Archives of Cardiovascular Diseases最新文献_第5页

First African validation study of HARMS2-AF and C2HEST scores to predict the onset of atrial fibrillation in patients with acute coronary syndrome treated by PCI: A report from the Moroccan data

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.acvd.2024.10.082

A. Bouchlarhem , N. Ismaili , N. El Ouafi

Introduction

New-onset atrial fibrillation (NOAF) during acute coronary syndrome (ACS) represents a complex association given the high thrombo-embolic risk.

Objective

We analyzed the validity of the HARMS2-AF and C2HEST score in predicting NOAF in patients with ACS treated by PCI in an African population using data from a Moroccan population.

Method

We examined the medical data of patients admitted to our CICU over a 4-year period. We excluded patients with AF prior to admission. Our primary outcome was an episode of NOAF in-hospital. Discrimination for NOAF was assessed using area under the receiver characteristic curve (AUC) values, and a comparison between the two scores was made using the De-long test. We also performed a multivariable logistic regression analysis to predict NOAF using the C2HEST score for a cut-off at 3 and the HARMS2-AF score for a cut-off at 7.

Results

We included 763 patients, 76.3% men, with 75% of patients admitted for STEMI. NOAF was diagnosed in 8.4% with 93% within the first 48 h after admission. Patients with NOAF were older (70.27 ± 11.64 vs. 64.24 ± 11.55, p < 0.001), with a longer length of hospital stay (5.7 ± 3.86 vs. 3.8 ± 2.05, p < 0.001), a lower ejection fraction (40, 96 ± 12.25 vs. 46.6 ± 12.06, p < 0.001), a higher C2HEST score (2.45 ± 1.79 vs. 2.27 ± 1.43, p = 0.003), and a higher HARMS2-AF score (9.22 ± 3.50 vs. 6.72 ± 2.94, p < 0.001). In multivariate logistic regression analysis, a C2HEST score > 3 was independently associated with the occurrence of NOAF (odds ratio 3.54; 95% CI 2.07–6.07, p < 0.001), as was a HARMS2-AF score > 7 (odds ratio 5.56; 95% CI 2.91–10.61, p < 0.001). ROC curve analysis showed good accuracy of the C2HEST score (AUC 0.69, 95% CI 0.665; 0.731; p < 0.001) and HARMS2-AF score (AUC 0.72, 95% CI 0.689; 0.754; p < 0.001) in predicting NOAF, with no significant difference between the two scores (De long test p value = 0.326) (Fig. 1)

Conclusion

As demonstrated by our results, HARMS2-AF and C2HEST scores can predict NOAF after ACS treated with PCI, which will allow selection of patients with a higher risk of stroke.

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引用次数: 0

Use of the AHEAD score in acute heart failure

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.acvd.2024.10.043

O. Zidi , Z. Ibn El Hadj , O. Ferchichi , H. Ben Arbia , L. Mariem , A. Sghaier , M.A. Almi , T. Amani , S. Bousnina , Z. Ajra , J. Arfaoui , A. Ben Halima , E. Bennour , I. Kammoun

Introduction

Heart failure (HF) is a major public-health problem. Recognition of predictors of an unfavourable outcome in HF is very important. With time many scores have been used to evaluate prognostic in HF. AHEAD score is based on the analysis of co-morbidities for the estimation of the short and long term prognosis of patients hospitalized for AHF.

Objective

The aim of this paper is to find a correlation between AHEAD score and both mortality and re-hospitalization.

Method

In this prospective study we enrolled 108 patients admitted to our cardiology department between 2021 and 2023 for acute HF. AHEAD score was calculated for each patient and the correlation between this ratio and mortality, re-hospitalizations, was studied.

Results

The mean age was 63.5 ± 11.9 years (79.6% men). Ischemic HF was the most common etiology (57.4%). Of these patients 30.6% were aged > 70 years, 28.7% had atrial fibrillation (AF), 42.2% had diabetes mellitus, 23.1% had anemia, and 16.7% had creatinine > 130 mmol/l. The mean AHEAD score was 1.4 ± 1. No patient had a score equal to 5. The one-year mortality rates in patients with AHEAD score of 0 to 4 were 0%, 2.5%, 10.7%, 0%, 40% respectively. The re-hospitalization rates in patients with AHEAD score of 0 to 4 were 8.7%, 5%, 17.9%, 0%, 20% respectively. The ROC curve analysis revealed a correlation between the AHEAD score and the occurrence of mortality (AUC = 0.763, P = 0.031) with a cutoff value of 2 with a sensitivity of 83.3% and a specificity of 60.8%. No correlation was found between the AHEAD score and re-hospitalization.

Conclusion

Our findings show that the AHEAD score estimates with good performance the mortality in patients with AHF. These results provide new insights into the evaluation of AHF patients.

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引用次数: 0

Long-term hydroxychloroquine exposure impairs the left ventricular longitudinal strain

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.acvd.2024.10.039

R. Didier , S. Berthier , G. Muller , G. Laurent , C. Guenancia , J.C. Eicher

Introduction

Antimalarial drugs are commonly used in connective tissue and rheumatologic diseases. Hydroxychloroquine (HCQ) impairs the lysosomal function leading to intracellular accumulation of metabolic degradation products. Retinopathy is the best-known complication of long-term HCQ use, but rare severe cardiac side effects have also been reported (heart failure, conduction disorders leading exceptionally to transplantation). To date, no prospective clinical research to detect cardiac HCQ-related toxicity has been conducted.

Objective

We aimed to evaluate whether chronic HCQ intake impairs the left ventricular systolic function assessed by global longitudinal strain (GLS).

Method

We prospectively investigated patients treated with HCQ and referred for a routine trans-thoracic echocardiography (TTE) in the Dijon university hospital between September 2017 and June 2023. Patients with a history of heart disease or heart failure, a decreased LVEF, or an abnormal ECG were excluded. Demographic data, duration of HCQ exposure, associated diseases and echocardiographic data (LVEF, LV diastolic function, global and regional strain) were collected. Patients were divided in tertile of HCQ-exposure duration (ED).

Results

Sixty-three patients were studied with a mean HCQ ED of 135.3 (± 81.1) months. The mean age was 50.4 years, 90% were women and 63.5% were treated for a lupus. The mean left ventricular GLS was −21.2% (± 3.0) and the mean LVEF was 65.5% (± 6.4). The mean corrected QT interval according to Bazett was 405.9 ms (± 37.7) with no differences among the three tertiles. There was a positive correlation between HCQ ED and GLS (Pearson r 0.32, P = 0.012, Fig. 1), whereas no significant correlations were found between HCQ ED and both LVEF and diastolic function. GLS was significantly different among the three tertiles (P = 0.020). Post hoc tests identified significant differences in mean GLS between the 1st tertile (mean ED 48 ± 23.5 months, mean GLS −22.4 ± 2.1%) and the 3rd tertile (mean ED 240 ± 23.5 months, mean GLS −19.9 ± 2.8%) (P = 0.018).

Conclusion

This is a princeps study demonstrating a significant correlation between the duration of HCQ exposure and left ventricular GLS alteration. Further studies are needed to determine the relevance of systematic TTE for the detection of cardiac HCQ- related toxicity.

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引用次数: 0

Mulmodality imaging in arrhythmogenic right ventricular dysplasia: From real life to guidelines: About 18 years observation

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.acvd.2024.10.052

N. Ali Tatar, R. Benkouar

Introduction

ARVD has been recognized as an important cause of sudden death in association with exercise.

Objective

To determine the clinical, electrocardiographic, echocardiographic, CMR profile of ARVD in our echocardiographic laboratory.

Method

We enrolled in a prospective study from January 2005 to January 2023, 50 patients (pts) with ARVD, predominantly males (84%) mean age 32 ± 17 years old. The clinical electrocardiographic, echocardiography,cardiac magnetic resonance (CMR) if done focused on RV inflow area, the apex,the infundibulum and the left ventricule data were collected.

Results

Palpitations were reported in 30 pts (60%), syncope in 12 pts (24%). AF occurs in 4 (8%), atrial flutter in 3 pts (8.1%) with transesophageal echocardiography (TEE) in order to atrial flutter ablation. Spontaneous echo contrast in all cases and in one, left atrial appendage (LAA) thrombus. The epsilon wave was identified in 12pts (24%) and negatives T waves from V1to V3 in the absence of a complete right bundle branch block (RBBB) in 93.7% of them (Fig. 1). VT sustained and non-sustained occur in 30% and all of the pts present ventricular arrhythmia on 24-hour Holter monitoring. Echo has identify right ventricular severe dilatation and apex aneurysm with trabeculations and marked global hypokinesia in 93.7%, spontaneous echo contrast on RV in 20%, global RV dysfunction in 20 pts (54%), severe tricuspid regurgitation with marked dilatation of the tricuspid annulus in 20pts. CMR done in 21 pts shows severe RV dilatation in 20pts, RV fat infiltration in 14 pts, localized RV aneurysm in 13 pts. ICD was implanted in 10 pts and the tachycardia ventricle (VT) ablation (RFA) in 18%. CMR has confirmed 16% of biventricular ARVD. 4 patients died from respectively sudden cardiac death, after ischemic stroke and right heart failure, the third one 17 years with dilatation of the RV and thrombus died after acute occlusion of the lower extremities, the last one in the setting of digestive surgery.

Conclusion

Multimodality imaging to characterize the cardiac phenotype (morphology and function) including tissue characterization is necessary in combination with a detailed personal and family history, clinical examination, electrocardiography, echocardiography, cardiac magnetic resonance and laboratory investigations. CMR must not oppose to echocardiography but must be complementary.

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引用次数: 0

Newcard telemonitoring system improves survival in comparison with other French telemonitoring systems in chronic heart failure as assessed by data extract from the French National Health Data System

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.acvd.2024.10.050

A. Pathak , F. Roubille , M. Galinier , P. Levy , P. De Groote , F. Mouquet , G. Perrard , L. Perrard

Introduction

In the NEWTS3 Program, we have shown an effect on global mortality for heart failure (HF) patients using NEWCARD telemonitoring system (NewTM) versus traditional approach. It was associated with an increase in hospitalizations but with less trips to the emergency room.

Objective

One aim of the NEWTS3EXT study is to extend this comparison to patients followed by other telemonitoring French systems (TLM) selected in the SNDS (French National Health Data System).

Method

All NewTM patients monitored at least 3 months between 2017 and 2020 were included. For each patient, anonymised data was retrieved from the SNDS. TLM group was randomly selected from an extraction of SNDS of patients with CHF including a reimbursement of telemonitoring but not followed by Newcard. This TLM group was matched in a 1:1 ratio to NewTM patients using a propensity score including baseline characteristics, presence of comorbidities and presence of significative treatments. Binomial negative GEE models were used on matched data sets to assess differences.

Results

919 NewTM patients were matched to 919 TLM patients. We show an increase statically significative in survival rates in the NewTM group versus TLM group at 48 months (OR 0.832 P = 0.0394) (Fig. 1). Despite no global difference in hospitalisation rate, there's a trend to a decrease statically significative in the NewTM group versus TLM group at 12 and 24 months. At the level of the emergency room, no differences between groups.

Conclusion

NEWTS3EXT Study is one of the first comparison between one specific solution and a group of others. Explaining the positive result on all-cause mortality for the NewTM must be a mix of plenty of specificities especially in a complex process like telemonitoring of HF. To help to find the best place for telemonitoring in the care pathway of HF, we can emphasize on the high level of adherence of the NewTM patients (data collected every 1.4 days) and on the precise process to ensure that every alert is followed by a medical response.

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引用次数: 0

Impact of SYNTAX score on 10-year outcomes in NSTE-ACS

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.acvd.2024.10.074

F. Boukerche

Introduction

The very long-term prognostic effect of Syntax score on mortality is still undetermined.

Objective

The aim of this study was to investigate the long-term impact of SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score (SS) on mortality after invasive management in NSTE-ACS.

Method

A total of 292 consecutive patients (median age 62 years) with non-ST-elevation ACS were included, followed up for ≥ 10 years and were compared according to baseline SS.

Results

Among 292 patients with baseline SS, 227 patients (77.7%) had low SS (≤ 22), 32 (10.9%) had intermediate SS (23 to 32), and 33 (11.4%) had high SS (≥ 33). Cardiovascular mortality during the follow-up according to SS group was 15.9%, 31.3% and 54.5% (p < 10-3), respectively (Fig. 1). In multivariable Cox regression analysis, only age and Syntax score were independently associated with patient outcome. Syntax score ≥ 17 showed a sensitivity of 60.9%, specificity of 61.4%. The area under the ROC curve was 0.70 (95% confidence interval of 0.62–0.77).

Conclusion

The discriminative capacity of SS on long-term outcomes was relevant in NSTE-ACS patients.

{"title":"Impact of SYNTAX score on 10-year outcomes in NSTE-ACS","authors":"F. Boukerche","doi":"10.1016/j.acvd.2024.10.074","DOIUrl":"10.1016/j.acvd.2024.10.074","url":null,"abstract":"<div><h3>Introduction</h3><div>The very long-term prognostic effect of Syntax score on mortality is still undetermined.</div></div><div><h3>Objective</h3><div>The aim of this study was to investigate the long-term impact of SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score (SS) on mortality after invasive management in NSTE-ACS.</div></div><div><h3>Method</h3><div>A total of 292 consecutive patients (median age 62 years) with non-ST-elevation ACS were included, followed up for≥10 years and were compared according to baseline SS.</div></div><div><h3>Results</h3><div>Among 292 patients with baseline SS, 227 patients (77.7%) had low SS (≤22), 32 (10.9%) had intermediate SS (23 to 32), and 33 (11.4%) had high SS (≥33). Cardiovascular mortality during the follow-up according to SS group was 15.9%, 31.3% and 54.5% (<em>p</em>    <!-->17 showed a sensitivity of 60.9%, specificity of 61.4%. The area under the ROC curve was 0.70 (95% confidence interval of 0.62–0.77).</div></div><div><h3>Conclusion</h3><div>The discriminative capacity of SS on long-term outcomes was relevant in NSTE-ACS patients.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Pages S14-S15"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150842","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}

引用次数: 0

Out-of-hospital management and outcomes of patients with ST-segment elevation myocardial infarction (STEMI) within 12 hours, from April to October 2021, on La Réunion island

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.acvd.2024.10.079

V. Lemerle , J. Corré

Introduction

The management of STEMI is well standardized through European guidelines. However, various factors can hinder its implementation, particularly on Réunion Island, due to its geographical features and the high prevalence of diabetes and obesity.

Objective

The primary outcome is to assess the conformity of timing and treatments for patients managed for ST-segment elevation myocardial infarction (STEMI) evolving for less than 12 hours according to the guidelines. This study also analyzed specific management practices among women, patients over 75 years old, and those who received thrombolysis.

Method

This multicenter retrospective study was conducted from April to October 2021 in La Réunion. 517 files were analyzed, 258 of which were ST-segment elevation myocardial infarctions (STEMIs), and among them, 180 had pain evolving for less than 12 hours, and 160 were complete.

Results

160 patients were included (median age: 60 years (IQR: 55; 67.2); 29% were women; 29% had prior angina; 32% received thrombolysis therapy). Management was in accordance with guidelines for 66 patients (41%): recommended treatment and timing were met in 127 (79%) and 77 patients (48%) respectively. However, it was significantly less appropriate for women (17% vs. 45%; p < 0.001) and those over 75 years old (8%; p < 0.01), with 24% receiving thrombolysis. Overall mortality at 28 days (3%) and 1 year (7%) did not differ based on the quality of management.

Conclusion

The management of STEMI could be improved on Réunion Island, especially among women and elderly individuals.

{"title":"Out-of-hospital management and outcomes of patients with ST-segment elevation myocardial infarction (STEMI) within 12 hours, from April to October 2021, on La Réunion island","authors":"V. Lemerle , J. Corré","doi":"10.1016/j.acvd.2024.10.079","DOIUrl":"10.1016/j.acvd.2024.10.079","url":null,"abstract":"<div><h3>Introduction</h3><div>The management of STEMI is well standardized through European guidelines. However, various factors can hinder its implementation, particularly on Réunion Island, due to its geographical features and the high prevalence of diabetes and obesity.</div></div><div><h3>Objective</h3><div>The primary outcome is to assess the conformity of timing and treatments for patients managed for ST-segment elevation myocardial infarction (STEMI) evolving for less than 12 hours according to the guidelines. This study also analyzed specific management practices among women, patients over 75 years old, and those who received thrombolysis.</div></div><div><h3>Method</h3><div>This multicenter retrospective study was conducted from April to October 2021 in La Réunion. 517 files were analyzed, 258 of which were ST-segment elevation myocardial infarctions (STEMIs), and among them, 180 had pain evolving for less than 12 hours, and 160 were complete.</div></div><div><h3>Results</h3><div>160 patients were included (median age: 60 years (IQR: 55; 67.2); 29% were women; 29% had prior angina; 32% received thrombolysis therapy). Management was in accordance with guidelines for 66 patients (41%): recommended treatment and timing were met in 127 (79%) and 77 patients (48%) respectively. However, it was significantly less appropriate for women (17% <em>vs.</em> 45%; <em>p</em>  <0.01), with 24% receiving thrombolysis. Overall mortality at 28 days (3%) and 1 year (7%) did not differ based on the quality of management.</div></div><div><h3>Conclusion</h3><div>The management of STEMI could be improved on Réunion Island, especially among women and elderly individuals.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S17"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143151186","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}

引用次数: 0

Diagnostic tools of heart failure with preserved ejection fraction: Comparison of left atrial strain to the HFA-PEFF score

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.acvd.2024.10.101

S. Antit , M.K. Bahri , R. Fekih , S. Romdhane , I. Boussabeh , L. Zakhama

Introduction

Heart failure with preserved ejection fraction (HFpEF) is an increasingly common health issue with a significant morbidity and mortality burden. Diagnosis remains challenging despite the great number of tests and parameters proposed.

Objective

The aim of this study was to assess the performance of left atrial strain (LAS) function in the diagnosis of HFpEF by comparison to the HFA-PEFF score.

Method

A total of 110 outpatients, symptomatic with exertion dyspnea, were prospectively recruited over the span of 18 months. The HFA-PEFF score was calculated for all patients, who then were sorted in 2 groups: with and without HFpEF. Performance of LAS functions (reservoir, pump, conduit) and the 2016 ASE/EACVI algorithm for the evaluation of Left ventricular filling pressure (LVFP), was assessed for the diagnosis of HFpEF.

Results

Prevalence of HFpEF in our sample was 40%. All LAS functions were significantly correlated to the presence of HFpEF and to the elevation of LVFP at rest and on exertion. Performance of the 2016 algorithm was mediocre in the diagnosis of HFpEF (AUC = 0.70, Specificity (Sp) = 71.2%, Sensitivity (Sn) = 72.7%, Accuracy (Acc) = 71.8%), with significant improvement after exclusion of indeterminate LVFP cases (AUC = 0.89, Sp = 94%, Sn = 84.2%, Acc = 89.7%), and only reaching maximal overall performance (AUC = 0.94, Sp = 94%, Sn = 94.7%, Acc = 94.3%) after exercise testing.

Performance of LAS functions yielded acceptable results, with the reservoir function having the most optimal outcomes, compared to booster and conduit functions, with a cutoff value of 24% (AUC = 0.91, Sp = 86%, Sn = 89.5%, Acc = 88.1%).

Considering the low sensitivity of the 2016 algorithm, we integrated the study of LAS reservoir function when LVFP were evaluated to be normal or indeterminate. The proposed new algorithm demonstrated improved performance (Sp = 90.7%, Sn = 90%, Acc = 90.1%) compared to the 2016 algorithm with inclusion of indeterminate LVFP cases.

Conclusion

LAS reservoir function is an efficient, easy to assess parameter that significantly improves the diagnostic yield of HFpEF in common practice, and diminishes the necessity of exercise echocardiography and invasive testing.

{"title":"Diagnostic tools of heart failure with preserved ejection fraction: Comparison of left atrial strain to the HFA-PEFF score","authors":"S. Antit , M.K. Bahri , R. Fekih , S. Romdhane , I. Boussabeh , L. Zakhama","doi":"10.1016/j.acvd.2024.10.101","DOIUrl":"10.1016/j.acvd.2024.10.101","url":null,"abstract":"<div><h3>Introduction</h3><div>Heart failure with preserved ejection fraction (HFpEF) is an increasingly common health issue with a significant morbidity and mortality burden. Diagnosis remains challenging despite the great number of tests and parameters proposed.</div></div><div><h3>Objective</h3><div>The aim of this study was to assess the performance of left atrial strain (LAS) function in the diagnosis of HFpEF by comparison to the HFA-PEFF score.</div></div><div><h3>Method</h3><div>A total of 110 outpatients, symptomatic with exertion dyspnea, were prospectively recruited over the span of 18 months. The HFA-PEFF score was calculated for all patients, who then were sorted in 2 groups: with and without HFpEF. Performance of LAS functions (reservoir, pump, conduit) and the 2016 ASE/EACVI algorithm for the evaluation of Left ventricular filling pressure (LVFP), was assessed for the diagnosis of HFpEF.</div></div><div><h3>Results</h3><div>Prevalence of HFpEF in our sample was 40%. All LAS functions were significantly correlated to the presence of HFpEF and to the elevation of LVFP at rest and on exertion. Performance of the 2016 algorithm was mediocre in the diagnosis of HFpEF (AUC=0.70, Specificity (Sp)=71.2%, Sensitivity (Sn)=72.7%, Accuracy (Acc)=71.8%), with significant improvement after exclusion of indeterminate LVFP cases (AUC=0.89, Sp=94%, Sn=84.2%, Acc=89.7%), and only reaching maximal overall performance (AUC=0.94, Sp=94%, Sn=94.7%, Acc=94.3%) after exercise testing.</div><div>Performance of LAS functions yielded acceptable results, with the reservoir function having the most optimal outcomes, compared to booster and conduit functions, with a cutoff value of 24% (AUC=0.91, Sp=86%, Sn=89.5%, Acc=88.1%).</div><div>Considering the low sensitivity of the 2016 algorithm, we integrated the study of LAS reservoir function when LVFP were evaluated to be normal or indeterminate. The proposed new algorithm demonstrated improved performance (Sp=90.7%, Sn=90%, Acc=90.1%) compared to the 2016 algorithm with inclusion of indeterminate LVFP cases.</div></div><div><h3>Conclusion</h3><div>LAS reservoir function is an efficient, easy to assess parameter that significantly improves the diagnostic yield of HFpEF in common practice, and diminishes the necessity of exercise echocardiography and invasive testing.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S56"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143151189","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}

引用次数: 0

Propensity score-matched analysis in isolated left ventricular dilation in non-ischaemic dilated cardiomyopathy

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.acvd.2024.10.096

T. Gonçalves , T. Pezel , P. Garot , S. Toupin , S. Duhamel , F. Sanguineti , T. Unterseeh , T. Hovasse , E. Gall , L. Hamzi , A. Unger , J.-G. Dillinger , P. Henry , V. Bousson , J. Garot

<div><h3>Introduction</h3><div>The presence and extent of late gadolinium enhancement (LGE) assessed by cardiac magnetic resonance imaging (CMR) are strong prognosticators of death in patients with non-ischaemic dilated cardiomyopathy (DCM), defined as left ventricular (LV) dilation and left ventricular ejection fraction (LVEF)<50%. Although the current guidelines defined the concept of “isolated LV dilation” (ILVD) as LV dilation with preserved LVEF≥50%, the prognostic value of the “LGE granularity” is not established in this population.</div></div><div><h3>Objective</h3><div>To assess the prognostic value of the concept of “LGE granularity” including its extent, location, and pattern for predicting all-cause death above traditional prognosticators in patients with DCM or ILVD, separately.</div></div><div><h3>Method</h3><div>Between 2008 and 2021, all consecutive patients with DCM and ILVD without implantable cardioverter-defibrillator or history of sustained ventricular arrhythmia referred for CMR were included in two centres. The primary outcome was all-cause death using the French National Registry of Death. A propensity score matching was performed to balance characteristics in patients with DCM vs. those with ILVD. Cox regressions were performed to determine the prognostic value of each LGE findings.</div></div><div><h3>Results</h3><div>Of 2752 patients analysed (age 52±8 years, 56% male), 15% patients died after a median (inter-quartile range) follow-up of 9 (7–12) years. A total of 737 (27%) patients had LGE. In the propensity-score matched population (<em>n</em>  =1084 in isolated LV dilation), the LGE presence was associated with death (HR=2.98, 95%CI: 1.97–4.50, <em>p</em>  =265), the LGE extent (HR=1.41, 95%CI: 1.09–1.83, <em>p</em>    <0.001) and the septal location (HR=2.97, 95%CI: 1.37–6.46, <em>p</em>  =268), the LGE extent (HR=1.42, 95%CI: 1.07–1.89, <em>p</em>    <0.001) and the septal location (HR=6.65, 95%CI: 3.02–14.6, <em>p</em>  <!-->0.001) were strongly associated with death.</div></div><div><h3>Conclusion</h3><div>The concept of “LGE granularity” was independently associated with all-cause death after adjust

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引用次数: 0

Sex-specific models to predict 5-year mortality after ST-elevation myocardial infarction using machine learning: Insight from FAST-MI registry

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.acvd.2024.10.068

M. Singh , K. Hamzi , S. Toupin , J.-G. Dillinger , P. Henry , G. Cayla , F. Schiele , J. Ferrières , T. Simon , N. Danchin , T. Pezel

Introduction

Most prognostic stratification tools in acute myocardial infarction (AMI) have been derived from populations including both women and men with only a small proportion of women.

Objective

Using supervised machine learning (ML), we assessed the performance of 2 models for 5-year mortality prediction after AMI, derived from men and women, to determine whether sex-specific models improved outcome prediction.

Method

This cohort study used the French registry on acute ST-elevation and non-ST-elevation myocardial infarction (FAST- MI) 2010 and 2015 surveys. This multicentric registry led in more than 200 French hospitals, enrolled all consecutive patients with acute myocardial infarction during a 1-month recruitment period. Our analysis included all men and women presenting STEMI who underwent invasive coronary angiography (ICA). To build and validate the models, the data set were split with a 70%/30% ratio into training and testing sets. The primary outcome was 5-year all-cause mortality. Then, 52 clinical, laboratory, ECG, echocardiographic, and ICA parameters were evaluated for feature selection using Boruta algorithm. Different supervised machine learning algorithms, including random forest (RF), were assessed for model building, and their performance were compared in women and men.

Results

1,189 consecutive women and 3,685 men with STEMI (mean age 61 ± 13 and 69 ± 15 years, respectively) were recruited; 12% of men and 20% of women experienced 5-year all-cause mortality. Using Boruta algorithm, the 10 most important variables for prediction were selected (Fig. 1). For women-based ML model building, the RF algorithm exhibited the best performance to predict mortality with an area under the receiver-operating characteristic curve (ROC-AUC) of 0.82 (95% CI: 0.77–0.88), an area under the precision-recall curve (PR-AUC) of 0.59 (95% CI: 0.54–0.64); and a F1-score of 0.58. The women-based ML model exhibited lower performance in men (ROC-AUC: 0.78; PR-AUC: 0.43). Conversely, the men-based model exhibited better accuracy in men than in women.

Conclusion

In a large multicentric cohort of STEMI patients, women- and men-based ML-models exhibited a good accuracy to predict 5-year all-cause mortality with a drop of accuracy when applied to the other sex. This suggests that sex-specific models might be superior to general models to predict mortality after AMI.

{"title":"Sex-specific models to predict 5-year mortality after ST-elevation myocardial infarction using machine learning: Insight from FAST-MI registry","authors":"M. Singh , K. Hamzi , S. Toupin , J.-G. Dillinger , P. Henry , G. Cayla , F. Schiele , J. Ferrières , T. Simon , N. Danchin , T. Pezel","doi":"10.1016/j.acvd.2024.10.068","DOIUrl":"10.1016/j.acvd.2024.10.068","url":null,"abstract":"<div><h3>Introduction</h3><div>Most prognostic stratification tools in acute myocardial infarction (AMI) have been derived from populations including both women and men with only a small proportion of women.</div></div><div><h3>Objective</h3><div>Using supervised machine learning (ML), we assessed the performance of 2 models for 5-year mortality prediction after AMI, derived from men and women, to determine whether sex-specific models improved outcome prediction.</div></div><div><h3>Method</h3><div>This cohort study used the French registry on acute ST-elevation and non-ST-elevation myocardial infarction (FAST- MI) 2010 and 2015 surveys. This multicentric registry led in more than 200 French hospitals, enrolled all consecutive patients with acute myocardial infarction during a 1-month recruitment period. Our analysis included all men and women presenting STEMI who underwent invasive coronary angiography (ICA). To build and validate the models, the data set were split with a 70%/30% ratio into training and testing sets. The primary outcome was 5-year all-cause mortality. Then, 52 clinical, laboratory, ECG, echocardiographic, and ICA parameters were evaluated for feature selection using Boruta algorithm. Different supervised machine learning algorithms, including random forest (RF), were assessed for model building, and their performance were compared in women and men.</div></div><div><h3>Results</h3><div>1,189 consecutive women and 3,685 men with STEMI (mean age 61±13 and 69±15 years, respectively) were recruited; 12% of men and 20% of women experienced 5-year all-cause mortality. Using Boruta algorithm, the 10 most important variables for prediction were selected (<span><span>Fig. 1</span></span>). For women-based ML model building, the RF algorithm exhibited the best performance to predict mortality with an area under the receiver-operating characteristic curve (ROC-AUC) of 0.82 (95% CI: 0.77–0.88), an area under the precision-recall curve (PR-AUC) of 0.59 (95% CI: 0.54–0.64); and a F1-score of 0.58. The women-based ML model exhibited lower performance in men (ROC-AUC: 0.78; PR-AUC: 0.43). Conversely, the men-based model exhibited better accuracy in men than in women.</div></div><div><h3>Conclusion</h3><div>In a large multicentric cohort of STEMI patients, women- and men-based ML-models exhibited a good accuracy to predict 5-year all-cause mortality with a drop of accuracy when applied to the other sex. This suggests that sex-specific models might be superior to general models to predict mortality after AMI.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Pages S11-S12"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143151202","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}

引用次数: 0