Risultati per: Passo 12. Ripulire in modo mirato le cartelle cliniche degli assisiti

Secondo la rivista Nature Medicine tra le sperimentazioni cliniche da tenere d’occhio nel 2024 ci sono tra l’altro nuovi farmaci, app per aiutare le donne che soffrono di depressione durante la gravidanza, nuovi vaccini e trapianti di neuroni ottenuti da cellule staminali embrionali per combattere il Parkinson

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Objective
This study aims to collect data on the experience and impact of gender-based violence experienced by women attending health clinics in Honiara, Solomon Islands.

Method
Any woman over the age of 18 who attended a local health clinic in Honiara, Solomon Islands during the time of recruitment (ten consecutive weekdays in May 2015) was eligible to participate in an interviewer administered, in-person survey, gathering data on gender-based violence over the past 12 months.

Results
A total of 100 women were recruited into this study. Of these women, 47% of women reported experiencing physical or sexual violence in the past 12 months. The most common perpetrators were the woman’s husband or boyfriend. There are low rates of reporting, particularly through formal avenues such as to police or village leaders. Alcohol was involved in more than half the cases of reported violence.

Conclusion
Women in this study report high rates of gender-based violence. To our knowledge, this is the only study examining women’s personal experience of gender-based violence in the Solomon Islands, with self-reported data on the frequency and nature of the violence, and the impact on women, including physical and mental, utilisation of healthcare services, police and legal involvement. Efforts to reduce gender-based violence should aim to reduce intimate partner violence, increase reporting and address wider social attitudes towards gender equality.

Circulation, Volume 148, Issue Suppl_1, Page A13832-A13832, November 6, 2023. Background/Rationale:Myocardial scar, identified by late gadolinium enhancement (LGE) on MRI, is associated with sudden death in HCM. Unlike ECG, MRI is expensive and adversely affected by artifacts from implanted devices. However, little is known about ECG features of LV-scar in HCM.Objective:Develop an ECG-based explainable machine learning method to identify and localize LV-scar in HCM.Method:We retrospectively studied 500 HCM patients (JH HCM Registry) for model development, and 248 patients (UCSF HCM Registry) for validation. All patients underwent MRI and ECHO within 1 year of ECG. LV-LGE (scar) was assessed using QMass. After excluding RV-insertion-point-LGE, the LV was divided into basal, mid, and apical regions for scar detection. Resting 12-lead ECGs were segmented, features were extracted and adjusted for LV-mass, age, sex. We utilized unsupervised and self-supervised ECG representation learning, where patients are partitioned into groups of several sub-clusters, each sharing similar ECG patterns, but with high separation between scar and no-scar classes. In each group, a self-supervised neural net and a fully connected neural net successfully predicted LV-scar (see Figure) and revealed ECG features of scar.Results:Our method identifies LV-scar in the JH-dataset with high precision (90%), sensitivity (95%), specificity (80%), F1-score (90%), and generalizes well to UCSF-data (precision:88%, sensitivity:90%, specificity:78%, F1-score:89%). The top ECG features for basal-scar are Q-amplitude, Q-slope, non-terminal QRS duration in aVR, and area under QRS and T wave energy in V1-V2. T-wave inversion in V4-V6, area under QRS in V3, TP slope in V3-V4 predicted apical scar. Features selected for mid scar prediction combine features for basal and apical scar.Conclusion:This is the first ECG-based ML model to identify/localize LV-scar in HCM. Our model demonstrates good performance and reveals ECG features of scar in HCM.

Circulation, Volume 148, Issue Suppl_1, Page A12785-A12785, November 6, 2023. Introduction:The ECG has always been evaluated as static risk factor for sudden cardiac death (SCD). The importance of dynamic ECG remodeling has not been investigated.Hypothesis:Abnormal ECG remodeling over time is associated with increased risk of SCD.Methods:We investigated pre-SCD ECG remodeling in SCD cases from 2 ongoing population-based studies of out-of-hospital SCD in Portland, OR (discovery) and Ventura County, CA (validation). Two archived pre-SCD ECGs performed at least 1 year apart were obtained from lifetime health records. Controls were matched on geographical region, age, sex, and duration between the 2 ECG recordings. Dynamic ECG remodeling was measured as the change in a previously validated cumulative 6-variable ECG electrical risk score (ERS) between the 1st and 2nd ECG.Results:A total of 231 SCD cases (66.5±13.6 years, 61% male), and 234 controls (65.8±11.1 years, 61% male) were included in the discovery cohort, and 203 SCD cases (70.3±14.4 years, 54% male), and 203 controls (68.4±11.8 years, 54% male) in the validation cohort. The mean time between the 2 ECG recordings in SCD cases and controls was 6.0±4.0 years vs 6.2±4.5 years (discovery) and 3.7±2.6 years vs. 3.7±1.6 years (validation), respectively. In both cohorts, SCD cases compared to controls had greater dynamic ECG remodeling over time: Discovery cohort ERS change +1.06 (95% CI +0.89 to +1.24) vs. -0.05 (-0.21 to +0.11; p

Circulation, Volume 148, Issue Suppl_1, Page A17454-A17454, November 6, 2023. Introduction:Over 100 FDA-approved medications, electrolyte perturbations, and many disease states can prolong the QT interval in up to 10% of patients. In contrast, approximately 1 in 2,000 people have congenital long QT syndrome (LQTS) hallmarked by pathological QT prolongation secondary to LQTS-causative mutations.Hypothesis:an artificial intelligence (AI) deep neural network (DNN) analysis of the 12-lead ECG can distinguish patients with LQTS from those with acquired QT prolongation.Methods:The study cohort included 1599 patients with genetically confirmed LQTS and over 2.5 million controls from Mayo Clinic’s ECG data vault. Every patient/control with ≥ 1 ECG above age- and sex- specific 99thpercentile values for QTc [ > 460 ms for all patients (male/female) < 13 years of age, or > 470 ms for men and > 480 ms for women above this age] was included. An AI-DNN involving a multi-layer convolutional neural network was developed. To simulate screening conditions, patients were matched at a ratio of 1:2,000 (incidence of LQTS) or 1:200 (balance of LQTS vs acquired QT prolongation in a tertiary referral center).Results:Among the 1,599 patients with LQTS, 808 ( > 50%) had ≥ 1 ECG with QTc above the aforementioned QTc thresholds (2,987 ECGs) compared to 361,069/2.5M controls (14% of Mayo Clinic patients getting an ECG, 989,313 ECGs). Following age- and sex- matching and splitting, the model successfully distinguished LQTS from those with acquired QT prolongation at 1:2,000 matching with an AUC of 0.937 (accuracy 89%, sensitivity 81%, specificity 90%, PPV 0.05, NPV 0.99). Furthermore, when matching at a rate that genetically-mediated QT prolongation would be encountered in clinic (1:200), the model still successfully separated the two groups (AUC 0.912, accuracy 88%, sensitivity 78%, specificity 89%, PPV 0.1, NPV 0.99).Conclusion:For patients with a QTc exceeding its 99thpercentile values seen in health, this novel AI-DNN 12-lead ECG distinguishes abnormal QT prolongation stemming from LQTS versus acquired QT prolongation with high performance characteristics (AUC > 0.93). Even when scaled to referral center and LQTS incidence ratios, a negative AI-DNN signal rules out the presence of a LQTS disease-causative mutation with 99% negative predictive value.

Circulation, Volume 148, Issue Suppl_1, Page A12019-A12019, November 6, 2023. Background:A treatment goal for obstructive hypertrophic cardiomyopathy (oHCM) is to reduce symptom burden and improve health status, which can be measured with the 23-item Kansas City Cardiomyopathy Questionnaire (KCCQ-23). While the KCCQ-23 has been validated in oHCM, the shorter 12-item version (KCCQ-12) is more feasible in clinical care but has not been validated.Hypothesis:The construct validity, reliability, and responsiveness of the KCCQ-12 will support its use for patients with oHCM.Aims:To validate the psychometric performance of the KCCQ-12 in patients with oHCM and its interpretability categorized by Patient Global Impression of Change (PGIC).Methods:The psychometric properties of the KCCQ-12 and domains were tested in 196 participants with symptomatic oHCM from the EXPLORER-HCM trial. Construct validity was assessed against clinical and patient-reported standards using Spearman Correlation coefficients. Reliability was assessed by Cronbach’s alpha ( > 0.70). Test-retest reliability was determined using intra-class correlation (ICC) coefficient (good correlation being ICC > 0.70) and paired t-tests of clinically stable patients (defined as no change in PGIC from baseline to 6 weeks and no change in Patient Global Impression of Severity from 18-30 weeks). Responsiveness and interpretability were assessed within categories of the 6-week PGIC.Results:KCCQ-12 domains and summary scores had moderate to strong correlations with most clinical standards (NYHA class, exercise duration, pVO2) and patient-reported scales (Table 1). The KCCQ-12 showed strong internal and test-retest reliability (Table 2). All KCCQ-12 scores demonstrated significant and proportional changes of different magnitudes of clinical change delineated by the PGIC (Table 3).Conclusion:The KCCQ-12 demonstrates good psychometric performance for patients with oHCM and can be confidently used to monitor the health status of patients with oHCM in clinical practice.

Circulation, Volume 148, Issue Suppl_1, Page A13260-A13260, November 6, 2023. Background:Aortic stenosis (AS) is associated with significant morbidity and mortality and is increasing in prevalence. Limited data exist regarding circulating biomarkers of AS risk.Methods:Among Atherosclerosis Risk in Communities study participants with available proteomics (Somascan v4) at study Visit 5 (2011-13; n=4,899; age 76 ± 5 years, 57% women), we used multivariable linear regression to evaluate the association of 4,877 plasma proteins with peak aortic valve (AV) velocity and AV dimensionless index. We then tested their association, when assessed at study Visit 3 (1993-95; n=11,430; age 60 ± 6, 54% women), with incident AV-related hospitalization post-Visit 3 (median follow-up 22, IQR 14 – 25 years) using multivariable Cox PH regression models. For the resulting candidate proteins, we assessed the association of Visit 5 protein levels with change in AV peak velocity over 6 years from Visit 5 to 7 (2018-19; n=2,314) and with quantitative AV calcification by cardiac CT at Visit 7 (n=1,804); associations with incident adjudicated AS in the Cardiovascular Health Study (CHS; n=3,413); and differences in AV tissue expression in normal, fibrotic, and calcific segments of explanted stenotic human AVs (n=3).Results:We identified 52 plasma proteins with consistent associations with AV peak velocity, AV dimensionless index, and incident AV hospitalization. Of these 52 proteins, MMP12 was also associated with magnitude of increase in AV peak velocity between Visits 5 and 7 (Figure), and with magnitude of AV calcification by CT at Visit 7 (adjusted OR 1.25 [95% CI 1.19-1.32], p=1.7×10-17). Higher MMP12 was also associated with incident moderate or severe AS in CHS, an independent cohort. MMP12 expression was greater in calcific compared to fibrotic or normal AV tissue segments.Conclusions:Plasma MM12 is a potential novel circulating biomarker of AS risk.

Circulation, Volume 148, Issue Suppl_1, Page A13412-A13412, November 6, 2023. Introduction:Multi-vessel coronary vasospastic angina (multi-VSA) is life-threatening disease. We tried to predict multi-VSA by machine learning (ML) on 12-lead electrocardiogram (ECG).Hypothesis:Machine learning on 12-lead ECG has powerful diagnostic value for multi-VSA.Methods:We recruited 227 consecutive sinus-rhythm patients (63.6±12.9years, 136men) who underwent acetylcholine-provocation test in coronary angiography (CAG). Multi-VSA was defined as spasm in at least 2 major branches. ECG was recorded before CAG in no chest pain period. ML was performed on table data of ECG parameters using several ensemble learning methods.Results:79 patients (35%) showed multi-VSA, and univariate logistic regression analysis extracted 23 significant but weak predictors, the highest area under receiver operating characteristics curve (AUROC) was 0.673. Conversely, ML demonstrated high diagnostic performance (AUROC of extra trees classifier: 0.817). Shapley additive explanation method showed male, QTc, J wave in lead II, and low amplitude of Q wave in lead I/aVL played essential roles to build the ML model.Conclusion:Several parameters of 12-lead ECG in multi-VSA patients contains potential features of VSA, and their aggregation and ensemble learning can predict VSA with high diagnostic performance.

Circulation, Volume 148, Issue Suppl_1, Page A12591-A12591, November 6, 2023. Introduction:Acute myocardial infarction (AMI) is the most prevalent cause of mortality and morbidity in patients with type 2 diabetes mellitus (T2DM). However, strict blood glucose control does not always prevent the development and progression of AMI.Aims:Therefore, the present study aimed to explore potential new biomarkers associated with the occurrence of AMI in T2DM patients.Methods:A total of 82 participants were recruited, including the control group (n=28), T2DM without AMI group (T2DM, n=30) and T2DM with initial AMI group (T2DM+AMI, n=24). The untargeted metabolomics using LC-MS analysis was performed to evaluate the changes in serum metabolites. Then, candidate metabolites were determined using ELISA method in the validation study (n=126/T2DM group, n=122/T2DM+AMI group).Results:The results showed that 146 differential serum metabolites were identified among the control, T2DM and T2DM+AMI, Moreover, 16 differentially-expressed metabolites were significantly altered in T2DM+AMI compared to T2DM. Furthermore, three candidate differential metabolites, 12,13-diHOME, noradrenaline (NE) and estrone sulfate (ES), were selected for validation study. Serum levels of 12,13-diHOME and NE in T2DM+AMI were significantly higher than those in T2DM. Multivariate logistic analyses showed that 12,13-diHOME (OR, 1.491; 95% CI, 1.230-1.807,P

Circulation, Volume 148, Issue Suppl_1, Page A15690-A15690, November 6, 2023. Introduction:Frailty is a syndrome of functional decline characterized by an increased risk for adverse health outcomes. The association between frailty and left atrial appendage closure (LAAC) outcomes has not been extensively studied yet. This study aims to analyze the impact of frailty on adverse health outcomes following LAAC.Method:Retrospective review of electronic medical records from June 2016 to December 2021 at the University of Illinois, Chicago identified LAAC patients, who were included if they were followed-up within 6 and 12 months of the procedure. Patients were stratified into frail and non-frail groups based on the Johns Hopkins Claims-based Frailty Indicator, an externally validated index. Outcomes included 6- and 12-months major bleeding event defined by VARC, death, and hospitalization indexes. Two-sample t-tests and chi-squared tests were used to compare continuous and categorical variables, respectively.Results:Our cohort included 101 patients (age 72 ± 9 years, 75% male, 24% white): frail (N=34) and non-frail (N=67) groups. There were no statistically significant differences in baseline demographics, comorbidities, and medication except for older age in frail patients (79.6 vs 68.3 years, p=0.000). Although frail patients had higher mortality rate at 6 months (8.82% vs 0%, p=0.014), no differences were seen for nonhome discharges (6.67% vs 1.54%, p=0.184), 6-months major bleeding events (2.94% vs 2.99%, p=0.990), 6-month emergency department visits (38.2% vs 28.4%, p=0.313), and 6-month hospital admission (20.6% vs 25.4%, p=0.593). There were also no differences seen for mortality rate at 12 months (11.8% vs 5.97%, p=0.308), length of hospital stays (1.35 vs 1.37 days, p=0.966), 12-months major bleeding event (2.94% vs 4.48%, p=0.708), and 12-months hospital admission (29.4% vs 31.3%, p=0.842).Conclusion:Our results suggest that frail patients are at a higher risk for death within 6 months following LAAC despite no observable differences in comorbidities, medications, other adverse events, and hospitalization indexes, including nonhome discharges. Additional analysis is needed to determine factors that may preclude frail patients from hospital admissions or precipitate earlier death.

Circulation, Volume 148, Issue Suppl_1, Page A18177-A18177, November 6, 2023. Background:In patients undergoing cardiac surgery who have ventricular arrhythmias (VAs) such as VT, VF, or PVCs, concurrent surgical ablation is an attractive therapeutic strategy. However, electrophysiologic mapping systems are not routinely available in the OR and it may be difficult to localize the VA origin. We developed a workflow incorporating novel 12-lead ECG computational model-based mapping to localize VAs.Hypothesis:We hypothesized that use of pre-operative computational ECG mapping can help guide surgical ablation of VAs in patients undergoing cardiac surgery.Methods:Patients undergoing cardiac surgery with pre-existing VT, VF or PVCs were enrolled with informed consent. A standard 12-lead ECG of the VA was recorded in the clinic or during non-invasive programmed stimulation in the EP lab. ECG mapping localized the VA and visualized on a 3D model. During circulatory arrest, surgical ablation was performed using either cryoablation or irrigated RF ablation probe. Follow-up was performed with event monitors or ICD monitoring.Results:A total of 7 patients (mean age 55±15 years, female 29%, EF 31%±20%) were enrolled (Table). Surgical indications included mitral annuloplasty (Pt 1), pulmonary thromboendoarterectomy + CABG (Pt 2), coronary artery unroofing (Pt 3), left ventricular assist device (Pt 4-6, Fig 1), and CABG (Pt 7). In this cohort, 5 PVCs, 3 monomorphic VT and 1 VF morphologies were localized using ECG mapping and surgically ablated at time of cardiac surgery. There was a 100% (18 to 0) decrease in VT/VF episodes and 97.2 ± 0.03% reduction in PVC burden at median 9.5 month (IQR 3.7-29.5) follow-up. No intra- or post-operative complications occurred.Conclusions:This case series illustrates feasibility and excellent efficacy of a novel preoperative ECG mapping workflow using a forward-solution algorithm to guide successful and safe concomitant ventricular arrhythmia ablation during cardiac surgery.