1
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Dirix P, Buoso S, Kozerke S. Optimizing encoding strategies for 4D Flow MRI of mean and turbulent flow. Sci Rep 2024; 14:19897. [PMID: 39191846 DOI: 10.1038/s41598-024-70449-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 08/16/2024] [Indexed: 08/29/2024] Open
Abstract
For 4D Flow MRI of mean and turbulent flow a compromise between spatiotemporal undersampling and velocity encodings needs to be found. Assuming a fixed scan time budget, the impact of trading off spatiotemporal undersampling versus velocity encodings on quantification of velocity and turbulence for aortic 4D Flow MRI was investigated. For this purpose, patient-specific mean and turbulent aortic flow data were generated using computational fluid dynamics which were embedded into the patient-specific background image data to generate synthetic MRI data with corresponding ground truth flow. Cardiac and respiratory motion were included. Using the synthetic MRI data as input, 4D Flow MRI was subsequently simulated with undersampling along pseudo-spiral Golden angle Cartesian trajectories for various velocity encoding schemes. Data were reconstructed using a locally low rank approach to obtain mean and turbulent flow fields to be compared to ground truth. Results show that, for a 15-min scan, velocity magnitudes can be reconstructed with good accuracy relatively independent of the velocity encoding scheme ( S S I M U = 0.938 ± 0.003 ) , good accuracy ( S S I M U ≥ 0.933 ) and with peak velocity errors limited to 10%. Turbulence maps on the other hand suffer from both lower reconstruction quality ( S S I M TKE ≥ 0.323 ) and larger sensitivity to undersampling, motion and velocity encoding strengths ( S S I M TKE = 0.570 ± 0.110 ) when compared to velocity maps. The best compromise to measure unwrapped velocity maps and turbulent kinetic energy given a fixed 15-min scan budget was found to be a 7-point multi- V enc acquisition with a low V enc tuned for best sensitivity to the range of expected intra-voxel standard deviations and a high V enc larger than the expected peak velocity.
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Affiliation(s)
- Pietro Dirix
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.
| | - Stefano Buoso
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
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2
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Billig S, Hein M, Uhlig M, Schumacher D, Thudium M, Coburn M, Weisheit CK. [Anesthesia for aortic valve stenosis : Anesthesiological management of patients with aortic valve stenosis during noncardiac surgery]. DIE ANAESTHESIOLOGIE 2024; 73:168-176. [PMID: 38334810 PMCID: PMC10920418 DOI: 10.1007/s00101-024-01380-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 02/10/2024]
Abstract
Aortic valve stenosis is a common condition that requires an anesthesiologist's in-depth knowledge of the pathophysiology, diagnostics and perioperative features of the disease. A newly diagnosed aortic valve stenosis is often initially identified from the anamnesis (dyspnea, syncope, angina pectoris) or a suspicious auscultation finding during the anesthesiologist's preoperative assessment. Interdisciplinary collaboration is essential to ensure the optimal management of these patients in the perioperative setting. An accurate anamnesis and examination during the preoperative assessment are crucial to select the most suitable anesthetic approach. Additionally, a precise understanding of the hemodynamic peculiarities associated with aortic valve stenosis is necessary. After a short summary of the overall pathophysiology of aortic valve stenosis, this review article focuses on the specific anesthetic considerations, risk factors for complications, and the perioperative management for noncardiac surgery in patients with aortic valve stenosis.
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Affiliation(s)
- Sebastian Billig
- Klinik für Anästhesiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
| | - Marc Hein
- Klinik für Anästhesiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Moritz Uhlig
- Klinik für Anästhesiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - David Schumacher
- Klinik für Anästhesiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Marcus Thudium
- Klinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Mark Coburn
- Klinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Christina K Weisheit
- Klinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
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3
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Zhang Y, Wang M, Zhang E, Wu Y. Artificial Intelligence in the Screening, Diagnosis, and Management of Aortic Stenosis. Rev Cardiovasc Med 2024; 25:31. [PMID: 39077660 PMCID: PMC11262349 DOI: 10.31083/j.rcm2501031] [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: 07/31/2023] [Revised: 08/30/2023] [Accepted: 09/13/2023] [Indexed: 07/31/2024] Open
Abstract
The integration of artificial intelligence (AI) into clinical management of aortic stenosis (AS) has redefined our approach to the assessment and management of this heterogenous valvular heart disease (VHD). While the large-scale early detection of valvular conditions is limited by socioeconomic constraints, AI offers a cost-effective alternative solution for screening by utilizing conventional tools, including electrocardiograms and community-level auscultations, thereby facilitating early detection, prevention, and treatment of AS. Furthermore, AI sheds light on the varied nature of AS, once considered a uniform condition, allowing for more nuanced, data-driven risk assessments and treatment plans. This presents an opportunity to re-evaluate the complexity of AS and to refine treatment using data-driven risk stratification beyond traditional guidelines. AI can be used to support treatment decisions including device selection, procedural techniques, and follow-up surveillance of transcatheter aortic valve replacement (TAVR) in a reproducible manner. While recognizing notable AI achievements, it is important to remember that AI applications in AS still require collaboration with human expertise due to potential limitations such as its susceptibility to bias, and the critical nature of healthcare. This synergy underpins our optimistic view of AI's promising role in the AS clinical pathway.
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Affiliation(s)
- Yuxuan Zhang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease,
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, 100037 Beijing, China
- Center for Structural Heart Diseases, State Key Laboratory of
Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College,
100037 Beijing, China
| | - Moyang Wang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease,
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, 100037 Beijing, China
- Center for Structural Heart Diseases, State Key Laboratory of
Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College,
100037 Beijing, China
| | - Erli Zhang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease,
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, 100037 Beijing, China
- Center for Structural Heart Diseases, State Key Laboratory of
Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College,
100037 Beijing, China
| | - Yongjian Wu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease,
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, 100037 Beijing, China
- Center for Structural Heart Diseases, State Key Laboratory of
Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College,
100037 Beijing, China
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4
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Bramucci A, Vignali L, Tadonio I, Losi L, Freyrie A, Perini P. Single-Stage Procedure of Transcatheter Aortic Valve Replacement and Endovascular Aneurysm Repair Under Local Anaesthesia and Percutaneous Access. Vasc Endovascular Surg 2023; 57:949-953. [PMID: 37309678 DOI: 10.1177/15385744231183499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Abdominal aortic aneurysms (AAA) are observed in 6% of patients with concomitant aortic valve stenosis (AS) requiring aortic valve replacement. Optimal management of these concomitant pathologies is still debated. CASE REPORT An 80-year-old man presented with acute heart failure due to a severe AS. Past medical history included AAA under regular surveillance. A thoracic and abdominal computed tomography angiography (CTA) confirmed a 6 mm increase of AAA over an 8-month period (max 55 mm). A multidisciplinary team prescribed a simultaneous endovascular approach of transcatheter aortic valve implantation (TAVI) followed by endovascular aneurysm repair (EVAR) under local anaesthesia with bilateral femoral percutaneous access. No intra or post-procedural complications were registered; technical success was confirmed by completion angiography and post-operative ultrasound. The patient was discharged on postoperative day 5. A 2-month post-operative CTA confirmed ongoing technical success. CONCLUSION Combined TAVI and EVAR under local anaesthesia for AS and AAA was associated with reduced hospital stay and technical success at 2 months from intervention in this case report.
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Affiliation(s)
- Alberto Bramucci
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Luigi Vignali
- Interventional Cardiology, University Hospital of Parma, Parma, Italy
| | - Iacopo Tadonio
- Interventional Cardiology, University Hospital of Parma, Parma, Italy
| | - Luciano Losi
- Interventional Cardiology, "Guglielmo da Saliceto" Hospital, Piacenza, Italy
| | - Antonio Freyrie
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Paolo Perini
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
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5
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Zamorano JL, Appleby C, Benamer H, Frankenstein L, Musumeci G, Nombela-Franco L. Improving access to transcatheter aortic valve implantation across Europe by restructuring cardiovascular services: An expert council consensus statement. Catheter Cardiovasc Interv 2023; 102:547-557. [PMID: 37431253 DOI: 10.1002/ccd.30760] [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: 12/20/2022] [Revised: 06/01/2023] [Accepted: 06/28/2023] [Indexed: 07/12/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is recommended for a growing range of patients with severe aortic stenosis in the European Society of Cardiology and European Association for Cardio-Thoracic Surgery (ESC/EACTS) 2021 Guidelines update. However, guideline implementation programs are needed to ensure the application of clinical recommendations which will favorably influence disease outcomes. An Expert Council was convened to identify whether cardiology services across Europe are set up to address the growing needs of patients with severe aortic stenosis for increased access to TAVI by identifying the key challenges faced in growing TAVI programs and mapping associated solutions. Wide variation exists across Europe in terms of TAVI availability and capacity to deliver the increased demand for TAVI in different countries. The recommendations of this Expert Council focus on the short-to-medium-term aspects where the most immediate, actionable impact can be achieved. The focus on improving procedural efficiency and optimizing the patient pathway via clinical practice and patient management demonstrates how to mitigate the current major issues of shortfall in catheterization laboratory, workforce, and bed capacity. Procedural efficiencies may be achieved through steps including streamlined patient assessment, the benchmarking of standards for minimalist procedures, standardized approaches around patient monitoring and conduction issues, and the implementation of nurse specialists and dedicated TAVI coordinators to manage organization, logistics, and early mobilization. Increased collaboration with wider stakeholders within institutions will support successful TAVI uptake and improve patient and economic outcomes. Further, increased education, collaboration, and partnership between cardiology centers will facilitate sharing of expertise and best clinical practice.
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Affiliation(s)
- José Luis Zamorano
- Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain
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6
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Conroy TB, Araos J, Kan EC. Systolic Time Interval Extraction in Hypertensive and Hypotensive Pig Models Using Wearable Near-Field Radio-Frequency Sensors. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-6. [PMID: 38082805 DOI: 10.1109/embc40787.2023.10340193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Screening and monitoring for cardiovascular diseases (CVDs) can be enabled by analyzing systolic time intervals (STIs). As CVDs have a strong causal correlation with hypertension, it is important to validate STI sensor accuracy in hypertensive hearts to ensure consistent performance in this prevalent cardiac disease state. This work presents STI extraction using a non-invasive near-field radio-frequency (RF) sensor during normotension, hypertension, and hypotension in a pig model. Waveform features of semilunar and atrioventricular valve dynamics during systole were extracted to derive isovolumic contraction time (ICT) and left ventricular ejection time (LVET), benchmarked by a phonocardiogram and aortic catheterization. Study-wide mean relative ICT and LVET errors were -4.4ms and -3.6ms, respectively, demonstrating high accuracy during both normal and abnormal systemic pressures.Clinical relevance- This work demonstrates accurate STI extraction with relative error less than 5 ms from a non-invasive near-field RF sensor during normotensive, hypotensive, and hypertensive systemic pressures, validating the sensor's accuracy as a screening tool during this disease state.
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7
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Carapinha JL, Iliescu VA, Dorobantu LF, Turcu-Stiolica A, Deckert J, White A, Salem A, Parasca C. Budget impact analysis of a bovine pericardial aortic bioprosthesis versus mechanical aortic valve replacement in adult patients with aortic stenosis in Romania. J Med Econ 2023; 26:998-1008. [PMID: 37505934 DOI: 10.1080/13696998.2023.2242188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/15/2023] [Accepted: 07/25/2023] [Indexed: 07/30/2023]
Abstract
AIMS An analysis of the budget impact of using a bovine pericardial aortic bioprosthesis (BPAB) or a mechanical valve (MV) in aortic stenosis (AS) patients in Romania. MATERIALS AND METHODS A decision-tree with a partitioned survival model was used to predict the financial outcomes of using either a BPAB (the Carpentier-Edwards Perimount Magna Ease Valve) or MV in aortic valve replacement (AVR) procedure over a 5-year period. The budget impact of various resource consumption including disabling strokes, reoperations, minor thromboembolic events, major bleeding, endocarditis, anticoagulation treatment and monitoring, and echocardiogram assessments were compared for both types of valves. One-way sensitivity analyses (OWSA) were conducted on the input costs and probabilities. RESULTS The use of BPAB compared to MV approaches budget neutrality due to incremental savings year-on-year. The initial surgical procedure and reoperation costs for BPAB are offset by savings in acenocoumarol use, disabling strokes, major bleeding, minor thromboembolic events, and anticoagulation complications. The cost of the initial procedure per patient is 460 euros higher for a BPAB due to the higher valve acquisition cost, although this is partially offset by a shorter hospital stay. The OWSA shows that the total procedure costs, including the hospital stay, are the primary cost drivers in the model. LIMITATIONS Results are limited by cost data aggregation in the DRG system, exclusion of costs for consumables and capital equipment use, possible underestimation of outpatient complication costs, age-related variations of event rates, and valve durability. CONCLUSIONS Adopting BPAB as a treatment option for AS patients in Romania can lead to cost savings and long-term economic benefits. By mitigating procedure costs and increasing anticoagulation treatment costs, BPAB offers a budget-neutral option that can help healthcare providers, policymakers, and patients alike manage the growing burden of AS in Romania.
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Affiliation(s)
- João L Carapinha
- Northeastern University School of Pharmacy, Boston, United States of America
- Syenza, Anaheim, United States of America
| | - Vlad A Iliescu
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | | | | | | | | | - Adham Salem
- Edwards Lifesciences, Dubai, United Arab Emirates
| | - Catalina Parasca
- "Prof. Dr. C.C. Iliescu" Institute for Cardiovascular Diseases, Bucharest, Romania
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8
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Nedadur R, Wang B, Tsang W. Artificial intelligence for the echocardiographic assessment of valvular heart disease. Heart 2022; 108:1592-1599. [PMID: 35144983 PMCID: PMC9554049 DOI: 10.1136/heartjnl-2021-319725] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/29/2021] [Indexed: 11/18/2022] Open
Abstract
Developments in artificial intelligence (AI) have led to an explosion of studies exploring its application to cardiovascular medicine. Due to the need for training and expertise, one area where AI could be impactful would be in the diagnosis and management of valvular heart disease. This is because AI can be applied to the multitude of data generated from clinical assessments, imaging and biochemical testing during the care of the patient. In the area of valvular heart disease, the focus of AI has been on the echocardiographic assessment and phenotyping of patient populations to identify high-risk groups. AI can assist image acquisition, view identification for review, and segmentation of valve and cardiac structures for automated analysis. Using image recognition algorithms, aortic and mitral valve disease states have been directly detected from the images themselves. Measurements obtained during echocardiographic valvular assessment have been integrated with other clinical data to identify novel aortic valve disease subgroups and describe new predictors of aortic valve disease progression. In the future, AI could integrate echocardiographic parameters with other clinical data for precision medical management of patients with valvular heart disease.
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Affiliation(s)
- Rashmi Nedadur
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Bo Wang
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Computer Science, University of Toronto, Toronto, Ontario, Canada
- Vector Institute of Artificial Intelligence, University of Toronto, Toronto, Ontario, Canada
- Peter Munk Cardiac Center, University Health Network, Toronto, Ontario, Canada
| | - Wendy Tsang
- Peter Munk Cardiac Center, University Health Network, Toronto, Ontario, Canada
- Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
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9
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Dirix P, Buoso S, Peper ES, Kozerke S. Synthesis of patient-specific multipoint 4D flow MRI data of turbulent aortic flow downstream of stenotic valves. Sci Rep 2022; 12:16004. [PMID: 36163357 PMCID: PMC9513106 DOI: 10.1038/s41598-022-20121-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/08/2022] [Indexed: 11/09/2022] Open
Abstract
We propose to synthesize patient-specific 4D flow MRI datasets of turbulent flow paired with ground truth flow data to support training of inference methods. Turbulent blood flow is computed based on the Navier-Stokes equations with moving domains using realistic boundary conditions for aortic shapes, wall displacements and inlet velocities obtained from patient data. From the simulated flow, synthetic multipoint 4D flow MRI data is generated with user-defined spatiotemporal resolutions and reconstructed with a Bayesian approach to compute time-varying velocity and turbulence maps. For MRI data synthesis, a fixed hypothetical scan time budget is assumed and accordingly, changes to spatial resolution and time averaging result in corresponding scaling of signal-to-noise ratios (SNR). In this work, we focused on aortic stenotic flow and quantification of turbulent kinetic energy (TKE). Our results show that for spatial resolutions of 1.5 and 2.5 mm and time averaging of 5 ms as encountered in 4D flow MRI in practice, peak total turbulent kinetic energy downstream of a 50, 75 and 90% stenosis is overestimated by as much as 23, 15 and 14% (1.5 mm) and 38, 24 and 23% (2.5 mm), demonstrating the importance of paired ground truth and 4D flow MRI data for assessing accuracy and precision of turbulent flow inference using 4D flow MRI exams.
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Affiliation(s)
- Pietro Dirix
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.
| | - Stefano Buoso
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Eva S Peper
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
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10
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Acute Decompensated Aortic Stenosis: State of the Art Review. Curr Probl Cardiol 2022; 48:101422. [PMID: 36167225 DOI: 10.1016/j.cpcardiol.2022.101422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 11/21/2022]
Abstract
Aortic stenosis (AS) is a progressive disease that carries a poor prognosis. Patients are managed conservatively until satisfying an indication for transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) based on AS severity and the presence of symptoms or adverse impact on the myocardium. Up to 1 in 3 TAVIs are performed for patients with acute symptoms of dyspnoea at rest, angina, and/or syncope - termed acute decompensated aortic stenosis (ADAS) and require urgent aortic valve replacement. These patients have longer hospital length of stay, undergo physical deconditioning, have a higher rate of acute kidney injury and mortality compared to stable patients with less severe symptoms. There is an urgent need to prevent ADAS and to deliver pathways to manage and improve ADAS-related outcomes. We provide here a contemporary review on epidemiological and pathophysiological aspects of ADAS, with a focus on the impact of ADAS from clinical and economic perspectives. We will offer also a global overview of the available evidence for treatment of ADAS and with priorities suggested for addressing current gaps in the literature and unmet clinical needs to improve outcomes for AS patients.
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11
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Ghanayim T, Lupu L, Naveh S, Bachner-Hinenzon N, Adler D, Adawi S, Banai S, Shiran A. Artificial Intelligence-Based Stethoscope for the Diagnosis of Aortic Stenosis. Am J Med 2022; 135:1124-1133. [PMID: 35640698 DOI: 10.1016/j.amjmed.2022.04.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/10/2022] [Accepted: 04/30/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The diagnostic accuracy of the stethoscope is limited and highly dependent on clinical expertise. Our purpose was to develop an electronic stethoscope, based on artificial intelligence (AI) and infrasound, for the diagnosis of aortic stenosis (AS). METHODS We used an electronic stethoscope (VoqX; Sanolla, Nesher, Israel) with subsonic capabilities and acoustic range of 3-2000 Hz. The study had 2 stages. In the first stage, using the VoqX, we recorded heart sounds from 100 patients referred for echocardiography (derivation group), 50 with moderate or severe AS and 50 without valvular disease. An AI-based supervised learning model was applied to the auscultation data from the first 100 patients used for training, to construct a diagnostic algorithm that was then tested on a validation group (50 other patients, 25 with AS and 25 without AS). In the second stage, conducted at a different medical center, we tested the device on 106 additional patients referred for echocardiography, which included patients with other valvular diseases. RESULTS Using data collected at the aortic and pulmonic auscultation points from the derivation group, the AI-based algorithm identified moderate or severe AS with 86% sensitivity and 100% specificity. When applied to the validation group, the sensitivity was 84% and specificity 92%; and in the additional testing group, 90% and 84%, respectively. The sensitivity was 55% for mild, 76% for moderate, and 93% for severe AS. CONCLUSION Our initial findings show that an AI-based stethoscope with infrasound capabilities can accurately diagnose AS. AI-based electronic auscultation is a promising new tool for automatic screening and diagnosis of valvular heart disease.
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Affiliation(s)
- Tamer Ghanayim
- Department of Cardiology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Lior Lupu
- Department of Cardiology, Tel Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Sivan Naveh
- Department of Cardiology, Tel Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | | | | | - Salim Adawi
- Department of Cardiology, Lady Davis Carmel Medical Center, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa
| | - Shmuel Banai
- Department of Cardiology, Tel Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Avinoam Shiran
- Department of Cardiology, Lady Davis Carmel Medical Center, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa.
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12
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Conroy TB, Zhou J, Kan EC. Physiological Features of Cardiac Ventricle and Valve Dynamics from Wearable Radio-Frequency Sensors. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:2906-2911. [PMID: 36086442 DOI: 10.1109/embc48229.2022.9871038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Early detection of cardiovascular diseases via non-invasive, convenient, and continuous monitoring is crucial to reducing preventable deaths. This paper illustrates such monitoring using wearable near-field radio-frequency sensors to analyze ventricle and valve transients, which can be used as indicators of myriad cardiac disorders. We applied a novel vector injection signal processing method to improve timing consistency in ventricular contraction, ventricular relaxation, and valve opening extraction. The median relative timing error in valve opening detection was 14.7ms and 37.8ms for semilunar and atrioventricular valves, respectively, as benchmarked by the S1 and S2 heart sounds from a synchronous phonocardiogram. Clinical Relevance- No wearable sensor currently exists to conveniently and reliably evaluate ventricular and valvular dynamics, specifically valvular opening. Beyond extraction of the heart rate and its variation, the method in this paper has the potential to enable non-invasive measurements of detailed cardiac cycle timing features including valve openings, isovolumetric contraction/relaxation times, and ejection periods, improving the monitoring of patient health away from clinical healthcare centers.
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13
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Pellikka PA, Padang R, Scott CG, Murphy SME, Fabunmi R, Thaden JJ. Impact of Managing Provider Type on Severe Aortic Stenosis Management and Mortality. J Am Heart Assoc 2022; 11:e025164. [PMID: 35766279 PMCID: PMC9333396 DOI: 10.1161/jaha.121.025164] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Many patients with symptomatic severe aortic stenosis do not undergo aortic valve replacement (AVR) despite clinical guidelines. This study analyzed the association of managing provider type with cardiac specialist follow-up, AVR, and mortality for patients with newly diagnosed severe aortic stenosis (sAS). Methods and Results We identified adults with newly diagnosed sAS per echocardiography performed between January 2017 and March 2019 using Optum electronic health record data. We then selected from those meeting all eligibility criteria patients managed by a primary care provider (n=1707 [25%]) or cardiac specialist (n=5039 [75%]). We evaluated the association of managing provider type with cardiac specialist follow-up, AVR, and mortality, as well as the independent association of cardiac specialist follow-up and AVR with mortality, within 1 year of echocardiography detecting sAS. A subgroup analysis was limited to patients with symptomatic sAS. Patient characteristics and comorbidities at baseline were used for covariate-adjusted cause-specific and multivariable Cox proportional hazard models assessing group differences in outcomes by managing provider type. An adjusted Cox proportional hazard model with additional time-dependent covariates for follow-up and AVR was used to assess these practices' association with mortality. Within 1 year of echocardiography detecting sAS, data revealed that primary care provider management was associated with lower rates of cardiac specialist follow-up (hazard ratio [HR], 0.47 [95% CI, 0.43-0.50], P<0.0001) and AVR (HR, 0.58 [95% CI, 0.53-0.64], P<0.0001) and with higher 1-year mortality (HR, 1.45 [95% CI, 1.26-1.66], P<0.0001). Cardiac specialist follow-up and AVR were independently associated with lower mortality (follow-up: HR, 0.55 [95% CI, 0.48-0.63], P<0.0001; AVR: HR, 0.70 [95% CI, 0.60-0.83], P<0.0001). Results were similar for patients with symptomatic sAS. All analyses were adjusted for baseline patient characteristics and comorbidities. Conclusions For patients newly diagnosed with sAS, we observed differences in rates of cardiac specialist follow-up and AVR and risk of mortality between primary care provider- versus cardiologist-managed patients with sAS. In addition, a lower likelihood of receiving follow-up and AVR was independently associated with higher mortality.
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Affiliation(s)
| | | | | | | | | | - Jeremy J Thaden
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
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14
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Dargam V, Ng HH, Nasim S, Chaparro D, Irion CI, Seshadri SR, Barreto A, Danziger ZC, Shehadeh LA, Hutcheson JD. S2 Heart Sound Detects Aortic Valve Calcification Independent of Hemodynamic Changes in Mice. Front Cardiovasc Med 2022; 9:809301. [PMID: 35694672 PMCID: PMC9174427 DOI: 10.3389/fcvm.2022.809301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background Calcific aortic valve disease (CAVD) is often undiagnosed in asymptomatic patients, especially in underserved populations. Although artificial intelligence has improved murmur detection in auscultation exams, murmur manifestation depends on hemodynamic factors that can be independent of aortic valve (AoV) calcium load and function. The aim of this study was to determine if the presence of AoV calcification directly influences the S2 heart sound. Methods Adult C57BL/6J mice were assigned to the following 12-week-long diets: (1) Control group (n = 11) fed a normal chow, (2) Adenine group (n = 4) fed an adenine-supplemented diet to induce chronic kidney disease (CKD), and (3) Adenine + HP (n = 9) group fed the CKD diet for 6 weeks, then supplemented with high phosphate (HP) for another 6 weeks to induce AoV calcification. Phonocardiograms, echocardiogram-based valvular function, and AoV calcification were assessed at endpoint. Results Mice on the Adenine + HP diet had detectable AoV calcification (9.28 ± 0.74% by volume). After segmentation and dimensionality reduction, S2 sounds were labeled based on the presence of disease: Healthy, CKD, or CKD + CAVD. The dataset (2,516 S2 sounds) was split subject-wise, and an ensemble learning-based algorithm was developed to classify S2 sound features. For external validation, the areas under the receiver operating characteristic curve of the algorithm to classify mice were 0.9940 for Healthy, 0.9717 for CKD, and 0.9593 for CKD + CAVD. The algorithm had a low misclassification performance of testing set S2 sounds (1.27% false positive, 1.99% false negative). Conclusion Our ensemble learning-based algorithm demonstrated the feasibility of using the S2 sound to detect the presence of AoV calcification. The S2 sound can be used as a marker to identify AoV calcification independent of hemodynamic changes observed in echocardiography.
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Affiliation(s)
- Valentina Dargam
- Department of Biomedical Engineering, Florida International University, Miami, FL, United States
| | - Hooi Hooi Ng
- Department of Biomedical Engineering, Florida International University, Miami, FL, United States
- Department of Human and Molecular Genetics, Florida International University, Miami, FL, United States
| | - Sana Nasim
- Department of Biomedical Engineering, Florida International University, Miami, FL, United States
| | - Daniel Chaparro
- Department of Biomedical Engineering, Florida International University, Miami, FL, United States
| | - Camila Iansen Irion
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Coral Gables, FL, United States
| | - Suhas Rathna Seshadri
- Department of Medical Education, University of Miami Miller School of Medicine, Coral Gables, FL, United States
| | - Armando Barreto
- Department of Electrical and Computer Engineering, Florida International University, Miami, FL, United States
| | - Zachary C. Danziger
- Department of Biomedical Engineering, Florida International University, Miami, FL, United States
| | - Lina A. Shehadeh
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Coral Gables, FL, United States
- Division of Cardiology, Department of Medicine, University of Miami Miller School of Medicine, Coral Gables, FL, United States
| | - Joshua D. Hutcheson
- Department of Biomedical Engineering, Florida International University, Miami, FL, United States
- Biomolecular Sciences Institute, Florida International University, Miami, FL, United States
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15
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Li SX, Patel NK, Flannery LD, Selberg A, Kandanelly RR, Morrison FJ, Kim J, Tanguturi VK, Crousillat DR, Shaqdan AW, Inglessis I, Shah PB, Passeri JJ, Kaneko T, Jassar AS, Langer NB, Turchin A, Elmariah S. Trends in Utilization of Aortic Valve Replacement for Severe Aortic Stenosis. J Am Coll Cardiol 2022; 79:864-877. [PMID: 35241220 DOI: 10.1016/j.jacc.2021.11.060] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/19/2021] [Accepted: 11/29/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Despite the rapid growth of aortic valve replacement (AVR) for aortic stenosis (AS), limited data suggest symptomatic severe AS remains undertreated. OBJECTIVES This study sought to investigate temporal trends in AVR utilization among patients with a clinical indication for AVR. METHODS Patients with severe AS (aortic valve area <1 cm2) on transthoracic echocardiograms from 2000 to 2017 at 2 large academic medical centers were classified based on clinical guideline indications for AVR and divided into 4 AS subgroups: high gradient with normal left ventricular ejection fraction (LVEF) (HG-NEF), high gradient with low LVEF (HG-LEF), low gradient with normal LVEF (LG-NEF), and low gradient with low LVEF (LG-LEF). Utilization of AVR was examined and predictors identified. RESULTS Of 10,795 patients, 6,150 (57%) had an indication or potential indication for AVR, of whom 2,977 (48%) received AVR. The frequency of AVR varied by AS subtype with LG groups less likely to receive an AVR (HG-NEF: 70%, HG-LEF: 53%, LG-NEF: 32%, LG-LEF: 38%, P < 0.001). AVR volumes grew over the 18-year study period but were paralleled by comparable growth in the number of patients with an indication for AVR. In patients with a Class I indication, younger age, coronary artery disease, smoking history, higher hematocrit, outpatient index transthoracic echocardiogram, and LVEF ≥0.5 were independently associated with an increased likelihood of receiving an AVR. AVR was associated with improved survival in each AS-subgroup. CONCLUSIONS Over an 18-year period, the proportion of patients with an indication for AVR who did not receive AVR has remained substantial despite the rapid growth of AVR volumes.
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Affiliation(s)
- Shawn X Li
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. https://twitter.com/ShawnXLiMD
| | - Nilay K Patel
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Laura D Flannery
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexandra Selberg
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ritvik R Kandanelly
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Fritha J Morrison
- Division of Endocrinology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Joonghee Kim
- Division of Endocrinology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Varsha K Tanguturi
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniela R Crousillat
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ayman W Shaqdan
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ignacio Inglessis
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Pinak B Shah
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan J Passeri
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Arminder S Jassar
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nathaniel B Langer
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander Turchin
- Division of Endocrinology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sammy Elmariah
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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16
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Garvick S, Gillette C, Gao H, Bates N, Waynick J, Crandall S. Can cardiac auscultation accuracy be improved with an additional app-based learning tool? CLINICAL TEACHER 2022; 19:112-120. [PMID: 35137534 PMCID: PMC9303325 DOI: 10.1111/tct.13462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 12/22/2021] [Accepted: 01/11/2022] [Indexed: 12/01/2022]
Abstract
Introduction Many institutions use simulation ‘events’ to instruct cardiac auscultation. Research shows that these ‘one and done’ events limit repetition, are costly and do not incorporate learning science techniques, such as spaced learning and retrieval practice. The Littmann Learning™ mobile app, which has unlimited access to a large library of real patient heart sounds, is a cost‐effective tool that we considered could be leveraged by educators to provide this training. Methods This was a quasi‐experimental pre‐ and post‐design consisting of an intervention group (PA22) and a non‐equivalent comparator group (PA21). The intervention group used a novel mobile app cardiac auscultation curriculum (MACAC), while the comparator group received standard didactic instruction. One‐way analyses of variance were used to analyse the data. Results A total of 174 PA students participated in the study. There was a significant (p < 0.001) difference in knowledge and auscultation scores between those who did and did not complete the MACAC. PA22 didactic year knowledge scores were 4.11 and 2.96 points higher than PA21 didactic and clinical year knowledge scores (p < 0.001, d = 1.61 and p < 0.001, d = 1.32), respectively. On average, PA22 didactic year auscultation scores were 0.83 points higher than PA21 clinical year scores (p < 0.001, d = 0.6). Conclusion Results indicate that students in their didactic year achieved proficiency in clinically identifying heart sounds, despite not having access to a mannequin simulator and not having an opportunity to identify these sounds bedside. Overall, a MACAC may be an effective method to teach cardiac auscultation to medical learners.
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Affiliation(s)
- Sarah Garvick
- PA Studies, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Chris Gillette
- PA Studies, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Hong Gao
- PA Studies, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Nathan Bates
- PA Studies, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Joshua Waynick
- PA Studies, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Sonia Crandall
- PA Studies, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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17
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Evaluating Medical Therapy for Calcific Aortic Stenosis: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 78:2354-2376. [PMID: 34857095 DOI: 10.1016/j.jacc.2021.09.1367] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/08/2021] [Accepted: 09/27/2021] [Indexed: 12/23/2022]
Abstract
Despite numerous promising therapeutic targets, there are no proven medical treatments for calcific aortic stenosis (AS). Multiple stakeholders need to come together and several scientific, operational, and trial design challenges must be addressed to capitalize on the recent and emerging mechanistic insights into this prevalent heart valve disease. This review briefly discusses the pathobiology and most promising pharmacologic targets, screening, diagnosis and progression of AS, identification of subgroups that should be targeted in clinical trials, and the need to elicit the patient voice earlier rather than later in clinical trial design and implementation. Potential trial end points and tools for assessment and approaches to implementation and design of clinical trials are reviewed. The efficiencies and advantages offered by a clinical trial network and platform trial approach are highlighted. The objective is to provide practical guidance that will facilitate a series of trials to identify effective medical therapies for AS resulting in expansion of therapeutic options to complement mechanical solutions for late-stage disease.
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18
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Ueda D, Yamamoto A, Ehara S, Iwata S, Abo K, Walston SL, Matsumoto T, Shimazaki A, Yoshiyama M, Miki Y. Artificial intelligence-based detection of aortic stenosis from chest radiographs. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 3:20-28. [PMID: 36713993 PMCID: PMC9707887 DOI: 10.1093/ehjdh/ztab102] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/16/2021] [Accepted: 11/30/2021] [Indexed: 02/01/2023]
Abstract
Aims We aimed to develop models to detect aortic stenosis (AS) from chest radiographs-one of the most basic imaging tests-with artificial intelligence. Methods and results We used 10 433 retrospectively collected digital chest radiographs from 5638 patients to train, validate, and test three deep learning models. Chest radiographs were collected from patients who had also undergone echocardiography at a single institution between July 2016 and May 2019. These were labelled from the corresponding echocardiography assessments as AS-positive or AS-negative. The radiographs were separated on a patient basis into training [8327 images from 4512 patients, mean age 65 ± (standard deviation) 15 years], validation (1041 images from 563 patients, mean age 65 ± 14 years), and test (1065 images from 563 patients, mean age 65 ± 14 years) datasets. The soft voting-based ensemble of the three developed models had the best overall performance for predicting AS with an area under the receiver operating characteristic curve, sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 0.83 (95% confidence interval 0.77-0.88), 0.78 (0.67-0.86), 0.71 (0.68-0.73), 0.71 (0.68-0.74), 0.18 (0.14-0.23), and 0.97 (0.96-0.98), respectively, in the validation dataset and 0.83 (0.78-0.88), 0.83 (0.74-0.90), 0.69 (0.66-0.72), 0.71 (0.68-0.73), 0.23 (0.19-0.28), and 0.97 (0.96-0.98), respectively, in the test dataset. Conclusion Deep learning models using chest radiographs have the potential to differentiate between radiographs of patients with and without AS. Lay Summary We created artificial intelligence (AI) models using deep learning to identify aortic stenosis (AS) from chest radiographs. Three AI models were developed and evaluated with 10 433 retrospectively collected radiographs and labelled from echocardiography reports. The ensemble AI model could detect AS in a test dataset with an area under the receiver operating characteristic curve of 0.83 (95% confidence interval 0.78-0.88). Since chest radiography is a cost-effective and widely available imaging test, our model can provide an additive resource for the detection of AS.
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Affiliation(s)
- Daiju Ueda
- Corresponding author. Tel: +81 6 6645 3831, Fax: +81 6 6646 6655,
| | - Akira Yamamoto
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Shoichi Ehara
- Department of Cardiovascular Medicine, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Shinichi Iwata
- Department of Cardiovascular Medicine, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Koji Abo
- Central Clinical Laboratory, Osaka City University Hospital, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Shannon L Walston
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Toshimasa Matsumoto
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Akitoshi Shimazaki
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Minoru Yoshiyama
- Department of Cardiovascular Medicine, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Yukio Miki
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
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19
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Selby J, Walker S. Post-exertional syncope as the first symptom of critical valvular cardiac disease: A cautionary tale for evaluating syncope in the emergency department. Emerg Med Australas 2021; 33:1130-1132. [PMID: 34549525 DOI: 10.1111/1742-6723.13872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 08/30/2021] [Accepted: 09/06/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Joel Selby
- Emergency Department, Gosford Hospital, Gosford, New South Wales, Australia
| | - Simon Walker
- Emergency Department, Gosford Hospital, Gosford, New South Wales, Australia
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20
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Chen J, Wu Z, Liu Y, Wang L, Li T, Dong Y, Qin Q, Ding S. Prevalence, Association Relation, and Dynamic Evolution Analysis of Critical Values in Health Checkup in China: A Retrospective Study. Front Public Health 2021; 9:630356. [PMID: 34368036 PMCID: PMC8339420 DOI: 10.3389/fpubh.2021.630356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 06/16/2021] [Indexed: 01/06/2023] Open
Abstract
Objective: The critical values in health checkup play a key role in preventing chronic diseases and different types of cancer. This study aimed to analyze the prevalence, association relation, and dynamic evolution of critical values in health checkups at a large physical examination center in China. Methods: Herein, we chose 33,639 samples of physical examiners from January 2017 to December 2019. After strict exclusion processes, combined with the critical values in health checkup reporting data, 4,721 participants with at least one critical value were included. We first defined a critical value list for laboratory test, imaging, cervical cancer screening, electrocardiogram, and health checkup informed on site, and then performed a cross-sectional study to analyze the distribution and significance of critical values of 4,721 participants from different views and the association relation of 628 participants with more than one critical value and a retrospective cohort study to analyze the incidence and dynamic evolution of critical values based on 2,813 participants attending the physical examination from 2017 to 2019. Results: A total of 4,721 participants were included in the retrospective study. The prevalence of 10 critical values from 33,639 participants was over 0.6%. The critical values of obesity, hypertension, Glucose_T, Liver_T, Kidney_T, Lipid_T, Urine_T, and Head_CT were significantly increased in men (P < 0.05), whereas the results were the opposite for the Blood_T and Thyroid_US (P < 0.01). The prevalence trend of critical values increased along with age, where the prevalence of men was higher than that of women under 60 years old (P < 0.01), while the prevalence of women increased by four times and exceeded the prevalence of men above 70 years old. Association relation analysis identified 16 and 6 effective rules for men and women, respectively, where the critical values of Urine_T and Glucose_T played the central roles. Furthermore, a retrospective dynamic evolution analysis found that the incidence of new critical values was about 10%, the incidence of persistent critical values was about 50%, and that most of the effective evolution paths tended to no critical values for men and women. Conclusion: In conclusion, this study provides a new perspective to explore the population health status using the critical value reporting data in a physical examination center, which can assist in decision-making by health management at the population level and in the prevention and treatment of various types of cancer and chronic diseases at the individual level.
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Affiliation(s)
- Jingfeng Chen
- Health Management Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhuoqing Wu
- Institute of Systems Engineering, Dalian University of Technology, Dalian, China
| | - Yanan Liu
- Health Management Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lin Wang
- Health Management Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tiantian Li
- Health Management Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yihan Dong
- Health Management Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qian Qin
- Health Management Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Suying Ding
- Health Management Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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21
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Khanji MY, Ricci F, Galusko V, Sekar B, Chahal CAA, Ceriello L, Gallina S, Kennon S, Awad WI, Ionescu A. Management of aortic stenosis: a systematic review of clinical practice guidelines and recommendations. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 7:340-353. [PMID: 33751049 DOI: 10.1093/ehjqcco/qcab016] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 02/27/2021] [Accepted: 03/03/2021] [Indexed: 02/06/2023]
Abstract
Multiple guidelines exist for the management of aortic stenosis (AS). We systematically reviewed current guidelines and recommendations, developed by national or international medical organizations, on management of AS to aid clinical decision-making. Publications in MEDLINE and EMBASE between 1 June 2010 and 15 January 2021 were identified. Additionally, the International Guideline Library, National Guideline Clearinghouse, National Library for Health Guidelines Finder, Canadian Medical Association Clinical Practice Guidelines Infobase, and websites of relevant organizations were searched. Two reviewers independently screened titles and abstracts. Two reviewers assessed rigour of guideline development and extracted the recommendations. Of the seven guidelines and recommendations retrieved, five showed considerable rigour of development. Those rigourously developed, agreed on the definition of severe AS and diverse haemodynamic phenotypes, indications and contraindications for intervention in symptomatic severe AS, surveillance intervals in asymptomatic severe AS, and the importance of multidisciplinary teams (MDTs) and shared decision-making. Discrepancies exist in age and surgical risk cut-offs for recommending surgical aortic valve replacement (SAVR) vs. transcatheter aortic valve implantation (TAVI), the use of biomarkers and complementary multimodality imaging for decision-making in asymptomatic patients and surveillance intervals for non-severe AS. Contemporary guidelines for AS management agree on the importance of MDT involvement and shared decision-making for individualized treatment and unanimously indicate valve replacement in severe, symptomatic AS. Discrepancies exist in thresholds for age and procedural risk used in choosing between SAVR and TAVI, role of biomarkers and complementary imaging modalities to define AS severity and risk of progression in asymptomatic patients.
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Affiliation(s)
- Mohammed Y Khanji
- Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, Glen Road, London E13 8SL, UK.,Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK.,NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London EC1A 7BE, UK
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Advanced Biomedical Technologies, "G.d'Annunzio" University, 66100 Chieti, Italy.,Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35, 205 02 Malmö, Sweden.,Department of Cardiology, Casa di Cura Villa Serena, 65013 Città Sant'Angelo, Pescara, Italy
| | - Victor Galusko
- Department of Cardiology, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Baskar Sekar
- Department of Cardiology, Morriston Cardiac Regional Centre, Swansea Bay Health Board, Heol Maes Eglwys, Swansea SA6 6NL, UK
| | - C Anwar A Chahal
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK.,Department of Cardiology, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA.,Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55902, USA
| | - Laura Ceriello
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Advanced Biomedical Technologies, "G.d'Annunzio" University, 66100 Chieti, Italy
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Advanced Biomedical Technologies, "G.d'Annunzio" University, 66100 Chieti, Italy
| | - Simon Kennon
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Wael I Awad
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Adrian Ionescu
- Department of Cardiology, Morriston Cardiac Regional Centre, Swansea Bay Health Board, Heol Maes Eglwys, Swansea SA6 6NL, UK
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22
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Steeds RP, Potter A, Mangat N, Fröhlich M, Deutsch C, Bramlage P, Thoenes M. Community-based aortic stenosis detection: clinical and echocardiographic screening during influenza vaccination. Open Heart 2021; 8:openhrt-2021-001640. [PMID: 34021069 PMCID: PMC8144056 DOI: 10.1136/openhrt-2021-001640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/14/2021] [Indexed: 11/25/2022] Open
Abstract
Background Degenerative aortic stenosis (AS), the most common valvular heart disease in the Western world, is often diagnosed late when the mortality risk becomes substantial. We determined the feasibility of AS screening during influenza vaccination at general practitioner (GP) surgeries in the UK. Methods Consecutive subjects aged >65 years presenting to a GP for influenza vaccination underwent heart auscultation and 2D echocardiography (V-scan). Based on these findings, a patient management strategy was determined (referral to cardiologist, review within own practice or no follow-up measures) and status at 3 months was determined. Results 167 patients were enrolled with a mean age of 75 years. On auscultation, a heart murmur was detected in 30 of 167 (18%) patients (6 subjects with an AS-specific and 24 with a non-specific murmur). 75.2% of those with no murmur had a negative V-scan finding. Conversely, 16 of 30 (53%) patients with any murmur had an abnormal V-scan finding that was largely related to the aortic valve. Using clinical auscultation and V-scan screening, a decision not to pursue follow-up measures was taken in 147 (88%) cases, whereas 18 (10.8%) subjects were referred onward; with 5 of 18 (27.8%) and 3 of 18 (16.7%) being diagnosed with mild and moderate AS. Conclusions Our pilot study confirms feasibility of valvular heart disease screening in the elderly in a primary care setting. Using simple and inexpensive diagnostic measures and 7.3 million UK inhabitants undergoing influenza vaccination, nationwide screening could potentially identify 130 000 patients with moderate AS and a significant number of patients with severe AS.
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Affiliation(s)
- Richard Paul Steeds
- Queen Elizabeth Hospital & Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | | | | | - Maren Fröhlich
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Martin Thoenes
- Leman Research Institute, Schaffhausen, Switzerland.,Medical Department, Edwards Lifesciences, Nyon, Switzerland
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23
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Gracia Baena JM, Calaf Vall I, Zielonka M, Marsal Mora JR, Godoy P, Worner Diz F. Risk factors and comorbidities associated with severe aortic stenosis: a case-control study. Rev Clin Esp 2021; 221:249-257. [PMID: 32591111 DOI: 10.1016/j.rce.2020.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/06/2020] [Accepted: 01/13/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Aortic stricture (AS) is one of the most prevalent cardiovascular diseases in individuals 65 years of age or older. A number of epidemiological studies have suggested that certain cardiovascular risk factors (CRFs) and comorbidities could be associated with AS. The aim of this study was to evaluate the association between CRFs and comorbidities and severe symptomatic AS in individuals 65 years of age or older in a Spanish healthcare region. PATIENTS AND METHODS We conducted an epidemiological case-control study from a single primary care centre. We collected information on exposure to CRFs and comorbidities and determined their association with AS, employing adjusted odds ratios (OR) and multiple logistic regression models. RESULTS The study included 102 cases (mean age, 77.6 years) and 221 controls (mean age, 75.5 years). The CRFs significantly associated with severe symptomatic AS were hypercholesterolaemia (OR, 2.67; p<.001), tobacco use (OR, 2.60; p<.001), hypertension (OR, 2.41; p=.010) and low HDL cholesterol readings (OR, 2.20; p=.007). The comorbidities significantly associated with severe symptomatic AS were carotid stenosis (OR, 14.5; p=.017), stroke (OR, 4.14; p=.024), chronic renal failure (OR, 3.78; p<.001) and low haemoglobin levels (OR, 0.76; p<.001). CONCLUSIONS Hypercholesterolaemia, tobacco use, arterial hypertension and low HDL cholesterol levels are the CRFs with a greater risk of severe AS. Furthermore, this disease is associated with a number of comorbidities (chronic renal failure, stroke, carotid stenosis and low haemoglobin levels), which could be markers of AS.
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Affiliation(s)
- J M Gracia Baena
- Servei de Cirurgia Cardíaca d'Adults, Hospital Universitari Vall d'Hebron, Barcelona, España; Unitat d'Epidemiologia Aplicada, Departament de Cirurgia, Universitat de Lleida, Lérida, España.
| | - I Calaf Vall
- Servei de Cardiologia, Hospital Universitari Arnau de Vilanova, Lérida, España
| | - M Zielonka
- Servei de Cardiologia, Hospital Universitari Arnau de Vilanova, Lérida, España
| | - J R Marsal Mora
- Unitat de Suport a la Recerca Lleida, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España
| | - P Godoy
- Unitat d'Epidemiologia Aplicada, Departament de Cirurgia, Universitat de Lleida, Lérida, España; CIBER de Epidemiología y Salud Pública CIBERESP, Barcelona, España; Agència de Salut Pública de Catalunya, Barcelona, España
| | - F Worner Diz
- Servei de Cardiologia, Hospital Universitari Arnau de Vilanova, Lérida, España
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24
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Abstract
Aortic stenosis (AS) remains one of the most common forms of valve disease, with significant impact on patient survival. The disease is characterized by left ventricular outflow obstruction and encompasses a series of stenotic lesions starting from the left ventricular outflow tract to the descending aorta. Obstructions may be subvalvar, valvar, or supravalvar and can be present at birth (congenital) or acquired later in life. Bicuspid aortic valve, whereby the aortic valve forms with two instead of three cusps, is the most common cause of AS in younger patients due to primary anatomic narrowing of the valve. In addition, the secondary onset of premature calcification, likely induced by altered hemodynamics, further obstructs left ventricular outflow in bicuspid aortic valve patients. In adults, degenerative AS involves progressive calcification of an anatomically normal, tricuspid aortic valve and is attributed to lifelong exposure to multifactoral risk factors and physiological wear-and-tear that negatively impacts valve structure-function relationships. AS continues to be the most frequent valvular disease that requires intervention, and aortic valve replacement is the standard treatment for patients with severe or symptomatic AS. While the positive impacts of surgical interventions are well documented, the financial burden, the potential need for repeated procedures, and operative risks are substantial. In addition, the clinical management of asymptomatic patients remains controversial. Therefore, there is a critical need to develop alternative approaches to prevent the progression of left ventricular outflow obstruction, especially in valvar lesions. This review summarizes our current understandings of AS cause; beginning with developmental origins of congenital valve disease, and leading into the multifactorial nature of AS in the adult population.
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Affiliation(s)
- Punashi Dutta
- The Herma Heart Institute, Section of Pediatric Cardiology, Children's Wisconsin, Milwaukee, WI (P.D., J.F.J., H.K., J.L.).,Department of Pediatrics, Medical College of Wisconsin, Milwaukee (P.D., J.F.J., J.L.)
| | - Jeanne F James
- The Herma Heart Institute, Section of Pediatric Cardiology, Children's Wisconsin, Milwaukee, WI (P.D., J.F.J., H.K., J.L.).,Department of Pediatrics, Medical College of Wisconsin, Milwaukee (P.D., J.F.J., J.L.)
| | - Hail Kazik
- The Herma Heart Institute, Section of Pediatric Cardiology, Children's Wisconsin, Milwaukee, WI (P.D., J.F.J., H.K., J.L.).,Department of Biomedical Engineering, Marquette University & Medical College of Wisconsin, Milwaukee (H.K.)
| | - Joy Lincoln
- The Herma Heart Institute, Section of Pediatric Cardiology, Children's Wisconsin, Milwaukee, WI (P.D., J.F.J., H.K., J.L.).,Department of Pediatrics, Medical College of Wisconsin, Milwaukee (P.D., J.F.J., J.L.)
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25
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MacCarthy P, Zaman A, Uren N, Cockburn J, Dorman S, Malik I, Muir D, Ozkor MM, Smith D, Shield S. Minimising permanent pacemaker implantation (PPI) after TAVI. THE BRITISH JOURNAL OF CARDIOLOGY 2021; 28:20. [PMID: 35747458 PMCID: PMC8822527 DOI: 10.5837/bjc.2021.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Increased demand for transcatheter aortic valve implantation (TAVI) procedures for patients with severe aortic stenosis has not been matched with a proportional increase in available resources in recent years. This article highlights the importance of developing integrated care pathways for TAVI, which incorporate standardised protocols for permanent pacemaker implantation (PPI) to ensure best practice, increase service efficiency and reduce rates of PPI post-TAVI.
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Affiliation(s)
- Philip MacCarthy
- Professor in Cardiology King's College Hospital NHS Foundation Trust, Denmark Hill, Brixton, London, SE5 9RS
| | - Azfar Zaman
- Professor of Cardiology Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Road, High Heaton, Newcastle-upon-Tyne, NE7 7DN
| | - Neal Uren
- Professor in Cardiology NHS Lothian, Waverley Gate, 2-4 Waterloo Place, Edinburgh, EH1 3EG
| | - James Cockburn
- Consultant Cardiologist Brighton and Sussex University Hospitals NHS Trust, Kemptown, Brighton, BN2 1ES
| | - Stephen Dorman
- Consultant Cardiologist University Hospitals Bristol NHS Foundation Trust, Trust Headquarters, Marlborough Street, Bristol, BS1 3NU
| | - Iqbal Malik
- Consultant Cardiologist Imperial College Healthcare NHS Trust, The Bays, S Wharf Road, Paddington, London, W2 1NY
| | - Douglas Muir
- Consultant Cardiologist South Tees Hospital NHS Foundation Trust, Marton Road, Middlesborough, TS4 3BW
| | - Muhiddin Mick Ozkor
- Consultant Cardiologist Barts Health NHS Trust, The Royal Hospital, Whitechapel Road, London, E1 1BB
| | - David Smith
- Consultant Cardiologist Swansea Bay University Health Board, 1 Talbot Gateway, Baglan Energy Park, Baglan, Port Talbot, SA12 7BR
| | - Sarah Shield
- Principal Healthcare Consultant Wilmington Healthcare, 5th Floor, 10 Whitechapel High Street, London, E1 8QS
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26
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Gracia Baena JM, Calaf Vall I, Zielonka M, Marsal Mora JR, Godoy P, Worner Diz F. Risk factors and comorbidities associated with severe aortic stenosis: A case-control study. Rev Clin Esp 2021; 221:249-257. [PMID: 33998510 DOI: 10.1016/j.rceng.2020.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/13/2020] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Aortic stricture (AS) is one of the most prevalent cardiovascular diseases in individuals 65 years of age or older. A number of epidemiological studies have suggested that certain cardiovascular risk factors (CRFs) and comorbidities could be associated with AS. The aim of this study was to evaluate the association between CRFs and comorbidities and severe symptomatic AS in individuals 65 years of age or older in a Spanish healthcare region. PATIENTS AND METHODS We conducted an epidemiological case-control study from a single primary care centre. We collected information on exposure to CRFs and comorbidities and determined their association with AS, employing adjusted odds ratios (OR) and multiple logistic regression models. RESULTS The study included 102 cases (mean age, 77.6 years) and 221 controls (mean age, 75.5 years). The CRFs significantly associated with severe symptomatic AS were hypercholesterolaemia (OR, 2.67; p < .001), tobacco use (OR, 2.60; p < .001), hypertension (OR, 2.41; p = .010) and low HDL cholesterol readings (OR, 2.20; p = .007). The comorbidities significantly associated with severe symptomatic AS were carotid stenosis (OR, 14.5; p = .017), stroke (OR, 4.14; p = .024), chronic renal failure (OR, 3.78; p < .001) and low haemoglobin levels (OR, 0.76; p < .001). CONCLUSIONS Hypercholesterolaemia, tobacco use, arterial hypertension and low HDL cholesterol levels are the CRFs with a greater risk of severe AS. Furthermore, this disease is associated with a number of comorbidities (chronic renal failure, stroke, carotid stenosis and low haemoglobin levels), which could be markers of AS.
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Affiliation(s)
- J M Gracia Baena
- Servei de Cirurgia Cardíaca d'Adults, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Unitat d'Epidemiologia Aplicada, Departament de Cirurgia, Universitat de Lleida, Lleida, Spain.
| | - I Calaf Vall
- Servei de Cardiologia, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - M Zielonka
- Servei de Cardiologia, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - J R Marsal Mora
- Unitat de Suport a la Recerca Lleida, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol iGurina (IDIAPJGol), Barcelona, Spain
| | - P Godoy
- Unitat d'Epidemiologia Aplicada, Departament de Cirurgia, Universitat de Lleida, Lleida, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Agència de Salut Pública de Catalunya, Barcelona, Spain
| | - F Worner Diz
- Servei de Cardiologia, Hospital Universitari Arnau de Vilanova, Lleida, Spain
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27
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Thoenes M, Agarwal A, Grundmann D, Ferrero C, McDonald A, Bramlage P, Steeds RP. Narrative review of the role of artificial intelligence to improve aortic valve disease management. J Thorac Dis 2021; 13:396-404. [PMID: 33569220 PMCID: PMC7867819 DOI: 10.21037/jtd-20-1837] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Valvular heart disease (VHD) is a chronic progressive condition with an increasing prevalence in the Western world due to aging populations. VHD is often diagnosed at a late stage when patients are symptomatic and the outcomes of therapy, including valve replacement, may be sub-optimal due the development of secondary complications, including left ventricular (LV) dysfunction. The clinical application of artificial intelligence (AI), including machine learning (ML), has promise in supporting not only early and more timely diagnosis, but also hastening patient referral and ensuring optimal treatment of VHD. As physician auscultation lacks accuracy in diagnosis of significant VHD, computer-aided auscultation (CAA) with the help of a commercially available digital stethoscopes improves the detection and classification of heart murmurs. Although used little in current clinical practice, CAA can screen large populations at low cost with high accuracy for VHD and faciliate appropriate patient referral. Echocardiography remains the next step in assessment and planning management and AI is delivering major changes in speeding training, improving image quality by pattern recognition and image sorting, as well as automated measurement of multiple variables, thereby improving accuracy. Furthermore, AI then has the potential to hasten patient disposal, by automated alerts for red-flag findings, as well as decision support in dealing with results. In management, there is great potential in ML-enabled tools to support comprehensive disease monitoring and individualized treatment decisions. Using data from multiple sources, including demographic and clinical risk data to image variables and electronic reports from electronic medical records, specific patient phenotypes may be identified that are associated with greater risk or modeled to the estimate trajectory of VHD progression. Finally, AI algorithms are of proven value in planning intervention, facilitating transcatheter valve replacement by automated measurements of anatomical dimensions derived from imaging data to improve valve selection, valve size and method of delivery.
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Affiliation(s)
- Martin Thoenes
- Léman Research Institute, Schaffhausen am Rheinfall, Switerzland
| | | | | | - Carmen Ferrero
- Departamento de Farmacia y Tecnología Farmacéutica, Facultad de Farmacia, Universidad de Sevilla, Spain
| | | | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Richard P Steeds
- Queen Elizabeth Hospital & Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
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28
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Córdova-Palomera A, Tcheandjieu C, Fries JA, Varma P, Chen VS, Fiterau M, Xiao K, Tejeda H, Keavney BD, Cordell HJ, Tanigawa Y, Venkataraman G, Rivas MA, Ré C, Ashley E, Priest JR. Cardiac Imaging of Aortic Valve Area From 34 287 UK Biobank Participants Reveals Novel Genetic Associations and Shared Genetic Comorbidity With Multiple Disease Phenotypes. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2020; 13:e003014. [DOI: 10.1161/circgen.120.003014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The aortic valve is an important determinant of cardiovascular physiology and anatomic location of common human diseases.
Methods:
From a sample of 34 287 white British ancestry participants, we estimated functional aortic valve area by planimetry from prospectively obtained cardiac magnetic resonance imaging sequences of the aortic valve. Aortic valve area measurements were submitted to genome-wide association testing, followed by polygenic risk scoring and phenome-wide screening, to identify genetic comorbidities.
Results:
A genome-wide association study of aortic valve area in these UK Biobank participants showed 3 significant associations, indexed by rs71190365 (chr13:50764607,
DLEU1
,
P
=1.8×10
−9
), rs35991305 (chr12:94191968,
CRADD
,
P
=3.4×10
−8
), and chr17:45013271:C:T (
GOSR2
,
P
=5.6×10
−8
). Replication on an independent set of 8145 unrelated European ancestry participants showed consistent effect sizes in all 3 loci, although rs35991305 did not meet nominal significance. We constructed a polygenic risk score for aortic valve area, which in a separate cohort of 311 728 individuals without imaging demonstrated that smaller aortic valve area is predictive of increased risk for aortic valve disease (odds ratio, 1.14;
P
=2.3×10
−6
). After excluding subjects with a medical diagnosis of aortic valve stenosis (remaining n=308 683 individuals), phenome-wide association of >10 000 traits showed multiple links between the polygenic score for aortic valve disease and key health-related comorbidities involving the cardiovascular system and autoimmune disease. Genetic correlation analysis supports a shared genetic etiology with between aortic valve area and birth weight along with other cardiovascular conditions.
Conclusions:
These results illustrate the use of automated phenotyping of cardiac imaging data from the general population to investigate the genetic etiology of aortic valve disease, perform clinical prediction, and uncover new clinical and genetic correlates of cardiac anatomy.
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Affiliation(s)
- Aldo Córdova-Palomera
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Stanford, CA (A.C.-P., C.T., K.X., H.T., J.R.P.)
| | - Catherine Tcheandjieu
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Stanford, CA (A.C.-P., C.T., K.X., H.T., J.R.P.)
| | - Jason A. Fries
- Department of Computer Science (J.F., V.S.C., M.F., C.R.), Stanford University, CA
- Center for Biomedical Informatics Research (J.F.), Stanford University, CA
| | - Paroma Varma
- Department of Electrical Engineering (P.V.), Stanford University, CA
| | - Vincent S. Chen
- Department of Computer Science (J.F., V.S.C., M.F., C.R.), Stanford University, CA
| | - Madalina Fiterau
- Department of Computer Science (J.F., V.S.C., M.F., C.R.), Stanford University, CA
| | - Ke Xiao
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Stanford, CA (A.C.-P., C.T., K.X., H.T., J.R.P.)
| | - Heliodoro Tejeda
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Stanford, CA (A.C.-P., C.T., K.X., H.T., J.R.P.)
| | - Bernard D. Keavney
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom (B.K.)
- Division of Medicine, Manchester University National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (B.K.)
| | - Heather J. Cordell
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom (H.J.C.)
| | - Yosuke Tanigawa
- Department of Biomedical Data Science (Y.T., G.V., M.R.), Stanford University, CA
| | - Guhan Venkataraman
- Department of Biomedical Data Science (Y.T., G.V., M.R.), Stanford University, CA
| | - Manuel A. Rivas
- Department of Biomedical Data Science (Y.T., G.V., M.R.), Stanford University, CA
| | - Christopher Ré
- Department of Computer Science (J.F., V.S.C., M.F., C.R.), Stanford University, CA
| | - Euan Ashley
- Department of Medicine (E.A.), Stanford University, CA
- Chan Zuckerberg Biohub, San Francisco, CA (E.A., J.R.P.)
| | - James R. Priest
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Stanford, CA (A.C.-P., C.T., K.X., H.T., J.R.P.)
- Chan Zuckerberg Biohub, San Francisco, CA (E.A., J.R.P.)
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29
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Matar GW, Abdou MM, Lyons ME, Alani F, Cheng CI, Ragina NP. The effects of geriatric aortic stenosis education and its implications on heart failure prevention in medically underserved communities. Eur J Prev Cardiol 2020; 27:2134-2137. [DOI: 10.1177/2047487319863505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- George W Matar
- Central Michigan University, College of Medicine, Mount Pleasant, MI, USA
| | - Merna M Abdou
- Central Michigan University, College of Medicine, Mount Pleasant, MI, USA
| | - Maryssa E Lyons
- Central Michigan University, College of Medicine, Mount Pleasant, MI, USA
| | - Firas Alani
- Central Michigan University, College of Medicine, Mount Pleasant, MI, USA
| | - Chin-I Cheng
- Central Michigan University, Department of Mathematics, Mount Pleasant, MI, USA
| | - Neli P Ragina
- Central Michigan University, College of Medicine, Mount Pleasant, MI, USA
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30
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Sharma SK, Rao RS, Chopra M, Sonawane A, Jose J, Sengottuvelu G. Myval transcatheter heart valve system in the treatment of severe symptomatic aortic stenosis. Future Cardiol 2020; 17:73-80. [PMID: 32628046 DOI: 10.2217/fca-2020-0020] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The transcatheter aortic valve replacement (TAVR) is an established treatment for patients with severe symptomatic aortic stenosis (AS) at prohibitive risk for surgery. It is an alternative treatment to surgical aortic valve replacement in patients with AS at intermediate- and high-surgical risk. Although regulatory authorities extend the indications of TAVR to treat patients at low-surgical risk, the limitations of earlier-generation transcatheter heart valve (THV) systems accelerate the development of improved newer generation of THV systems. Myval™ THV (Meril Life Sciences Pvt. Ltd., Vapi, Gujarat, India) is a newer-generation, balloon-expandable TAVR system with features that facilitate accurate positioning of the bioprosthetic valve and favorable procedural and clinical outcomes. This review summarizes existing preclinical and clinical data on Myval THV for the intervention of symptomatic native AS and lays out the plan for future research program.
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Affiliation(s)
- Samin K Sharma
- Director of Clinical and Interventional Cardiology and Dean of International Clinical Affiliations, Mount Sinai Health System, NY, USA
| | - Ravinder S Rao
- Department of Cardiology, Eternal Heart Care Centre & Research Institute Pvt. Ltd., Jaipur, Rajasthan 302017, India
| | - Manik Chopra
- Department of Cardiology, Narayana Multispeciality Hospital, Ahmedabad, Gujarat 380023, India
| | - Anmol Sonawane
- Department of Cardiology, Breach Candy Hospital, Mumbai, Maharashtra 400026, India
| | - John Jose
- Department of Cardiology, Christian Medical College & Hospital, Vellore, Tamil Nadu 632002, India
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31
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National Trends of Outcomes in Transcatheter Aortic Valve Replacement (TAVR) Through Transapical Versus Endovascular Approach: From the National Inpatient Sample (NIS). CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:964-970. [PMID: 32553852 DOI: 10.1016/j.carrev.2020.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 04/07/2020] [Accepted: 05/12/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND To evaluate the trends in complication rates following transcatheter aortic valve replacement (TAVR) procedures according to the type of vascular approach (endovascular vs. transapical) in a large US population sample. METHODS The National Inpatient Sample (NIS) was queried for all patients diagnosed with aortic stenosis who underwent a TAVR procedure in the United States during the years 2012-2016. Outcomes assessed were peri-procedural mortality, cardiac, and non-cardiac complications. Hospitalization outcomes were modeled using logistic regression for binary outcomes and generalized linear models for continuous outcomes. RESULTS There were 97,320 endovascular-TAVR patients and 11,140 transapical-TAVR patients. The mean age was 80.8 years (standard error of the mean: ± 0.1). Most patients were males (53.7%) and Caucasian (87.1%). On multivariate analysis, after adjusting for age, gender, comorbidities, as well as hospital factors, patients with the transapical approach had a higher risk for mortality and adverse outcomes. Among the endovascular-TAVR group, national trends showed a diminishing incidence of procedural mortality (incidence rate ratio [IRR] 0.77; 95% CI: 0.72-0.84, p < 0.001), stroke (IRR 0.80; 95% CI: 0.73-0.87, p < 0.001), and all secondary outcomes, but no significant change in myocardial infarction. In contrast, most transapical-TAVR related procedural complications remained unchanged over time, except for a significant decrease in stroke, acute respiratory failure and need for pacemaker insertion. CONCLUSION National trends show a steady increase in the number of endovascular-TAVR procedures with a concurrent decrease in procedural complications.
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32
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Affiliation(s)
- Patrick A Gladding
- Cardiology Department Waitemata District Health Board Auckland New Zealand.,Auckland Bioengineering Institute Auckland New Zealand
| | - Will Hewitt
- Auckland Bioengineering Institute Auckland New Zealand
| | - Todd T Schlegel
- Department of Clinical Physiology Karolinska Institutet Stockholm Sweden.,Nicollier-Schlegel Sàrl Trélex Switzerland
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33
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Hengstenberg C, Thoenes M, Bramlage P, Siller-Matula J, Mascherbauer J. Aortic valve stenosis awareness in Austria-results of a nationwide survey in 1001 subjects. Wien Med Wochenschr 2019; 170:141-149. [PMID: 31541366 PMCID: PMC7098927 DOI: 10.1007/s10354-019-00708-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/16/2019] [Indexed: 12/05/2022]
Abstract
Despite the prognostic significance of severe aortic valve stenosis, knowledge is limited in the general population. To document the status quo for Austria, knowledge about valvular heart disease/aortic valve stenosis was documented in 1001 participants >60 years of age. 6.7% of respondents were knowledgeable of aortic valve stenosis, with 1.6% being concerned about the condition (24.1% cancer, 18.8% Alzheimer’s disease, 15.1% stroke). 29.5% were familiar with valvular heart disease (76.7% heart attack, 36.9% stroke). Only 1/3 reported auscultation by their general practitioner (GP) at least every third visit. Typical symptoms of aortic valve stenosis were likely to be reported by 50%. After exposure to further information on aortic valve stenosis, only 20% reported to be more concerned and ready to obtain more disease-related information. Awareness of surgical and catheter-based treatment options was claimed by 77% of respondents. Awareness campaigns on valvular heart disease are warranted to improve patient care in Austria.
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Affiliation(s)
- Christian Hengstenberg
- Department of Internal Medicine, Division of Cardiology, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | | | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Jolanta Siller-Matula
- Department of Internal Medicine, Division of Cardiology, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Julia Mascherbauer
- Department of Internal Medicine, Division of Cardiology, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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