Jingchaun Guo, Matthew R Petersen, Huilin Tang, L. Meece, H. Shao, Mustafa M. Ahmed
Objective: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are approved for heart failure with reduced ejection fraction (HFrEF). However, their cost-effectiveness remains unknown. We aimed to compare the cost-effectiveness of SGLT2i versus mineralocorticoid antagonists (MRAs). Methods: Data from the RALES, EPHESUS, EMPHASIS, DAPA-HF, and EMPEROR-Reduced trials were included. We calculated the risk-ratio (RR) for a composite of cardiovascular death or heart failure hospitalization (CV death-HHF), all-cause mortality, and heart failure hospitalization (HHF) between MRAs and SGLT2i. A Markov model was developed to simulate the progression of HFrEF over 5 years. The primary outcome was incremental cost-effectiveness ratio (ICER), measured by cost per quality-adjusted life-year (QALY) gained. Results: We observed a similar benefit in CV death-HHF (RR 1.04; 95% CI 0.82–1.31), all-cause mortality (RR 0.91; 95% CI 0.78–1.06), and HHF (RR 1.05; 95% CI 0.84–1.31) between MRAs and SGLT2i. In a 5-year model, no difference in survival was observed between treatments. MRAs were associated with lower cost ($63,135.52 vs. $80,365.31) and more QALYs gained per patient (2.53 versus 2.49) than SGLT2i. The ICER for SGLT2i versus MRAs was $-172,014.25/QALY, in favor of MRAs. Conclusion: MRAs and SGLT2i provided similar benefits; however, MRAs were a more cost-effective treatment than SGLT2i.
目的:钠-葡萄糖共转运蛋白2抑制剂(SGLT2i)被批准用于心力衰竭伴射血分数降低(HFrEF)。然而，它们的成本效益仍然未知。我们的目的是比较SGLT2i与矿皮质激素拮抗剂(MRAs)的成本效益。方法:纳入来自RALES、EPHESUS、EMPHASIS、DAPA-HF和EMPEROR-Reduced试验的数据。我们计算了mra和SGLT2i之间心血管死亡或心力衰竭住院(CV death-HHF)、全因死亡率和心力衰竭住院(HHF)的复合风险比(RR)。建立了一个马尔可夫模型来模拟HFrEF在5年内的进展。主要结局是增量成本-效果比(ICER)，通过获得的每个质量调整生命年(QALY)的成本来衡量。结果:我们在CV死亡- hhf方面观察到类似的获益(RR 1.04;95% CI 0.82-1.31)，全因死亡率(RR 0.91;95% CI 0.78-1.06)和HHF (RR 1.05;mra和SGLT2i之间95% CI 0.84-1.31)。在一个5年的模型中，两种治疗方法的生存率没有差异。与SGLT2i相比，MRAs的成本更低(63,135.52美元对80,365.31美元)，每位患者获得的qaly(2.53美元对2.49美元)更多。SGLT2i与mra的ICER为-172,014.25美元/QALY，有利于mra。结论:MRAs和SGLT2i具有相似的疗效;然而，mra是比SGLT2i更具成本效益的治疗方法。
{"title":"Cost Effectiveness of Sodium-Glucose Cotransporter 2 Inhibitors Compared with Mineralocorticoid Receptor Antagonists among Patients with Heart Failure and a Reduced Ejection Fraction","authors":"Jingchaun Guo, Matthew R Petersen, Huilin Tang, L. Meece, H. Shao, Mustafa M. Ahmed","doi":"10.15212/cvia.2023.0037","DOIUrl":"https://doi.org/10.15212/cvia.2023.0037","url":null,"abstract":"Objective: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are approved for heart failure with reduced ejection fraction (HFrEF). However, their cost-effectiveness remains unknown. We aimed to compare the cost-effectiveness of SGLT2i versus mineralocorticoid antagonists (MRAs). Methods: Data from the RALES, EPHESUS, EMPHASIS, DAPA-HF, and EMPEROR-Reduced trials were included. We calculated the risk-ratio (RR) for a composite of cardiovascular death or heart failure hospitalization (CV death-HHF), all-cause mortality, and heart failure hospitalization (HHF) between MRAs and SGLT2i. A Markov model was developed to simulate the progression of HFrEF over 5 years. The primary outcome was incremental cost-effectiveness ratio (ICER), measured by cost per quality-adjusted life-year (QALY) gained. Results: We observed a similar benefit in CV death-HHF (RR 1.04; 95% CI 0.82–1.31), all-cause mortality (RR 0.91; 95% CI 0.78–1.06), and HHF (RR 1.05; 95% CI 0.84–1.31) between MRAs and SGLT2i. In a 5-year model, no difference in survival was observed between treatments. MRAs were associated with lower cost ($63,135.52 vs. $80,365.31) and more QALYs gained per patient (2.53 versus 2.49) than SGLT2i. The ICER for SGLT2i versus MRAs was $-172,014.25/QALY, in favor of MRAs. Conclusion: MRAs and SGLT2i provided similar benefits; however, MRAs were a more cost-effective treatment than SGLT2i.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":"1 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67306852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Several biomarkers have been studied as prognostic indicators among people with diabetes and coronary artery disease (CAD). The purpose of this study was to determine the prognostic value of neutrophil counts and the Gensini score in patients with diabetes and ACS undergoing percutaneous coronary intervention (PCI). Methods: A total of 694 people with ACS and T2DM who simultaneously had elevated HBA1c received PCI. Spearman rank correlation estimates were used for correlation evaluation. Multivariate Cox regression and Kaplan-Meier analysis were used to identify characteristics associated with major adverse cardiovascular and cerebrovascular events (MACCEs) and patient survival. The effects of single- and multi-factor indices on MACCEs were evaluated through receiver operating characteristic curve analysis. Results: The Gensini score and neutrophil count significantly differed between the MACCE and non-MACCE groups among patients receiving PCI who had concomitant ACS and T2DM with elevated HBA1c (P<0.001). The Gensini score and neutrophil count were strongly associated with MACCEs (log-rank, P<0.001). The Gensini score and neutrophil count, alone or in combination, were predictors of MACCEs, according to multivariate Cox regression analysis (adjusted hazard ratio [HR], 1.005; 95% confidence interval [CI], 1.002–1.008; P=0.002; adjusted HR, 1.512; 95% CI, 1.005–2.274; P=0.047, respectively). The Gensini score was strongly associated with neutrophil count (variance inflation factor ≥ 5). Area under the curve analysis revealed that the combination of multivariate factors predicted the occurrence of MACCEs better than any single variable. Conclusion: In patients with T2DM and ACS with elevated HBA1c who underwent PCI, both the Gensini score and neutrophil count were independent predictors of outcomes. The combination of both predictors has a higher predictability.
{"title":"Combination of Neutrophil Count and Gensini Score as a Prognostic Marker in Patients with ACS and Uncontrolled T2DM Undergoing PCI","authors":"Yanyan Xu, Zhen Qin, Jiamin Gao, Yu Yang, Yongzhen Lu, Fengyi Yu, Yan Lv, Zhaowei Sun, Jinying Zhang, Junnan Tang","doi":"10.15212/cvia.2023.0051","DOIUrl":"https://doi.org/10.15212/cvia.2023.0051","url":null,"abstract":"Background: Several biomarkers have been studied as prognostic indicators among people with diabetes and coronary artery disease (CAD). The purpose of this study was to determine the prognostic value of neutrophil counts and the Gensini score in patients with diabetes and ACS undergoing percutaneous coronary intervention (PCI). Methods: A total of 694 people with ACS and T2DM who simultaneously had elevated HBA1c received PCI. Spearman rank correlation estimates were used for correlation evaluation. Multivariate Cox regression and Kaplan-Meier analysis were used to identify characteristics associated with major adverse cardiovascular and cerebrovascular events (MACCEs) and patient survival. The effects of single- and multi-factor indices on MACCEs were evaluated through receiver operating characteristic curve analysis. Results: The Gensini score and neutrophil count significantly differed between the MACCE and non-MACCE groups among patients receiving PCI who had concomitant ACS and T2DM with elevated HBA1c (P<0.001). The Gensini score and neutrophil count were strongly associated with MACCEs (log-rank, P<0.001). The Gensini score and neutrophil count, alone or in combination, were predictors of MACCEs, according to multivariate Cox regression analysis (adjusted hazard ratio [HR], 1.005; 95% confidence interval [CI], 1.002–1.008; P=0.002; adjusted HR, 1.512; 95% CI, 1.005–2.274; P=0.047, respectively). The Gensini score was strongly associated with neutrophil count (variance inflation factor ≥ 5). Area under the curve analysis revealed that the combination of multivariate factors predicted the occurrence of MACCEs better than any single variable. Conclusion: In patients with T2DM and ACS with elevated HBA1c who underwent PCI, both the Gensini score and neutrophil count were independent predictors of outcomes. The combination of both predictors has a higher predictability.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":"1 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67307288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Durable left ventricular assist devices (LVADs) offer a viable option for patients with advanced heart failure and have been demonstrated to be superior to optimal medical therapy in terms of both mortality and quality of life, in selected patients. However, durable LVADs can be associated with severe morbidity. Because the rates of cardiac transplantation are limited by supply, understanding of the evolution of durable LVAD support is necessary to drive innovations to optimize outcomes. Herein, we review progress in durable LVAD support in contemporary practice and propose future directions that will require additional study.
{"title":"Alive Without a Pulse: Evolution of Durable Left Ventricular Assist Devices","authors":"Eric Czinn, Anas Jawaid, Leway Chen","doi":"10.15212/cvia.2023.0056","DOIUrl":"https://doi.org/10.15212/cvia.2023.0056","url":null,"abstract":"Durable left ventricular assist devices (LVADs) offer a viable option for patients with advanced heart failure and have been demonstrated to be superior to optimal medical therapy in terms of both mortality and quality of life, in selected patients. However, durable LVADs can be associated with severe morbidity. Because the rates of cardiac transplantation are limited by supply, understanding of the evolution of durable LVAD support is necessary to drive innovations to optimize outcomes. Herein, we review progress in durable LVAD support in contemporary practice and propose future directions that will require additional study.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135355447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zhao Yang, Man Ki Kwok, Catherine Mary Schooling, Jing Liu
Objective: This study aimed to investigate the effects of the 2011 Chinese Society of Cardiology guidelines (2011 CSC guidelines) on the overall and subtype specific cardiovascular disease (CVD) burden in China. Methods: We conducted a Bayesian causal impact analysis to investigate changes in the burden of CVD overall and 13 subcategories, before and after release of the 2011 CSC guidelines, by using publicly available data during 1990–2019. Results: The 2011 CSC guidelines were associated with moderate declines in CVD mortality (5.7%; equivalent to 161 per 100,000) and DALYs (2.9%; 1429 per 100,000), but small increases in incidence and prevalence, with an approximately 1-year lagged effect. Similar impact patterns were observed for ischemic stroke, cardiomyopathy and myocarditis, and aortic aneurysm. Release of the 2011 CSC guidelines increased intracerebral hemorrhage incidence, but sharply decreased rheumatic, ischemic, and non-rheumatic valvular heart disease mortality and DALY rates. The burden of other CVD subcategories was unchanged. Health worker numbers, population size, disposable income, hospital admission rates, and crude death rates were critical contributors to CVD burden beyond the 2011 CSC guidelines. Conclusion: The 2011 CSC guidelines decreased the burden of CVD and several subcategories. However, efforts to enhance health promotion and strengthen healthcare remain urgently needed in China.
{"title":"Changes in Cardiovascular Disease Burden in China after Release of the 2011 Chinese Guidelines for Cardiovascular Disease Prevention: A Bayesian Causal Impact Analysis","authors":"Zhao Yang, Man Ki Kwok, Catherine Mary Schooling, Jing Liu","doi":"10.15212/cvia.2023.0069","DOIUrl":"https://doi.org/10.15212/cvia.2023.0069","url":null,"abstract":"Objective: This study aimed to investigate the effects of the 2011 Chinese Society of Cardiology guidelines (2011 CSC guidelines) on the overall and subtype specific cardiovascular disease (CVD) burden in China. Methods: We conducted a Bayesian causal impact analysis to investigate changes in the burden of CVD overall and 13 subcategories, before and after release of the 2011 CSC guidelines, by using publicly available data during 1990–2019. Results: The 2011 CSC guidelines were associated with moderate declines in CVD mortality (5.7%; equivalent to 161 per 100,000) and DALYs (2.9%; 1429 per 100,000), but small increases in incidence and prevalence, with an approximately 1-year lagged effect. Similar impact patterns were observed for ischemic stroke, cardiomyopathy and myocarditis, and aortic aneurysm. Release of the 2011 CSC guidelines increased intracerebral hemorrhage incidence, but sharply decreased rheumatic, ischemic, and non-rheumatic valvular heart disease mortality and DALY rates. The burden of other CVD subcategories was unchanged. Health worker numbers, population size, disposable income, hospital admission rates, and crude death rates were critical contributors to CVD burden beyond the 2011 CSC guidelines. Conclusion: The 2011 CSC guidelines decreased the burden of CVD and several subcategories. However, efforts to enhance health promotion and strengthen healthcare remain urgently needed in China.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135444944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yingfang Liu, Yan Wang, Ye Meng, Qiuli Wang, Yifang Guo
Introduction: Hypertension and left ventricular hypertrophy (LVH) have emerged as significant risk factors for cardiovascular events and all-cause mortality. Inflammation and nutrition play critical roles in the development of hypertension and damage to target organs. The HALP Score, which assesses levels of hemoglobin, albumin, lymphocytes, and platelets, is an index closely associated with inflammation and nutrition, and has been demonstrated to be particularly effective in the older population. Hence, the objective of this study was to examine the correlation between the HALP Score and LVH in older patients with hypertension. Methods: We collected and retrospectively analyzed data from 234 older patients, including clinical data, and routine blood, liver function, kidney function, and cardiac ultrasound parameters. All patients were categorized into a non-left ventricular hypertrophy (NLVH) group (n = 131) or an LVH group (n = 103). The association between the HALP Score and LVH was investigated, and potential influencing factors were considered. Results: The LVH group had a significantly lower HALP Score than the NLVH group. Logistic regression analysis revealed that a lower HALP Score and female sex were independent factors associated with LVH in older patients with hypertension (OR = 0.944, 9.962, 95% CI: 0.910–0.979, 3.866–24.300, P = 0.002, <0.001). The area under the curve for the HALP Score in diagnosing LVH in older patients with hypertension was 0.708 (95% CI: 0.641–0.776, P = 0.002). Conclusion: The HALP Score is significantly associated with LVH in older patients with hypertension: lower scores indicate a greater likelihood of LVH. The HALP Score has moderate diagnostic value for LVH in this population.
{"title":"Correlation between the Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) Score and Left Ventricular Hypertrophy in Older Patients with Hypertension*","authors":"Yingfang Liu, Yan Wang, Ye Meng, Qiuli Wang, Yifang Guo","doi":"10.15212/cvia.2023.0068","DOIUrl":"https://doi.org/10.15212/cvia.2023.0068","url":null,"abstract":"Introduction: Hypertension and left ventricular hypertrophy (LVH) have emerged as significant risk factors for cardiovascular events and all-cause mortality. Inflammation and nutrition play critical roles in the development of hypertension and damage to target organs. The HALP Score, which assesses levels of hemoglobin, albumin, lymphocytes, and platelets, is an index closely associated with inflammation and nutrition, and has been demonstrated to be particularly effective in the older population. Hence, the objective of this study was to examine the correlation between the HALP Score and LVH in older patients with hypertension. Methods: We collected and retrospectively analyzed data from 234 older patients, including clinical data, and routine blood, liver function, kidney function, and cardiac ultrasound parameters. All patients were categorized into a non-left ventricular hypertrophy (NLVH) group (n = 131) or an LVH group (n = 103). The association between the HALP Score and LVH was investigated, and potential influencing factors were considered. Results: The LVH group had a significantly lower HALP Score than the NLVH group. Logistic regression analysis revealed that a lower HALP Score and female sex were independent factors associated with LVH in older patients with hypertension (OR = 0.944, 9.962, 95% CI: 0.910–0.979, 3.866–24.300, P = 0.002, <0.001). The area under the curve for the HALP Score in diagnosing LVH in older patients with hypertension was 0.708 (95% CI: 0.641–0.776, P = 0.002). Conclusion: The HALP Score is significantly associated with LVH in older patients with hypertension: lower scores indicate a greater likelihood of LVH. The HALP Score has moderate diagnostic value for LVH in this population.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135444946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has rapidly become a global health emergency. In addition to causing respiratory effects, SARS-CoV-2 can result in cardiac involvement leading to myocardial damage, which is increasingly being explored in the literature. Myocardial injury is an important pathogenic feature of COVID-19. The angiotensin-converting enzyme-2 receptor plays a key role in the pathogenesis of the virus, serving as a “bridge” allowing SARS-CoV-2 to invade the body. However, the exact mechanism underlying how SARS-CoV-2 causes myocardial injury remains unclear. This review summarizes the main possible mechanisms of myocardial injury in patients with COVID-19, including direct myocardial cell injury, microvascular dysfunction, cytokine responses and systemic inflammation, hypoxemia, stress responses, and drug-induced myocardial injury. Understanding of the underlying mechanisms would aid in proper identification and treatment of myocardial injury in patients with COVID-19.
{"title":"Possible Mechanisms of SARS-CoV2-Mediated Myocardial Injury","authors":"Bing Yu, Yalin Wu, Xiaosu Song, Gaizhen Liu, Fengqin Wang, Fenfang Zhang, B. Liang","doi":"10.15212/cvia.2023.0031","DOIUrl":"https://doi.org/10.15212/cvia.2023.0031","url":null,"abstract":"Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has rapidly become a global health emergency. In addition to causing respiratory effects, SARS-CoV-2 can result in cardiac involvement leading to myocardial damage, which is increasingly being explored in the literature. Myocardial injury is an important pathogenic feature of COVID-19. The angiotensin-converting enzyme-2 receptor plays a key role in the pathogenesis of the virus, serving as a “bridge” allowing SARS-CoV-2 to invade the body. However, the exact mechanism underlying how SARS-CoV-2 causes myocardial injury remains unclear. This review summarizes the main possible mechanisms of myocardial injury in patients with COVID-19, including direct myocardial cell injury, microvascular dysfunction, cytokine responses and systemic inflammation, hypoxemia, stress responses, and drug-induced myocardial injury. Understanding of the underlying mechanisms would aid in proper identification and treatment of myocardial injury in patients with COVID-19.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":"1 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67306392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: This study was aimed at validating the accuracy of a proposed algorithm for fully automatic 3D left atrial segmentation and to compare its performance with existing deep learning algorithms. Methods: A two-stage method with a shared 3D U-Net was proposed to segment the 3D left atrium. In this architecture, the 3D U-Net was used to extract 3D features, a two-stage strategy was used to decrease segmentation error caused by the class imbalance problem, and the shared network was designed to decrease model complexity. Model performance was evaluated with the DICE score, Jaccard index and Hausdorff distance. Results: Algorithm development and evaluation were performed with a set of 100 late gadolinium-enhanced cardiovascular magnetic resonance images. Our method achieved a DICE score of 0.918, a Jaccard index of 0.848 and a Hausdorff distance of 1.211, thus, outperforming existing deep learning algorithms. The best performance of the proposed model (DICE: 0.851; Jaccard: 0.750; Hausdorff distance: 4.382) was also achieved on a publicly available 2013 image data set. Conclusion: The proposed two-stage method with a shared 3D U-Net is an efficient algorithm for fully automatic 3D left atrial segmentation. This study provides a solution for processing large datasets in resource-constrained applications. Significance Statement: Studying atrial structure directly is crucial for comprehending and managing atrial fibrillation (AF). Accurate reconstruction and measurement of atrial geometry for clinical purposes remains challenging, despite potential improvements in the visibility of AF-associated structures with late gadolinium-enhanced magnetic resonance imaging. This difficulty arises from the varying intensities caused by increased tissue enhancement and artifacts, as well as variability in image quality. Therefore, an efficient algorithm for fully automatic 3D left atrial segmentation is proposed in the present study.
{"title":"A Two-stage Method with a Shared 3D U-Net for Left Atrial Segmentation of Late Gadolinium-Enhanced MRI Images","authors":"Jieyun Bai, Ruiyu Qiu, Jianyu Chen, Liyuan Wang, Lulu Li, Yanfeng Tian, Huijin Wang, Yaosheng Lu, Jichao Zhao","doi":"10.15212/cvia.2023.0039","DOIUrl":"https://doi.org/10.15212/cvia.2023.0039","url":null,"abstract":"Objective: This study was aimed at validating the accuracy of a proposed algorithm for fully automatic 3D left atrial segmentation and to compare its performance with existing deep learning algorithms. Methods: A two-stage method with a shared 3D U-Net was proposed to segment the 3D left atrium. In this architecture, the 3D U-Net was used to extract 3D features, a two-stage strategy was used to decrease segmentation error caused by the class imbalance problem, and the shared network was designed to decrease model complexity. Model performance was evaluated with the DICE score, Jaccard index and Hausdorff distance. Results: Algorithm development and evaluation were performed with a set of 100 late gadolinium-enhanced cardiovascular magnetic resonance images. Our method achieved a DICE score of 0.918, a Jaccard index of 0.848 and a Hausdorff distance of 1.211, thus, outperforming existing deep learning algorithms. The best performance of the proposed model (DICE: 0.851; Jaccard: 0.750; Hausdorff distance: 4.382) was also achieved on a publicly available 2013 image data set. Conclusion: The proposed two-stage method with a shared 3D U-Net is an efficient algorithm for fully automatic 3D left atrial segmentation. This study provides a solution for processing large datasets in resource-constrained applications. Significance Statement: Studying atrial structure directly is crucial for comprehending and managing atrial fibrillation (AF). Accurate reconstruction and measurement of atrial geometry for clinical purposes remains challenging, despite potential improvements in the visibility of AF-associated structures with late gadolinium-enhanced magnetic resonance imaging. This difficulty arises from the varying intensities caused by increased tissue enhancement and artifacts, as well as variability in image quality. Therefore, an efficient algorithm for fully automatic 3D left atrial segmentation is proposed in the present study.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":"1 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67306656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Cardiovascular diseases, particularly acute myocardial infarction, are the leading cause of disability and death. Atherosclerosis, the pathological basis of AMI, can be accelerated by chronic inflammation. Ulcerative colitis (UC), a chronic inflammatory disease associated with immunity, contributes to the risk of AMI development. However, controversy continues to surround the relationship between these two diseases. The present study unravels the pathogenesis of AMI and UC, to provide a new perspective on the clinical management of patients with these comorbidities. Methods: Microarray datasets GSE66360 and GSE87473 were downloaded from the Gene Expression Omnibus database. Common differentially expressed genes (co-DEGs) between AMI and UC were identified, and the following analyses were performed: enrichment analysis, protein-protein interaction network construction, hub gene identification and co-expression analysis. Results: A total of 267 co-DEGs (233 upregulated and 34 downregulated) were screened for further analysis. GO enrichment analysis suggested important roles of chemokines and cytokines in AMI and UC. In addition, the lipopolysaccharide-mediated signaling pathway was found to be closely associated with both diseases. KEGG enrichment analysis revealed that lipid and atherosclerosis, NF-κB, TNF and IL-17 signaling pathways are the core mechanisms involved in the progression of both diseases. Finally, 11 hub genes were identified with cytoHubba: TNF, IL1B, TLR2, CXCL8, STAT3, MMP9, ITGAX, CCL4, CSF1R, ICAM1 and CXCL1. Conclusion: This study reveals a co-pathogenesis mechanism of AMI and UC regulated by specific hub genes, thus providing ideas for further mechanistic studies, and new perspectives on the clinical management of patients with these comorbidities.
{"title":"Uncovering the Genetic Link between Acute Myocardial Infarction and Ulcerative Colitis Co-Morbidity through a Systems Biology Approach","authors":"Chen Chang, Ru-Ping Cai, Qiang Wu, Q. Su","doi":"10.15212/cvia.2023.0034","DOIUrl":"https://doi.org/10.15212/cvia.2023.0034","url":null,"abstract":"Background: Cardiovascular diseases, particularly acute myocardial infarction, are the leading cause of disability and death. Atherosclerosis, the pathological basis of AMI, can be accelerated by chronic inflammation. Ulcerative colitis (UC), a chronic inflammatory disease associated with immunity, contributes to the risk of AMI development. However, controversy continues to surround the relationship between these two diseases. The present study unravels the pathogenesis of AMI and UC, to provide a new perspective on the clinical management of patients with these comorbidities. Methods: Microarray datasets GSE66360 and GSE87473 were downloaded from the Gene Expression Omnibus database. Common differentially expressed genes (co-DEGs) between AMI and UC were identified, and the following analyses were performed: enrichment analysis, protein-protein interaction network construction, hub gene identification and co-expression analysis. Results: A total of 267 co-DEGs (233 upregulated and 34 downregulated) were screened for further analysis. GO enrichment analysis suggested important roles of chemokines and cytokines in AMI and UC. In addition, the lipopolysaccharide-mediated signaling pathway was found to be closely associated with both diseases. KEGG enrichment analysis revealed that lipid and atherosclerosis, NF-κB, TNF and IL-17 signaling pathways are the core mechanisms involved in the progression of both diseases. Finally, 11 hub genes were identified with cytoHubba: TNF, IL1B, TLR2, CXCL8, STAT3, MMP9, ITGAX, CCL4, CSF1R, ICAM1 and CXCL1. Conclusion: This study reveals a co-pathogenesis mechanism of AMI and UC regulated by specific hub genes, thus providing ideas for further mechanistic studies, and new perspectives on the clinical management of patients with these comorbidities.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":"1 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67306892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jiaxin Zeng, Siyuan Xue, F. Zou, Yuan-hao Qiu, J. Zou
Left bundle branch pacing (LBBP) emerged as a new physiological pacing strategy during the past several years. Recent observational studies have demonstrated the advantages of LBBP, including a high success rate, stable pacing parameters, and excellent clinical benefits. Widespread adoption of LBBP will depend on improvements in device/lead technology and further verification of its efficacy in large randomized clinical trials. In this review, we summarize recent advancements in LBBP, including the definition and evaluation of left bundle branch capture, LBBP applications, and future directions in this growing field.
{"title":"Advances in Left Bundle Branch Pacing: Definition, Evaluation, and Applications","authors":"Jiaxin Zeng, Siyuan Xue, F. Zou, Yuan-hao Qiu, J. Zou","doi":"10.15212/cvia.2023.0047","DOIUrl":"https://doi.org/10.15212/cvia.2023.0047","url":null,"abstract":"Left bundle branch pacing (LBBP) emerged as a new physiological pacing strategy during the past several years. Recent observational studies have demonstrated the advantages of LBBP, including a high success rate, stable pacing parameters, and excellent clinical benefits. Widespread adoption of LBBP will depend on improvements in device/lead technology and further verification of its efficacy in large randomized clinical trials. In this review, we summarize recent advancements in LBBP, including the definition and evaluation of left bundle branch capture, LBBP applications, and future directions in this growing field.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":"1 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67307045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Traditional percutaneous coronary intervention (T-PCI) has long been an effective method for treating coronary heart disease (CHD), but the radiation hazards and orthopedic injuries among T-PCI operators are concerning. These problems have been mitigated with the emergence of robotic percutaneous coronary intervention (R-PCI), which is expected to increase intervention accuracy and safety. In this review, we first summarize the current status of PCI development, including robot systems, and PCI application and evaluation. Second, we compare T-PCI and R-PCI to identify the benefits for patients and physicians. In addition, we describe a new R-PCI system, R-PCI WSER-CD01, which incorporates multi-instrument collaborative delivery and provides full-process assistance in minimally invasive vascular intervention. This system introduces three key innovations that address safety concerns, and improve the accuracy, wire compatibility, and remote operation capabilities of existing of vascular intervention robot systems. Finally, we discuss prospects for the development of R-PCI. As an emerging technology, R-PCI aligns well with the trends of precision medicine and telemedicine, and therefore warrants continued innovation.
{"title":"Robotic Percutaneous Coronary Intervention in Coronary Heart Disease: Applications and Recent Advances","authors":"Yan-Jun Song, Zechen Liu, Weihua Song, Dong Yin, Kefei Dou","doi":"10.15212/cvia.2023.0062","DOIUrl":"https://doi.org/10.15212/cvia.2023.0062","url":null,"abstract":"Traditional percutaneous coronary intervention (T-PCI) has long been an effective method for treating coronary heart disease (CHD), but the radiation hazards and orthopedic injuries among T-PCI operators are concerning. These problems have been mitigated with the emergence of robotic percutaneous coronary intervention (R-PCI), which is expected to increase intervention accuracy and safety. In this review, we first summarize the current status of PCI development, including robot systems, and PCI application and evaluation. Second, we compare T-PCI and R-PCI to identify the benefits for patients and physicians. In addition, we describe a new R-PCI system, R-PCI WSER-CD01, which incorporates multi-instrument collaborative delivery and provides full-process assistance in minimally invasive vascular intervention. This system introduces three key innovations that address safety concerns, and improve the accuracy, wire compatibility, and remote operation capabilities of existing of vascular intervention robot systems. Finally, we discuss prospects for the development of R-PCI. As an emerging technology, R-PCI aligns well with the trends of precision medicine and telemedicine, and therefore warrants continued innovation.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135908754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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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