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Journal and News Scan
Researchers from the University of Nottingham studied 502,628 adults aged 40 to 69 years whose health information was logged in the UK Biobank between 2006 and 2010. Using demographic data and taking into account biometric, clinical, and lifestyle factors, the authors developed predictive mortality models using deep learning, random forest, and Cox regression.
Death occurred in 14,418 adults (2.9%) over a total follow-up time of 3,508,454 person-years, and mortality data was corroborated with national records. The age- and gender-based Cox model was the least predictive, with an area under the curve (AUC) of 0.689, followed by the multivariate Cox regression model, which improved discrimination by 6.2% for an AUC of 0.751. The application of machine-learning algorithms further improved discrimination by 3.2% using the random forest model (AUC = 0.783; 95% confidence interval (CI), 0.776 - 0.791) and 3.9% using deep learning model (AUC = 0.790; 95% CI, 0.783 - 0.797). The two machine-learning algorithms improved discrimination by 9.4% and 10.1% respectively from a simple age and gender Cox regression model.
This work suggest machine learning significantly improved accuracy of prediction of premature all-cause mortality in this middle-aged population, compared to standard methods. This study illustrates the value of machine learning for risk prediction within a traditional epidemiological study design.
A robust meta-analysis of randomized controlled trials on stem cell therapies for refractory angina, offering some encouragement.
In this state-of-the-art review review, the authors summarize current knowledge of anatomic, structural, metabolic, functional, and hemodynamic characteristics of the right ventricle (RV) in both health and disease. Highlights of this review are:
- Anatomically and functionally different from the left ventricle, the RV plays an increasingly recognized role in determining both symptoms and outcomes in multiple conditions.
- The normal RV is coupled to the low-pressure, high-compliance pulmonary circulation to ensure transfer of blood to the pulmonary arteries in an energy-efficient fashion. RV adaptation to disease is determined by the degree of pressure overload, volume overload, and alterations in intrinsic contractility. These 3 situations have distinct clinical course and therapeutic approach although they commonly coexist in various degrees.
- Advances promise to enhance our understanding of the mechanisms of RV adaptation or maladaptation to pathologic conditions. These include refinements in the evaluation of RV anatomy, myoarchitecture, ultrastructure, metabolism, perfusion, function, and degree of coupling to the pulmonary circulation. Such evaluation can be performed invasively but increasingly is accomplished through noninvasive imaging.
Professor Sharma and his team from London investigated the prevalence of an enlarged aorta in 3781 British athletes and 806 control individuals. The mean age was 19 ± 5.9 years, and 63.3% were male. The average time of training was 16.7 hours per week. The follow-up lasted for 5 ± 1.5 years.
This study found that athletes had a slightly larger aortic diameter compared to controls (28.3 ± 4.1 versus 27.8 ± 4.1 mm; p=0.01), but this difference was only 0.9 mm. The 99th percentile value for the aortic diameter in men and women was 40 mm and 38 mm, respectively, which represent an enlarged aortic diameter. The aortic diameter did not exceed 43 mm in any man or 41 mm in any woman. Five men and 6 women had an enlarged aortic diameter. These 11 athletes were followed for more than 5 years with serial echocardiograms and continued to exercise during that period. No progressive enlargement in the aortic diameter was observed in this group of athletes.
In conclusion, a small minority of athletes (0.3%) had a slightly enlarged aorta. The aortic diameter rarely exceeded 40 mm in men or 38 mm in women. Medium-term follow-up revealed no evidence of progressive enlargement of the aortic diameter in those athletes with an enlarged aorta.
Cook Medical announced that Dr Joseph Lombardi in New Jersey treated the first patient in the US using the newly approved Zenith® Dissection Endovascular System as part of the device's commercial launch. The system consists of a proximal stent-graft component and a distal bare stent component. “The value in this dissection stent is that it’s pathology-specific, designed just for this disease," said Dr Lombardi, the Global Principal Investigator of the STABLE I and STABLE II clinical trials.
Patient Care and General Interest
The US Centers for Medicare and Medicaid Services have released their proposed update to the national coverage policy for transcatheter aortic valve replacement, in which they did not increase volume requirements.
An updated guideline for lung cancer diagnosis and management from the UK National Institute for Health and Care Excellence was published in the British Medical Journal.
Research, Trials, and Funding
A randomized trial conducted in 18 countries and published in the Canadian Medical Association Journal suggests that steroid administration during coronary artery bypass grafting (CABG) does not reduce the risk of acute kidney injury.
Researchers in Pennsylvania, USA, have applied a machine learning algorithm to low-dose computed tomography scans try to reduce false positives in lung cancer screening.
Motion-correcting software combined with fetal magnetic resonance imaging was used to generate improved 3D images for diagnosing congenital heart disease, report researchers from London, UK, in the Lancet.
Researchers in Milan, Italy, report results from the randomized MYRIAD trial, finding that patients undergoing CABG have equivalent survival whether they receive intravenous or inhaled anesthesia.
A population-based prospective study of more than 50,000 individuals in northeastern Iran found an association between the preference for drinking one’s tea “very hot” and esophageal cancer risk, say researchers in the International Journal of Cancer.
Sun and colleagues investigated the relationship between low skeletal muscle mass and the prognosis of early-stage non–small cell lung cancer (NSCLC). In more than 300 patients with early-stage NSCLC, the truncal muscle index at the first lumbar vertebral level correlated with lower rates of recurrence-free and overall survival five years after resection. The authors conclude that the truncal muscle index could be useful to include in the preoperative assessment of patients for whom curative resection of NSCLC is planned.
Professor Yacoub and his team reported their experience with the use of the Mustard operation, in its original form and in a new modification designed to enhance the atrial functions and filling of the left ventricle.
In 5 years, 101 patients with transposition of the great arteries (TGA) underwent the Mustard operation, 86 with the new modification. The median age at operation was 16 months (6 months - 27 years), 75 patients were male (74.3%), and median preoperative oxygen saturation was 71%. There were no early deaths. Three patients died during a median follow-up of 24.2 months, all with large VSD and established pulmonary vascular disease. At latest follow up, all patients were in stable sinus rhythm. There were no baffle leaks. Seven patients had asymptomatic narrowing of the superior baffle, and one required balloon dilation. The authors report that follow-up is 100% complete and includes CT and MRI at regular intervals (75 patients to date). Analysis of representative subsets showed enhanced rate and pattern of left ventricle filling in the modified operation compared to the classic Mustard operation.
The authors conclude that the Mustard operation, particularly the modified technique, should play an important role in treating late-presenting patients with TGA. Improving the pattern of filling of the left ventricle could enhance the long-term results of the Mustard operation.
Heimeshoff and colleagues retrospectively analyzed the function of wearable cardioverter-defibrillators (WCDs) provided for 100 patients after cardiac surgery. Patients received a WCD if their left ventricular ejection fraction was 35% or lower, or if their implantable cardioverter-defibrillator (ICD) had been explanted. Left ventricular ejection fraction was improved from 28.9 ± 8% after surgery to 36.7 ± 11% at follow-up (p < 0.001). Ventricular arrhythmias occurred in 13% of patients. Three patients were successfully defibrillated, and WCDs did not give any inappropriate shocks. After the wearing period for the WCD was complete, 25 patients had an ICD implanted. The authors conclude that WCDs were effective in protecting patients against postoperative ventricular tachyarrhythmias.
The investigators published the final analysis of the MOMENTUM 3 trial comparing the fully magnetically levitated centrifugal continuous-flow HeartMate 3 pump to the mechanical-bearing axial continuous-flow HeartMate II pump. The composite primary end point was survival at two years free of disabling stroke or reoperation to replace or remove a malfunctioning device. The principal secondary end point was pump replacement at two years.
HeartMate 3 and HeartMate II were implanted in 516 and 512 patients, respectively. In the analysis of the primary end point, 397 patients (76.9%) with HeartMate 3, as compared with 332 (64.8%) with HeartMate II, remained alive and free of disabling stroke or reoperation to replace or remove a malfunctioning device at two years (relative risk, 0.84; 95% confidence interval [CI], 0.78 to 0.91; P<0.001 for superiority). Pump replacement was less common in the HeartMate 3 group than in the HeartMate II group (12 patients [2.3%] versus 57 patients [11.3%]; relative risk, 0.21; 95% CI, 0.11 to 0.38; P<0.001). The number of events per patient-year for stroke of any severity, major bleeding, and gastrointestinal hemorrhage were lower in patients with HeatMate 3 comparted to patients with HeartMate II.
These data show that among patients with advanced heart failure, the fully magnetically levitated centrifugal-flow HeartMate 3 was associated with less frequent need for pump replacement and superior survival free of disabling stroke or reoperation to replace or remove a malfunctioning device.