Minerva Cardiology and Angiology

Applications and potential of machine learning augmented chest X-ray interpretation in cardiology
Milne MR, Ahmad HK, Buchlak QD, Esmaili N, Tang C, Seah J, Ektas N, Brotchie P, Marwick TH and Jones CM
The chest X-ray (CXR) has a wide range of clinical indications in the field of cardiology, from the assessment of acute pathology to disease surveillance and screening. Despite many technological advancements, CXR interpretation error rates have remained constant for decades. The application of machine learning has the potential to substantially improve clinical workflow efficiency, pathology detection accuracy, error rates and clinical decision making in cardiology. To date, machine learning has been developed to improve image processing, facilitate pathology detection, optimize the clinical workflow, and facilitate risk stratification. This review explores the current and potential future applications of machine learning for chest radiography to facilitate clinical decision making in cardiology. It maps the current state of the science and considers additional potential use cases from the perspective of clinicians and technologists actively engaged in the development and deployment of deep learning driven clinical decision support systems.
Cerebrovascular events after perioperative paroxysmal atrial fibrillation in patients undergoing aortic valve replacement
Cassar A, Montanaro G, Booker B, Sammut MA, Manche A and Galea JF
Postoperative atrial fibrillation (POAF) is common after aortic valve replacement (AVR). However, the long-term risk of cerebrovascular ischemic events (CVA) associated with POAF in this scenario is not known. The study objective was to look at the long-term risk of stroke in patients undergoing AVR with POAF compared to those with no POAF, particularly in patients having a bioprosthetic valve and not discharged on anticoagulation. We also looked at the risk of peri-operative stroke and long-term mortality.
Prolonged atrial refractoriness to predict the onset of atrial fibrillation after transcatheter aortic valve implantation
Özdemir Ö, Doğanözü E and Yildirim O
Atrial fibrillation (AF) is the most common atrial arrhythmia after transcatheter aortic valve implantation (TAVI) and is associated with high mortality. Although some clinical and echocardiographic variables have been defined to predict new-onset atrial fibrillation (NOAF), electrophysiologic (EP) parameters have not been identified yet. We aimed to investigate the impact of atrial refractoriness on NOAF after TAVI.
miRNA-148a-3p targets to regulate the lipid metabolism gene SOCS3 to reduce myocardial ischemia/reperfusion injury
Mo C, Tang X, Wei Y, Han H, Wei G, Wei L and Lin X
Acute myocardial infarction (AMI) is a major cause of death in cardiovascular patients. SOCS3's protective role in cardiac I/R-I is being explored, and miRNAs, particularly miRNA-148a-3p, are suspected to target SOCS3. To elucidate the role of miRNA-148a-3p targeting lipid metabolism gene SOCS3 in cardiac ischemia-reperfusion injury (I/R-I) in rats.
Cardiac contractility modulation: from molecular patterns to tailored treatment in heart failure subgroups
Pierucci N, D'Amato A, Fanisio F, Bruti RM, Mariani MV, Prosperi S, Labbro Francia A, Filomena D, Trivigno S, LA Fazia VM, Piro A, Badagliacca R, Chimenti C, Severino P and Lavalle C
Cardiac contractility modulation (CCM) signals are non-excitatory signals that are applied during the myocyte's absolute refractory period. These signals have been demonstrated to have an inotropic effect without increasing myocardial oxygen consumption. This has been observed in both preclinical animal studies and randomized clinical trials. CCM influences the expression of various genes that are abnormally expressed in heart failure: it reverses fetal myocyte gene programming associated with heart failure and regulates the expression of genes associated with calcium cycling and myocardial contractile machinery. Clinical investigations have primarily focused on patients with heart failure and normal QRS duration where CCM has demonstrated its safety and effectiveness in reducing heart failure-related hospitalizations, as well as improving symptoms, functional capacity, and overall quality of life. Currently, for individuals experiencing symptomatic heart failure with an ejection fraction ranging from 25% to 45% and a QRS duration of less than 130 ms, who are not suitable candidates for cardiac resynchronization therapy, CCM offers a viable treatment option. Even though promising results in specific HF subgroups have been published, further studies are needed to understand the role of CCM in tailored treatment for heart failure. Moreover, the role of multimodality imaging in lead placement and prognostic stratification in CCM patients should be further investigated. This review aims to summarize the main pathophysiological evidence related to the use of CCM and to highlight its role as a possible additional weapon in tailored treatment for specific subgroups of patients with heart failure.
Tribute to Prof. Alessandro Santo Bortone
DE Cillis E, Pepe M, Gaglione A, Pestrichella V, Marchese A, Masi F, Iacovelli F, Contegiacomo G, Iorio E, Signore N, Colonna G, Giordano A, Piccinni G, Guaricci AI and Ciccone MM
Overexpression of long non-coding RNA cytoskeleton regulator RNA in patients with acute myocardial infarction with arrhythmia
Ma H, Tian F, Wang D, Fan L, Wang L, Chen J and Song L
Complications of arrhythmia often occur in patients with acute myocardial infarction (AMI). This study mainly explored the expression and diagnostic significance of long non-coding RNA CYTOR (lncRNA CYTOR) in patients with AMI with arrhythmia, and analyzed the effects of CYTOR on inflammation and oxidative stress responses of cardiomyocytes.
Cardiovascular and renal benefits of sodium-glucose cotransporter-2 inhibitors: pathophysiologic mechanisms and clinical evidence
Small AM and Wiviott SD
Large-scale clinical outcome trials have demonstrated significant reductions in cardiovascular (CV) and renal outcomes with sodium-glucose cotransporter-2 inhibitors (SGLT2i). These benefits are sustained in patients with a range of left ventricular ejection fractions (LVEF), irrespective of diabetes status, and in a variety of clinical settings, prompting incorporation into clinical practice guidelines for patients with chronic kidney disease (CKD), heart failure (HF), and atherosclerotic cardiovascular disease (ASCVD). The clinical benefits are mediated by an interplay of cardio-metabolic-renal mechanisms, and they have a favorable safety profile. We provide a review of the proposed mechanisms of cardiorenal protection and the evidence supporting the clinical benefits of SGLT2i in CKD, acute and chronic HF treatment and prevention , and ASCVD, highlighting the uses of SGLT2i in clinical practice guidelines.
Low vitamin D levels are associated with impaired diastolic function in patients with acute coronary syndrome
Algül E, Özbeyaz NB, Şahan HF, Aydinyilmaz F, Erdoğan A, Erzurum M, Sunman H, Efe TH and Özdemir Ö
Vitamin D deficiency is a common clinical picture associated with poor cardiovascular prognosis. It is also associated with impaired diastolic dysfunction in stable coronary artery disease. We investigated the relationship between vitamin D levels and diastolic dysfunction in patients with acute coronary syndrome (ACS).
Clinical implications of residual shunt after patent foramen ovale closure
Iannetta L, Presbitero P, Onorato EM, Ferrari F and Missiroli B
Residual shunt (RS) after percutaneous patent foramen ovale (PFO) closure has classically been a question of debate for controversial results about its association with increased risk of recurrent ischemic events. Different underlying processes of neural tissue injury have to be taken into account evaluating clinical impact of residual shunt after PFO closure: clotting mechanisms and non-clotting, vasoactive or oxidative mechanisms. Some biochemical studies demonstrated the importance of effective PFO closure aimed to obtain significant reduction of several molecules involved in PFO related strokes. Blood levels of serotonin and homocysteine seem to significantly decrease after percutaneous procedures. A recent study on a pro-thrombotic phenotype of migraineurs with aura and PFO demonstrated that PFO closure reduce activated platelets and thrombin at the value of healthy subjects, underlining the importance of the correct sealing of the defect. The aim of this review is to examine currently available literature studies. Different and discordant results have been obtained due to heterogeneity of study population, instrumental assessment of RS and follow-up methods and length. In the 2021 American Guidelines for the prevention of stroke, RS was definitely considered a predictor of recurrence of ischemic events. Management of this subset of patients is still an unresolved issue and more studies are encouraged.
Inflammation-related markers in COVID-19 infection and ST-segment elevation myocardial infarction
Baytuğan NZ, Kandemir HC, Çelik AI and Bezgin T
The aim of this study is to investigate the association between inflammation-related markers in COVID-19 infection and ST-segment elevation myocardial infarction (STEMI).
Operator-dependent and operator-independent contrast media minimization strategies to prevent acute kidney injury after percutaneous coronary intervention
Paolucci L, Cavaliere V, DE Micco F, Scarpelli M, Focaccio A, Quintavalle C and Briguori C
Contrast associated acute kidney injury (CA-AKI) is a major complication of contrast media (CM) exposure following percutaneous coronary intervention (PCI), associated with high rates of morbidity and mortality in both early and late phases. During the past years, several CA-AKI prevention strategies based on CM sparing have been proposed, which differ significantly in terms of methodological features and efficacy. In this review, we propose a new classification of these techniques based on their dependency on operators' management. Following, we summarize current evidence on the effectiveness in terms of CA-AKI reduction of each one of the currently available operator-dependent and -independent CM minimization strategies.
Artificial intelligence tools in medicine: navigating the horizon of promise and caution
Veneziano FA and Biondi-Zoccai G
Discovery of five diagnostic biomarkers associated with immune cell infiltration in cases of acute myocardial infarction
Suo Q, Li P, Liu Z, Qu C and Song H
Acute myocardial infarction (AMI) remains one of the leading causes of mortality and morbidity worldwide.
Relationship between sST2 and NT-proBNP levels and postoperative atrial fibrillation in patients having non-cardiac surgery
Somuncu MU, Güdül NE, Köktürk U, Köksal BG, Tatar FP and Avci A
We explored the link between sST2 and NT-proBNP levels and postoperative atrial fibrillation (POAF) incidence in non-cardiac surgery patients in this study.
Is vitamin D a new target for patients with acute coronary syndrome and diastolic dysfunction?
Pavasini R and Verdoia M
Role of polypill in cardiovascular prevention and treatment
DE Luca L, Crispino SP, Andreoli F, DI Fusco SA, Pannone A, Nusca A, Colivicchi F, Grigioni F and Gabrielli D
Cardiovascular diseases (CVD) remain the leading cause of mortality globally and require innovative strategies for effective prevention and treatment. The polypill concept, which integrates multiple cardioprotective agents into a single dosage form, has emerged as a promising approach to improve adherence and simplify the management of cardiovascular risk factors. We review clinical trials and observational studies evaluating the impact of the polypill on reducing the incidence of major cardiovascular events (MACEs), its influence on medication adherence, and its potential to fill treatment gaps in diverse populations. Also of note are the pharmacoeconomic implications of the widespread use of the polypill, particularly in low- and middle-income countries where the burden of cardiovascular disease is increasing. Although the polypill demonstrates a favorable profile in improving therapeutic compliance and reducing cardiovascular risk factors, debates persist regarding its efficacy compared to individualized treatment regimens. This review summarizes the current evidence on the efficacy, safety, and cost-effectiveness of the polypill in CVD primary and secondary prevention. Furthermore, potential challenges in implementing the polypill strategy include tailoring the components to patient-specific risk profiles and the need for robust evidence from large-scale randomized controlled trials to substantiate its long-term benefits.
Prospective evaluation of treatment strategies in patients presenting with chronic total occlusion at coronary angiogram: rationale, design and baseline data of the PETS-CTO Registry
Castaldi G, Zivelonghi C, Scott B, Poletti E, Benedetti A, Moroni A, Wilgenhof A, Bezzeccheri A, Vescovo G, Budassi S, El Jattari H, Convens C, Verheye S, Vermeersch P and Agostoni P
Coronary chronic total occlusions (CTO) are associated with an increased chance of untreatable symptoms and worse prognosis. However, limited data are available about the interaction between treatment strategy, potential ischemia burden reduction and quality of life (QoL) improvement.
LncRNA MBNL1-AS1 functions as an alternative atherosclerosis biomarker in elderly hypertensive patients and regulates vascular smooth muscle cell function
Song Y, Zhu X, Cai X, Yu Y and Hu D
The clinical role of long non-coding RNA (MBNL1-AS1) in diagnosing atherosclerosis (AS) risks of hypertensive patients and the effects of MBNL1-AS1 on vascular smooth muscle cells (VSMCs) triggered by angiotensin II (Ang II) were investigated.
Diagnostic value of combined detection of serum neuron-specific enolase and homocysteine in patients with coronary atherosclerosis
Liu F, Wang Z, Ren L and Xu J
The aim of this paper was to investigate the diagnostic significance and severity assessment of serum neuron-specific enolase (NSE) combined with homocysteine (Hcy) for patients with coronary atherosclerosis (coronary artery disease, CAD).
Diagnostic and prognostic significance of serum lncRNA MBNL1-AS1 expression in patients with atherosclerosis
Wang Z, Cheng L, Zhao Z, Chen H, Wang J, Niu J, Wang Y and Zhang X
Atherosclerosis (AS) is the pathological basis of many cardiovascular and cerebrovascular diseases. To further the investigation of treatments for AS, this research analyzed the role of lncRNA MBNL1-AS1.