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1. Exploring the prognostic impact of triglyceride-glucose index in critically ill patients with first-ever stroke: insights from traditional methods and machine learning-based mortality prediction

Author

Yang Chen, Zhenkun Yang, Yang Liu, Yuanjie Li, Ziyi Zhong, Garry McDowell, Coleen Ditchfield, Taipu Guo, Mingjuan Yang, Rui Zhang, Bi Huang, Ying Gue, and Gregory Y. H. Lip

Subjects
Stroke, First-ever stroke, Insulin resistance, Triglyceride-glucose index, Intensive care unit, All-cause mortality, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Background The incidence and mortality of first-ever strokes have risen sharply, especially in the intensive care unit (ICU). Emerging surrogate for insulin resistance, triglyceride-glucose index (TyG), has been linked to stroke prognosis. We aims to explore the relationships between TyG with ICU all-cause mortality and other prognosis, and to develop machine learning (ML) models in predicting ICU all-cause mortality in the first-ever strokes. Methods We included first-ever stroke patients from the eICU Collaborative Research Database in 2014–2015 as the primary analysis cohort (then divided into training and internal validation cohorts) and from local hospital’s ICUs as the external validation cohort. Multivariate Cox proportional hazards models and restricted cubic spline analyses were used to evaluate the association between TyG and ICU/hospital all-cause mortality. Linear regression and correlation analyses were performed to examine the relationships between TyG with length of ICU/hospital stay and Glasgow Coma Score. Results The primary analysis cohort included 3173 first-ever strokes (median age 68.0 [55.0–68.0] years; 63.0% male), while the external validation cohort included 201 first-ever strokes (median age 71.0 [63.0–77.0] years; 62.3% male). Multivariate Cox proportional hazards models revealed that the high TyG group (TyG ≥ 9.265) was associated with higher ICU (HR 1.92, 95% CI 1.38–2.66) and hospital (HR 1.69, 95% CI 1.32–2.16) all-cause mortality, compared with low TyG group (TyG

Published
2024
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2. Prognostic value of glycaemic variability for mortality in critically ill atrial fibrillation patients and mortality prediction model using machine learning

Author

Yang Chen, Zhengkun Yang, Yang Liu, Ying Gue, Ziyi Zhong, Tao Chen, Feifan Wang, Garry McDowell, Bi Huang, and Gregory Y. H. Lip

Subjects
Glycaemic variability, Atrial fibrillation, Intensive care unit, Mortality, Machine learning, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Background The burden of atrial fibrillation (AF) in the intensive care unit (ICU) remains heavy. Glycaemic control is important in the AF management. Glycaemic variability (GV), an emerging marker of glycaemic control, is associated with unfavourable prognosis, and abnormal GV is prevalent in ICUs. However, the impact of GV on the prognosis of AF patients in the ICU remains uncertain. This study aimed to evaluate the relationship between GV and all-cause mortality after ICU admission at short-, medium-, and long-term intervals in AF patients. Methods Data was obtained from the Medical Information Mart for Intensive Care IV 3.0 database, with admissions (2008–2019) as primary analysis cohort and admissions (2020–2022) as external validation cohort. Multivariate Cox proportional hazards models, and restricted cubic spline analyses were used to assess the associations between GV and mortality outcomes. Subsequently, GV and other clinical features were used to construct machine learning (ML) prediction models for 30-day all-cause mortality after ICU admission. Results The primary analysis cohort included 8989 AF patients (age 76.5 [67.7–84.3] years; 57.8% male), while the external validation cohort included 837 AF patients (age 72.9 [65.3–80.2] years; 67.4% male). Multivariate Cox proportional hazards models revealed that higher GV quartiles were associated with higher risk of 30-day (Q3: HR 1.19, 95%CI 1.04–1.37; Q4: HR 1.33, 95%CI 1.16–1.52), 90-day (Q3: HR 1.25, 95%CI 1.11–1.40; Q4: HR 1.34, 95%CI 1.29–1.50), and 360-day (Q3: HR 1.21, 95%CI 1.09–1.33; Q4: HR 1.33, 95%CI 1.20–1.47) all-cause mortality, compared with lowest GV quartile. Moreover, our data suggests that GV needs to be contained within 20.0%. Among all ML models, light gradient boosting machine had the best performance (internal validation: AUC [0.780], G-mean [0.551], F1-score [0.533]; external validation: AUC [0.788], G-mean [0.578], F1-score [0.568]). Conclusion GV is a significant predictor of ICU short-term, mid-term, and long-term all-cause mortality in patients with AF (the potential risk stratification threshold is 20.0%). ML models incorporating GV demonstrated high efficiency in predicting short-term mortality and GV was ranked anterior in importance. These findings underscore the potential of GV as a valuable biomarker in guiding clinical decisions and improving patient outcomes in this high-risk population.

Published
2024
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3. Impact of surrogates for insulin resistance on mortality and life expectancy in primary care: a nationwide cross-sectional study with registry linkage (LIPIDOGRAM2015)Research in context

Author

Yang Chen, Ziyi Zhong, Ying Gue, Maciej Banach, Garry McDowell, Dimitri P. Mikhailidis, Peter P. Toth, Peter E. Penson, Tomasz Tomasik, Adam Windak, Marek Gierlotka, Tadeusz Osadnik, Agnieszka Kuras, Marcin Miga, Jacek Jozwiak, Gregory Y.H. Lip, B. Al-Shaer, W. Andrusewicz, M. Andrzejczuk-Rosa, E. Anusz-Gaszewska, A. Bagińska, P. Balawajder, G. Bańka, E. Barańska-Skubisz, B. Barbara Przyczyna, S. Bartkowiak, J. Bartodziej, M. Bartosiewicz, M. Basałyga, A. Batyra, A. Bąk, M. Bednarz, K. Bejnar, W. Bernacki, M. Betiuk-Kwiatkowska, S. Biegaj, M. Bień, W. Bilski, M. Biłogan, G. Biruta-Pawłowska, A. Biskup, B. Błaszczyk, H. Błaszczyk, T. BłońskaJankowska, B. Bogacka-Gancarczyk, M. Bojanowska, E. Bonda, J. Borowik-Skwarek, J. Borowska, J. Bruckner, J. Brzostek, M. Brzuchacz, M. Budzyńska, I. Bulzacka-Fugiel, J. Bulzak, K. Bunikowski, A. Cebulska, T. Celka, E. Cempel-Nowak, W. Chechliński, A. Chludzińska, D. Chmiel, M. Chmielewska, M. Cichy, A. Ciemięga, A. Ciepluch, I. Cieszyńska, B. Czajka, B. Czapla, M. Czerner, B. Czerwińska, W. Czuryszkiewicz, E. Daleka, Z. Dawid, M. Dąbrowska, R. Dąbrowska, D. Dąbrowski, M. Dąbrowski, K. Demczyszyn, A. Dębowska-Serwińska, J. Dmochowski, J. Dobrzecka-Kiwior, E. Dolanowska, H. Dolanowski, P. Dołek, M. Domagała, H. Domański, A. Doszel, D. Duda, M. Dudkowska, B. Dudziuk, P. Dybciak, M. Dymanowski, L. Dziadzio-Bolek, M. Eicke, H. El-Hassan, A. Eremus, M. Fąferek-Muller, E. Figura-Roguska, I. Fijałkowska-Kaczmarek, M. Flis, T. Florczak, M. Florczuk, E. Foryszewska-Witan, W. Frydrych, A. Fugiel, E. Futyma, A. Gaca-Jaroszewicz, I. Gajdamowicz, K. Ganczarski, A. Gatnar, M. Gers, A. Głowacki, K. Głód, J. Godula, J. Gołąb, M. Gołębiewski, E. Goszczyńska, K. Gościcka, A. GórnaHajduga, E. Górny, T. Grabowska, R. Grabowski, A. Graczyk-Duda, A. Gromow, A. Grudewicz, J. Gruszecka, A. Gruszka, J. Gryboś, J. Grzebyk, A. Grzechowiak, D. Grzesiak, T. Grześkowiak, A. Guźla, G. Hachuła, B. Hawel, H. Hiltawska, E. Honkowicz, J. Ignatowicz, K. Imielski, A. Iwaniura, A. JagiełaSzymala, M. Jalć-Sowała, A. Janczylik, E. Janisz, M. Janiszek, K. Jankiewicz-Ziobro, K. Januszewska, A. Jaremek, A. Jaros-Urbaniak, J. Jarosz, P. Jarosz, W. Jasiński, M. Jezierska-Wasilewska, T. Jędraszewski, A. Jędrzejowska, R. Józefowicz, K. Juźwin, E. Kacprzak, J. Kaczmarek-Szewczyk, M. Kaczmarzyk, R. Kandziora, C. Kaniewski, L. Karolak-Brandt, S. Kasperczyk, E. Kasperek-Dyląg, I. Kedziora, A. Kępa, J. Kiciński, J. Kielak-Al-Hosam, Ł. Kiełczawa, P. Kilimowicz, K. Kitliński, T. Kiwka, U. Klein, L. Klichowicz, A. Klimowicz, B. Klonowski, B. Kmolek, E. Kobyłko-Klepacka, A. Kocoń, A. Kolenda, E. Kollek, M. Kopeć, B. Koper-Kozikowska, J. Koralewska, M. Korczyńska, M.T. Korzeniewski, A. Kosk, K. Kotarski, E. Kowalczyk, M. Kowalczyk, I. Kowalik, B. Kozak-Błażkiewicz, M. Kozik, D. Kozłowska, E. Kozłowska, M. Kozłowska, T. Kozubski, K. Kózka, L. Kraśnik, T. Krężel, B. Krochmal, B. Król, G. Król, J. Król, T. Królikowska, H. Kruszewska, B. Krygier-Potrykus, W. Krystek, J. Krzysztoń, T. Kubicki, A. Kuczmierczyk-El-Hassan, W. Kuczyńska-Witek, D. Kujda, A. Kurowski, I. Kurzelewska-Solarz, M. Kwaczyńska, M. Kwaśniak, P. Kwaśniak, T. Kwietniewska, A. Łebek-Ordon, A. Lebiedowicz, L. Lejkowska-Olszewska, M. Lentas, A. Lesiewicz-Ksycińska, M. Limanowski, S. Łoniewski, J.A. Łopata, B. Łubianka, I. Łukasiuk, M. Łużna, M. Łysiak, B. Łysik, Z. Machowski, J. Maciaczyk-Kubiak, G. Mackiewicz-Zabochnicka, Z. Magner-Krężel, S. Majda, P. Malinowski, J. Mantyka, E. Marchlik, G. Martyna-Ordyniec, J. Marzec, M. Marzec, R. Matejko-Wałkiewicz, M. Mazur, M. Michalczak, A. Michalska-Żyłka, M. Michniewicz, D. Mika-Staniszewska, E. Mikiciuk, T. Mikołajczak, J. Milewski, E. Miller, B. Misiaszek, M. Mizik-Łukowska, E. Młyńczyk-Pokutycka, M. Mocek, M. Moczała, M. Morawska-Hermanowicz, P. Moryc, A. Moskal, S. Moskal, A. Moździerz, P. Moździerz, M. Mrozińska, K. Mrozowicz, G. Mróz, T. Munia, A. Mura, M. Muras-Skudlarska, E.Z. Murawska, Ł. Murawski, R. Murawski, R. Musielak, K. Nadaj, W. Nagarnowicz, R. Napierała, M. Niedźwiecka, A. Niemirski, J. Nikiel, M. Nosal, W. Nowacki, J. Nowak, M. Nyrka, A. Obst, J. Ochowicz, E. Ogonowska, M. Oleszczyk, A. Ołdakowski, I. Ołowniuk-Stefaniak, J. Ordowska-Rejman, M. Orliński, B. Osińska, A. Ostańska-Burian, A. Paciorkowska, U. Paczkowska, L. Paluch, L. Pałka, J. Paszko-Wojtkowska, A. Paszkowska, E. PawlakGanczarska, W. Pawlik, I. Pawłowska, M. Paździora, G. Permiakow, A. Petlic-Marendziak, T. Piasecka, E. Piaścińska, A. Piktel, A. Pilarska-Igielska, A. Piotrkowska, K. Piwowar-Klag, M. Planer, J. Plewa, P. Płatkiewicz, B. Płonczyńska, A. Podgórska, M. Polewska, B. Porębska, P. Porwoł, I. Potakowska, A. Prokop, J. Przybylski, M. Przybyła, H. Psiuk, K. Ptak, G. Puzoń, N. Rabiza, S. Rachwalik, E. Raczyńska, M. Raniszewska, A. Romanek-Kozik, A. Rosa, K. Rosa, A. Rozewicz, J. Rudzka-Kałwak, J. Rusak, D. Rutkowska, M. Rybacki, D. Rybińska, A. Rycyk-Sadowska, L. Rynda, B. Rynkiewicz, B. SadowskaKrawczyk, M. Sadowska-Zarzycka, B. Sarnecka, E. Sawalach-Tomanik, B. Sidor-Drozd, M. SiemieniakDębska, A. Sieroń, B. Siewniak-Zalewska, A. Sikora, B. Sitarska-Pawlina, J. Skorupski, I. SkrzypińskaMansfeld, J. Skubisz, R. Skwarek, M. Słodyczka, M. Smentek, K. Smolińska, B. Solarz, W. Sosnowska, B. Sroka, H. Stachura, D. Stangreciak, M. Staniak, Z. Stańczyk, D. Stańszczak-Ozga, E. Startek, M. Stefańczyk, R. Stelmach, E. Sternadel-Rączka, M. Sternik, J. Stępień, J. Stocka, M. Stokowska-Wojda, M. Studler-Karpińska, W. Suchorukow, W. Sufryd, B. Supłacz, J. Sygacz, Ł. Szczepański, J. Szkandera, J. Szłapa-Zellner, D. Szydlarska, T. Śliwa, J. Śliwka, Ł. Śmiejkowski, A. Targońska, E. Tesarska, M. Tobiasz, J. Tomaka, K. Tomalska-Bywalec, E. Tomiak, S. Topczewski, A. Trawińska, L. Trela-Mucha, D. Trojanowski, M. Trzaskowska, B. Trzcińska-Larska, A. Trznadel-Mozul, K. Ulanicka-Liwoch, M. Urbanowicz, A. Uthke-Kluzek, J. Waczyński, J. Walczak, L. Warsz, M. Wasyńczuk, U. Wąchała-Jędras, D. Wąsowicz, J. Wczysła, F. Wenda, E. Werner-Kubicka, E. Weryszko, B. Węgrzynowska, M. Wiaksa, M. Wiankowski, A. Wicherek, R. Wieczorek, R. Wiencek, G. Wienzek-Tatara, B. Wierzbicka, M. Wierzbicki, B. Wilczyńska, D. Wilmańska, P. Winiarski, A. Wiszniewska-Pabiszczak, M.B. Witkowska, J. Witzling, A. Wlaź, I. Wojtkowiak, J. Woydyłło, K. Woźniak, A. Wójtowicz, J. Wrona, M. Wrońska, H. Wujkowska, J. Wyrąbek, O. Wysokiński, R. Zakrzewski, J. Zaleska-Zatkalik, J. Zaleski, M. Zalewska-Dybciak, E. Zalewska, B. Zalewska-Uchimiak, J. Zawadzka-Krajewska, J. Zawadzki, A. Zieliński, E. Zubrycka, I. Żybort, and M. Żymełka

Subjects
Triglyceride-glucose index, TyG-adjusted body mass index, TyG-adjusted waist circumference, Insulin resistance, All-cause mortality, Premature mortality, Public aspects of medicine, RA1-1270
Abstract

Summary: Background: Insulin resistance (IR) is an important risk factor for multiple chronic diseases, increasing mortality and reducing life expectancy. The associations between emerging surrogates for IR, triglyceride-glucose index (TyG) and TyG-related indicators, with all-cause mortality and life expectancy in middle-aged and older patients in primary care are unclear. Methods: This study originated from the Polish primary care cohort LIPIDOGRAM2015, including patients aged ≥45 years. Baseline fasting triglycerides and fasting glucose were used to derive TyG. Other TyG-related indicators included TyG-adjusted body mass index (TyG-BMI), TyG-adjusted waist circumference (TyG-WC), TyG-adjusted waist-to-hip, and TyG-adjusted waist-to-height. In this longitudinal analysis, we assessed associations between TyG-related indicators with total all-cause mortality, premature (age at death ≤75 years) all-cause mortality and years of life lost (YLL). Findings: We included 10,688 patients (mean age 61.8 ± 9.3 years; 63.5% female). Cumulative total and premature all-cause mortality were 7.2% and 4.6%, respectively, during 5.7 years (IQR 5.6–5.7) of follow-up. Lowest (Q1) and highest quartile (Q4) of TyG-BMI and TyG-WC were associated with total all-cause mortality (second quartile [Q2]: reference; TyG-BMI: Q1: aHR 1.33, 95% CI 1.07–1.65, Q4: aHR 1.28, 95% CI 1.03–1.58; TyG-WC: Q1: aHR 1.44, 95% CI 1.14–1.82, Q4: aHR 1.29, 95% CI 1.04–1.59), similar results for premature all-cause mortality. Within age 45–80 years, compared with Q2 and third quartile, YLL were 4.49 and 5.46 years for TyG-BMI Q1 and Q4, respectively, 3.24 and 5.31 years for TyG-WC Q1 and Q4, respectively. Interpretation: TyG-BMI and TyG-WC demonstrated a U-shaped association with total and premature all-cause mortality. Low and high levels of TyG-BMI and TyG-WC were associated with reduced life expectancy. Despite the relatively short follow-up period, significant associations were still observed, but longer follow-up studies are required to further explore these relationships. Funding: Polish Lipid Association, College of Family Physician in Poland, Valeant in Poland.

Published
2025
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4. Phenotypes of South Asian patients with atrial fibrillation and holistic integrated care management: cluster analysis of data from KERALA-AF RegistryResearch in context

Author

Yang Chen, Bi Huang, Peter Calvert, Yang Liu, Ying Gue, Dhiraj Gupta, Garry McDowell, Jinbert Lordson Azariah, Narayanan Namboodiri, Govindan Unni, Jayagopal Pathiyil Balagopalan, Gregory Yoke Hong Lip, Bahuleyan Charantharayil Gopalan, A. Jabir, A. George Koshy, Geevar Zachariah, M. Shifas Babu, K. Venugopal, Eapen Punnose, K.U. Natarajan, Johny Joseph, C. Ashokan Nambiar, P.B. Jayagopal, P.P. Mohanan, Raju George, C.G. Sajeev, N. Syam, Anil Roby, Rachel Daniel, V.V. Krishnakumar, Anand M. Pillai, Stigi Joseph, G.K. Mini, Shaffi Fazaludeen Koya, Koshy Eapen, Raghu Ram, Cibu Mathew, Ali Faizal, Biju Issac, Sujay Renga, Jaideep Menon, D. Harikrishna, K. Suresh, Tiny Nair, S.S. Susanth, R.Anil Kumar, T.P. Abilash, P. Sreekala, E. Rajeev, Arun Raj, Ramdas Naik, S. Rajalekshmi, Anoop Gopinath, R. Binu, Jossy Chacko, P.T. Iqbal, N.M. Sudhir, Madhu Sreedharan, N. Balakrishnan, Muhammed Musthaffa, B. Jayakumar, Sheeba George, Anand Kumar, Thomas Mathew, V.K. Pramod, Muhammed Shaloob, Madhu Paulose Chandy, K.R. Vinod, Karuana Das, Z.Sajan Ahamad, and Pramod Mathew

Subjects
Atrial fibrillation, Clustering analysis, Phenotype classification, ABC pathway, Kerala, South Asia, Public aspects of medicine, RA1-1270
Abstract

Summary: Background: Patients with atrial fibrillation (AF) frequently experience multimorbidity. Cluster analysis, a machine learning method for classifying patients with similar phenotypes, has not yet been used in South Asian AF patients. Methods: The Kerala Atrial Fibrillation Registry is a prospective multicentre cohort study in Kerala, India, and the largest prospective AF registry in South Asia. Hierarchical clustering was used to identify different phenotypic clusters. Outcomes were all-cause mortality, major adverse cardiovascular events (MACE), and composite bleeding events within one-year follow-up. Findings: 3348 patients were included (median age 65.0 [56.0–74.0] years; 48.8% male; median CHA2DS2-VASc 3.0 [2.0–4.0]). Five clusters were identified. Cluster 1: patients aged ≤65 years with rheumatic conditions; Cluster 2: patients aged >65 years with multi-comorbidities, suggestive of cardiovascular-kidney-metabolic syndrome; Cluster 3: patients aged ≤65 years with fewer comorbidities; Cluster 4: heart failure patients with multiple comorbidities; Cluster 5: male patients with lifestyle-related risk factors. Cluster 1, 2 and 4 had significantly higher MACE risk compared to Cluster 3 (Cluster 1: OR 1.36, 95% CI 1.08–1.71; Cluster 2: OR 1.79, 95% CI 1.42–2.25; Cluster 4: OR 1.76, 95% CI 1.31–2.36). The results for other outcomes were similar. Atrial fibrillation Better Care (ABC) pathway in the whole cohort was low (10.1%), especially in Cluster 4 (1.9%). Overall adherence to the ABC pathway was associated with reduced all-cause mortality (OR 0.26, 95% CI 0.15–0.46) and MACE (OR 0.45, 95% CI 0.31–0.46), similar trends were evident in different clusters. Interpretation: Cluster analysis identified distinct phenotypes with implications for outcomes. There was poor ABC pathway adherence overall, but adherence to such integrated care was associated with improved outcomes. Funding: Kerala Chapter of Cardiological Society of India.

Published
2024
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5. One‐year outcomes of rate versus rhythm control of atrial fibrillation in the Kerala‐AF Registry

Author

Peter Calvert, Yang Chen, Ying Gue, Dhiraj Gupta, Jinbert Lordson Azariah, A. George Koshy, Geevar Zachariah, Gregory Y. H. Lip, Bahuleyan Charantharayil Gopalan, and the Kerala AF Registry Investigators

Subjects
atrial fibrillation, rate control, rhythm control, South Asia, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Background There is ongoing debate around rate versus rhythm control strategies for managing atrial fibrillation (AF), however, much of the data comes from Western cohorts. Kerala‐AF represents the largest prospective AF cohort study from the Indian subcontinent. Objectives To compare 12‐month outcomes between rate and rhythm control strategies. Methods Patients aged ≥18 years with non‐transient AF were recruited from 53 hospitals across Kerala. Patients were stratified by rate or rhythm control. The primary outcome was a composite of all‐cause mortality, arterial thromboembolism, acute coronary syndrome or hospitalization due to heart failure or arrhythmia at 12 months. Secondary outcomes included bleeding events and individual components of the primary. Predictors of the composite outcome were analysed by logistic regression. Results A total of 2901 patients (mean age 64.6 years, 51% female) were included (2464 rate control, 437 rhythm control). Rates of the primary composite outcome did not differ between groups (29.7% vs 30.0%; p = .955), nor did any component of the primary. Bleeding outcomes were also similar (1.6% vs 1.9%; p = .848). Independent predictors of the primary composite outcome were older age (aOR 1.01; p = .013), BMI

Published
2024
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6. Evaluation of Huawei smart wearables for detection of atrial fibrillation in patients following ischemic stroke:The Liverpool-Huawei Stroke Study

Author

Stephanie L. Harrison, Benjamin J.R. Buckley, Yalin Zheng, Andrew Hill, Thant Hlaing, Ruth Davies, Yutao Guo, Deirdre A. Lane, Gregory Y.H. Lip, Sylvia Choi, Sandra Elsheikh, Dimitrios Sagris, Martha Joddrell, Muath Alobaida, E. McCarthy, Elizabeth McCarthy, I. Eustace, Ian Eustace, K. Hoad, S.J. Katie Hoad, Sunil Jit R.J. Logantha, Garry McDowell, Alena Shantsila, Ying Gue, M Isanejad, I. Jones, Masoud Isanejad, and Ian Jones

Subjects
Cardiology and Cardiovascular Medicine
Abstract

BACKGROUND: Atrial fibrillation (AF) often remains undetected following stroke. Documenting AF is critical to initiate oral anticoagulation, which has proven benefit in reducing recurrent stroke and mortality in patients with AF. The accuracy and acceptability of using smart wearables to detect AF in patients following stroke is unknown.METHODS: The aims of the Liverpool-Huawei Stroke Study are to determine the effectiveness, cost-effectiveness and patient and staff acceptability of using Huawei smart wearables to detect AF following ischemic stroke. The study plans to recruit 1,000 adults aged ≥18 years following ischemic stroke from participating hospitals over 12 months. All participants will be asked to wear a Huawei smart band for 4 weeks postdischarge. If participants do not have access to a compatible smartphone required for the study, they will be provided with a smartphone for the 4-week AF monitoring period.RESULTS: Participants with suspected AF detected by the smart wearables, without previous known AF, will be referred for further evaluation. To determine the effectiveness of the Huawei smart wearables to detect AF, the positive predictive value will be determined. Patient acceptability of using this technology will also be examined. Additional follow-up assessments will be conducted at 6 and 12 months, and clinical outcomes recorded in relation to prevalent and incident AF post-stroke. The study opened for recruitment on May 30, 2022, and is currently open at 4 participating hospitals; the first 106 participants have been recruited. One further hospital is preparing to open for recruitment.CONCLUSIONS: This prospective study will examine the effectiveness and acceptability of the use of smart wearables in patients following ischemic stroke. This could have important implications for detection of AF and therefore, earlier prophylaxis for recurrent stroke. The study is registered on https://www.isrctn.com/ (Identifier ISRCTN30693819).

Published
2023
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7. Poster No. 004 Cardiovascular and metabolic effects of ovarian suppression as adjuvant therapy for early breast cancer: a systematic review and meta-analysis

Author

Ying Gue

Subjects
Physiology, Physiology (medical), Cardiology and Cardiovascular Medicine
Abstract

Background Adjuvant endocrine therapy is key treatment in early oestrogen receptor positive breast cancer (BC). In premenopausal BC ovarian function suppression (OFS) in combination with tamoxifen or aromatase inhibitor (AI) is commonly used, particularly in high-risk patients who have received chemotherapy. The profound suppression of circulating oestradiol associated with OFS could have adverse cardiovascular and metabolic effects, We aim to evaluate the reported adverse effects within randomised phase III trials in premenopausal women with BC. Methods A systematic search of online databases was conducted to identify randomised control trials (RCTs) involving OFS which reported adverse events (hypertension, weight gain, thrombosis, cardiac ischemia, glucose intolerance and hyperglyacemia). Pooled odds ratios (OR) with 95% confidence interval (CI) were estimated using a random-effects model. Results Four RCTs were included in the metanalysis with a total of 7808 patients, separated into 3 main treatment groups: Tamoxifen, OFS plus Tamoxifen and OFS plus AI. We found that OFS increased risk of hypertension when compared to Tamoxifen alone (7.6% vs. .4.8%, OR 1.49,95%CI 1.09–2.01; P = 0.01). Tamoxifen with OFS increased risk of thrombosis when compared to AI with OFS (1.7% vs. .0.7%, OR 2.87,95%CI 1.19–6.9; P = 0.02). Conclusions This highlights the possible impact of OFS in premenopausal women as it increases risk of developing hypertension which may require closer monitoring and initiation of early treatment. There appears to be a protective effect of AI when compared to Tamoxifen in terms of thrombosis. Further studies are needed to explore the impact of these drugs on the cardiovascular health of these young women with BC.

Published
2022
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8. Safety of the oral factor XIa inhibitor asundexian compared with apixaban in patients with atrial fibrillation (PACIFIC-AF): a multicentre, randomised, double-blind, double-dummy, dose-finding phase 2 study

Author

Jonathan P Piccini, Valeria Caso, Stuart J Connolly, Keith A A Fox, Jonas Oldgren, W Schuyler Jones, Diana A Gorog, Václav Durdil, Thomas Viethen, Christoph Neumann, Hardi Mundl, Manesh R Patel, Johann Auer, Martin Hubauer, Sead Pandzic, Eva Preishuber, Carina Primus-Grabscheit, Dietmar Reitgruber, Florian Schmalzer, Christopher Adlbrecht, Andreas Schober, Johannes Hajos, Christoph Keil, Alexandra Schratter, Matthias Frick, Magdalena Anna Benda, Maximilian Mächler, Beatrix Mutschlechner, Christoph Saely, Lukas Sprenger, Michael Lichtenauer, Miriam Eber, Uta Hoppe, Tobias Kolbitsch, Peter Michael Jirak, Moritz Mirna, Robert Schönbauer, Jutta Bergler-Klein, Christian Hengstenberg, Stefan Stojkovic, Daniel Scherr, Martin Manninger-Wünscher, Ursula Rohrer, Markus Stühlinger, Wilfried Schgoer, Jana Schwarzl, Helmut Pürerfellner, Michael Derndorfer, Christian Ebner, Veronika Eder, Georgios Kollias, Thomas Sturmberger, Stefan Sieghartsleitner, Johan Vijgen, Peter Koopman, Karl Dujardin, Wim Anné, Michel De Ceuninck, Rene Tavernier, Mattias Duytschaever, Sébastien Knecht, Luc Missault, Yves Vandekerckhove, Tom Rossenbacker, Bavo Ector, Filip Charlier, Philippe Debruyne, Willem Dewilde, Luc Janssens, John Roosen, Bart Vankelecom, Hein Heidbuchel, Michiel Delesie, Gert Vervoort, Hans Rombouts, Thomas Vanassche, Matthias Engelen, Peter Verhamme, Rik Willems, Christian Constance, Nicolas Pranno, Jafna Cox, Iqbal Bata, Laurent Macle, Martin Aguilar, Julia Cadrin Tourigny, Marc Dubuc, Katia Dyrda, Peter Guerra, Paul Khairy, Blandine Mondésert, Léna Rivard, Denis Roy, Rafik Tadros, Mario Talajic, Bernard Thibault, Isabelle Nault, Louis Blier, Jean Champagne, Franck Molin, Gilles O'Hara, François Philippon, Benoit Plourde, Jean-François Sarrazin, Christian Steinberg, Zdenek Coufal, David Balazsik, Michal Mikulica, Jakub Zapeca, Ondrej Cermak, Tomas Drasnar, Matej Falc, Josef Hornof, Blazej Racz, Danica Weissova, Hana Linkova, Eva Paskova, Robert Petr, Andrea Sirakova, Jiri Kettner, Ales Benak, Martin Holek, Ivo Podpera, Monika Podperova, Vlastimil Vancura, Tomas Jandik, Jiri Smid, Vratislav Dedek, Jan Banik, Vaclav Durdil, Tomas Hnat, Nicolas Lellouche, Ségolène Rouffiac, Guillaume Taldir, Valentin Bridonneau, Philippe Couffon, Magalie Daudin, Cécile Hamon, Jonathan Lacaze, Anne Quentin, Christophe Thebault, Emmanuel Boiffard, Olivier Billon, Fabien Miette, Hervé Pouliquen, Guillaume Turlotte, Hervé Gorka, Franck Albert, Sandrine Bayle, Reda Bensaid, Madalina Dasoveanu, Thibaud Demichili, Teodora Dutoiu, Cliff Khalil, Caterina Loghin, Grégoire Range, Laurent Roussel, Pierre Socié, Christophe Thuaire, Fabrice Extramiana, Vincent Algalarrondo, Haten Boughanmi, Noreddine El Mansour, Usman Mohammad, Romain Sellier, Meyer Elbaz, Clémence Laperche, Philippe Maury, Robert Kiss, Tunde Borsanyi, Zoltan Gingl, Balaza Polgar, Bela Benczur, Alexandra Bodor, Tamas Hepp, Eva Malati, Laszlo Nagy, Norbert Erdei, Jozsef Kapus, Katalin Kapus, Brigitta Toth, Andras Matoltsy, Tunde Kiss, Bela Merkely, Szilvia Herczeg, Orsolya Kiss, Zoltan Sallo, Kalman Toth, Tamas Habon, Miklos Rabai, Kinga Totsimon, Zsolt Zilahi, Gabriella Bencze, Janos Santa, Daniel Aradi, Barbara Kelemen, Leonardo Bolognese, Martina Nesti, Pasquale Giovanni Notarstefano, Simona D'Orazio, Franco Cosmi, Cecilia Becattini, Giancarlo Agnelli, Belinda Broccatelli, Maria Giulia Mosconi, Maurizio Paciaroni, Chiara Urbini, Vito Maurizio Parato, Camilla Notaristefani, Michele Scarano, Pietro Ameri, Giorgio Ghigliotti, Giulia Guglielmi, Roberta Lotti, Andrea Carlo Merlo, Maria Lorenza Muiesan, Andrea Abondio, Caterina Berasi, Elena Mattiuzzo, Claudio Mutti, Massimo Salvetti, Pasquale Pignatelli, Danilo Menichelli, Daniele Pastori, Eiji Tamiya, Takahiro Matsumoto, Tomosato Takabe, Shoichi Yamamoto, Haruyo Yamashita, Shinichi Higashiue, Onichi Furuya, Norihiko Hiramatsu, Kensuke Kasuga, Saburo Kojima, Masatoshi Komooka, Satoshi Kuroyanagi, Makoto Matsuura, Tetsushi Takemoto, Shuji Yamamoto, Katusmi Saito, Takuro Abe, Issei Ishida, Yuji Iwanami, Shohei Kataoka, Tetsu Moriyama, Akira Murohashi, Akihito Sasaki, Yuichiro Nakamura, Tetsuya Ueno, Akira Shimane, Tomoyo Hamana, Hirotoshi Ichibori, Tomohiro Inoue, Mitsuaki Itoh, Seigo Iwane, Hiroya Kawai, Tatsuya Kokawa, Akiko Masumoto, Koki Matsuo, Taishi Miyata, Shinsuke Nakano, Shogo Oishi, Tetsuari Onishi, Takahiro Sawada, Takayuki Saito, Mitsuhiko Shoda, Nobuyuki Takahashi, Tomofumi Takaya, Yasuyo Taniguchi, Shota Tsukamoto, Yasue Tsukishiro, Yoshiro Tsukiyama, Hiroshi Tsunamoto, Kenzo Uzu, Hiroyuki Yamamoto, Tetsuya Yamamoto, Kiminobu Yokoi, Chiaki Yoshida, Nobuhiro Watanabe, Tetsuo Betsuyaku, Kumiko Adachi, Kouichi Awane, Daisuke Goto, Mamoru Sakakibara, Masashi Watanabe, Hideki Ueno, Yoshitaka Hiroe, Koshi Matsuo, Kenji Ayata, Ko Fukuda, Yoshiki Hata, Katsushi Hashimoto, Hiroaki Matsumi, Akira Nikaido, Shuichi Okamoto, Iveta Sime, Valters Stirna, Ilze Reinholde, Silvija Hansone, Anita Kozlovska, Janina Romanova, Dace Klincare, Natalja Pontaga, Igors Dirmans, Artis Kalnins, Dana Upite, Arcils Gersamija, Arturs Teleznikovs, Nadezda Rozkova, Jelena Safro, Ignasi Anguera Camós, Paolo Domenico Dallaglio, Rafael Salguero Bodes, Fernando Arnbas, Luis Borrego, Alvaro Marco, Javier Ramos Jimenez, Juan José Gómez-Doblas, Alejandro Pérez Cabeza, Ignacio Ferreira Gonzålez, Javier Limeres Freire, Merce Lopez Grau, Xavier Viñolas Prat, Zoraida Moreno Weidmann, Jose Maria Guerra Ramos, Maria Concepcion Alonso Martin, Bieito Campos Garcia, Javier Mauricio Mogro Carranza, Francisco Javier Mendez Zurita, Enrique Rodriguez Font, Carlos Eduardo Gonzales Matos, Víctor García Hernando, Carl-Johan Lindholm, Jörgen Thulin, Håkan Wallén, Kristina Hagwall, Ken Eliasson, Martin Lundvall, Jens Olsson, Björn Kjellman, Markus Lind, Lars Johansson, Niclas Svedberg, Stefan Berglund, Julia Söderberg, Christer Zedigh, Thomas Mooe, Mattias Axelsson, Emil Binsell, Daniel Huber, Christian Müller, Isabelle Danier, Michael Kühne, Bernhard Okamura, Hadrien Schoepfer, Cornelia Simmen, Tobias Reichlin, Laurève Chollet, Anna Lam, Severin Wittmer, Hans Rickli, Christian Gall, Greta Hametner, Stephanie Intorp, Daniel Luescher, Laurent Haegeli, Jan Christopher Berg, Ramin Ebrahimi, Angelo Auricchio, Carmela Crljenica, Tizziano Moccetti, Cristina Monti, Elena Pasotti, Iveta Petrova, Mariagrazia Rossi, François Mach, Mehdi Namdar, Joris de Groot, Virginnio Proost, Joline Neefs, Dominik Linz, Twan van Stipdonk, Dennis den Uijl, Marco Alings, Jeroen Schaap, Dolf Segers, Noemi Wouters, Louis Bartels, Robert Tieleman, Ron Pisters, Tim de Vries, Jaap Selig, Aaf Kuijper, Pieter Bot, Mitran Keijzers, Gerardus Verdel, Raymond Tukkie, Ewout van den Bos, Floris Kauer, Rohit Oemrawsingh, Jeroen Stevenhagen, Jan van Es, Gregory Lip, Dhiraj Gupta, Agnieszka Kotalczyk, Anthony Gunstone, Richard David Brixey, Diana Gorog, Danial Dinarvand, Ying Gue, Rahim Kanji, Vassilios Memtsas, Roxy Senior, Gabriel Bioh, Yuk-Ki Wong, Nick Child, Cardiology, and ACS - Heart failure & arrhythmias

Subjects
anticoagulants, factor xa inhibitors, General Medicine, aged, double-blind method, female, hemorrhage, humans, male, pyrazoles, pyridones, treatment outcome, atrial fibrillation, 610 Medicine & health
Abstract

BACKGROUND Direct-acting oral anticoagulant use for stroke prevention in atrial fibrillation is limited by bleeding concerns. Asundexian, a novel, oral small molecule activated coagulation factor XIa (FXIa) inhibitor, might reduce thrombosis with minimal effect on haemostasis. We aimed to determine the optimal dose of asundexian and to compare the incidence of bleeding with that of apixaban in patients with atrial fibrillation. METHODS In this randomised, double-blind, phase 2 dose-finding study, we compared asundexian 20 mg or 50 mg once daily with apixaban 5 mg twice daily in patients aged 45 years or older with atrial fibrillation, a CHA2DS2-VASc score of at least 2 if male or at least 3 if female, and increased bleeding risk. The study was conducted at 93 sites in 14 countries, including 12 European countries, Canada, and Japan. Participants were randomly assigned (1:1:1) to a treatment group using an interactive web response system, with randomisation stratified by whether patients were receiving a direct-acting oral anticoagulant before the study start. Masking was achieved using a double-dummy design, with participants receiving both the assigned treatment and a placebo that resembled the non-assigned treatment. The primary endpoint was the composite of major or clinically relevant non-major bleeding according to International Society on Thrombosis and Haemostasis criteria, assessed in all patients who took at least one dose of study medication. This trial is registered with ClinicalTrials.gov, NCT04218266, and EudraCT, 2019-002365-35. FINDINGS Between Jan 30, 2020, and June 21, 2021, 862 patients were enrolled. 755 patients were randomly assigned to treatment. Two patients (assigned to asundexian 20 mg) never took any study medication, resulting in 753 patients being included in the analysis (249 received asundexian 20 mg, 254 received asundexian 50 g, and 250 received apixaban). The mean age of participants was 73·7 years (SD 8·3), 309 (41%) were women, 216 (29%) had chronic kidney disease, and mean CHA2DS2-VASc score was 3·9 (1·3). Asundexian 20 mg resulted in 81% inhibition of FXIa activity at trough concentrations and 90% inhibition at peak concentrations; asundexian 50 mg resulted in 92% inhibition at trough concentrations and 94% inhibition at peak concentrations. Ratios of incidence proportions for the primary endpoint were 0·50 (90% CI 0·14-1·68) for asundexian 20 mg (three events), 0·16 (0·01-0·99) for asundexian 50 mg (one event), and 0·33 (0·09-0·97) for pooled asundexian (four events) versus apixaban (six events). The rate of any adverse event occurring was similar in the three treatment groups: 118 (47%) with asundexian 20 mg, 120 (47%) with asundexian 50 mg, and 122 (49%) with apixaban. INTERPRETATION The FXIa inhibitor asundexian at doses of 20 mg and 50 mg once daily resulted in lower rates of bleeding compared with standard dosing of apixaban, with near-complete in-vivo FXIa inhibition, in patients with atrial fibrillation. FUNDING Bayer.

Published
2022

9. Case report of subacute presentation of tricuspid valve thrombus complicated by widespread bilateral pulmonary emboli: a multifactorial aetiology

Author

Ioannis Vasiliadis, Libor Myslivecek, and Ying Gue

Subjects
medicine.medical_specialty, Trans-thoracic echocardiogram, Tricuspid valve, business.industry, Pulmonary embolism, Atrial fibrillation, medicine.disease, medicine.anatomical_structure, Right heart thrombus, Internal medicine, Lower respiratory tract infection, Case report, Right heart, Cardiology, medicine, Etiology, cardiovascular system, AcademicSubjects/MED00200, Tricuspid valve thrombus, cardiovascular diseases, Presentation (obstetrics), Thrombus, Cardiology and Cardiovascular Medicine, business
Abstract

Background Right heart thrombus (RHTh) complicated by pulmonary embolism (PE) usually presents as a medical emergency with significant haemodynamic instability. However, less is known about subacute presentations. Case summary We present a 74-year-old haemodynamically stable gentleman with a 3-week history of mild pleuritic chest pain and exertional dyspnoea preceded by lower respiratory tract infection. Early trans-thoracic echocardiogram (TTE) revealed a 3 cm elongated tricuspid valve thrombus with right ventricular dysfunction, new-onset atrial fibrillation, and new-onset severe left ventricular impairment. Subsequent computed tomography pulmonary angiogram showed widespread bilateral pulmonary emboli with retrograde opacification of the hepatic veins. The RHTh successfully resolved with warfarin therapy with no further complications, and the patient was discharged on Day 8 of hospitalization. Discussion An early TTE is crucial in detecting the RHTh in patients suspected of PE and can significantly change the management compared with uncomplicated PE. The index of suspicion for PE and RHTh should remain high even in subacute cases.

Published
2021

10. Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI):a single-blind randomised controlled trial

Author

Derek J Hausenloy, Rajesh K Kharbanda, Ulla Kristine Møller, Manish Ramlall, Jens Aarøe, Robert Butler, Heerajnarain Bulluck, Tim Clayton, Ali Dana, Matthew Dodd, Thomas Engstrom, Richard Evans, Jens Flensted Lassen, Erika Frischknecht Christensen, José Manuel Garcia-Ruiz, Diana A Gorog, Jakob Hjort, Richard F Houghton, Borja Ibanez, Rosemary Knight, Freddy K Lippert, Jacob T Lønborg, Michael Maeng, Dejan Milasinovic, Ranjit More, Jennifer M Nicholas, Lisette Okkels Jensen, Alexander Perkins, Nebojsa Radovanovic, Roby D Rakhit, Jan Ravkilde, Alisdair D Ryding, Michael R Schmidt, Ingunn Skogstad Riddervold, Henrik Toft Sørensen, Goran Stankovic, Madhusudhan Varma, Ian Webb, Christian Juhl Terkelsen, John P Greenwood, Derek M Yellon, Hans Erik Bøtker, Anders Junker, Anne Kaltoft, Morten Madsen, Evald Høj Christiansen, Lars Jakobsen, Steen Carstensen, Steen Dalby Kristensen, Troels Thim, Karin Møller Pedersen, Mette Tidemand Korsgaard, Allan Iversen, Erik Jørgensen, Francis Joshi, Frants Pedersen, Hans Henrik Tilsted, Karam Alzuhairi, Kari Saunamäki, Lene Holmvang, Ole Ahlehof, Rikke Sørensen, Steffen Helqvist, Bettina Løjmand Mark, Anton Boel Villadsen, Bent Raungaard, Leif Thuesen, Martin Kirk Christiansen, Philip Freeman, Svend Eggert Jensen, Charlotte Schmidt Skov, Ahmed Aziz, Henrik Steen Hansen, Julia Ellert, Karsten Veien, Knud Erik Pedersen, Knud Nørregård Hansen, Ole Ahlehoff, Helle Cappelen, Daniel Wittrock, Poul Anders Hansen, Jens Peter Ankersen, Kim Witting Hedegaard, John Kempel, Henning Kaus, Dennis Erntgaard, Danny Mejsner Pedersen, Matthias Giebner, Troels Martin Hansen Hansen, Mina Radosavljevic-Radovanovic, Maja Prodanovic, Lidija Savic, Marijana Pejic, Dragan Matic, Ana Uscumlic, Ida Subotic, Ratko Lasica, Vladan Vukcevic, Alfonso Suárez, Beatriz Samaniego, César Morís, Eduardo Segovia, Ernesto Hernández, Iñigo Lozano, Isaac Pascual, Jose M. Vegas-Valle, José Rozado, Juan Rondán, Pablo Avanzas, Raquel del Valle, Remigio Padrón, Alfonso García-Castro, Amalia Arango, Ana B. Medina-Cameán, Ana I. Fente, Ana Muriel-Velasco, Ángeles Pomar-Amillo, César L. Roza, César M. Martínez-Fernández, Covadonga Buelga-Díaz, David Fernández-Gonzalo, Elena Fernández, Eloy Díaz-González, Eugenio Martinez-González, Fernando Iglesias-Llaca, Fernando M. Viribay, Francisco J. Fernández-Mallo, Francisco J. Hermosa, Ginés Martínez-Bastida, Javier Goitia-Martín, José L. Vega-Fernández, Jose M. Tresguerres, Juan A. Rodil-Díaz, Lara Villar-Fernández, Lucía Alberdi, Luis Abella-Ovalle, Manuel de la Roz, Marcos Fernández-Carral Fernández-Carral, María C. Naves, María C. Peláez, María D. Fuentes, María García-Alonso, María J. Villanueva, María S. Vinagrero, María Vázquez-Suárez, Marta Martínez-Valle, Marta Nonide, Mónica Pozo-López, Pablo Bernardo-Alba, Pablo Galván-Núñez, Polácido J. Martínez-Pérez, Rafael Castro, Raquel Suárez-Coto, Raquel Suárez-Noriega, Rocío Guinea, Rosa B. Quintana, Sara de Cima, Segundo A. Hedrera, Sonia I. Laca, Susana Llorente-Álvarez, Susana Pascual, Teodorna Cimas, Anthony Mathur, Eleanor McFarlane-Henry, Gerry Leonard, Jessry Veerapen, Mark Westwood, Martina Colicchia, Mary Prossora, Mervyn Andiapen, Saidi Mohiddin, Valentina Lenzi, Jun Chong, Rohin Francis, Amy Pine, Caroline Jamieson-Leadbitter, Debbie Neal, J. Din, Jane McLeod, Josh Roberts, Karin Polokova, Kristel Longman, Lucy Penney, Nicki Lakeman, Nicki Wells, Oliver Hopper, Paul Coward, Peter O'Kane, Ruth Harkins, Samantha Guyatt, Sarah Kennard, Sarah Orr, Stephanie Horler, Steve Morris, Tom Walvin, Tom Snow, Michael Cunnington, Amanda Burd, Anne Gowing, Arvindra Krishnamurthy, Charlotte Harland, Derek Norfolk, Donna Johnstone, Hannah Newman, Helen Reed, James O'Neill, John Greenwood, Josephine Cuxton, Julie Corrigan, Kathryn Somers, Michelle Anderson, Natalie Burtonwood, Petra Bijsterveld, Richard Brogan, Tony Ryan, Vivek Kodoth, Arif Khan, Deepti Sebastian, Diana Gorog, Georgina Boyle, Lucy Shepherd, Mahmood Hamid, Mohamed Farag, Nicholas Spinthakis, Paulina Waitrak, Phillipa De Sousa, Rishma Bhatti, Victoria Oliver, Siobhan Walshe, Toral Odedra, Ying Gue, Rahim Kanji, Alisdair Ryding, Amanda Ratcliffe, Angela Merrick, Carol Horwood, Charlotte Sarti, Clint Maart, Donna Moore, Francesca Dockerty, Karen Baucutt, Louise Pitcher, Mary Ilsley, Millie Clarke, Rachel Germon, Sara Gomes, Thomas Clare, Sunil Nair, Jocasta Staines, Susan Nicholson, Oliver Watkinson, Ian Gallagher, Faye Nelthorpe, Janine Musselwhite, Konrad Grosser, Leah Stimson, Michelle Eaton, Richard Heppell, Sharon Turney, Victoria Horner, Natasha Schumacher, Angela Moon, Paula Mota, Joshua O'Donnell, Abeesh Sadasiva Panicker, Anntoniette Musa, Luke Tapp, Suresh Krishnamoorthy, Valerie Ansell, Danish Ali, Samantha Hyndman, Prithwish Banerjee, Martin Been, Ailie Mackenzie, Andrew McGregor, David Hildick-Smith, Felicity Champney, Fiona Ingoldby, Kirstie Keate, Lorraine Bennett, Nicola Skipper, Sally Gregory, Scott Harfield, Alexandra Mudd, Christopher Wragg, David Barmby, Ever Grech, Ian Hall, Janet Middle, Joann Barker, Joyce Fofie, Julian Gunn, Kay Housley, Laura Cockayne, Louise Weatherlley, Nana Theodorou, Nigel Wheeldon, Pene Fati, Robert F. Storey, James Richardson, Javid Iqbal, Zul Adam, Sarah Brett, Michael Agyemang, Cecilia Tawiah, Kai Hogrefe, Prashanth Raju, Christine Braybrook, Jay Gracey, Molly Waldron, Rachael Holloway, Senem Burunsuzoglu, Sian Sidgwick, Simon Hetherington, Charmaine Beirnes, Olga Fernandez, Nicoleta Lazar, Abigail Knighton, Amrit Rai, Amy Hoare, Jonathan Breeze, Katherine Martin, Michelle Andrews, Sheetal Patale, Amy Bennett, Andrew Smallwood, Elizabeth Radford, James Cotton, Joe Martins, Lauren Wallace, Sarah Milgate, Shahzad Munir, Stella Metherell, Victoria Cottam, Ian Massey, Jane Copestick, Jane Delaney, Jill Wain, Kully Sandhu, Lisa Emery, Charlotte Hall, Chiara Bucciarelli-Ducci, Rissa Besana, Jodie Hussein, Sheila Bell, Abby Gill, Emily Bales, Gary Polwarth, Clare East, Ian Smith, Joana Oliveira, Saji Victor, Sarah Woods, Stephen Hoole, Angelo Ramos, Annaliza Sevillano, Anne Nicholson, Ashley Solieri, Emily Redman, Jean Byrne, Joan Joyce, Joanne Riches, John Davies, Kezia Allen, Louie Saclot, Madelaine Ocampo, Mark Vertue, Natasha Christmas, Raiji Koothoor, Reto Gamma, Wilson Alvares, Stacey Pepper, Barbara Kobson, Christy Reeve, Iqbal Malik, Emma Chester, Heidi Saunders, Idah Mojela, Joanna Smee, Justin Davies, Nina Davies, Piers Clifford, Priyanthi Dias, Ramandeep Kaur, Silvia Moreira, Yousif Ahmad, Lucy Tomlinson, Clare Pengelley, Amanda Bidle, Sharon Spence, Rasha Al-Lamee, Urmila Phuyal, Hakam Abbass, Tuhina Bose, Rebecca Elliott, Aboo Foundun, Alan Chung, Beth Freestone, Dr Kaeng Lee, Dr Mohamed Elshiekh, George Pulikal, Gurbir Bhatre, James Douglas, Lee Kaeng, Mike Pitt, Richard Watkins, Simrat Gill, Amy Hartley, Andrew Lucking, Berni Moreby, Damaris Darby, Ellie Corps, Georgina Parsons, Gianluigi De Mance, Gregor Fahrai, Jenny Turner, Jeremy Langrish, Lisa Gaughran, Mathias Wolyrum, Mohammed Azkhalil, Rachel Bates, Rachel Given, Rajesh Kharbanda, Rebecca Douthwaite, Steph Lloyd, Stephen Neubauer, Deborah Barker, Anne Suttling, Charlotte Turner, Clare Smith, Colin Longbottom, David Ross, Denise Cunliffe, Emily Cox, Helena Whitehead, Karen Hudson, Leslie Jones, Martin Drew, Nicholas Chant, Peter Haworth, Robert Capel, Rosalynn Austin, Serena Howe, Trevor Smith, Alex Hobson, Philip Strike, Huw Griffiths, Brijesh Anantharam, Pearse Jack, Emma Thornton, Adrian Hodgson, Alan Jennison, Anna McSkeane, Bethany Smith, Caroline Shaw, Chris Leathers, Elissa Armstrong, Gayle Carruthers, Holly Simpson, Jan Smith, Jeremy Hodierne, Julie Kelly, Justin Barclay, Kerry Scott, Lisa Gregson, Louise Buchanan, Louise McCormick, Nicci Kelsall, Rachel Mcarthy, Rebecca Taylor, Rebecca Thompson, Rhidian Shelton, Roger Moore, Sharon Tomlinson, Sunil Thambi, Theresa Cooper, Trevor Oakes, Zakhira Deen, Chris Relph, Scott prentice, Lorna Hall, Angela Dillon, Deborah Meadows, Emma Frank, Helene Markham-Jones, Isobel Thomas, Joanne Gale, Joanne Denman, John O'Connor, Julia Hindle, Karen Jackson-Lawrence, Karen Warner, Kelvin Lee, Robert Upton, Ruth Elston, Sandra Lee, Vinod Venugopal, Amanda Finch, Catherine Fleming, Charlene Whiteside, Chris Pemberton, Conor Wilkinson, Deepa Sebastian, Ella Riedel, Gaia Giuffrida, Gillian Burnett, Helen Spickett, James Glen, Janette Brown, Lauren Thornborough, Lauren Pedley, Maureen Morgan, Natalia Waddington, Oliver Brennan, Rebecca Brady, Stephen Preston, Chris Loder, Ionela Vlad, Julia Laurence, Angelique Smit, Kirsty Dimond, Michelle Hayes, Loveth Paddy, Jacolene Crause, Nadifa Amed, Priya Kaur-Babooa, Roby Rakhit, Tushar Kotecha, Hossam Fayed, Antonis Pavlidis, Bernard Prendergast, Brian Clapp, Divaka Perara, Emma Atkinson, Howard Ellis, Karen Wilson, Kirsty Gibson, Megan Smith, Muhammed Zeeshan Khawaja, Ruth Sanchez-Vidal, Simon Redwood, Sophie Jones, Aoife Tipping, Anu Oommen, Cara Hendry, DR Fazin Fath-Orboubadi, Hannah Phillips, Laurel Kolakaluri, Martin Sherwood, Sarah Mackie, Shilpa Aleti, Thabitha Charles, Liby Roy, Rob Henderson, Rod Stables, Michael Marber, Alan Berry, Andrew Redington, Kristian Thygesen, Henning Rud Andersen, Colin Berry, Andrew Copas, Tom Meade, Henning Kelbæk, Hector Bueno, Paul von Weitzel-Mudersbach, Grethe Andersen, Andrew Ludman, Nick Cruden, Dragan Topic, Zlatko Mehmedbegovic, Jesus Maria de la Hera Galarza, Steven Robertson, Laura Van Dyck, Rebecca Chu, Josenir Astarci, Zahra Jamal, Daniel Hetherington, Lucy Collier, British Heart Foundation, University College London Hospitals NHS Foundation Trust, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden, National Institute for Health Research (Reino Unido), Singapore Ministry of Health, Ministry of Education (Singapur), and Unión Europea. European Cooperation in Science and Technology (COST)

Subjects
Male, Death, Sudden, Cardiac/prevention & control, medicine.medical_treatment, Myocardial Infarction, 030204 cardiovascular system & hematology, law.invention, 0302 clinical medicine, Randomized controlled trial, law, Medicine, ST-SEGMENT ELEVATION, Single-Blind Method, 030212 general & internal medicine, Myocardial infarction, Prospective Studies, Prospective cohort study, Heart Failure/etiology, 11 Medical and Health Sciences, Myocardial Infarction/complications, General Medicine, Middle Aged, RC666, Combined Modality Therapy, LIMB, 3. Good health, Intention to Treat Analysis, Hospitalization, Treatment Outcome, Ischemic Preconditioning, Myocardial, Female, Life Sciences & Biomedicine, Ischemic Preconditioning, Myocardial/methods, medicine.medical_specialty, CONDI-2/ERIC-PPCI Investigators, ISCHEMIA/REPERFUSION INJURY, 03 medical and health sciences, CARDIOPROTECTION, Medicine, General & Internal, Percutaneous Coronary Intervention, General & Internal Medicine, Humans, In patient, Aged, Heart Failure, Intention-to-treat analysis, Science & Technology, ADJUNCT, business.industry, Percutaneous coronary intervention, medicine.disease, United Kingdom, SIZE, Death, Sudden, Cardiac, Emergency medicine, Myocardial infarction complications, Single blind, business, TASK-FORCE
Abstract

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden. The ERIC-PPCI trial was funded by a British Heart Foundation clinical study grant (grant number CS/14/3/31002) and a University College London Hospitals/University College London Biomedical Research Centre clinical research grant. The CONDI-2 trial was funded by Danish Innovation Foundation grants (grant numbers 11-108354 and 11-115818), Novo Nordisk Foundation (grant number NNF13OC0007447), and TrygFonden (grant number 109624). DJH was supported by the British Heart Foundation (grant number FS/10/039/28270), the National Institute for Health Research (NIHR) Biomedical Research Centre at University College London Hospitals, the Duke-National University Singapore Medical School, the Singapore Ministry of Health’s National Medical Research Council under its Clinician Scientist-Senior Investigator scheme (grant number NMRC/CSA-SI/0011/2017) and its Collaborative Centre Grant scheme (grant number NMRC/CGAug16C006), and the Singapore Ministry of Education Academic Research Fund Tier 2 (grant number MOE2016-T2-2-021). HEB was supported by the Novo Nordisk Foundation (grant numbers NNF14OC0013337, NNF15OC0016674). RKK is supported by the Oxford NIHR Biomedical Centre. The research was also supported by the NIHR infrastructure at Leeds. The views expressed are those of the author(s) and not necessarily those of the National Health Service, the NIHR, or the Department of Health. This article is based on the work of COST Action EU-CARDIOPROTECTION (CA16225) and supported by COST (European Cooperation in Science and Technology). We thank all study personnel for their invaluable assistance. Sí

Published
2019
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11. Evaluating the OpenAI’s GPT-3.5 Turbo’s performance in extracting information from scientific articles on diabetic retinopathy

Author

Celeste Ci Ying Gue, Noorul Dharajath Abdul Rahim, William Rojas-Carabali, Rupesh Agrawal, Palvannan RK, John Abisheganaden, and Wan Fen Yip

Subjects
Information extraction, Concordance, GPT-3.5 Turbo, Medicine
Abstract

Abstract We aimed to compare the concordance of information extracted and the time taken between a large language model (OpenAI’s GPT-3.5 Turbo via API) against conventional human extraction methods in retrieving information from scientific articles on diabetic retinopathy (DR). The extraction was done using GPT3.5 Turbo as of October 2023. OpenAI’s GPT-3.5 Turbo significantly reduced the time taken for extraction. Concordance was highest at 100% for the extraction of the country of study, 64.7% for significant risk factors of DR, 47.1% for exclusion and inclusion criteria, and lastly 41.2% for odds ratio (OR) and 95% confidence interval (CI). The concordance levels seemed to indicate the complexity associated with each prompt. This suggests that OpenAI’s GPT-3.5 Turbo may be adopted to extract simple information that is easily located in the text, leaving more complex information to be extracted by the researcher. It is crucial to note that the foundation model is constantly improving significantly with new versions being released quickly. Subsequent work can focus on retrieval-augmented generation (RAG), embedding, chunking PDF into useful sections, and prompting to improve the accuracy of extraction.

Published
2024
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