Pub Date : 2024-08-19DOI: 10.1101/2024.08.14.24311086
Ivan Eltsov, Alvise Del Monte, Luigi Pannone, INGRID OVEREINDER, Domenico Della Rocca, Roberto Scacciavillani, Frederik Hendrik Verbrugge, Qingguo Zeng, Gezim Bala, Andrea Paparella, Giacomo Talevi, Erwin Stroker, Juan Sieira, Ali Gharaviri, Andrea Sarkozy, Gian-Battista Chierchia, Mark La Meir, Carlo de Asmundis, Alexandre Almorad
Background. Left Bundle bracnch area pacing has become the procedure of choice for various indications including atrioventricular block and considered to be physiologic modality of pacing compare to RV apex pacing. Objectives. The purpose of this study was to assess ventricular activation and synchrony in patients with LBBAP device using ECG imaging. Methods. 25 consecutive patients underwent an LBBAP device implantation have been included in the study. ECG and ECGI analysys have been performed the day after implantation. Native and paced QRS, LVAT, RVAT and V1AD were calculated using ECG. TVACT, LVACT, LVACTi, RVACT, RVACTi and IVDS were calculated based on ECGI. All patients were followed up for at least 1 year. Results All patients were divided in 2 groups (wide and narrow QRS) based on intrinsic ECG and then based on paced ECG parameters. Study showed that for initially narrow QRS group activation time and synchrony during pacing was comparable to native. In wide QRS group these parameters were significantly improved. For paced rhythm analysis classic ECG LBBAP parameters (paced QRS and LVAT) were not sufficient to properly evaluate the ventricular activation for paced rhythm. Discordance between ECG and ECGI analysys was identified. Two additional 12 lead ECG parameters predicting the ECGI measurements were found. Follow up did not show any worsening of device parameters or Echographic and ECG signs of ventricular dissynchrony Conclusions ECG imaging can bring a significant value into assessing the efficacy of new pacing modalities and provide much more data for precise determination of implantation outcome including detailed activation assessment and comparison to intrinsic conduction. Key ECGI values confirming proper ventricular activation have been defined and corresponding 12 lead parameters were also identified.
{"title":"Noninvasive electrocardiographic imaging assessment of conduction system pacing device: a novel algorithm to assess intraventricular synchrony","authors":"Ivan Eltsov, Alvise Del Monte, Luigi Pannone, INGRID OVEREINDER, Domenico Della Rocca, Roberto Scacciavillani, Frederik Hendrik Verbrugge, Qingguo Zeng, Gezim Bala, Andrea Paparella, Giacomo Talevi, Erwin Stroker, Juan Sieira, Ali Gharaviri, Andrea Sarkozy, Gian-Battista Chierchia, Mark La Meir, Carlo de Asmundis, Alexandre Almorad","doi":"10.1101/2024.08.14.24311086","DOIUrl":"https://doi.org/10.1101/2024.08.14.24311086","url":null,"abstract":"Background. Left Bundle bracnch area pacing has become the procedure of choice for various indications including atrioventricular block and considered to be physiologic modality of pacing compare to RV apex pacing. Objectives. The purpose of this study was to assess ventricular activation and synchrony in patients with LBBAP device using ECG imaging. Methods. 25 consecutive patients underwent an LBBAP device implantation have been included in the study. ECG and ECGI analysys have been performed the day after implantation. Native and paced QRS, LVAT, RVAT and V1AD were calculated using ECG. TVACT, LVACT, LVACTi, RVACT, RVACTi and IVDS were calculated based on ECGI.\u0000All patients were followed up for at least 1 year. Results All patients were divided in 2 groups (wide and narrow QRS) based on intrinsic ECG and then based on paced ECG parameters. Study showed that for initially narrow QRS group activation time and synchrony during pacing was comparable to native. In wide QRS group these parameters were significantly improved. For paced rhythm analysis classic ECG LBBAP parameters (paced QRS and LVAT) were not sufficient to properly evaluate the ventricular activation for paced rhythm. Discordance between ECG and ECGI analysys was identified. Two additional 12 lead ECG parameters predicting the ECGI measurements were found.\u0000Follow up did not show any worsening of device parameters or Echographic and ECG signs of ventricular dissynchrony Conclusions ECG imaging can bring a significant value into assessing the efficacy of new pacing modalities and provide much more data for precise determination of implantation outcome including detailed activation assessment and comparison to intrinsic conduction. Key ECGI values confirming proper ventricular activation have been defined and corresponding 12 lead parameters were also identified.","PeriodicalId":501297,"journal":{"name":"medRxiv - Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142219006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-19DOI: 10.1101/2024.08.16.24312144
Shijie Zhou, Douglas S. Lee, Francis Nguyen, Harsukh Benipal, Richard Perez, Peter C. Austin, Husam Abdel-Qadir, Jacob A. Udell, Catherine Demers
Background: To support family physicians (FPs) in managing patients with heart failure (HF), the Ministry of Health in Ontario, Canada, implemented the Q050 billing code in 2008, a pay-for-performance (P4P) incentive for guideline-based HF care. We studied whether the incentive was associated with any change in process-of-care measure, particularly the prescriptions of HF medications. Methods: We identified all patients with HF in Ontario of age>65, who were managed by FPs claiming the Q050 incentive between 2008 and 2021. We counted the number of patients who were prescribed renin-angiotensin system inhibitors (RASi), beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), and diuretics three months before and after the Q050 billing code was claimed for these patients. Where applicable, we classified the agents within each class by whether they are guideline-directed as recommended by the Canadian Cardiovascular Society (CCS). Results: We included 39,425 HF patients in the study. The median age was 80 (IQR 73-85) years; 49% were female. Half were assessed by an internist or cardiologist during the six months before their HF diagnosis. Compared to pre-Q050, there was an increase in RASi prescriptions from 42.5% to 45.8%, BB from 51.9% to 54.4%, MRA from 9.2% to 11.7%, and diuretics from 63.2% to 65.7% after the incentive (p<0.05). There was a decrease in those not on any HF medications from 27.5% to 24.9% (p<0.001). Those with newly diagnosed HF and prompt follow-up with FPs experienced the largest but clinically modest increase in HF medications. Conclusions: To our knowledge, this is the first evaluation of process-of-care measures related to a pay-for-performance program in primary care HF management. The Q050 incentive led to a minimal increase in the prescription of HF medications; there is underutilization of disease-modifying agents. Further research is needed to understand why pay-for-performance programs had no effect on physician prescribing behaviours.
{"title":"The effect of an incentive billing code on heart failure management in primary care: a population-based study","authors":"Shijie Zhou, Douglas S. Lee, Francis Nguyen, Harsukh Benipal, Richard Perez, Peter C. Austin, Husam Abdel-Qadir, Jacob A. Udell, Catherine Demers","doi":"10.1101/2024.08.16.24312144","DOIUrl":"https://doi.org/10.1101/2024.08.16.24312144","url":null,"abstract":"Background: To support family physicians (FPs) in managing patients with heart failure (HF), the Ministry of Health in Ontario, Canada, implemented the Q050 billing code in 2008, a pay-for-performance (P4P) incentive for guideline-based HF care. We studied whether the incentive was associated with any change in process-of-care measure, particularly the prescriptions of HF medications.\u0000Methods: We identified all patients with HF in Ontario of age>65, who were managed by FPs claiming the Q050 incentive between 2008 and 2021. We counted the number of patients who were prescribed renin-angiotensin system inhibitors (RASi), beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), and diuretics three months before and after the Q050 billing code was claimed for these patients. Where applicable, we classified the agents within each class by whether they are guideline-directed as recommended by the Canadian Cardiovascular Society (CCS). Results: We included 39,425 HF patients in the study. The median age was 80 (IQR 73-85) years; 49% were female. Half were assessed by an internist or cardiologist during the six months before their HF diagnosis. Compared to pre-Q050, there was an increase in RASi prescriptions from 42.5% to 45.8%, BB from 51.9% to 54.4%, MRA from 9.2% to 11.7%, and diuretics from 63.2% to 65.7% after the incentive (p<0.05). There was a decrease in those not on any HF medications from 27.5% to 24.9% (p<0.001). Those with newly diagnosed HF and prompt follow-up with FPs experienced the largest but clinically modest increase in HF medications. Conclusions: To our knowledge, this is the first evaluation of process-of-care measures related to a pay-for-performance program in primary care HF management. The Q050 incentive led to a minimal increase in the prescription of HF medications; there is underutilization of disease-modifying agents. Further research is needed to understand why pay-for-performance programs had no effect on physician prescribing behaviours.","PeriodicalId":501297,"journal":{"name":"medRxiv - Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142219005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Heart failure is a complex clinical syndrome resulting from structural and functional impairment of ventricular filling or ejection of blood. Cor pulmonale is one type of this clinical syndrome. There are only a few published studies on cor pulmonale from Ethiopia. The objective of this study was to determine the prevalence among patients with heart failure and the clinical and laboratory profiles of patients with cor pulmonale who had follow up at one of the tertiary hospitals in Ethiopia Methods: A hospital-based cross-sectional study was conducted at Felege Hiwot Referral Hospital from December 2018 to April 2019. A single population proportion formula was used to determine the number of heart failure patients that had to be included in the study to determine the prevalence of cor pulmonale. The medical records of cor pulmonale patients among the sample heart failure patients were then retrieved and data was extracted using a structured checklist. Data was entered into, cleaned, and analyzed using IBM.SPSS version 23.0. Descriptive statistics were used to report the findings. Results: Eight percent (35) of patients with heart failure had cor pulmonale. Fifty-four point three percent (19) of the patients with cor pulmonale were males and 45.7 %( 16) were females. The median age of patients with cor pulmonale was 55 years. The commonest clinical features were cough and dyspnea (91.4 % and 97.1 % respectively). All patients had right ventricular dilation on echocardiography. Pulmonary Complications post-treatment for tuberculosis were the leading causes followed by interstitial lung disease. There was no identified respiratory disease in 40% of patients with cor pulmonale Conclusion: Cor pulmonale accounted for less than 10 % of heart failure cases. Complications post-pulmonary tuberculosis were found to be the leading respiratory conditions underlying the cor pulmonale. Programs on prevention, early detection, and treatment of pulmonary tuberculosis must be strengthened.
{"title":"The prevalence among heart failure patients and clinical profiles of patients with cor pulmonale at a tertiary center in Ethiopia","authors":"Sewale Anagaw Tadesse, Habtamu Bayih, Netsanet Fentahun, Yohannes Tekleab","doi":"10.1101/2024.08.16.24312095","DOIUrl":"https://doi.org/10.1101/2024.08.16.24312095","url":null,"abstract":"Background: Heart failure is a complex clinical syndrome resulting from structural and functional impairment of ventricular filling or ejection of blood. Cor pulmonale is one type of this clinical syndrome. There are only a few published studies on cor pulmonale from Ethiopia. The objective of this study was to determine the prevalence among patients with heart failure and the clinical and laboratory profiles of patients with cor pulmonale who had follow up at one of the tertiary hospitals in Ethiopia\u0000Methods: A hospital-based cross-sectional study was conducted at Felege Hiwot Referral Hospital from December 2018 to April 2019. A single population proportion formula was used to determine the number of heart failure patients that had to be included in the study to determine the prevalence of cor pulmonale. The medical records of cor pulmonale patients among the sample heart failure patients were then retrieved and data was extracted using a structured checklist. Data was entered into, cleaned, and analyzed using IBM.SPSS version 23.0. Descriptive statistics were used to report the findings.\u0000Results: Eight percent (35) of patients with heart failure had cor pulmonale. Fifty-four point three percent (19) of the patients with cor pulmonale were males and 45.7 %( 16) were females. The median age of patients with cor pulmonale was 55 years. The commonest clinical features were cough and dyspnea (91.4 % and 97.1 % respectively). All patients had right ventricular dilation on echocardiography. Pulmonary Complications post-treatment for tuberculosis were the leading causes followed by interstitial lung disease. There was no identified respiratory disease in 40% of patients with cor pulmonale\u0000Conclusion: Cor pulmonale accounted for less than 10 % of heart failure cases. Complications post-pulmonary tuberculosis were found to be the leading respiratory conditions underlying the cor pulmonale. Programs on prevention, early detection, and treatment of pulmonary tuberculosis must be strengthened.","PeriodicalId":501297,"journal":{"name":"medRxiv - Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142219008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-17DOI: 10.1101/2024.08.16.24312093
gürkan karakuş, cemşit karakurt, yılmaz tabel, mehmet çağatay taşkapan, ayşehan akıncı, harika gözde gözükara bağ
Background: The studies examining the relationship between hypertension, obesity and inflammation are increasing. It is suggested that markers of inflammation may predict obesity-related hypertension.Objective: The aim of study is to determine the relationship between the inflammation and the severity of hypertension with the inflammation biomarkers including CRP, IL-1, pro-BNP, leptin, pentraxin-3 levels in children with obesity-related hypertension.Material and Methods: This cross-sectional study involved patients diagnosed with obesity-related hypertension and healthy children. The sociodemographic data, anthropometric measurements, blood pressure, 24-hour ambulatory blood pressure, and echocardiographic findings were recorded. IL-1, CRP, leptin, pro-BNP, and pentraxin-3 levels were measured in the venous blood sample taken from the patient and control groups.Results: Systolic blood pressure, diastolic blood pressure, height, weight, body mass index were statistically significantly higher in the patient group than the healthy controls. In patient group, echocardiographic examination revealed findings confirming left ventricular hypertrophy. CRP (p=0.041) and leptin (p<0.001) levels of the patient group were found to be significantly higher than the control group. There was no significant difference between the groups in terms of pentraxin-3 (p=0.917), IL-1 (p=0.981), and pro-BNP (p=0.288) levels. We found that there was a moderate positive correlation between leptin and systolic blood pressure in healthy children, moderately strong correlations between Pro-BNP and systolic blood pressure in the negative corelation, and a weak positive correlation between leptin and diastolic blood pressure in obesity group.
{"title":"EVALUATON OF INFLAMMATION WITH CRP, IL-1, PRO-BNP, LEPTIN AND PETRAXIN -3 LEVELS IN OBESITY-RELATED HYPERTENSION","authors":"gürkan karakuş, cemşit karakurt, yılmaz tabel, mehmet çağatay taşkapan, ayşehan akıncı, harika gözde gözükara bağ","doi":"10.1101/2024.08.16.24312093","DOIUrl":"https://doi.org/10.1101/2024.08.16.24312093","url":null,"abstract":"Background: The studies examining the relationship between hypertension, obesity and inflammation are increasing. It is suggested that markers of inflammation may predict obesity-related hypertension.Objective: The aim of study is to determine the relationship between the inflammation and the severity of hypertension with the inflammation biomarkers including CRP, IL-1, pro-BNP, leptin, pentraxin-3 levels in children with obesity-related hypertension.Material and Methods: This cross-sectional study involved patients diagnosed with obesity-related hypertension and healthy children. The sociodemographic data, anthropometric measurements, blood pressure, 24-hour ambulatory blood pressure, and echocardiographic findings were recorded. IL-1, CRP, leptin, pro-BNP, and pentraxin-3 levels were measured in the venous blood sample taken from the patient and control groups.Results: Systolic blood pressure, diastolic blood pressure, height, weight, body mass index were statistically significantly higher in the patient group than the healthy controls. In patient group, echocardiographic examination revealed findings confirming left ventricular hypertrophy. CRP (p=0.041) and leptin (p<0.001) levels of the patient group were found to be significantly higher than the control group. There was no significant difference between the groups in terms of pentraxin-3 (p=0.917), IL-1 (p=0.981), and pro-BNP (p=0.288) levels. We found that there was a moderate positive correlation between leptin and systolic blood pressure in healthy children, moderately strong correlations between Pro-BNP and systolic blood pressure in the negative corelation, and a weak positive correlation between leptin and diastolic blood pressure in obesity group.","PeriodicalId":501297,"journal":{"name":"medRxiv - Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142219023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-15DOI: 10.1101/2024.08.14.24312025
Omar Qureshi, Carlos Mena-Hurtado, Gaëlle Romain, Jacob Cleman, Santiago Callegari, Kim G. Smolderen
Background Approximately 20% of ischemic strokes in the U.S. result from carotid artery stenosis. Carotid artery stenting (CAS) can reduce stroke risk, but variability in post-stenting health outcomes and their predictors are poorly understood. We examined 30-day post-CAS health status and derived its most important clinical predictors.
背景 美国约有 20% 的缺血性中风是由颈动脉狭窄引起的。颈动脉支架置入术（CAS）可降低中风风险，但人们对支架置入术后健康状况的变化及其预测因素知之甚少。我们研究了 CAS 术后 30 天的健康状况，并得出了其最重要的临床预测因素。
{"title":"Applying a Random Forest Approach in Predicting Health Status in Patients with Carotid Artery Stenosis 30 Days Post-Stenting","authors":"Omar Qureshi, Carlos Mena-Hurtado, Gaëlle Romain, Jacob Cleman, Santiago Callegari, Kim G. Smolderen","doi":"10.1101/2024.08.14.24312025","DOIUrl":"https://doi.org/10.1101/2024.08.14.24312025","url":null,"abstract":"<strong>Background</strong> Approximately 20% of ischemic strokes in the U.S. result from carotid artery stenosis. Carotid artery stenting (CAS) can reduce stroke risk, but variability in post-stenting health outcomes and their predictors are poorly understood. We examined 30-day post-CAS health status and derived its most important clinical predictors.","PeriodicalId":501297,"journal":{"name":"medRxiv - Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142219010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-08DOI: 10.1101/2024.08.06.24311534
Rafik Margaryan, Giovanni Concistre', Giacomo bianchi, Marco Solinas
Objective Aim of this study was to compare old (manufacturer recommended) and new (institution based) sizing techniques for sutureless valve. Materials A 226 consecutively operated patients underwent aortic valve replacement with Perceval sutureless valve (Corcym) and had CT scan with contrast enhancement were included to this study. The final decision of appropriate size is based on intra-operative obturator sizing. Briefly, we have measured on the CT scans the annular ring surface and perimeter in order to estimate the prosthesis size. New sizing technique uses only white obturator of Perceval and it should passe trough the annulus with slight friction, which practically under-sizes with respect to manufacturer's recommendations. Results The operative mortality was 1 (0.44 %). There were no prosthesis migration neither annular rupture in any group. The mean follow up was lower in new group (3.3 ± 2.0 vs 9.7 ± 1.6, p < 0.01). At the discharge the patients who have used the new sizing technique had less gradient on the prosthetic valve (13.4 ± 5.0 vs 15.2 ± 5.5, p = 0.02). The new sizing was less prone to degeneration at the follow-up which would require intervention (13.4 ± 5.0 vs 15.2 ± 5.5, p = 0.02). Oversizing of 22.6% had significant role on valve gradient increase and structural degeneration (p < 0.05). Conclusions New sizing technique is safe and reproducible. It seem to deliver better immediate and long term benefits for Perceval sutureless valve, less postoperative gradient, less probability or structural degeneration.
{"title":"Novel Perceval Sizing Technique: Single Center Experience","authors":"Rafik Margaryan, Giovanni Concistre', Giacomo bianchi, Marco Solinas","doi":"10.1101/2024.08.06.24311534","DOIUrl":"https://doi.org/10.1101/2024.08.06.24311534","url":null,"abstract":"Objective Aim of this study was to compare old (manufacturer recommended) and new (institution based) sizing techniques for sutureless valve. Materials A 226 consecutively operated patients underwent aortic valve replacement with Perceval sutureless valve (Corcym) and had CT scan with contrast enhancement were included to this study. The final decision of appropriate size is based on intra-operative obturator sizing. Briefly, we have measured on the CT scans the annular ring surface and perimeter in order to estimate the prosthesis size. New sizing technique uses only white obturator of Perceval and it should passe trough the annulus with slight friction, which practically under-sizes with respect to manufacturer's recommendations. Results The operative mortality was 1 (0.44 %). There were no prosthesis migration neither annular rupture in any group. The mean follow up was lower in new group (3.3 ± 2.0 vs 9.7 ± 1.6, p < 0.01). At the discharge the patients who have used the new sizing technique had less gradient on the prosthetic valve (13.4 ± 5.0 vs 15.2 ± 5.5, p = 0.02). The new sizing was less prone to degeneration at the follow-up which would require intervention (13.4 ± 5.0 vs 15.2 ± 5.5, p = 0.02). Oversizing of 22.6% had significant role on valve gradient increase and structural degeneration (p < 0.05). Conclusions New sizing technique is safe and reproducible. It seem to deliver better immediate and long term benefits for Perceval sutureless valve, less postoperative gradient, less probability or structural degeneration.","PeriodicalId":501297,"journal":{"name":"medRxiv - Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141942171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-06DOI: 10.1101/2024.08.05.24311527
Lei Wang, Xinmeng Zhang, You Chen, Charles Robb Flynn, Wayne English, Jason Samuels, D. Brandon Williams, Matthew Spann, Vance L. Albaugh, Xiao Ou Shu, Danxia Yu
Background: We applied the novel Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) equations to evaluate cardiovascular-kidney-metabolic (CKM) health and estimated CVD risk, including heart failure (HF), after bariatric surgery. Methods: Among 7804 patients (20-79 years) undergoing bariatric surgery at Vanderbilt University Medical Center during 1999-2022, CVD risk factors at pre-surgery, 1-year, and 2-year post-surgery were extracted from electronic health records. The 10- and 30-year risks of total CVD, atherosclerotic CVD (ASCVD), coronary heart disease (CHD), stroke, and HF were estimated for patients without a history of CVD or its subtypes at each time point, using the social deprivation index-enhanced PREVENT equations. Paired t-tests or McNemar tests were used to compare pre- with post-surgery CKM health and CVD risk. Two-sample t-tests were used to compare CVD risk reduction between patient subgroups defined by age, sex, race, operation type, weight loss, and history of diabetes, hypertension, and dyslipidemia. Results: CKM health was significantly improved after surgery with lower systolic blood pressure, non-high-density-lipoprotein cholesterol (non-HDL), and diabetes prevalence, but higher HDL and estimated glomerular filtration rate (eGFR). The 10-year total CVD risk decreased from 6.51% at pre-surgery to 4.81% and 5.08% at 1- and 2-year post-surgery (relative reduction: 25.9% and 16.8%), respectively. Significant risk reductions were seen for all CVD subtypes (i.e., ASCVD, CHD, stroke, and HF), with the largest reduction for HF (relative reduction: 55.7% and 44.8% at 1- and 2-year post-surgery, respectively). Younger age, White race, >30% weight loss, diabetes history, and no dyslipidemia history were associated with greater HF risk reductions. Similar results were found for the 30-year risk estimates. Conclusions: Bariatric surgery significantly improves CKM health and reduces estimated CVD risk, particularly HF, by 45-56% within 1-2 years post-surgery. HF risk reduction may vary by patient's demographics, weight loss, and disease history, which warrants further research.
{"title":"Reduced Risk of Cardiovascular Diseases after Bariatric Surgery Based on the New PREVENT Equations","authors":"Lei Wang, Xinmeng Zhang, You Chen, Charles Robb Flynn, Wayne English, Jason Samuels, D. Brandon Williams, Matthew Spann, Vance L. Albaugh, Xiao Ou Shu, Danxia Yu","doi":"10.1101/2024.08.05.24311527","DOIUrl":"https://doi.org/10.1101/2024.08.05.24311527","url":null,"abstract":"Background: We applied the novel Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) equations to evaluate cardiovascular-kidney-metabolic (CKM) health and estimated CVD risk, including heart failure (HF), after bariatric surgery. Methods: Among 7804 patients (20-79 years) undergoing bariatric surgery at Vanderbilt University Medical Center during 1999-2022, CVD risk factors at pre-surgery, 1-year, and 2-year post-surgery were extracted from electronic health records. The 10- and 30-year risks of total CVD, atherosclerotic CVD (ASCVD), coronary heart disease (CHD), stroke, and HF were estimated for patients without a history of CVD or its subtypes at each time point, using the social deprivation index-enhanced PREVENT equations. Paired t-tests or McNemar tests were used to compare pre- with post-surgery CKM health and CVD risk. Two-sample t-tests were used to compare CVD risk reduction between patient subgroups defined by age, sex, race, operation type, weight loss, and history of diabetes, hypertension, and dyslipidemia. Results: CKM health was significantly improved after surgery with lower systolic blood pressure, non-high-density-lipoprotein cholesterol (non-HDL), and diabetes prevalence, but higher HDL and estimated glomerular filtration rate (eGFR). The 10-year total CVD risk decreased from 6.51% at pre-surgery to 4.81% and 5.08% at 1- and 2-year post-surgery (relative reduction: 25.9% and 16.8%), respectively. Significant risk reductions were seen for all CVD subtypes (i.e., ASCVD, CHD, stroke, and HF), with the largest reduction for HF (relative reduction: 55.7% and 44.8% at 1- and 2-year post-surgery, respectively). Younger age, White race, >30% weight loss, diabetes history, and no dyslipidemia history were associated with greater HF risk reductions. Similar results were found for the 30-year risk estimates.\u0000Conclusions: Bariatric surgery significantly improves CKM health and reduces estimated CVD risk, particularly HF, by 45-56% within 1-2 years post-surgery. HF risk reduction may vary by patient's demographics, weight loss, and disease history, which warrants further research.","PeriodicalId":501297,"journal":{"name":"medRxiv - Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141941986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-06DOI: 10.1101/2024.08.02.24310874
James N Brundage, Josh P Barrios, Geoffrey H Tison, James P Pirruccello
Heart structure and function change with age, and the notion that the heart may age faster for some individuals than for others has driven interest in estimating cardiac age acceleration. However, current approaches have limited feature richness (heart measurements; radiomics) or capture extraneous data and therefore lack cardiac specificity (deep learning [DL] on unmasked chest MRI). These technical limitations have been a barrier to efforts to understand genetic contributions to age acceleration. We hypothesized that a video-based DL model provided with heart-masked MRI data would capture a rich yet cardiac-specific representation of cardiac aging. In 61,691 UK Biobank participants, we excluded noncardiac pixels from cardiac MRI and trained a video-based DL model to predict age from one cardiac cycle in the 4-chamber view. We then computed cardiac age acceleration as the bias-corrected prediction of heart age minus the calendar age. Predicted heart age explained 71.1% of variance in calendar age, with a mean absolute error of 3.3 years. Cardiac age acceleration was linked to unfavorable cardiac geometry and systolic and diastolic dysfunction. We also observed links between cardiac age acceleration and diet, decreased physical activity, increased alcohol and tobacco use, and altered levels of 239 serum proteins, as well as adverse brain MRI characteristics. We found cardiac age acceleration to be heritable (h2g 26.6%); a genome-wide association study identified 8 loci related to linked to cardiomyopathy (near TTN, TNS1, LSM3, PALLD, DSP, PLEC, ANKRD1 and MYO18B) and an additional 16 loci (near MECOM, NPR3, KLHL3, HDGFL1, CDKN1A, ELN, SLC25A37, PI15, AP3M1, HMGA2, ADPRHL1, PGAP3, WNT9B, UHRF1 and DOK5). Of the discovered loci, 21 were not previously associated with cardiac age acceleration. Mendelian randomization revealed that lower genetically mediated levels of 6 circulating proteins (MSRA most strongly), as well as greater levels of 5 proteins (LXN most strongly) were associated with cardiac age acceleration, as were greater blood pressure and Lp(a). A polygenic score for cardiac age acceleration predicted earlier onset of arrhythmia, heart failure, myocardial infarction, and mortality. These findings provide a thematic understanding of cardiac age acceleration and suggest that heart- and vascular-specific factors are key to cardiac age acceleration, predominating over a more global aging program.
{"title":"Genetics of Cardiac Aging Implicate Organ-Specific Variation","authors":"James N Brundage, Josh P Barrios, Geoffrey H Tison, James P Pirruccello","doi":"10.1101/2024.08.02.24310874","DOIUrl":"https://doi.org/10.1101/2024.08.02.24310874","url":null,"abstract":"Heart structure and function change with age, and the notion that the heart may age faster for some individuals than for others has driven interest in estimating cardiac age acceleration. However, current approaches have limited feature richness (heart measurements; radiomics) or capture extraneous data and therefore lack cardiac specificity (deep learning [DL] on unmasked chest MRI). These technical limitations have been a barrier to efforts to understand genetic contributions to age acceleration. We hypothesized that a video-based DL model provided with heart-masked MRI data would capture a rich yet cardiac-specific representation of cardiac aging. In 61,691 UK Biobank participants, we excluded noncardiac pixels from cardiac MRI and trained a video-based DL model to predict age from one cardiac cycle in the 4-chamber view. We then computed cardiac age acceleration as the bias-corrected prediction of heart age minus the calendar age. Predicted heart age explained 71.1% of variance in calendar age, with a mean absolute error of 3.3 years. Cardiac age acceleration was linked to unfavorable cardiac geometry and systolic and diastolic dysfunction. We also observed links between cardiac age acceleration and diet, decreased physical activity, increased alcohol and tobacco use, and altered levels of 239 serum proteins, as well as adverse brain MRI characteristics. We found cardiac age acceleration to be heritable (h2g 26.6%); a genome-wide association study identified 8 loci related to linked to cardiomyopathy (near TTN, TNS1, LSM3, PALLD, DSP, PLEC, ANKRD1 and MYO18B) and an additional 16 loci (near MECOM, NPR3, KLHL3, HDGFL1, CDKN1A, ELN, SLC25A37, PI15, AP3M1, HMGA2, ADPRHL1, PGAP3, WNT9B, UHRF1 and DOK5). Of the discovered loci, 21 were not previously associated with cardiac age acceleration. Mendelian randomization revealed that lower genetically mediated levels of 6 circulating proteins (MSRA most strongly), as well as greater levels of 5 proteins (LXN most strongly) were associated with cardiac age acceleration, as were greater blood pressure and Lp(a). A polygenic score for cardiac age acceleration predicted earlier onset of arrhythmia, heart failure, myocardial infarction, and mortality.\u0000These findings provide a thematic understanding of cardiac age acceleration and suggest that heart- and vascular-specific factors are key to cardiac age acceleration, predominating over a more global aging program.","PeriodicalId":501297,"journal":{"name":"medRxiv - Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141941994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-06DOI: 10.1101/2024.08.05.24311525
Ali AlRamini, Farahnaz Tafti, Mohammad Ali Takallou, Iraklis Ilias Pipinos, Sara A. Myers, Fadi Alsaleem
Peripheral Artery Disease (PAD) significantly impairs quality of life and presents varying degrees of severity that correctly identifying would help choose the proper treatment approach and enable personalized treatment approaches. However, the challenge is that there is no single agreed-on measure to quantify the severity of a patient with PAD. This led to a trial-and-error approach to deciding the course of treatment for a given patient with PAD. This study uses non-clinical data, such as biomechanical data and advanced machine-learning techniques, to detect PAD severity levels and enhance treatment selection to overcome this challenge. After analyzing biomechanical data from 42 healthy controls and 65 patients with PAD before and after treatment and correlating it with other measures such as quality of life questionnaires, our findings reveal that ground reaction forces (GRF) features emerged as robust indicators of PAD severity. The GRF Propulsive Peak, in particular, demonstrated high accuracy (0.909) in quantifying PAD severity and is used to develop a straightforward metric for assessing PAD severity. This severity metric is used to gauge the outcome of a specific PAD treatment by comparing the severity before and after the treatment. Machine-learning models were then developed to predict such post-treatment outcomes effectively from the patient non-clinical data before treatment. This approach showed promise in predicting the effectiveness of a treatment for a patient with PAD before performing it, highlighting the potential of machine learning models in revolutionizing PAD treatment strategies. Our findings lay the groundwork for a more data-driven, patient-centric approach to PAD management, optimizing treatment strategies for better patient outcomes.
外周动脉疾病（PAD）严重影响生活质量，其严重程度各不相同，正确识别有助于选择适当的治疗方法，实现个性化治疗。然而，目前面临的挑战是没有一种公认的方法来量化 PAD 患者的严重程度。这就导致在决定给定的 PAD 患者的治疗方案时需要反复试验。本研究利用生物力学数据等非临床数据和先进的机器学习技术来检测 PAD 的严重程度并加强治疗选择，从而克服了这一难题。在对 42 名健康对照组和 65 名 PAD 患者治疗前后的生物力学数据进行分析，并将其与生活质量调查问卷等其他测量方法进行关联后，我们的研究结果表明，地面反作用力（GRF）特征是 PAD 严重程度的可靠指标。尤其是地面反作用力推进峰，在量化 PAD 严重程度方面表现出了很高的准确性（0.909），并被用于制定评估 PAD 严重程度的直接指标。通过比较治疗前后的严重程度，该严重程度指标可用于衡量特定 PAD 治疗的结果。然后开发了机器学习模型，以便从患者治疗前的非临床数据中有效预测治疗后的结果。这种方法显示了在对 PAD 患者进行治疗前预测治疗效果的前景，凸显了机器学习模型在革新 PAD 治疗策略方面的潜力。我们的研究结果为以数据为驱动、以患者为中心的PAD管理方法奠定了基础，优化了治疗策略，改善了患者的预后。
{"title":"Toward Predicting Peripheral Artery Disease Treatment Outcomes Using Non-Clinical Data","authors":"Ali AlRamini, Farahnaz Tafti, Mohammad Ali Takallou, Iraklis Ilias Pipinos, Sara A. Myers, Fadi Alsaleem","doi":"10.1101/2024.08.05.24311525","DOIUrl":"https://doi.org/10.1101/2024.08.05.24311525","url":null,"abstract":"Peripheral Artery Disease (PAD) significantly impairs quality of life and presents varying degrees of severity that correctly identifying would help choose the proper treatment approach and enable personalized treatment approaches. However, the challenge is that there is no single agreed-on measure to quantify the severity of a patient with PAD. This led to a trial-and-error approach to deciding the course of treatment for a given patient with PAD. This study uses non-clinical data, such as biomechanical data and advanced machine-learning techniques, to detect PAD severity levels and enhance treatment selection to overcome this challenge. After analyzing biomechanical data from 42 healthy controls and 65 patients with PAD before and after treatment and correlating it with other measures such as quality of life questionnaires, our findings reveal that ground reaction forces (GRF) features emerged as robust indicators of PAD severity. The GRF Propulsive Peak, in particular, demonstrated high accuracy (0.909) in quantifying PAD severity and is used to develop a straightforward metric for assessing PAD severity. This severity metric is used to gauge the outcome of a specific PAD treatment by comparing the severity before and after the treatment. Machine-learning models were then developed to predict such post-treatment outcomes effectively from the patient non-clinical data before treatment. This approach showed promise in predicting the effectiveness of a treatment for a patient with PAD before performing it, highlighting the potential of machine learning models in revolutionizing PAD treatment strategies. Our findings lay the groundwork for a more data-driven, patient-centric approach to PAD management, optimizing treatment strategies for better patient outcomes.","PeriodicalId":501297,"journal":{"name":"medRxiv - Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141941987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-04DOI: 10.1101/2024.08.02.24311436
C (Linda) MC van Campen, Freek W.A. Verheugt, Peter C Rowe, Frans C Visser
Introduction: Orthostatic intolerance is highly prevalent in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and is caused by an abnormal reduction in cerebral blood flow (CBF). In healthy controls (HC) regulation of CBF is complex and involves multiple mechanisms including cardiac output (CO), cerebral perfusion pressure, PO2 and PCO2, flow-metabolism coupling, and innervation of cerebral vessels. In ME/CFS multiple other mechanisms have also been identified. Aim of the study: We previously found that both CBF and CO were reduced in ME/CFS patients during tilt testing, and we hypothesized that the relation between CBF and CO is abnormal and different from HC. In this retrospective study we analyzed this relation in a large group of patients. To compare the patient data with those of HC, we focused on patients with a normal heart rate (HR) and blood pressure (BP) response to upright tilt. Also, the influence of clinical data was analyzed. Methods: A total of 534 ME/CFS patients and 49 HC underwent tilt testing with measurements of HR, BP, CBF, and CO. In 46 (9%) patients CO and CBF changes were in the normal range of HC, and in 488 (91%) an abnormal CO and CBF reduction was found. Results: patients with a CO and CBF reduction in the range of HC had less severe disease and were more likely to be male. In patients with an abnormal CO and CBF reduction the slope of the regression line of CO versus CBF reduction was almost 1. A multiple regression analysis of the latter group, including patients with PetCO2 measurements (440/488: 90%) showed that the CO reduction for the major part predicted the CBF reduction, with a limited role for the PetCO2 reduction and the tilt duration. Other data did not add to the model. Conclusions: Two different patient groups with a normal HR and BP response during the tilt were identified: those with a CO and CBF in the normal range of HC and those with an abnormal CO and CBF reduction during the tilt (91% of patients). The former group had milder disease and included more men. In the largest group of patients there was an almost 1:1 relation between the CO and CBF reduction, suggesting absence of compensatory vasodilation in the cerebral vasculature. This may be an appropriate target for clinical and therapeutic interventions.
导言：肌痛性脑脊髓炎/慢性疲劳综合征（ME/CFS）患者普遍存在直立性不耐受，其原因是脑血流量（CBF）异常减少。在健康对照组（HC）中，CBF 的调节是复杂的，涉及多种机制，包括心输出量（CO）、脑灌注压、PO2 和 PCO2、血流-代谢耦合以及脑血管的神经支配。在 ME/CFS 中还发现了其他多种机制：我们曾发现，在倾斜试验中，ME/CFS 患者的 CBF 和 CO 均减少，我们假设 CBF 和 CO 之间的关系异常，且不同于 HC。在这项回顾性研究中，我们分析了一大批患者的这种关系。为了将患者数据与 HC 患者数据进行比较，我们将重点放在直立倾斜时心率（HR）和血压（BP）反应正常的患者身上。此外，我们还分析了临床数据的影响：共有 534 名 ME/CFS 患者和 49 名 HC 接受了倾斜测试，并测量了心率、血压、CBF 和 CO。结果：CO 和 CBF 下降幅度在 HC 范围内的患者病情较轻，且更可能是男性。在 CO 和 CBF 下降异常的患者中，CO 与 CBF 下降的回归线斜率几乎为 1。对后一组患者（包括 PetCO2 测量值患者（440/488：90%））进行的多元回归分析表明，CO 下降在很大程度上预测了 CBF 下降，而 PetCO2 下降和倾斜持续时间的作用有限。其他数据并未对模型起到补充作用：结论：倾斜过程中心率和血压反应正常的两组不同患者被识别出来：一组是 CO 和 CBF 在 HC 正常范围内的患者，另一组是倾斜过程中 CO 和 CBF 降低异常的患者（91% 的患者）。前一组患者病情较轻，男性患者较多。在最大的一组患者中，CO 和 CBF 减少之间的关系几乎为 1:1，这表明脑血管没有代偿性血管扩张。这可能是临床和治疗干预的适当目标。
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