A machine-learning based bio-psycho-social model for the prediction of non-obstructive and obstructive coronary artery disease

Background: Mechanisms of myocardial ischemia in obstructive and non-obstructive coronary artery disease (CAD), and the interplay between clinical, functional, biological and psycho-social features, are still far to be fully elucidated. Objectives: To develop a machine-learning (ML) model for the supervised prediction of obstructive versus non-obstructive CAD. Methods: From the EVA study, we analysed adults hospitalized for IHD undergoing conventional coronary angiography (CCA). Non-obstructive CAD was defined by a stenosis < 50% in one or more vessels. Baseline clinical and psycho-socio-cultural characteristics were used for computing a Rockwood and Mitnitski frailty index, and a gender score according to GENESIS-PRAXY methodology. Serum concentration of inflammatory cytokines was measured with a multiplex flow cytometry assay. Through an XGBoost classifier combined with an explainable artificial intelligence tool (SHAP), we identified the most influential features in discriminating obstructive versus non-obstructive CAD. Results: Among the overall EVA cohort (n = 509), 311 individuals (mean age 67 ± 11 years, 38% females; 67% obstructive CAD) with complete data were analysed. The ML-based model (83% accuracy and 87% precision) showed that while obstructive CAD was associated with higher frailty index, older age and a cytokine signature characterized by IL-1β, IL-12p70 and IL-33, non-obstructive CAD was associated with a higher gender score (i.e., social characteristics traditionally ascribed to women) and with a cytokine signature characterized by IL-18, IL-8, IL-23. Conclusions: Integrating clinical, biological, and psycho-social features, we have optimized a sex- and gender-unbiased model that discriminates obstructive and non-obstructive CAD. Further mechanistic studies will shed light on the biological plausibility of these associations. Clinical trial registration: NCT02737982

The Sex-Specific Detrimental Effect of Diabetes and Gender-Related Factors on Pre-admission Medication Adherence Among Patients Hospitalized for Ischemic Heart Disease: Insights From EVA Study

Background: Sex and gender-related factors have been under-investigated as relevant determinants of health outcomes across non-communicable chronic diseases. Poor medication adherence results in adverse clinical outcomes and sex differences have been reported among patients at high cardiovascular risk, such as diabetics. The effect of diabetes and gender-related factors on medication adherence among women and men at high risk for ischemic heart disease (IHD) has not yet been fully investigated.Aim: To explore the role of sex, gender-related factors, and diabetes in pre-admission medication adherence among patients hospitalized for IHD.Materials and Methods: Data were obtained from the Endocrine Vascular disease Approach (EVA) (ClinicalTrials.gov Identifier: NCT02737982), a prospective cohort of patients admitted for IHD. We selected patients with baseline information regarding the presence of diabetes, cardiovascular risk factors, and gender-related variables (i.e., gender identity, gender role, gender relations, institutionalized gender). Our primary outcome was the proportion of pre-admission medication adherence defined through a self-reported questionnaire. We performed a sex-stratified analysis of clinical and gender-related factors associated with pre-admission medication adherence.Results: Two-hundred eighty patients admitted for IHD (35% women, mean age 70), were included. Around one-fourth of the patients were low-adherent to therapy before hospitalization, regardless of sex. Low-adherent patients were more likely diabetic (40%) and employed (40%). Sex-stratified analysis showed that low-adherent men were more likely to be employed (58 vs. 33%) and not primary earners (73 vs. 54%), with more masculine traits of personality, as compared with medium-high adherent men. Interestingly, women reporting medication low-adherence were similar for clinical and gender-related factors to those with medium-high adherence, except for diabetes (42 vs. 20%, p = 0.004). In a multivariate adjusted model only employed status was associated with poor medication adherence (OR 0.55, 95%CI 0.31–0.97). However, in the sex-stratified analysis, diabetes was independently associated with medication adherence only in women (OR 0.36; 95%CI 0.13–0.96), whereas a higher masculine BSRI was the only factor associated with medication adherence in men (OR 0.59, 95%CI 0.35–0.99).Conclusion: Pre-admission medication adherence is common in patients hospitalized for IHD, regardless of sex. However, patient-related factors such as diabetes, employment, and personality traits are associated with adherence in a sex-specific manner

Effects of Pegvisomant on left ventricular mass in refractroy acromegalic patients: a 4 years follow-up observational study

Effects of Pegvisomant on left ventricular mass in refractroy acromegalic patients: a 4 years follow-up observational study Moroni Carlo et al.; Cuore e Grossi Vasi, Endocrinologia, “Sapienza” Università di Roma Objective: Since morpho-functional bi-ventricular impairment (i.e. left ventricular hypertrophy, LVH) is described in Acromegalic patients (pts), the effects of medical and surgical treatments have been previously examined. Pegvisomant (PegV) is a GH receptor antagonist, indicated for acromegalic pts with unsuccessful surgical, radiation, and/or medical treatments, with the goal of obtaining normal IGF-1 serum levels. Aim of this observational study is to evaluate the effect of PegV on left ventricular structure. Methods: We evaluated seven consecutive pts (4 males, mean age was 50.1SD 9.8 years), with active acromegaly, eligible to PegV treatment (mean disease duration before PegV: 8 years ± 3.2) by means of a 4 yy clinical and instrumental follow-up. Starting from 10 mg daily, PegV was titrated to reach the expected levels of IGF-1 for sex and age. All patients underwent to transthoracic echocardiogram (TTE) yearly from acromegaly diagnosis; in our study we considered the following TTE results: 2 years before starting PegV (T -2), at the enrolment for PegV therapy (T0) and, respectively, after two and four years of treatment (T2, T4). We compared left ventricular dimensions, geometry (LVEDD: left ventricle end-diastolic diameter; RWT: relative wall thickness) and mass (LVM and LVM index , expressed as g/h2.7). Students t test for paired data was used. Results: At six months therapy all pts normalized IGF-1 levels, which remained stable during the whole follow up. LVM and LVMi were significantly higher at T0 when compared with T-2 (before PegV: p< 0.05 for both) whereas significantly lower at T+2 (after 2 yy PegV therapy: p<0.05 vs T0 for both). The improvement trend was confirmed after 4 years PegV treatment (p<0.05 vs T0 and vs T+2 for both). Conclusions: In our study, successful PegV treatment (involving IGF-1 serum level normalization) seems to be effective in inducing a significant LV mass reduction, whereas previous treatments showed no effect (Fig.1). The observed LVM reduction after PevG treatment could play a role in improving the cardiovascular prognosis of hypertrophic acromegalic patients