazard ratio of 1.2 to be clinically non-relevant, surgery with two or more grafts was significantly non-inferior to surgery with just one graft (p-value = 0.0057).ConclusionIn experienced hands, MICS CABG is a safe and effective procedure. Survival and durability are comparable with MIDCAB.
{"title":"Is minimally invasive multi-vessel off-pump coronary surgery as safe and effective as MIDCAB?","authors":"Magdalena I. Rufa, Adrian Ursulescu, Juergen Dippon, Dincer Aktuerk, Ragi Nagib, Marc Albert, Ulrich F. W. Franke","doi":"10.3389/fcvm.2024.1385108","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1385108","url":null,"abstract":"IntroductionThe safety and efficacy of minimally invasive direct coronary artery bypass (MIDCAB) surgery has been confirmed in numerous reports. However, minimally invasive multi-vessel off-pump coronary artery bypass grafting (MICS CABG) has lower uptake and has not yet gained widespread adoption. The study aimed to investigate the non-inferiority of MICS CABG to MIDCAB in long-term follow-up for several clinical outcomes, including angina pectoris, major adverse cardiac and cerebrovascular events (MACCE) and overall survival.MethodsThis is an observational, retrospective, single center study of 1,149 patients who underwent either MIDCAB (<jats:italic>n</jats:italic> = 626) or MICS CABG (<jats:italic>n</jats:italic> = 523) at our institution between 2007 and 2018. The left internal thoracic artery and portions of the radial artery and saphenous vein were used for the patients’ single-, double-, or triple-vessel revascularization procedures. We used gradient boosted propensity-score estimation to account for possible interactions between variables. After propensity-score adjustment, the two groups were similar in terms of preoperative demographics and risk profile. Long-term follow-up (mean 5.87, median 5.6 years) was available for 1,089 patients (94.8%).ResultsA total of 626, 454 and 69 patients underwent single, double and triple coronary revascularization, respectively. The long-term outcomes of freedom from angina pectoris, acute myocardial infarction, and revascularization rate were similar between the two groups. During follow-up, there were 123 deaths in the MIDCAB group and 96 in the MICS CABG group. The 1-, 3-, 5-, and 10-year survival rates were 97%, 92%, 85%, and 69% for the MIDCAB group and 97%, 93%, 89%, and 74% for the MICS CABG group, respectively. The hazard ratio of overall survival for patients with two or more bypass grafts compared to those with one bypass graft was 1.190 (<jats:italic>p</jats:italic>-value = 0.234, 95% CI: 0.893–1.586). This indicates that there was no significant difference in survival between the two groups. Furthermore, if we consider a hazard ratio of 1.2 to be clinically non-relevant, surgery with two or more grafts was significantly non-inferior to surgery with just one graft (<jats:italic>p</jats:italic>-value = 0.0057).ConclusionIn experienced hands, MICS CABG is a safe and effective procedure. Survival and durability are comparable with MIDCAB.","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142221642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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