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Tao G, Yang S, Xu J, Wang L, Yang B. Global research trends and hotspots of artificial intelligence research in spinal cord neural injury and restoration-a bibliometrics and visualization analysis. Front Neurol 2024; 15:1361235. [PMID: 38628700 PMCID: PMC11018935 DOI: 10.3389/fneur.2024.1361235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 03/19/2024] [Indexed: 04/19/2024] Open
Abstract
Background Artificial intelligence (AI) technology has made breakthroughs in spinal cord neural injury and restoration in recent years. It has a positive impact on clinical treatment. This study explores AI research's progress and hotspots in spinal cord neural injury and restoration. It also analyzes research shortcomings related to this area and proposes potential solutions. Methods We used CiteSpace 6.1.R6 and VOSviewer 1.6.19 to research WOS articles on AI research in spinal cord neural injury and restoration. Results A total of 1,502 articles were screened, in which the United States dominated; Kadone, Hideki (13 articles, University of Tsukuba, JAPAN) was the author with the highest number of publications; ARCH PHYS MED REHAB (IF = 4.3) was the most cited journal, and topics included molecular biology, immunology, neurology, sports, among other related areas. Conclusion We pinpointed three research hotspots for AI research in spinal cord neural injury and restoration: (1) intelligent robots and limb exoskeletons to assist rehabilitation training; (2) brain-computer interfaces; and (3) neuromodulation and noninvasive electrical stimulation. In addition, many new hotspots were discussed: (1) starting with image segmentation models based on convolutional neural networks; (2) the use of AI to fabricate polymeric biomaterials to provide the microenvironment required for neural stem cell-derived neural network tissues; (3) AI survival prediction tools, and transcription factor regulatory networks in the field of genetics were discussed. Although AI research in spinal cord neural injury and restoration has many benefits, the technology has several limitations (data and ethical issues). The data-gathering problem should be addressed in future research, which requires a significant sample of quality clinical data to build valid AI models. At the same time, research on genomics and other mechanisms in this field is fragile. In the future, machine learning techniques, such as AI survival prediction tools and transcription factor regulatory networks, can be utilized for studies related to the up-regulation of regeneration-related genes and the production of structural proteins for axonal growth.
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Affiliation(s)
- Guangyi Tao
- College of Orthopedics and Traumatology, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Shun Yang
- Department of Pain, Henan Provincial Hospital of Traditional Chinese Medicine/The Second Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Junjie Xu
- College of Orthopedics and Traumatology, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Linzi Wang
- College of Orthopedics and Traumatology, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Bin Yang
- Department of Pain, Henan Provincial Hospital of Traditional Chinese Medicine/The Second Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China
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Ito S, Cohen-Shelly M, Attia ZI, Lee E, Friedman PA, Nkomo VT, Michelena HI, Noseworthy PA, Lopez-Jimenez F, Oh JK. Correlation between artificial intelligence-enabled electrocardiogram and echocardiographic features in aortic stenosis. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2023; 4:196-206. [PMID: 37265870 PMCID: PMC10232245 DOI: 10.1093/ehjdh/ztad009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/25/2022] [Accepted: 02/06/2023] [Indexed: 06/03/2023]
Abstract
Aims An artificial intelligence-enabled electrocardiogram (AI-ECG) is a promising tool to detect patients with aortic stenosis (AS) before developing symptoms. However, functional, structural, or haemodynamic components reflected in AI-ECG responsible for its detection are unknown. Methods and results The AI-ECG model that was developed at Mayo Clinic using a convolutional neural network to identify patients with moderate-severe AS was applied. In patients used as the testing group, the correlation between the AI-ECG probability of AS and echocardiographic parameters was investigated. This study included 102 926 patients (63.0 ± 16.3 years, 52% male), and 28 464 (27.7%) were identified as AS positive by AI-ECG. Older age, atrial fibrillation, hypertension, diabetes, coronary artery disease, and heart failure were more common in the positive AI-ECG group than in the negative group (P < 0.001). The AI-ECG was correlated with aortic valve area (ρ = -0.48, R2 = 0.20), peak velocity (ρ = 0.22, R2 = 0.08), and mean pressure gradient (ρ = 0.35, R2 = 0.08). The AI-ECG also correlated with left ventricular (LV) mass index (ρ = 0.36, R2 = 0.13), E/e' (ρ = 0.36, R2 = 0.12), and left atrium volume index (ρ = 0.42, R2 = 0.12). Neither LV ejection fraction nor stroke volume index had a significant correlation with the AI-ECG. Age correlated with the AI-ECG (ρ = 0.46, R2 = 0.22) and its correlation with echocardiography parameters was similar to that of the AI-ECG. Conclusion A combination of AS severity, diastolic dysfunction, and LV hypertrophy is reflected in the AI-ECG to detect AS. There seems to be a gradation of the cardiac anatomical/functional features in the model and its identification process of AS is multifactorial.
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Affiliation(s)
- Saki Ito
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW Rochester, MN 55905, USA
| | - Michal Cohen-Shelly
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW Rochester, MN 55905, USA
- Department of Cardiology, Sheba Medical Center, Tel Hashomer, Israel
| | - Zachi I Attia
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW Rochester, MN 55905, USA
| | - Eunjung Lee
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW Rochester, MN 55905, USA
| | - Paul A Friedman
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW Rochester, MN 55905, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW Rochester, MN 55905, USA
| | - Hector I Michelena
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW Rochester, MN 55905, USA
| | - Peter A Noseworthy
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW Rochester, MN 55905, USA
| | - Francisco Lopez-Jimenez
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW Rochester, MN 55905, USA
| | - Jae K Oh
- Corresponding author. Tel: +507 266 1376, Fax: +507 266 9142,
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Simon LR, Scott AJ, Figueroa Rios L, Zembles J, Masters KS. Cellular-scale sex differences in extracellular matrix remodeling by valvular interstitial cells. Heart Vessels 2023; 38:122-130. [PMID: 36070095 PMCID: PMC10120251 DOI: 10.1007/s00380-022-02164-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 08/24/2022] [Indexed: 01/06/2023]
Abstract
Males acquire calcific aortic valve disease (CAVD) twice as often as females, yet stenotic valves from females display significantly higher levels of fibrosis compared to males with similar extent of disease. Fibrosis occurs as an imbalance between the production and degradation of the extracellular matrix (ECM), specifically type I collagen. This work characterizes ECM production and remodeling by male and female valvular interstitial cells (VICs) to better understand the fibrocalcific divergence between sexes evident in CAVD. Male and female VICs were assessed for gene and protein expression of myofibroblastic markers, ECM components, matrix metalloproteinases (MMPs), and tissue inhibitors of MMPs (TIMPs) via qRT-PCR and western blot. Overall metabolic activity was also measured. Activity assays for collagenase and gelatinase were performed to examine degradation behavior. Male VICs produced greater levels of myofibroblastic markers while female VICs showed greater metabolic activity and collagen production. In general, females displayed a greater level of MMP expression and production than males, but no sex differences were observed in TIMP production. Male VICs also displayed a greater level of collagenase and gelatinase activity than female VICs. This work displays sex differences in ECM remodeling by VICs that could be related to the sexual dimorphism in ECM structure seen in clinical CAVD.
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Affiliation(s)
- LaTonya R Simon
- Department of Biomedical Engineering, University of Wisconsin-Madison, 1111 Highland Ave, WIMR 8531, Madison, WI, 53705, USA
| | - Ashley J Scott
- Cellular and Molecular Biology Training Program, University of Wisconsin-Madison, Madison, WI, 53705, USA
| | - Lysmarie Figueroa Rios
- Department of Biomedical Engineering, University of Wisconsin-Madison, 1111 Highland Ave, WIMR 8531, Madison, WI, 53705, USA
| | - Joshua Zembles
- Department of Biomedical Engineering, University of Wisconsin-Madison, 1111 Highland Ave, WIMR 8531, Madison, WI, 53705, USA
| | - Kristyn S Masters
- Department of Biomedical Engineering, University of Wisconsin-Madison, 1111 Highland Ave, WIMR 8531, Madison, WI, 53705, USA.
- Cellular and Molecular Biology Training Program, University of Wisconsin-Madison, Madison, WI, 53705, USA.
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, 53705, USA.
- Department of Materials Science and Engineering, University of Wisconsin-Madison, Madison, WI, 53705, USA.
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Kotecha D, DeVore AD, Asselbergs FW. Fit for the future: empowering clinical trials with digital technology. Eur Heart J 2023; 44:64-67. [PMID: 36369983 DOI: 10.1093/eurheartj/ehac650] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/25/2022] [Accepted: 10/28/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Dipak Kotecha
- University of Birmingham Institute of Cardiovascular Sciences, Medical School, Vincent Drive, Birmingham B15 2TT, UK
- Health Data Research UK Midlands, Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2GW, UK
- Department of Cardiology, Division of Heart & Lungs, University Medical Center Utrecht, Heidelberglaan 8, 3584 CX Utrecht, The Netherlands
| | - Adam D DeVore
- Division of Cardiology and Duke Clinical Research Institute, Duke University School of Medicine, 300 W. Morgan Street, Durham, NC 27701, USA
| | - Folkert W Asselbergs
- Department of Cardiology, Division of Heart & Lungs, University Medical Center Utrecht, Heidelberglaan 8, 3584 CX Utrecht, The Netherlands
- Institute of Cardiovascular Science and Institute of Health Informatics, Faculty of Population Health Sciences, University College London, 222 Euston Road, London NW1 2DA, UK
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Iribarren AC, AlBadri A, Wei J, Nelson MD, Li D, Makkar R, Merz CNB. Sex differences in aortic stenosis: Identification of knowledge gaps for sex-specific personalized medicine. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 21:100197. [PMID: 36330169 PMCID: PMC9629620 DOI: 10.1016/j.ahjo.2022.100197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/18/2022] [Accepted: 08/20/2022] [Indexed: 06/16/2023]
Abstract
Objectives This review summarizes sex-based differences in aortic stenosis (AS) and identifies knowledge gaps that should be addressed by future studies. Background AS is the most common valvular heart disease in developed countries. Sex-specific differences have not been fully appreciated, as a result of widespread under diagnosis of AS in women. Summary Studies including sex-stratified analyses have shown differences in pathophysiology with less calcification and more fibrosis in women's aortic valve. Women have impaired myocardial perfusion reserve and different compensatory response of the left ventricle (LV) to pressure overload, with concentric remodeling and more diffuse fibrosis, in contrast to men with more focal fibrosis and more dilated/eccentrically remodeled LV. There is sex difference in clinical presentation and anatomical characteristics, with women having more paradoxical low-flow/low-gradient AS, under-diagnosis and severity underestimated, with less referral to aortic valve replacement (AVR) compared to men. The response to therapies is also different: women have more adverse events with surgical AVR and greater survival benefit with transcatheter AVR. After AVR, women would have more favorable LV remodeling, but sex-related differences in changes in myocardial reserve flow need future research. Conclusions Investigation into these described sex-related differences in AS offers potential utility for improving prevention and treatment of AS in women and men. To better understand sex-based differences in pathophysiology, clinical presentation, and response to therapies, sex-specific critical knowledge gaps should be addressed in future research for sex-specific personalized medicine.
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Affiliation(s)
- Ana C. Iribarren
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States of America
| | - Ahmed AlBadri
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States of America
| | - Janet Wei
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States of America
- Cedars-Sinai Biomedical Imaging Research Institute, Los Angeles, CA, United States of America
| | - Michael D. Nelson
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States of America
| | - Debiao Li
- Cedars-Sinai Biomedical Imaging Research Institute, Los Angeles, CA, United States of America
| | - Raj Makkar
- Cedars-Sinai Cardiovascular Intervention Center, Smidt Heart Institute, Los Angeles, CA, United States of America
| | - C. Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States of America
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Plunde O, Svenungsson E, Ferrannini G, Franco-Cereceda A, Bäck M. Antiphospholipid antibodies in patients with calcific aortic valve stenosis. Rheumatology (Oxford) 2022; 62:1187-1196. [PMID: 35961031 PMCID: PMC9977117 DOI: 10.1093/rheumatology/keac466] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/09/2022] [Accepted: 08/09/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The antiphospholipid syndrome is defined by antiphospholipid antibodies (aPL) together with arterial and/or venous thromboembolism and/or obstetric morbidities. aPL are overrepresented in SLE and acute myocardial infarction, but it is unknown whether aPL are associated with calcific aortic valve stenosis (CAVS) in the general population. The prevalence of aPL and other SLE-associated autoantibodies and their impact on aortic valve transcriptomics were therefore determined. METHODS A total of 233 tricuspid CAVS cases (median age 74, 69% male) and an age- and sex-matched control population were included. aPL were measured as anti-cardiolipin and anti-β2Glycoprotein-I of IgG/M/A isotypes. Resilient, thickened and calcified aortic valve (AV) tissue derived from five aPL positive and five matched aPL negative CAVS patients undergoing surgical aortic valve replacement were analysed by microarrays. RESULTS The prevalence of positivity for any aPL (IgG/M/A) in patients with CAVS was 6.4% (95% CI 3.6% - 10.4%: n = 233). aPL IgG was significantly more prevalent in CAVS cases vs controls (4.6% vs 0.6%, P = 0.04). AV tissue from aPL IgG/IgM-positive patients was negatively enriched in pathways related to interferon signalling. One hundred differentially expressed genes could predict local AV CAVS progression with supervised machine learning algorithms. CONCLUSIONS aPL IgG was more common in CAVS patients compared with matched controls and aPL positivity was associated with altered AV transcriptomics related to local disease progression and interferon pathways. Further studies should aim to establish aPL as a possible risk marker and/or causal factor for CAVS and could offer new precision therapeutic targets.
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Affiliation(s)
- Oscar Plunde
- Correspondence to: Oscar Plunde, Department of Medicine, Karolinska Institutet, Translational Cardiology, Neo Research Building, Blickagången 16, 14157 Stockholm, Sweden. E-mail:
| | - Elisabet Svenungsson
- Department of Medicine Solna, Karolinska Institutet,Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital
| | - Giulia Ferrannini
- Department of Medicine Solna, Karolinska Institutet,Theme Heart and Vessels
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7
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Carracedo M, Pawelzik SC, Artiach G, Pouwer MG, Plunde O, Saliba-Gustafsson P, Ehrenborg E, Eriksson P, Pieterman E, Stenke L, Princen HMG, Franco-Cereceda A, Bäck M. The tyrosine kinase inhibitor nilotinib targets discoidin domain receptor 2 in calcific aortic valve stenosis. Br J Pharmacol 2022; 179:4709-4721. [PMID: 35751904 PMCID: PMC9544120 DOI: 10.1111/bph.15911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/16/2022] [Accepted: 04/14/2022] [Indexed: 11/27/2022] Open
Abstract
Background and Purpose Tyrosine kinase inhibitors (TKI) used to treat chronic myeloid leukaemia (CML) have been associated with cardiovascular side effects, including reports of calcific aortic valve stenosis. The aim of this study was to establish the effects of first and second generation TKIs in aortic valve stenosis and to determine the associated molecular mechanisms. Experimental Approach Hyperlipidemic APOE*3Leiden.CETP transgenic mice were treated with nilotinib, imatinib or vehicle. Human valvular interstitial cells (VICs) were isolated and studied in vitro. Gene expression analysis was perfromed in aortic valves from 64 patients undergoing aortic valve replacement surgery. Key Results Nilotinib increased murine aortic valve thickness. Nilotinib, but not imatinib, promoted calcification and osteogenic activation and decreased autophagy in human VICs. Differential tyrosine kinase expression was detected between healthy and calcified valve tissue. Transcriptomic target identification revealed that the discoidin domain receptor DDR2, which is preferentially inhibited by nilotinib, was predominantly expressed in human aortic valves but markedly downregulated in calcified valve tissue. Nilotinib and selective DDR2 targeting in VICs induced a similar osteogenic activation, which was blunted by increasing the DDR2 ligand, collagen. Conclusions and Implications These findings suggest that inhibition of DDR2 by nilotinib promoted aortic valve thickening and VIC calcification, with possible translational implications for cardiovascular surveillance and possible personalized medicine in CML patients.
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Affiliation(s)
| | - Sven-Christian Pawelzik
- Department of Medicine, Karolinska Institutet.,Theme Heart and Vessels, Division of Valvular and Coronary Disease, Karolinska University Hospital, Stockholm, Sweden
| | | | - Marianne G Pouwer
- Metabolic Health Research, Gaubius Laboratory, The Netherlands Organization of Applied Scientific Research (TNO), Leiden, the Netherlands
| | | | | | | | | | - Elsbet Pieterman
- Metabolic Health Research, Gaubius Laboratory, The Netherlands Organization of Applied Scientific Research (TNO), Leiden, the Netherlands
| | - Leif Stenke
- Department of Medicine, Karolinska Institutet.,Theme Cancer, Division of Hematology, Karolinska University Hospital
| | - Hans M G Princen
- Metabolic Health Research, Gaubius Laboratory, The Netherlands Organization of Applied Scientific Research (TNO), Leiden, the Netherlands
| | - Anders Franco-Cereceda
- Department of Molecular Medicine and Surgery, Karolinska Institutet.,Theme Heart and Vessels, Division of Valvular and Coronary Disease, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Bäck
- Department of Medicine, Karolinska Institutet.,Theme Heart and Vessels, Division of Valvular and Coronary Disease, Karolinska University Hospital, Stockholm, Sweden
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8
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Matilla L, Garaikoetxea M, Arrieta V, García-Peña A, Fernández-Celis A, Navarro A, Gainza A, Álvarez V, Sádaba R, Jover E, López-Andrés N. Sex-Differences in Aortic Stenosis: Mechanistic Insights and Clinical Implications. Front Cardiovasc Med 2022; 9:818371. [PMID: 35282345 PMCID: PMC8907577 DOI: 10.3389/fcvm.2022.818371] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/31/2022] [Indexed: 12/22/2022] Open
Abstract
Objective We aim to analyse sex-specific differences in aortic valves (AVs) and valve interstitial cells (VICs) from aortic stenosis (AS) patients. Approach and Results 238 patients with severe AS undergoing surgical valve replacement were recruited. Two hundred and two AVs (39.1% women) were used for ex vivo analyses and 36 AVs (33.3% women) for in vitro experiments. AVs from men presented increased levels of the inflammatory molecules interleukin (IL)-1β, IL-6, Rantes, and CD45. Oxidative stress (eNOS, myeloperoxidase, malondialdehyde and nitrotyrosine) was upregulated in male AVs. Concerning fibrosis, similar levels of collagen type I, decreased levels of collagen type III and enhanced fibronectin, active Lox-1 and syndecan-1 expressions were found in AVs from men compared with women. Extracellular matrix (ECM) remodeling was characterized by reduced metalloproteinase-1 and 9 expression and increased tissue inhibitor of metalloproteinase-2 expression in male AVs. Importantly, osteogenic markers (bone morphogenetic protein-9, Rank-L, osteopontin, periostin, osteocalcin and Sox-9) and apoptosis (Bax, Caspase 3, p53, and PARP1) were enhanced in AVs from men as compared to women. Isolated male VICs presented higher myofibroblast-like phenotype than female VICs. Male VICs exhibited increased inflammatory, oxidative stress, fibrotic, apoptosis and osteogenic differentiation markers. Conclusions Our results suggest that the mechanisms driving the pathogenesis of AS could be different in men and women. Male AVs and isolated VICs presented more inflammation, oxidative stress, ECM remodeling and calcification as compared to those from women. A better knowledge of the pathophysiological pathways in AVs and VICs will allow the development of sex-specific options for the treatment of AS.
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Affiliation(s)
- Lara Matilla
- Cardiovascular Translational Research, Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Mattie Garaikoetxea
- Cardiovascular Translational Research, Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Vanessa Arrieta
- Cardiovascular Translational Research, Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Amaia García-Peña
- Cardiovascular Translational Research, Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Amaya Fernández-Celis
- Cardiovascular Translational Research, Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Adela Navarro
- Cardiovascular Translational Research, Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Alicia Gainza
- Cardiovascular Translational Research, Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Virginia Álvarez
- Cardiovascular Translational Research, Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Rafael Sádaba
- Cardiovascular Translational Research, Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Eva Jover
- Cardiovascular Translational Research, Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Natalia López-Andrés
- Cardiovascular Translational Research, Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
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9
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Calcific aortic valve stenosis and COVID-19: clinical management, valvular damage, and pathophysiological mechanisms. CARDIOLOGY PLUS 2022. [DOI: 10.1097/cp9.0000000000000001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Eysenbach G, Noh MFM, Ismail SR, van Daalen KR, Kamaruddin PSNM, Zulkiply SH, Azizul NH, Khalid NM, Ali A, Idris IM, Mei YS, Abdullah SR, Faridus N, Yusof NAM, Yusoff NNFM, Jamal R, Rahim AAA, Ghapar AKA, Radhakrishnan AK, Fong AYY, Ismail O, Krishinan S, Lee CY, Bang LH, Mageswaren E, Mahendran K, Amin NHM, Muthusamy G, Jin AOH, Ramli AW, Ross NT, Ruhani AI, Yahya M, Yusoff Y, Abidin SKZ, Amado L, Bolton T, Weston S, Crawte J, Ovenden N, Michielsen A, Monower MM, Mahiyuddin WRW, Wood A, Di Angelantonio E, Sulaiman NS, Danesh J, Butterworth AS. Investigating Genetic and Other Determinants of First-Onset Myocardial Infarction in Malaysia: Protocol for the Malaysian Acute Vascular Events Risk Study. JMIR Res Protoc 2022; 11:e31885. [PMID: 35142634 PMCID: PMC8874931 DOI: 10.2196/31885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/01/2021] [Accepted: 10/06/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Although the burden of premature myocardial infarction (MI) is high in Malaysia, direct evidence on the determinants of MI in this multi-ethnic population remains sparse. OBJECTIVE The Malaysian Acute Vascular Events Risk (MAVERIK) study is a retrospective case-control study established to investigate the genomic, lipid-related, and other determinants of acute MI in Malaysia. In this paper, we report the study protocol and early results. METHODS By June 2019, we had enrolled approximately 2500 patients with their first MI and 2500 controls without cardiovascular disease, who were frequency-matched by age, sex, and ethnicity, from 17 hospitals in Malaysia. For each participant, serum and whole blood have been collected and stored. Clinical, demographic, and behavioral information has been obtained using a 200-item questionnaire. RESULTS Tobacco consumption, a history of diabetes, hypertension, markers of visceral adiposity, indicators of lower socioeconomic status, and a family history of coronary disease were more prevalent in cases than in controls. Adjusted (age and sex) logistic regression models for traditional risk factors indicated that current smoking (odds ratio [OR] 4.11, 95% CI 3.56-4.75; P<.001), previous smoking (OR 1.34, 95% CI 1.12-1.60; P=.001), a history of high blood pressure (OR 2.13, 95% CI 1.86-2.44; P<.001), a history of diabetes mellitus (OR 2.72, 95% CI 2.34-3.17; P<.001), a family history of coronary heart disease (OR 1.28, 95% CI 1.07-1.55; P=.009), and obesity (BMI >30 kg/m2; OR 1.19, 95% CI 1.05-1.34; P=.009) were associated with MI in age- and sex-adjusted models. CONCLUSIONS The MAVERIK study can serve as a useful platform to investigate genetic and other risk factors for MI in an understudied Southeast Asian population. It should help to hasten the discovery of disease-causing pathways and inform regionally appropriate strategies that optimize public health action. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/31885.
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Affiliation(s)
| | - Mohd Fairulnizal Md Noh
- Institute for Medical Research, National Institute of Health, Ministry of Health, Kuala Lumpur, Malaysia
| | - Sophia Rasheeqa Ismail
- Institute for Medical Research, National Institute of Health, Ministry of Health, Kuala Lumpur, Malaysia
| | - Kim Robin van Daalen
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | | | - Siti Hafizah Zulkiply
- Institute for Medical Research, National Institute of Health, Ministry of Health, Kuala Lumpur, Malaysia
| | - Nur Hayati Azizul
- Institute for Medical Research, National Institute of Health, Ministry of Health, Kuala Lumpur, Malaysia
| | - Norhayati Mustafa Khalid
- Institute for Medical Research, National Institute of Health, Ministry of Health, Kuala Lumpur, Malaysia
| | - Azizan Ali
- Institute for Medical Research, National Institute of Health, Ministry of Health, Kuala Lumpur, Malaysia
| | - Izyan Mohd Idris
- Institute for Medical Research, National Institute of Health, Ministry of Health, Kuala Lumpur, Malaysia
| | - Yong Shih Mei
- Institute for Medical Research, National Institute of Health, Ministry of Health, Kuala Lumpur, Malaysia
| | - Shazana Rifham Abdullah
- Institute for Medical Research, National Institute of Health, Ministry of Health, Kuala Lumpur, Malaysia
| | - Norfashihah Faridus
- Institute for Medical Research, National Institute of Health, Ministry of Health, Kuala Lumpur, Malaysia
| | - Nur Azirah Md Yusof
- Institute for Medical Research, National Institute of Health, Ministry of Health, Kuala Lumpur, Malaysia
| | - Nur Najwa Farahin M Yusoff
- Institute for Medical Research, National Institute of Health, Ministry of Health, Kuala Lumpur, Malaysia
| | - Rahman Jamal
- UKM Medical Molecular Biological Institute, Kuala Lumpur, Malaysia
| | | | | | - Ammu Kutty Radhakrishnan
- Jeffery Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Alan Yean Yip Fong
- Department of Cardiology, Sarawak Heart Centre, Kota Samarahan, Malaysia.,Clinical Research Centre, Institute for Clinical Research, Sarawak General Hospital, Kuching, Malaysia
| | - Omar Ismail
- Department of Cardiology, Hospital Pulau Pinang, Pulau Pinang, Malaysia
| | | | - Chuey Yan Lee
- Department of Cardiology, Hospital Sultanah Aminah, Johor, Malaysia
| | - Liew Houng Bang
- Department of Cardiology & Clinical Research Centre, Hospital Queen Elizabeth II, Sabah, Malaysia
| | - Eashwary Mageswaren
- Department of General Medicine, Hospital Tengku Ampuan Rahimah, Selangor, Malaysia
| | - Kauthaman Mahendran
- Department of General Medicine & Clinical Research Centre, Hospital Melaka, Melaka, Malaysia
| | - Nor Hanim Mohd Amin
- Department of General Medicine, Hospital Raja Permaisuri Bainun, Perak, Malaysia
| | | | - Aaron Ong Hean Jin
- Department of General Medicine, Hospital Tuanku Fauziah, Perlis, Malaysia
| | - Ahmad Wazi Ramli
- Department of Cardiology, Hospital Sultanah Nur Zahirah, Terengganu, Malaysia
| | - Noel Thomas Ross
- Department of General Medicine, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | | | - Mansor Yahya
- Institute for Medical Research, National Institute of Health, Ministry of Health, Kuala Lumpur, Malaysia
| | - Yusniza Yusoff
- Department of General Medicine, Hospital Sungai Buloh, Selangor, Malaysia
| | | | - Laryssa Amado
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Thomas Bolton
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.,National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
| | - Sophie Weston
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Jason Crawte
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Niko Ovenden
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Ank Michielsen
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Md Mostafa Monower
- National Heart Foundation Hospital & Research Institute, Mirpur, Dhaka, Bangladesh
| | - Wan Rozita Wan Mahiyuddin
- Institute for Medical Research, National Institute of Health, Ministry of Health, Kuala Lumpur, Malaysia
| | - Angela Wood
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.,National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom.,Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, United Kingdom.,British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, United Kingdom
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.,National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom.,Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, United Kingdom.,British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, United Kingdom
| | - Nur Suffia Sulaiman
- Institute for Medical Research, National Institute of Health, Ministry of Health, Kuala Lumpur, Malaysia
| | - John Danesh
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.,National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom.,Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, United Kingdom.,British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, United Kingdom.,Department of Human Genetics, Wellcome Sanger Institute, Hinxton, United Kingdom
| | - Adam S Butterworth
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.,National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom.,Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, United Kingdom.,British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, United Kingdom
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11
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Jiang C, Jiang W. AGTR1, PLTP, and SCG2 associated with immune genes and immune cell infiltration in calcific aortic valve stenosis: analysis from integrated bioinformatics and machine learning. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2022; 19:3787-3802. [PMID: 35341274 DOI: 10.3934/mbe.2022174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background: Calcific aortic valve stenosis (CAVS) is a crucial cardiovascular disease facing aging societies. Our research attempts to identify immune-related genes through bioinformatics and machine learning analysis. Two machine learning strategies include Least Absolute Shrinkage Selection Operator (LASSO) and Support Vector Machine Recursive Feature Elimination (SVM-RFE). In addition, we deeply explore the role of immune cell infiltration in CAVS, aiming to study the potential therapeutic targets of CAVS and explore possible drugs. Methods: Download three data sets related to CAVS from the Gene Expression Omnibus. Gene set variation analysis (GSVA) looks for potential mechanisms, determines differentially expressed immune-related genes (DEIRGs) by combining the ImmPort database with CAVS differential genes, and explores the functions and pathways of enrichment. Two machine learning methods, LASSO and SVM-RFE, screen key immune signals and validate them in external data sets. Single-sample GSEA (ssGSEA) and CIBERSORT analyze the subtypes of immune infiltrating cells and integrate the analysis with DEIRGs and key immune signals. Finally, the possible targeted drugs are analyzed through the Connectivity Map (CMap). Results: GSVA analysis of the gene set suggests that it is highly correlated with multiple immune pathways. 266 differential genes (DEGs) integrate with immune genes to obtain 71 DEIRGs. Enrichment analysis found that DEIRGs are related to oxidative stress, synaptic membrane components, receptor activity, and a variety of cardiovascular diseases and immune pathways. Angiotensin II Receptor Type 1(AGTR1), Phospholipid Transfer Protein (PLTP), Secretogranin II (SCG2) are identified as key immune signals of CAVS by machine learning. Immune infiltration found that B cells naï ve and Macrophages M2 are less in CAVS, while Macrophages M0 is more in CAVS. Simultaneously, AGTR1, PLTP, SCG2 are highly correlated with a variety of immune cell subtypes. CMap analysis found that isoliquiritigenin, parthenolide, and pyrrolidine-dithiocarbamate are the top three targeted drugs related to CAVS immunity. Conclusion: The key immune signals, immune infiltration and potential drugs obtained from the research play a vital role in the pathophysiological progress of CAVS.
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Affiliation(s)
- Chenyang Jiang
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Weidong Jiang
- Department of Cardiology, Nantong Traditional Chinese Medicine Hospital, Nantong 226001, China
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12
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Ferrari S, Pesce M. The Complex Interplay of Inflammation, Metabolism, Epigenetics, and Sex in Calcific Disease of the Aortic Valve. Front Cardiovasc Med 2022; 8:791646. [PMID: 35071359 PMCID: PMC8770423 DOI: 10.3389/fcvm.2021.791646] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/30/2021] [Indexed: 12/20/2022] Open
Abstract
Calcification of the aortic valve is one of the most rapidly increasing pathologies in the aging population worldwide. Traditionally associated to cardiovascular risk conditions, this pathology is still relatively unaddressed on a molecular/cellular standpoint and there are no available treatments to retard its progression unless valve substitution. In this review, we will describe some of the most involved inflammatory players, the metabolic changes that may be responsible of epigenetic modifications and the gender-related differences in the onset of the disease. A better understanding of these aspects and their integration into a unique pathophysiology context is relevant to improve current therapies and patients management.
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Affiliation(s)
- Silvia Ferrari
- Unità di Ingegneria Tissutale Cardiovascolare, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Maurizio Pesce
- Unità di Ingegneria Tissutale Cardiovascolare, Centro Cardiologico Monzino, IRCCS, Milan, Italy
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13
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Ullah W, Gul S, Saleem S, Syed MA, Khan MZ, Zahid S, Minhas AMK, Virani SS, Mamas MA, Fischman DL. Trend, predictors, and outcomes of combined mitral valve replacement and coronary artery bypass graft in patients with concomitant mitral valve and coronary artery disease: a National Inpatient Sample database analysis. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac002. [PMID: 35919659 PMCID: PMC9242072 DOI: 10.1093/ehjopen/oeac002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/09/2021] [Accepted: 01/05/2022] [Indexed: 04/16/2023]
Abstract
Aims Combined mitral valve replacement (MVR) and coronary artery bypass graft (CABG) procedures have been the norm for patients with concomitant mitral valve disease (MVD) and coronary artery disease (CAD) with no large-scale data on their safety and efficacy. Methods and results The National Inpatient Sample database (2002-18) was queried to identify patients undergoing MVR and CABG. The major adverse cardiovascular events (MACE) and its components were compared using a propensity score-matched (PSM) analysis to calculate adjusted odds ratios (OR). A total of 6 145 694 patients (CABG only 3 971 045, MVR only 1 933 459, MVR + CABG 241 190) were included in crude analysis, while a matched cohort of 724 237 (CABG only 241 436, MVR only 241 611 vs. MVR + CABG 241 190) was selected in PSM analysis. The combined MVR + CABG procedure had significantly higher adjusted odds of MACE [OR 1.13, 95% confidence interval (CI) 1.11-1.14 and OR 1.96, 95% CI 1.93-1.99] and in-hospital mortality (OR 1.29, 95% CI 1.27-1.31 and OR 2.1, 95% CI 2.05-2.14) compared with CABG alone and MVR alone, respectively. Similarly, the risk of post-procedure bleeding, major bleeding, acute kidney injury, cardiogenic shock, sepsis, need for intra-aortic balloon pump, mean length of stay, and total charges per hospitalization were significantly higher for patients undergoing the combined procedure. These findings remained consistent on yearly trend analysis favouring the isolated CABG and MVR groups. Conclusion Combined procedure (MVR + CABG) in patients with MVD and CAD appears to be associated with worse in-hospital outcomes, increased mortality, and higher resource utilization compared with isolated CABG and MVR procedures. Randomized controlled trials are needed to determine the relative safety of these procedures in the full spectrum of baseline valvular and angiographic characteristics.
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Affiliation(s)
- Waqas Ullah
- Thomas Jefferson University Hospitals, Philadelphia, PA, USA
- Corresponding author. Tel: 215-955-6000,
| | | | | | | | | | | | | | - Salim S Virani
- Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Mamas A Mamas
- Thomas Jefferson University Hospitals, Philadelphia, PA, USA
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
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14
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Alamgir A, Mousa O, Shah Z. Artificial Intelligence in Predicting Cardiac Arrest: Scoping Review. JMIR Med Inform 2021; 9:e30798. [PMID: 34927595 PMCID: PMC8726033 DOI: 10.2196/30798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/07/2021] [Accepted: 10/10/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Cardiac arrest is a life-threatening cessation of activity in the heart. Early prediction of cardiac arrest is important, as it allows for the necessary measures to be taken to prevent or intervene during the onset. Artificial intelligence (AI) technologies and big data have been increasingly used to enhance the ability to predict and prepare for the patients at risk. OBJECTIVE This study aims to explore the use of AI technology in predicting cardiac arrest as reported in the literature. METHODS A scoping review was conducted in line with the guidelines of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews. Scopus, ScienceDirect, Embase, the Institute of Electrical and Electronics Engineers, and Google Scholar were searched to identify relevant studies. Backward reference list checks of the included studies were also conducted. Study selection and data extraction were independently conducted by 2 reviewers. Data extracted from the included studies were synthesized narratively. RESULTS Out of 697 citations retrieved, 41 studies were included in the review, and 6 were added after backward citation checking. The included studies reported the use of AI in the prediction of cardiac arrest. Of the 47 studies, we were able to classify the approaches taken by the studies into 3 different categories: 26 (55%) studies predicted cardiac arrest by analyzing specific parameters or variables of the patients, whereas 16 (34%) studies developed an AI-based warning system. The remaining 11% (5/47) of studies focused on distinguishing patients at high risk of cardiac arrest from patients who were not at risk. Two studies focused on the pediatric population, and the rest focused on adults (45/47, 96%). Most of the studies used data sets with a size of <10,000 samples (32/47, 68%). Machine learning models were the most prominent branch of AI used in the prediction of cardiac arrest in the studies (38/47, 81%), and the most used algorithm was the neural network (23/47, 49%). K-fold cross-validation was the most used algorithm evaluation tool reported in the studies (24/47, 51%). CONCLUSIONS AI is extensively used to predict cardiac arrest in different patient settings. Technology is expected to play an integral role in improving cardiac medicine. There is a need for more reviews to learn the obstacles to the implementation of AI technologies in clinical settings. Moreover, research focusing on how to best provide clinicians with support to understand, adapt, and implement this technology in their practice is also necessary.
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Affiliation(s)
- Asma Alamgir
- College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Osama Mousa
- College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Zubair Shah
- College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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15
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Imamura T, Narang N, Onoda H, Tanaka S, Ushijima R, Sobajima M, Fukuda N, Ueno H, Kinugawa K. Implications of Elevated Fibrosis-4 Index in Patients Receiving Trans-Catheter Aortic Valve Replacement. J Clin Med 2021; 10:jcm10245778. [PMID: 34945074 PMCID: PMC8705603 DOI: 10.3390/jcm10245778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/01/2021] [Accepted: 12/03/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The prognostic implication of the fibrosis-4 index, which represents the degree of hepatic injury, on patients receiving trans-catheter aortic valve replacement (TAVR) remains unknown. METHODS Patients who underwent TAVR to treat severe aortic stenosis at our institute between 2015 and 2020 were included in this retrospective study and followed for 2 years from the index discharge. The impact of the fibrosis-4 index, which was calculated using age, hepatic enzymes, and platelet count, on 2-year heart failure readmissions was investigated. RESULTS A total of 272 patients (median age 85 (82, 88) years old, 76 (28%) men) were included. The median baseline fibrosis-4 index was 2.8 (2.2, 3.7). A high fibrosis-4 index (>3.79) was associated with higher cumulative incidence of the primary endpoint (18% versus 4%, p < 0.001) and higher event rates (0.1041 versus 0.0222 events/year, p < 0.001), with an adjusted hazard ratio of 1.27 (95% confidence interval 1.04-1.54, p = 0.019). CONCLUSION an elevated fibrosis-4 index at baseline, indicating the existence of persistent hepatic congestion, was associated with incidences of heart failure following TAVR. Calculating the fibrosis-4 index before TAVR is highly encouraged for risk stratification and shared decision making.
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Affiliation(s)
- Teruhiko Imamura
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan; (H.O.); (S.T.); (R.U.); (M.S.); (N.F.); (H.U.); (K.K.)
- Correspondence: ; Tel.: +81-76-434-2246; Fax: +81-76-434-5026
| | - Nikhil Narang
- Advocate Christ Medical Center, Chicago, IL 60453, USA;
| | - Hiroshi Onoda
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan; (H.O.); (S.T.); (R.U.); (M.S.); (N.F.); (H.U.); (K.K.)
| | - Shuhei Tanaka
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan; (H.O.); (S.T.); (R.U.); (M.S.); (N.F.); (H.U.); (K.K.)
| | - Ryuichi Ushijima
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan; (H.O.); (S.T.); (R.U.); (M.S.); (N.F.); (H.U.); (K.K.)
| | - Mitsuo Sobajima
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan; (H.O.); (S.T.); (R.U.); (M.S.); (N.F.); (H.U.); (K.K.)
| | - Nobuyuki Fukuda
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan; (H.O.); (S.T.); (R.U.); (M.S.); (N.F.); (H.U.); (K.K.)
| | - Hiroshi Ueno
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan; (H.O.); (S.T.); (R.U.); (M.S.); (N.F.); (H.U.); (K.K.)
| | - Koichiro Kinugawa
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan; (H.O.); (S.T.); (R.U.); (M.S.); (N.F.); (H.U.); (K.K.)
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16
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Kraler S, Blaser MC, Aikawa E, Camici GG, Lüscher TF. Calcific aortic valve disease: from molecular and cellular mechanisms to medical therapy. Eur Heart J 2021; 43:683-697. [PMID: 34849696 DOI: 10.1093/eurheartj/ehab757] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 09/12/2021] [Accepted: 10/20/2021] [Indexed: 12/12/2022] Open
Abstract
Calcific aortic valve disease (CAVD) is a highly prevalent condition that comprises a disease continuum, ranging from microscopic changes to profound fibro-calcific leaflet remodelling, culminating in aortic stenosis, heart failure, and ultimately premature death. Traditional risk factors, such as hypercholesterolaemia and (systolic) hypertension, are shared among atherosclerotic cardiovascular disease and CAVD, yet the molecular and cellular mechanisms differ markedly. Statin-induced low-density lipoprotein cholesterol lowering, a remedy highly effective for secondary prevention of atherosclerotic cardiovascular disease, consistently failed to impact CAVD progression or to improve patient outcomes. However, recently completed phase II trials provide hope that pharmaceutical tactics directed at other targets implicated in CAVD pathogenesis offer an avenue to alter the course of the disease non-invasively. Herein, we delineate key players of CAVD pathobiology, outline mechanisms that entail compromised endothelial barrier function, and promote lipid homing, immune-cell infiltration, and deranged phospho-calcium metabolism that collectively perpetuate a pro-inflammatory/pro-osteogenic milieu in which valvular interstitial cells increasingly adopt myofibro-/osteoblast-like properties, thereby fostering fibro-calcific leaflet remodelling and eventually resulting in left ventricular outflow obstruction. We provide a glimpse into the most promising targets on the horizon, including lipoprotein(a), mineral-binding matrix Gla protein, soluble guanylate cyclase, dipeptidyl peptidase-4 as well as candidates involved in regulating phospho-calcium metabolism and valvular angiotensin II synthesis and ultimately discuss their potential for a future therapy of this insidious disease.
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Affiliation(s)
- Simon Kraler
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland.,University Heart Center, Department of Cardiology, University Hospital, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Mark C Blaser
- Center for Interdisciplinary Cardiovascular Sciences, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 3 Blackfan Street, Boston, MA 02115, USA
| | - Elena Aikawa
- Center for Interdisciplinary Cardiovascular Sciences, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 3 Blackfan Street, Boston, MA 02115, USA.,Center for Excellence in Vascular Biology, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 77 Ave Louis Pasteur, NRB7, Boston, MA 02115, USA
| | - Giovanni G Camici
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland.,University Heart Center, Department of Cardiology, University Hospital, Rämistrasse 100, 8091 Zurich, Switzerland.,Department of Research and Education, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Thomas F Lüscher
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland.,Heart Division, Royal Brompton & Harefield Hospitals, Sydney Street, London SW3 6NP, UK.,National Heart and Lung Institute, Imperial College, Guy Scadding Building, Dovehouse Street, London SW3 6LY, UK
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17
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Shara N, Anderson KM, Falah N, Ahmad MF, Tavazoei D, Hughes JM, Talmadge B, Crovatt S, Dempers R. The process of sourcing and preparing EHR data to implement a machine-learning algorithm for early identification of maternal cardiovascular risk (Preprint). JMIR Med Inform 2021; 10:e34932. [PMID: 35142637 PMCID: PMC8874927 DOI: 10.2196/34932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/06/2021] [Accepted: 01/02/2022] [Indexed: 12/05/2022] Open
Abstract
Background Health care data are fragmenting as patients seek care from diverse sources. Consequently, patient care is negatively impacted by disparate health records. Machine learning (ML) offers a disruptive force in its ability to inform and improve patient care and outcomes. However, the differences that exist in each individual’s health records, combined with the lack of health data standards, in addition to systemic issues that render the data unreliable and that fail to create a single view of each patient, create challenges for ML. Although these problems exist throughout health care, they are especially prevalent within maternal health and exacerbate the maternal morbidity and mortality crisis in the United States. Objective This study aims to demonstrate that patient records extracted from the electronic health records (EHRs) of a large tertiary health care system can be made actionable for the goal of effectively using ML to identify maternal cardiovascular risk before evidence of diagnosis or intervention within the patient’s record. Maternal patient records were extracted from the EHRs of a large tertiary health care system and made into patient-specific, complete data sets through a systematic method. Methods We outline the effort that was required to define the specifications of the computational systems, the data set, and access to relevant systems, while ensuring that data security, privacy laws, and policies were met. Data acquisition included the concatenation, anonymization, and normalization of health data across multiple EHRs in preparation for their use by a proprietary risk stratification algorithm designed to establish patient-specific baselines to identify and establish cardiovascular risk based on deviations from the patient’s baselines to inform early interventions. Results Patient records can be made actionable for the goal of effectively using ML, specifically to identify cardiovascular risk in pregnant patients. Conclusions Upon acquiring data, including their concatenation, anonymization, and normalization across multiple EHRs, the use of an ML-based tool can provide early identification of cardiovascular risk in pregnant patients.
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Affiliation(s)
- Nawar Shara
- MedStar Health Research Institute, Georgetown-Howard Universities Center for Clinical and Translational Science, Hyattsville, MD, United States
| | | | - Noor Falah
- MedStar Health Research Institute, Hyattsville, MD, United States
| | - Maryam F Ahmad
- MedStar Health Research Institute, Hyattsville, MD, United States
| | - Darya Tavazoei
- MedStar Health Research Institute, Hyattsville, MD, United States
| | - Justin M Hughes
- MedStar Health Research Institute, Hyattsville, MD, United States
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18
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Arnardottir H, Thul S, Pawelzik SC, Karadimou G, Artiach G, Gallina AL, Mysdotter V, Carracedo M, Tarnawski L, Caravaca AS, Baumgartner R, Ketelhuth DF, Olofsson PS, Paulsson-Berne G, Hansson GK, Bäck M. The resolvin D1 receptor GPR32 transduces inflammation-resolution and atheroprotection. J Clin Invest 2021; 131:142883. [PMID: 34699386 DOI: 10.1172/jci142883] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/19/2021] [Indexed: 11/17/2022] Open
Abstract
Chronic inflammation is a hallmark of atherosclerosis and results from an imbalance between pro-inflammatory and pro-resolving signaling. The human GPR32 receptor, together with the ALX/FPR2 receptor, transduces biological actions of several pro-resolving mediators that stimulate resolution of inflammation. However, since no murine homologs of the human GPR32 exist, comprehensive in vivo studies are lacking. Using human atherosclerotic lesions from carotid endarterectomies and creating a transgenic mouse model expressing human GPR32 on a Fpr2×apolipoprotein E double KO background (hGPR32myc×Fpr2-/-×Apoe-/-), we investigated the role of GPR32 in atherosclerosis and self-limiting acute inflammation. GPR32 mRNA was reduced in human atherosclerotic lesions and correlated with the immune cell markers ARG1, NOS2 and FOXP3. Atherosclerotic lesions, necrotic core and aortic inflammation were reduced in hGPR32mycTg×Fpr2-/-×Apoe-/- transgenic mice as compared to Fpr2-/-×Apoe-/- non-transgenic littermates. In a zymosan induced peritonitis model, the hGPR32mycTg×Fpr2-/-×Apoe-/- transgenic mice had reduced inflammation at 4h and enhanced pro-resolving macrophage responses at 24h compared to non-transgenic littermates. The GPR32 agonist aspirin-triggered resolvin D1 (AT-RvD1) regulated leukocyte responses, including enhancing macrophage phagocytosis and intracellular signaling in hGPR32mycTg×Fpr2-/-×Apoe-/- transgenic mice but not in the Fpr2-/-×Apoe-/- non-transgenic littermates. Altogether these results provide the first evidence that GPR32 regulates resolution of inflammation and is atheroprotective in vivo.
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Affiliation(s)
| | - Silke Thul
- Department of Medicone, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Gonzalo Artiach
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Miguel Carracedo
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Laura Tarnawski
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - April S Caravaca
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Peder S Olofsson
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Göran K Hansson
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Bäck
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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Bäck M. Aortic valve calcification score utility extended to moderate aortic stenosis. Eur Heart J Cardiovasc Imaging 2021; 23:185-187. [PMID: 34618019 DOI: 10.1093/ehjci/jeab204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Magnus Bäck
- University of Lorraine, Nancy University Hospital, INSERM U1116, 9 Avenue de la Forêt de Haye, 54505 Vandoeuvre les Nancy Cedex, France
- Department of Cardiology, Karolinska University Hospital Huddinge, M85, Stockholm 141 86, Sweden
- Translational Cardiology, Department of Medicine Solna, Karolinska Institutet, 17176 Stockholm, Sweden
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Does Oxygen Content Play a Role in Spontaneous Closure of Perimembranous Ventricular Septal Defects? CHILDREN-BASEL 2021; 8:children8100881. [PMID: 34682146 PMCID: PMC8534918 DOI: 10.3390/children8100881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 09/28/2021] [Accepted: 09/30/2021] [Indexed: 11/21/2022]
Abstract
(1) Background: the impact of a series of laboratory parameters (haemoglobin, haematocrit, foetal haemoglobin, peripheral oxygen saturation, iron, transferrin, ferritin, and albumin) on perimembranous ventricular septal defects spontaneous healing was tested. (2) Methods: one hundred and seven patients were enrolled in the study (57% males; mean age 2.1 ± 0.4 years) and were subsequently subdivided into two groups: self-healing (n = 36) and in need of intervention (n = 71). Self-healing subjects were defined on the basis of an absence of residual shunts at colorDoppler across the previous defect. (3) Results: no statistically significant differences were reported in the size of perimembranous ventricular septal defects between the two groups (p = ns). Conversely, prevalence of anaemia was significantly higher in those requiring intervention than in the self-healing group (p < 0.03), while haemoglobin, iron, ferritin, and albumin levels were lower (p < 0.001, p < 0.05, p < 0.02, p < 0.007, respectively). In multivariable linear regression analysis, only haemoglobin and albumin were found to be associated with spontaneous closure (p < 0.005 and p < 0.02, respectively). In multiple logistic regression analysis, haemoglobin independently increased the probability of self-healing of perimembranous ventricular septal defects (p = 0.03). All patients needing an interventional closure of perimembranous ventricular septal defects presented with haemoglobin <12.7 g/dL. (4) Conclusion: the self-resolution of perimembranous ventricular septal defects seems to rely on numerous factors, including oxygen content, which is likely to promote cell proliferation as well as tissue regeneration. Haemoglobin blood concentration seems to influence the natural history of perimembranous ventricular septal defects and improvement of anaemia by supplementation of iron intake might represent a simple and reliable method to promote self-healing.
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Choe S, Park E, Shin W, Koo B, Shin D, Jung C, Lee H, Kim J. Short-Term Event Prediction in the Operating Room (STEP-OP) of Five-Minute Intraoperative Hypotension Using Hybrid Deep Learning: Retrospective Observational Study and Model Development. JMIR Med Inform 2021; 9:e31311. [PMID: 34591024 PMCID: PMC8517810 DOI: 10.2196/31311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/07/2021] [Accepted: 08/24/2021] [Indexed: 01/14/2023] Open
Abstract
Background Intraoperative hypotension has an adverse impact on postoperative outcomes. However, it is difficult to predict and treat intraoperative hypotension in advance according to individual clinical parameters. Objective The aim of this study was to develop a prediction model to forecast 5-minute intraoperative hypotension based on the weighted average ensemble of individual neural networks, utilizing the biosignals recorded during noncardiac surgery. Methods In this retrospective observational study, arterial waveforms were recorded during noncardiac operations performed between August 2016 and December 2019, at Seoul National University Hospital, Seoul, South Korea. We analyzed the arterial waveforms from the big data in the VitalDB repository of electronic health records. We defined 2s hypotension as the moving average of arterial pressure under 65 mmHg for 2 seconds, and intraoperative hypotensive events were defined when the 2s hypotension lasted for at least 60 seconds. We developed an artificial intelligence–enabled process, named short-term event prediction in the operating room (STEP-OP), for predicting short-term intraoperative hypotension. Results The study was performed on 18,813 subjects undergoing noncardiac surgeries. Deep-learning algorithms (convolutional neural network [CNN] and recurrent neural network [RNN]) using raw waveforms as input showed greater area under the precision-recall curve (AUPRC) scores (0.698, 95% CI 0.690-0.705 and 0.706, 95% CI 0.698-0.715, respectively) than that of the logistic regression algorithm (0.673, 95% CI 0.665-0.682). STEP-OP performed better and had greater AUPRC values than those of the RNN and CNN algorithms (0.716, 95% CI 0.708-0.723). Conclusions We developed STEP-OP as a weighted average of deep-learning models. STEP-OP predicts intraoperative hypotension more accurately than the CNN, RNN, and logistic regression models. Trial Registration ClinicalTrials.gov NCT02914444; https://clinicaltrials.gov/ct2/show/NCT02914444.
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Affiliation(s)
- Sooho Choe
- School of Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eunjeong Park
- Cerebro-Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Wooseok Shin
- School of Industrial and Management Engineering, Korea University, Seoul, Republic of Korea
| | - Bonah Koo
- SK Inc C&C, Seoul, Republic of Korea
| | - Dongjin Shin
- School of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chulwoo Jung
- Department of Anesthesiology and Pain Medicine, Seoul National University, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyungchul Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeongmin Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Sarajlic P, Simonsson M, Jernberg T, Bäck M, Hofmann R. Incidence, associated outcomes, and predictors of upper gastrointestinal bleeding following acute myocardial infarction: a SWEDEHEART-based nationwide cohort study. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2021; 8:483-491. [PMID: 34423350 PMCID: PMC9366628 DOI: 10.1093/ehjcvp/pvab059] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/15/2021] [Accepted: 08/02/2021] [Indexed: 01/10/2023]
Abstract
Aims Of all spontaneous bleeding complications in patients with acute myocardial infarction (MI), upper gastrointestinal bleeding (UGIB) is common and of specific interest since it could be prevented by several prophylactic measures. We aimed to determine the incidence, associated outcomes, and predictors of UGIB following acute MI. Methods and results All patients with acute MI enrolled in the SWEDEHEART (Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies) registry from January 2007 to June 2016 and discharged alive on any antithrombotic therapy (n = 149 477) were followed regarding UGIB for 1 year. Associated outcomes were determined by Cox proportional hazards regression with UGIB as a time-dependent covariate, adjusting for baseline characteristics, invasive treatment, and medical treatment at discharge. Predictors of UGIB were determined by logistic regression and machine learning models. At 1 year, UGIB had occurred in 2230 patients (cumulative incidence 1.5%) and was significantly associated with an increased risk of all-cause death [hazard ratio (HR) 2.86, 95% confidence interval (CI) 2.58–3.16] and stroke (HR 1.80, 95% CI 1.32–2.45) but not with recurrent MI (HR 1.17, 95% CI 0.97–1.42). The most important predictors of UGIB were haemoglobin, age, systolic blood pressure, blood glucose, smoking status, previous upper gastrointestinal bleeding, and antithrombotic and gastroprotective treatment. Conclusion After acute MI, readmission because of UGIB is common and significantly associated with poor prognosis. By using machine learning in addition to traditional logistic regression, new predictors of UGIB, such as blood glucose and smoking status, were identified.
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Affiliation(s)
- Philip Sarajlic
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Moa Simonsson
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institute, Stockholm, Sweden.,Theme Heart and Vessels, Division of Valvular and Coronary Disease, Karolinska University Hospital, Stockholm, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Magnus Bäck
- Department of Medicine, Karolinska Institute, Stockholm, Sweden.,Theme Heart and Vessels, Division of Valvular and Coronary Disease, Karolinska University Hospital, Stockholm, Sweden
| | - Robin Hofmann
- Department of Clinical Science and Education, Division of Cardiology, Karolinska Institute, Sodersjukhuset, Stockholm, Sweden
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Mercier N, Bäck M. The double-action of hydrogen peroxide on the oxidative atherosclerosis battlefield. Atherosclerosis 2021; 331:28-30. [PMID: 34391571 DOI: 10.1016/j.atherosclerosis.2021.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/02/2021] [Indexed: 12/28/2022]
Affiliation(s)
- Nathalie Mercier
- CHRU de Nancy and Inserm, UMR_S 1116, DCAC, Université de Lorraine, Nancy, France.
| | - Magnus Bäck
- CHRU de Nancy and Inserm, UMR_S 1116, DCAC, Université de Lorraine, Nancy, France; Department of Cardiology Karolinska University Hospital and Department of Medicine Karolinska Institutet, Stockholm, Sweden
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