Univariate Logistic Regression Research Articles

Predicting ECGs masquerading AS STEMI with machine learning

Abstract Background Advancements in the management of ST elevation myocardial infarction (STEMI) in the last 15 years include early STEMI identification in the prehospital setting leading to expedited cardiac catheterisation laboratory (CCL) activation or fibrinolytic therapy. We have previously reported of patients who met the Glasgow algorithm (GA) ECG criteria for STEMI; 50% did not actually have an acute STEMI according to the 4th universal definition of MI (4UDMI)1. Identifying such patients could avoid unnecessary emergency CCL activations or inappropriate fibrinolytic administration. Methods From June 2010 to October 2021, we identified 2992 patients with ECG transmissions to Liverpool Hospital, Sydney Australia which met GA criteria for STEMI. These were adjudicated according to the 4UDMI for true-positive STEMI. We used univariate and multivariate logistic regression to identify likely patient characteristics that were predictive of true-positive STEMI. We then improved model performance using receiver-operator curve (ROC) with simple random forest machine learning algorithms. Results Among 2994 patients with prehospital ECG transmissions that met GA-criteria, 1553 (51%) were adjudicated as true-positive STEMI, which is comparable to previous findings1. All standard modifiable and non-modifiable risk factors were independently predictive of true-positive STEMI; however, in multivariate logistic regression gender, hypertension and diabetes lost significance. Dyslipidemia and current smoking were positively predictive of true-positive STEMI status (OR = 1.64 and 1.32 respectively), whereas age and previous MI were negatively associated (OR = 0.98 (per year increment) and 0.4). Using these identified predictors in a random forest to predict true-positive STEMI yielded an AUC of 0.65 (Figure 1). Conclusion Specific clarification of dyslipidaemia and current smoking status at first medical contact may be the most salient in predicting a true-positive STEMI during prehospital assessment which may assist in avoiding unnecessary emergency CCL activation or inappropriate fibrinolytic administration.ROC of ST elevation STEMI recognition

Prediction of microvascular invasion in hepatocellular carcinoma with conventional ultrasound, Sonazoid-enhanced ultrasound, and biochemical indicator: a multicenter study

PurposeTo develop and validate a preoperative prediction model based on multimodal ultrasound and biochemical indicator for identifying microvascular invasion (MVI) in patients with a single hepatocellular carcinoma (HCC) ≤ 5 cm.MethodsFrom May 2022 to November 2023, a total of 318 patients with pathologically confirmed single HCC ≤ 5 cm from three institutions were enrolled. All of them underwent preoperative biochemical, conventional ultrasound (US), and contrast-enhanced ultrasound (CEUS) (Sonazoid, 0.6 mL, bolus injection) examinations. Univariate and multivariate logistic regression analyses on clinical information, biochemical indicator, and US imaging features were performed in the training set to seek independent predictors for MVI-positive. The models were constructed and evaluated using the area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis in both validation and test sets. Subgroup analyses in patients with different liver background and tumor sizes were conducted to further investigate the model’s performance.ResultsLogistic regression analyses showed that obscure tumor boundary in B-mode US, intra-tumoral artery in pulsed-wave Doppler US, complete Kupffer-phase agent clearance in Sonazoid-CEUS, and biomedical indicator PIVKA-II were independently correlated with MVI-positive. The combined model comprising all predictors showed the highest AUC, which were 0.937 and 0.893 in the validation and test sets. Good calibration and prominent net benefit were achieved in both sets. No significant difference was found in subgroup analyses.ConclusionsThe combination of biochemical indicator, conventional US, and Sonazoid-CEUS features could help preoperative MVI prediction in patients with a single HCC ≤ 5 cm.Critical relevance statementInvestigation of imaging features in conventional US, Sonazoid-CEUS, and biochemical indicators showed a significant relation with MVI-positivity in patients with a single HCC ≤ 5 cm, allowing the construction of a model for preoperative prediction of MVI status to help treatment decision making.Key PointsMVI status is important for patients with a single HCC ≤ 5 cm.The model based on conventional US, Sonazoid-CEUS and PIVKA-II performs best for MVI prediction.The combined model has potential for preoperative prediction of MVI status.Graphical

Analysis of the prevalence characteristics and risk factors of pulmonary tuberculosis combined with extrapulmonary tuberculosis in elderly patients

To analyze the clinical features, epidemiological characteristics, risk factors, and complication characteristics of pulmonary tuberculosis (PTB) combined with extrapulmonary tuberculosis (EPTB) in elderly patients (aged > 60 years). Clinical data were collected from pathogen positive elderly patients with PTB hospitalized in a teaching hospital in Zhejiang from 2017 to 2023. We retrospectively analyzed the risk factors for complications of EPTB in elderly patients with PTB by univariate and multivariate logistic regression models. We also described the characteristics of complications in PTB with EPTB. A total of 781 PTB elderly patients were enrolled, of whom 86 (11.01%) had complicated EPTB. The most commonly invasive sites for EPTB were thoracic spine (17.53%), cervical lymph nodes (13.40%), and meninges (12.37%). 60 < aged < 80 years (OR = 2.876, 95%CI 1.290–6.412; P = 0.010), anaemia (OR = 2.212, 95%CI 1.135–3.967; P = 0.018) and osteoporosis (OR = 4.925, 95%CI 1.501–16.160; P = 0.009) were the independent risk factors for PTB with EPTB infection. PTB with EPTB had a higher proportion of multiple serous cavity effusion (19.8% vs. 12.2%) and longer hospitalisation (17 vs. 15, P = 0.004). 60 < aged < 80 years, anaemia and osteoporosis were found to be independent risk factors for PTB with EPTB in elderly patients. We compared the epidemiological and clinical characteristics of PTB with EPTB. These results are important for improving the diagnosis of EPTB, reducing complications, and improving prognosis.

Angioembolization for hemostasis in craniofacial fractures had a higher probability of delayed traumatic intracerebral hemorrhage

IntroductionWhile angioembolization is occasionally required for craniofacial fracture patients who experience massive maxillofacial hemorrhage, complications such as headache, temporal-facial pain, soft tissue necrosis, and embolic material migration leading to stroke or blindness can arise. Few studies have explored delayed or progressive intracerebral hemorrhage (ICH) following angioembolization for craniofacial fractures. MethodsA retrospective review of craniofacial fracture patients from January 1, 2015, to December 31, 2022 at our institution was conducted. We applied univariate and multivariable logistic regression (MLR) analyses to assess whether angioembolization served as an independent factor for delayed or progressive ICH. Propensity score matching (PSM) was used to balance the groups of patients who underwent angioembolization with those who did not. Outcome measurements included delayed or progressive ICH occurring within 72 hours, the need for additional neurosurgical interventions, and the length of stay (LOS) in the intensive care unit (ICU) and hospital. ResultsOf the 2,519 craniofacial fracture patients studied over an 8-year period, 21 (0.8%) underwent angioembolization for maxillofacial hemorrhage. MLR analysis revealed that angioembolization was an independent factor for delayed or progressive ICH (odds ratio=5.71, p = 0.028). After 1:2 PSM, patients who underwent angioembolization had greater rates of delayed or progressive ICH (28.6% vs. 7.1%, p = 0.023), an extended hospital LOS (17.0 vs. 15.0 days, p = 0.009) and a longer ICU LOS (10.0 vs. 4.0 days, p = 0.004). ConclusionsA greater probability of delayed or progressive ICH was observed in craniofacial fracture patients who underwent angioembolization for maxillofacial hemostasis.

Nutritional assessment of Chinese gynecologic cancer survivors with post-surgical lower limb lymphedema: a cross-sectional study.

This study aims to evaluate the nutritional status of Chinese gynecologic cancer survivors with post-surgical lower limb lymphedema (LLL) by analyzing serum albumin levels and the prognostic nutritional index (PNI). A retrospective cross-sectional study was conducted at two Chinese medical centers. The cohort comprised 155 gynecologic cancer survivors who developed symptomatic unilateral LLL post-surgery, during the period from September 2021 to June 2024. Nutritional status was assessed by measuring serum albumin and PNI. Statistical analysis was performed using univariate and multivariate logistic regression models to identify factors associated with low serum albumin and PNI. The mean age of the cohort was 55.47 ± 10.56 years, and the median total survival time was 72.0 months (36.5, 111.5 months). The prevalence of low serum albumin (< 40 g/L) was 40.0%, and low PNI (< 45) was 80.6%. Significant associations were found between low hemoglobin levels and both low serum albumin (OR = 1.05, 95% CI: 1.02-1.08, p < 0.001) and low PNI (OR = 1.09, 95% CI: 1.04-1.13, p < 0.001). Advanced International Society of Lymphology stage 3 was also associated with low albumin (OR = 0.18, 95% CI: 0.03-0.99, p < 0.05). The study highlights a significant prevalence of high risk of malnutrition among Chinese gynecologic cancer survivors with LLL, underscoring the need for regular nutritional assessments and interventions.

Systemic immune inflammatory index (SII) and systemic inflammatory response index (SIRI) as predictors of postoperative delirium in patients undergoing off-pump coronary artery bypass grafting (OPCABG) with cerebral infarction

ObjectivePostoperative delirium (POD) is a common complication following off-pump coronary artery bypass grafting (OPCABG) and is associated with significant morbidity. This study aims to evaluate the correlation of systemic immune inflammatory index (SII) and systemic inflammatory response index (SIRI) with postoperative delirium (POD) in patients with cerebral infarction undergoing OPCABG.MethodsThe perioperative cohort study included 321 patients who underwent OPCABG. Patients were divided into two groups based on the occurrence of POD: the delirium group (n = 113) and the non-delirium group (n = 208). Baseline characteristics, including gender, left ventricular ejection fraction (LVEF), surgery duration, hypertension, age, and smoking history were analyzed. SII and SIRI values were calculated preoperatively, and their association with POD was assessed using univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curves were used to evaluate the predictive accuracy of SII and SIRI.ResultsStatistical differences between SII and SIRI in the two groups (P < 0.05) were observed. Multivariate analysis confirmed that SII and SIRI, age and preoperative smoking history were predictors of POD. ROC curve analysis demonstrated that SII and SIRI had considerable predictive power, with AUC values of 0.73 (0.67–0.79) for SII and 0.75 (0.69–0.81) for SIRI.ConclusionSII and SIRI were found to be associated with an increased risk of POD in patients undergoing OPCABG, but further research is needed to confirm these findings and determine their independence as risk factors.

Perception of stress among healthcare workers in hospitals in Belgrade during COVID-19 pandemic

Abstract Background The COVID-19 pandemic has affected healthcare institutions and workers, exposing them to unfamiliar and hazardous conditions, increased workloads, and changing directives. This has led to work-related stress, resulting in burnout, depression, anxiety disorders, and other health issues among healthcare workers. Methods This cross-sectional study utilized an anonymous questionnaire with closed-ended questions. To assess stress levels among healthcare workers, a Likert-type scale was used. Over 6.000 healthcare workers completed the questionnaire in 2022. The relationship between the dependent variable (perceived stress level) and predictors was modelled using generalized ordinal univariate and multivariate logistic regression. Results Almost a third (30.7%) of respondents felt a very high amount of tension, stress, or pressure while performing their jobs under the conditions of the COVID-19 epidemic, while 422 (6.8%) did not feel tension, stress, or pressure at all. In the multivariate logistic regression model, statistically significant predictors of higher levels of perceived stress in the conditions of the COVID-19 epidemic include female sex (OR = 0,80), older age (OR = 1.19), being in a managerial position (OR = 1.32), lower satisfaction with available work time (OR = 0.82), patient relations (OR = 0.81), financial compensation (OR = 0.83), and cooperation with colleagues (OR = 0.93). Conclusions Through the identification of potential stress predictors, valuable insights are gained to aid policymakers in the planning and enhancement of healthcare personnel’s work during pandemics, as well as in situations characterized by heightened stress levels. Key messages • These findings emphasize supporting healthcare workers during the pandemic. • Strategies for reducing stress should be directed towards healthcare professionals who experience higher stress levels.

Nomogram-based prediction of MACE in older adults with STEMI

Abstract Introduction Despite the significant progress made in diagnosing and treating patients with ST elevation myocardial infarction (STEMI), high-risk subgroups such as older adults (those over 65 years-old) still face considerable residual risk of major adverse cardiovascular events (MACE) following treatment for their index event. Thus, it is crucial to create accurate, validated, and actionable tools to stratify patients according to their risk of MACE after admission for STEMI. Purpose Utilizing clinical data obtained from a registry of patients diagnosed with STEMI, this study aims to develop a nomogram that can reliably predict the likelihood of MACE incidence. Methods Using a large electronic single-center registry, all consecutive patients with STEMI, undergoing primary percutaneous coronary intervention (PCI), and aged 65 and above were identified. Demographic, laboratory, clinical and intra-procedural variables were examined. Univariate and multivariate logistic regression analyses were utilized to identify those factors which were independently associated with MACE incidence in the post PCI follow-up period. A nomogram was developed in a training set, and performance metrics such as receiver operating curves (ROC), calibration plots, and decision curve analysis were used for validation in a testing set. Analyses were performed using tidyverse and rms packages in R programming language. Results 1946 patients were included in the study and split into 70% training and 30% testing sets. Both groups were similar in terms of baseline demographic and clinical characteristics. Mean follow-up period was 17 months. Total MACE incidence in the post PCI follow-up period was 18%. Thirty-eight factors with limited missing information (&amp;lt;5%) were examined for their relationship with MACE incidence and after performing univariate and multivariate analysis 8 were selected for construction of the nomogram: left-ventricular ejection fraction (LVEF), serum creatinine, hemoglobin and fasting blood glucose levels, presence of valvular heart disease, post PCI TIMI flow grade, diameter of the stent placed in the culprit lesion, and presence of shock in the post PCI setting. The area under the curve (AUC) for MACE prediction in post PCI follow-up period showed acceptable discrimination (c-statistic=73%, 95%CI 71.2% to 76.3%). Calibration plots demonstrated that the nomogram model was well-calibrated, and its predictions were closely aligned with observed outcomes. Additionally, decision curve analysis indicated that the model exhibited strong discriminatory ability in predicting MACE. Conclusions A nomogram developed using a combination of laboratory, clinical, and procedural parameters reliably predicts future risk for MACE in older adults following STEMI. Future implementation of this model may identify the highest risk individuals to target more aggressive preventive efforts in a vulnerable cohort of patients.Plot 1Plot 2

Influence of implant density on mechanical complications in adult spinal deformity surgery.

The purpose was to analyze how rod characteristics, screw density and cages influence the incidence of mechanical complications compared to patient-related factors and alignment in adult spinal deformity instrumented T9-T11 to pelvis. Register data of 302 patients was analyzed. Relative lumbar lordosis (RLL) and relative sagittal alignment (RSA) was measured. Surgical data included rod characteristics, pedicle screw density and interbody cages. Univariate and multivariate logistic regression models were used. Pseudarthrosis occurred in 24.1%. On univariate analysis Odds Ratio (OR) was 0.74 for ≥ 3 cages (p = 0.452), 0.48 for 4 rods (p = 0.008), 4.30 for high screw density (p = 0.001). Patient-related factors were non-significant. Multivariate OR was 0.59 for 4 rods (p = 0.084) and 4.67 for high screw density (p = 0.005). PJK/PJF occurred in 19.2%. Age > 60 had an OR 2.83 (p = 0.023), postoperative RSA malaligned OR 2.84 (p = 0.030), severely malaligned OR 6.54 (p < 0.001). Implant characteristics were non-significant. Multivariate OR was 1.26 for age > 60 (p = 0.657), 2.32 for malaligned RSA (p = 0.097), 5.69 for severely malaligned RSA (p = 0.001). Screw loosening occurred in 8.9%. Univariate OR was 0.95 for ≥ 3 cages (p = 0.920), 1.64 for 4 rods (p = 0.235), 0.25 for high screw density 1.5-2 (p = 0.011). Patient-related factors were non-significant. Multivariate OR for high screw density was 0.23 (p = 0.022). Four rods decrease the pseudarthrosis risk. Cages have a secondary role. High screw density doesn't prevent from pseudarthrosis. Postoperative malalignment is the main PJK/PJF risk factor. Age plays a secondary role. Implant characteristics have a minor influence. High screw density constructs have a lower risk for screw loosening. 3-Retrospective register study.

Long COVID Prevalence and Factors Among ethnically Diverse UK Healthcare Workers

Abstract Background Long COVID (LC), characterised by persistent symptoms post-acute COVID-19 infection, presents a growing public health concern. Data on prevalence among healthcare workers (HCWs) are lacking. Our study aimed to establish the proportion of UK HCWs with symptoms lasting beyond five weeks and identify factors associated with LC in a diverse cohort. Methods We conducted a cross-sectional analysis from December 2020 to March 2021. The main outcome was LC in relation to self-reported ethnicity. Univariable and multivariable logistic regression identified associations. Odds ratios (ORs) and adjusted odds ratios (aORs) were calculated with 95% confidence intervals (95%CIs). The multivariate analysis adjusted for demographic information, job role, household factors, health status, and existing long-term conditions. Missing data were imputed via chained equations. Results From 11,513 HCWs, 2,331 (20.2%) reported COVID-19, with 525 (22.5%) experiencing LC. 80.0% of those reporting LC were female, compared to 74.3% without LC were female. Participants with LC (median age 46 [IQR 36-54)]) were slightly older than those without LC (median age 41 [IQR 31-52]). In multivariable analyses of those who reported having had COVID-19, HCWs in nursing/midwifery roles (aOR 1.76, 95% CI 1.26-2.46, p = 0.001) and allied health professions (aOR 1.42, 95% CI 1.05-1.93, p = 0.023) had higher odds of reporting LC compared to those in medical roles. Significant associations were also found with self-reported depression, anxiety, and asthma. There was no significant association between ethnicity and experiencing LC. Conclusions In this large ethnically diverse cohort study, there is a substantial burden of LC among UK HCWs. Further research and collaborative efforts are urgently needed to address these factors effectively, develop targeted public health interventions, and understand the temporal and longitudinal dynamics of the condition. Key messages • One in five UK healthcare workers reported long COVID, indicating critical needs for targeted public health interventions. • Our study highlights urgent public health responses to address long COVID among healthcare professionals.

Joint effect of tobacco and meat on cardiovascular disease and treatment adherence in Indian Women

Abstract Background Cardiovascular disease (CVD) is a leading cause of death for both men and women in India. But it is often overlooked in women. Tobacco and meat consumption are common risk factors for CVD. While individual studies have explored the link between tobacco or meat consumption and CVD, their joint effect remained understudied. Methods The study analyzed data from the National Family Health Survey 2019-21, of 711431 women aged 15 to 49 in India. Univariate and multivariate logistic regression were used to assess the risk of individual and joint effects of tobacco and meat consumptions on self-reported CVD prevalence. Age, BMI, education, wealth index, residency, region, religion, and alcohol were used as covariates. Additionally, interactions model was assessed. Lastly, treatment adherence for CVD was studied, considering treatment behavior, insurance, and healthcare access barriers. Results Cardiovascular disease prevalence was 0.72%. The risk of CVD was higher among the smokers [aOR: 2.26(1.83-2.73)] than smokeless tobacco [aOR: 1.34(1.21-1.49)] consumers. In contrast daily meat consumers showed higher risk [aOR: 1.23(1.03-1.47)] than meat non-consumers. Women who were consumers of both tobacco and meat had risk of [aOR: 1.15 (1.02 - 1.30)] CVD compared to who did not consume both tobacco and meat. Interaction was not detected between tobacco and meat consumption. CVD treatment adherence was higher among the women who possess an insurance [OR: 1.11(1.04-1.19)]. The risk of treatment non-adherence was higher among women who were aged below 40 with no education and from the poorest section of the society. Barriers for accessing health care facilities were solo attendance, provider availability, and drug access. Conclusions Tobacco and meat both need to be addressed to control CVD among women. Empowering women and bringing them under government insurance with an improve health care system are crucial. Key messages • The joint effect of tobacco and meat consumption increased the risk of cardiovascular diseases among women. However, there was no interaction effects observed between tobacco and meat consumption. • Healthcare facilities needs to be improved and awareness among young adults are extremely crucial for better CVD treatment management among women in India.

Risk factors for access site-related complications after distal transradial catheterization

Abstract Introduction Distal transradial catheterization (dTRA) has emerged as a viable alternative to conventional transradial access for various interventional procedures. Purpose This study aims to identify the risk factors associated with access site-related complications following dTRA. Methods A total of 4,977 patients who underwent dTRA were included in this retrospective study. The patients were divided into two groups based on the occurrence of access site-related complications: Complication(+) group (n=272) and Complication(-) group (n=4,705). Various demographic, clinical, and procedural parameters were analyzed to identify potential risk factors. Univariate and multivariate logistic regression models were employed to determine the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for each risk factor. Results The Complication(+) group exhibited a higher prevalence of male gender (53.7% vs. 68.4%, p&amp;lt;0.001), older age (68.140 ± 11.46 vs. 66.33 ± 11.90, p=0.014), lower body mass index (BMI) (24.35 ± 3.54 vs. 24.97 ± 3.55, p=0.005), larger sheath size (2.45 ± 0.24 vs. 2.40 ± 0.24, p&amp;lt;0.001), increased serum creatinine (Cr) levels (1.33 ± 1.76 vs. 1.10 ± 1.46, p=0.013), longer access time (209.26 ± 237.72 vs. 149.26 ± 143.98, p&amp;lt;0.001), prolonged hemostasis time (257.64 ± 202.40 vs. 197.60 ± 133.39, p&amp;lt;0.001), and extended procedure time (32.24 ± 29.07 vs. 23.04 ± 26.19, p&amp;lt;0.001). Additionally, the Complication(+) group received higher heparin doses (6275.48 ± 2971.05 vs. 5282.74 ± 2952.31, p&amp;lt;0.001) and had a higher incidence of multiple antiplatelet therapy (73.2% vs. 51.3%, p&amp;lt;0.001). However, no significant differences were observed in hypertension, dyslipidemia, diabetes mellitus, or smoking history between the two groups. The multivariate analysis identified male gender (adjusted OR: 2.073, 95% CI: 1.376 - 3.123, p&amp;lt;0.001), and increased Cr levels (adjusted OR: 1.083, 95% CI: 1.024 - 1.144, p=0.005) as independent risk factors for access site-related complications after dTRA. Moreover, the use of multiple antiplatelet therapy was found to be significantly associated with an increased risk of complications (adjusted OR: 1.948, 95% CI: 1.420 - 2.671, p&amp;lt;0.001). Conclusion In patients undergoing dTRA, male gender, increased serum creatinine levels, and the use of multiple antiplatelet therapy were identified as independent risk factors for access site-related complications. These findings highlight the importance of careful patient selection and procedural optimization to minimize complications during dTRA.

The dynamic increment of epicardial adipose tissue is associated with reverse remodeling after guideline-directed medical treatment in dilated cardiomyopathy patients

Abstract Background/Introduction Epicardial adipose tissue (EAT) accumulation is associated with adverse prognosis in patients with HFpEF and a better prognosis in HFrEF patients. Whether EAT is playing a protective role in dilated cardiomyopathy (DCM) patients have been described sparingly. Purpose Aim to explore whether the epicardial fat would change along with the dynamic changes in cardiac function and volumes after receiving guideline-directed medical therapy (GDMT) in patients with DCM. Methods We prospectively enrolled 232 DCM patients who underwent complete baseline and follow-up Cardiac magnetic resonance (CMR) examinations. The measurement of the epicardial fat composition includes epicardial fat thickness, paracardial fat thickness, and paracardial fat volume, while the measurement of body fat composition includes subcutaneous and visceral abdominal fat, while We used univariable and multivariable logistic regression to evaluate the association between different body and cardiac fat depots with the changes in bi-ventricular structure (delta indexed EDV) and function (delta EF). Results The study included 232 patients (mean age 46.1±14.1 years, 157 (67.7%) males). After GDMT, we found that the visceral fat thickness and EAT (thickness and volume) tend to significantly increase. The increase in the (left ventricular reverse remodeling) LVRR group was significantly higher compared with the non-LVRR group. Independently with the changes of BMI and body fat depots, the increment of EAT was associated with the improvement in bi-ventricular function and volumes (significantly positively correlated with the improvement of LVEF (r = 0.499, p &amp;lt; 0.001), and RVEF (r = 0.482, p &amp;lt; 0.001), negatively correlated with delta LVEDVi (r = -0.407, p &amp;lt; 0.001), delta RVEDVi (r = -0.305, p &amp;lt; 0.001)). Conclusions After GDMT, the increment of EAT was positively correlated with the improvement of bi-ventricular structure and function, independent of the changes in BMI and body fat depots.Graphic Abstract

Cluster-specific predictors of early rhythm control in contemporary European cohort of patients with atrial fibrillation: The EHRA-PATHS Project

Abstract Background Early rhythm control (ERC) using antiarrhytmic drugs, electrical cardioversion or catheter ablation for AF within a year from first diagnosis of atrial fibrillation (AF) has been shown to reduce the risk of major adverse outcomes compared to usual care, and the effects of ERC have been suggested to be consistent across all AF subgroups with different risk profiles. We aimed to identify cluster-specific predictors of ERC in pre-defined AF clusters in contemporary European EHRA-PATHS AF cohort. Methods The EHRA-PATHS AF cohort was derived from the three prospective EurObservational Research Programme (EORP) AF registries - General Pilot, General Long-term, and AF III registry. A two-step cluster analysis was performed. A hierarchical cluster analysis with 18 variables was used to identify the optimal number of clusters, followed by a K-means cluster analysis to determine variable cluster association. Cluster-specific predictors of ERC were identified using univariate and multivariate logistic regression analyses. Results Of 18,799 patients, AF was diagnosed within 1 year in 8088 (43.0%), and 3913/8088 patients (48.4%) were treated with ERC. Among the three clusters - Cluster 1 (younger healthier AF patients) compared with Cluster 2 (Elderly with less comorbidity, mostly non-cardiovascular) and Cluster 3 (Elderly with more comorbidity, mostly cardiovascular), see Table, ERC was significantly more often used in Cluster 1 compared with Cluster 2 and Cluster 3 (both P&amp;lt;0.001), and in Cluster 2 compared with Cluster 3. Cluster-specific multivariable predictors of ERC are shown in Table. In all three clusters, asymptomatic AF (EHRA score I) and Northern Europe residence were inversely associated with ERC, while Western Europe residence was positively associated with ERC in Cluster 2 and 3. In Cluster 1, low stroke risk and hypertension were positively associated with ERC, while dilated left atrium (LA) and reduced left ventricular ejection fraction (LV EF) were negative predictors of ERC. In Cluster 2, age ≥80 years, enlarged LA, and CHA2DS2-VASc ≥2 for males and ≥3 for females were negatively associated with ERC. In Cluster 3, age ≥75 years, cardiomyopathy, liver disease, dementia and reduced LV EF were negative predictors of ERC. Conclusion Our study of a large European AF cohort showed that likelihood for ERC was greater in younger and healthier AF patients, as well as in elderly from Western Europe, while ERC was significantly less likely with increasing age and comorbidity (especially cardiovascular diseases). These findings likely reflect the lack of high-quality evidence supporting aggressive ERC in high-risk patients with AF. With increasing body of evidence favouring ERC such patients, a shift towards less selective consideration of ERC in daily practice may be expected.

Sociodemographic predictors of the association between self-reported sleep duration and depression

Abstract Background This cross-sectional study is apart from one of the first and largest population-based prospective cohort studies in the UAE called the United Arab Emirates Healthy Future Study (UAEHFS). The aim of this study is to investigate the association between self-perceived sleep duration and self-perceived depression after adjustment for sociodemographic factors. Baseline line data from UAEHFS cohort participants were included in this cross-sectional study. Univariable and multivariable logistic regression models were fitted, with the binarized self-reported sleep hours as an outcome. The predictors were the self-reported PHQ-8, sociodemographic factors, and body mass index (BMI). Odds ratios with 95% confidence intervals (CI) were reported. Results Of 11,455 participants, 4,295 (37.5%) were included in the complete case analysis after omitting missing values. We applied a complete case analysis following omitting missing values. Participants’ median age was 32.0 years (Interquartile-Range: 24.0, 39.0). In total, 63.6% of the participants reported sleep duration of more than 7 hours. Statistically significant negative association was observed between the total PHQ-8 score and binarized self-reported sleep, OR = 0.961 (95% CI: 0.948, 0.974). For one unit increase in age and BMI, the odds ratio of reporting shorter sleep with OR of 0.979 (95% CI: 0.969, 0.990) and 0.987 (95% CI: 0.977, 0.998) respectively. Conclusions The study findings indicate a correlation between higher total PHQ-8 scores and an increased probability of individuals reporting shorter self-perceived sleep durations when considering some sociodemographic factors such as age, marital status and employment status. However, there was no difference between females and males in reporting self-perceived sleep duration among depressed individuals. Key messages • There is a correlation between higher total PHQ-8 scores and an increased probability of individuals reporting shorter self-perceived sleep durations. • Our results can help contribute to the knowledge based on current and potential population mental health in the UAE and Gulf Region.

Circulating Angiopoietin-2 (Angpt2) levels predict diagnosis of Chronic Thromboembolic Pulmonary Hypertension (CTEPH)

Abstract Background Vascular remodeling following incomplete thrombus resolution is considered to be a key factor in the progression to chronic thromboembolic pulmonary hypertension (CTEPH) after acute pulmonary embolism (PE). Recent data demonstrated that Angpt2, which controls signaling via the Tie2 receptor, could interfere with the normal process of thrombus resolution. Our prior findings have shown that patients presenting with acute PE and having plasma levels of Angt-2 ≥5.5 ng/ml at admission are at a significantly increased risk (93 times higher) of being diagnosed with CTEPH in subsequent assessments. Purpose To externally validate the prognostic performance of Angpt2 for the development of CTEPH. Methods In a prospective cohort study of unselected consecutive all-comers with PE, survivors of the index acute event underwent 3-, 12- and 24-month follow-up with venous blood sampling for subsequent biomarker measurements. Angpt2 was measured on admission using specific enzyme linked immunosorbent assays (ELISA) detecting both the endogenous and the recombinant protein, according to the manufacturer (R&amp;D Systems). Results Overall, 319 patients with acute PE (median age: 62 [IQR, 50-73]; females: 55.2%) were included in the analysis with a median Angpt2 plasma level of 2.6 ng/ml (IQR, 1.8-3.7) (Figure 1). Patients with PE and Angpt-2 plasma levels above the median had more often comorbidities, such as chronic heart failure (24.2% and 11.0.%; p=0.045), chronic kidney disease (33.3% vs 14.0%; p=0.010), or diabetes (27.3% vs. 12.9%; p=0.032). Angpt2 plasma levels correlated with haemodynamic status and parameters indicating severe PE (right ventricle dysfunction, r=0.129 [p=0.021) and troponin, r=0.246 [p&amp;lt;0.001]). In total, post-PE impairment (PPEI) was diagnosed in 33 (10.3%) and CTEPH in four (1.3%) patients during follow-up. Angpt2 plasma levels were higher on admission in patients developing PPEI or CTEPH during follow-up compared to patients without PPEI or CTEPH (PPEI vs non-PPEI: median, 3.2 [2.3-4.1] ng/ml vs. 2.5 [1-3.4] ng/ml, p=0.035; CTEPH vs. non-CTEPH: median, 5.1 [2.9-10.5] ng/ml vs. 2.5 [1.7-3.6] ng/ml, p=0.055). Regarding the diagnosis of CTEPH during follow-up, ROC analysis illustrated an AUC for Angpt2 (0.779 [95% CI 0.56–0.99]; p=0.055]) (Figure 2). By using univariate logistic regression analysis, the calculated predefined Angpt2 cut-off value of ≥5.5 ng/ml was associated with a 9.2-fold increased risk (1.3–67.4, p=0.030) for a diagnosis of CTEPH during follow-up. Conclusion We were able to validate in a different patient cohort the usefulness of Angpt2 as a novel biomarker to identify patients at risk for CTEPH.

Predictive factors for recurrent tricuspid regurgitation after tricuspid annuloplasty: 3D echocardiography study

Abstract Introduction There is growing concern about the recurrence of tricuspid regurgitation (TR) after tricuspid annuloplasty (TA) in individuals with functional tricuspid regurgitation (FTR). While TA is effective in treating FTR, a comprehensive understanding of the echocardiographic factors influencing TR recurrence is crucial. Aim This study aims to employ multivariate regression analysis to investigate the prognostic significance of tricuspid valve (TV) geometry and echocardiographic parameters associated with both RV geometry and function. The focus is on comprehending these relationships in the context of recurrent TR subsequent to TA. Methods This prospective observational cohort study aimed to explore factors contributing to recurrent tricuspid regurgitation (TR) after tricuspid annuloplasty (TA). The focus was on patients with moderate or severe functional TR due to left heart valvular disease, particularly severe mitral regurgitation, excluding those with ischemic heart disease. The cohort included 66 individuals undergoing preoperative assessments with 2D and 3D echocardiography, quantifying RV and right atrial (RA) geometry, functional, and tricuspid valve (TV) parameters. TR severity followed ESC guidelines. Patients were categorized into effective TA (50 patients) and recurrent TR (16 patients) groups, defined by mild-moderate TR and significant moderate-severe TR one year post-surgery, respectively. SPSS software facilitated statistical analysis, with adjusted logistic regression considering parameters such as age and gender. Results Among the patients (54% male, mean age 68±9 years), no significant differences were found in gender, left ventricular and atrial parameters, or preoperative TV orifice area between groups (recurrent TR vs. effective TA: 38 [33] mm2 vs. 29 [15] mm2, p=0.117). Univariate logistic regression analysis identified Septal-Lateral Systolic TA Diameter (OR 1.62), Septal-Lateral Diastolic TA Diameter (OR 1.99), and Major Axis Diastolic TA Diameter (OR 1.59) as key predictors. For diagnostic efficacy, ROC analysis revealed Major Axis Diastolic TA Diameter (AUC 0.848; cut-off 52.5 mm), TV Leaflet Tenting Volume (AUC 0.778; cut-off 5.1 ml), and RV Basal Diameter (AUC 0.763; cut-off 47.5 mm) as the most predictive parameters. The combined use of predefined RV basal diameter and Major Axis Diastolic TA Diameter showed the highest odds ratio for recurrent TR. Conclusion Key predictors, including Septal-Lateral Systolic and Diastolic TA Diameters, and Major Axis Diastolic TA Diameter, were identified, emphasizing their significance in understanding TR recurrence after tricuspid annuloplasty. The combination of predefined RV basal diameter and Major Axis Diastolic TA Diameter showed the highest odds ratio for recurrent TR, offering valuable insights for clinical assessment and preventive strategies.

Impact of obesity on pathological complete remission in early stage breast cancer patients after neoadjuvant chemotherapy: a retrospective study from a German University breast center.

Breast cancer is a primary cause of cancer-related death among women worldwide. Neoadjuvant chemotherapy (NACT) is a cornerstone treatment for locally advanced, non-metastatic breast cancer. Achieving pathological complete response (pCR) is often used as a surrogate marker for long-term outcomes. This study examines the impact of obesity, defined by a body mass index (BMI) over 30kg/m2, on achieving pCR in patients with early stage breast cancer (eBC) undergoing NACT. A retrospective analysis was conducted on patients with eBC treated with NACT at the University of Tübingen. The primary objective was to assess the impact of obesity on achieving pCR. Logistic regression analysis was used to determine the association between pre-treatment BMI and pCR, adjusting for covariates such as age, tumor stage, grading, and chemotherapy intensity. The study included 325 patients, with 24% classified as obese. While the univariate logistic regression analysis showed no significant impact of obesity on the odds ratio of achieving pCR, the multivariate analysis, accounting for covariates, demonstrated that obese patients had a significantly higher likelihood of achieving pCR. In this retrospective study, obesity significantly affected the likelihood of achieving pCR in patients with eBC cancer undergoing NACT after adjusting for covariates. While obesity is a known risk factor for breast cancer development and progression, its impact on the efficacy of NACT in terms of achieving pCR was positive in our study. These findings contribute to the ongoing debate in the literature, though the retrospective design and potential uncontrolled factors should be considered.

Novel scoring system specific for patients treated with micro-axial percutaneous left ventricular assist device

Abstract Background Cardiogenic shock (CS) is characterized by high mortality. The impact of micro-axial percutaneous left ventricular assist devices (ma-pLVAD) remains unclear. Nevertheless, the utilization of these devices increased lately which binds considerable resources. Accurate prognosis assessment is crucial for physicians to identify patients who may benefit from the device upfront. Purpose We developed a novel scoring system predicting 30-day all-cause mortality specifically for CS patients treated with ma-pLVAD. Methods Data were collected from an ongoing Impella registry including more than 830 patients since 2014. Among them, 460 patients received a ma-pLVAD in CS. Based on 53 clinically relevant parameters univariate logistic regressions on 30-day-mortality were performed. Subsequently, parameters with a p-value &amp;lt; 0.1 were included in a multivariate logistic regression analysis (MLRA) using backwards selection by likelihood ratio. The remaining continuous parameters underwent a correlation and regression tree analysis (CART) to define the optimal thresholds and MLRA was performed on all the selected parameters for calculation of odds ratios. These were used for score building. All-cause mortality was assessed by Kaplan-Meier method. Area under the curve (AUC) based on receiver operating characteristic (ROC) was estimated to determine the predictive value of the novel score for 30-day-mortality. Validation was performed on a timely independent cohort of CS patients treated with ma-pLVAD. Results Patients were 68±1 years old with predominance of male gender (74.4% [n=342]). CS was mainly caused by acute myocardial infarction (AMI) (60% [n=276]). A cardio-pulmonary resuscitation before ma-pLVAD was performed in 49.0% [n=215]. Initial serum lactate was 8.6±0.3 mmol/l. All-cause mortality at 30 days was 65.1±2.2% (Fig. 1A). A model of 6 parameters resulted after first MLRA with following odds ratios provided in Tab. 1A. CART analysis revealed optimal thresholds for age with 68 a [Gini-coefficient (G)=0.1], for initial serum lactate with 6.5 mmol/l [G=0.042], thrombocytes with 210 Gpt/l [G=0.021], and mean arterial pressure (MAP) with 70 and 90 mmHg [G1=0.027; G2=0.008]. Results of MLRA on the 6 parameters including the determined thresholds are given in Tab. 1B. A 0 to 17 point risk score resulted by using the odds ratios (Tab. 1C). ROC analysis indicated strong predictive capability for 30-day mortality (ROC AUC [95% CI] 0.767 [0.722-0.811]; p&amp;lt;0.001, Fig. 1B), with discrimination details provided in Tab. 1D. In the validation cohort, the score demonstrated favorable performance (ROC AUC [95% CI] 0.793 [0.607-0.979]; p=0.016; n=24). Conclusion We developed an internally validated, clinically feasible scoring system to estimate 30-day-mortality of CS patients treated with ma-pLVAD. Further studies are mandatory for external validation.

Estimated aortic pulse wave velocity predicts adverse events in females with thoracic aortic aneurysms

Abstract Introduction Despite being more common in males, thoracic aortic aneurysms (TAAs) have worse prognosis in females. Females with TAA are 3x more likely to experience acute aortic syndromes, and 40% more likely to die than their male counterparts, but mechanisms underlying this paradox are incompletely understood. The estimated aortic pulse wave velocity (e-PWV) is a marker of aortic stiffness that can be used widely due to its simplicity, as it does not require specialized equipment. We have previously shown that e-PWV was independently associated with faster TAA growth,(1) and that this association was twice as strong in females than males, but the role of e-PWV as a predictor of adverse outcomes in TAA remains unknown. Purpose We sought to evaluate the sex-specific association of e-PWV with adverse outcomes in patients with TAA. Methods We performed a prospective study of 102 males and 48 females with TAA. e-PWV was calculated according to validated equations utilizing age, mean arterial pressure, and presence/absence of cardiovascular risk factors.(2) The primary outcome was a composite of acute aortic syndromes, death, or elective aortic surgery. We used a Cox proportional hazard model to determine the independent association of e-PWV with the primary outcome, adjusted for age, BSA, aneurysm size and location, hypertension, and pulse pressure. Sex-specific models were performed if the interaction of sex*e-PWV was significant (P≤0.05). Univariate logistic regression models were performed to determine the c-statistic for e-PWV in predicting adverse outcomes, and the best e-PWV cutoff for this prediction was established based on sensitivity and specificity. Kaplan-Meier curves were performed using this cut-off. Results A summary of study design and results is presented in Picture 1. Mean age was 62±12 years, 70 (47%) had degenerative etiology, baseline aneurysm size was 46.3±4.3mm, and e-PWV was 9.5±1.9 m/s (not different between sexes, P&amp;gt;0.07 for each). Mean follow-up was 4.6±2.4 years in females and 5.5±2.3 years in males, P=0.031. The primary outcome occurred in 37 (25%) participants (3 dissections, 3 intramural hematomas, 1 aortic rupture, 22 elective surgical repairs and 11 deaths - 3 of which followed surgery). The interaction term sex*e-PWV was significant (P=0.0001), so sex-specific models were performed. e-PWV independently predicted the primary outcome in females (HR for 1m/s increase in e-PWV: 3.4; 95% confidence interval (CI): 1.1-14.7, P=0.033), but not in males (HR: 0.87; 95% CI: 0.50-1.51, P=0.622). In females, e-PWV had a c-statistic of 0.860 for the detection of the primary outcome, with a best e-PWV cutoff of 11.58 m/s (73% sensitivity, 92% specificity). Kaplan-Meier curves for the primary outcome in females using this cutoff are shown in Picture 2. Conclusion e-PWV independently predicts adverse outcomes in females with TAA, highlighting a novel marker for risk stratification and therapeutic targeting.Study summaryKaplan-Meier curves