The Cardiac Analytics and Innovation (CardiacAI) Data Repository: An Australian data resource for translational cardiovascular research

In Australia, cardiovascular diseases (CVD) are managed in a complex and fragmented healthcare system across multiple providers. A data repository that links data sources, and enables advanced analytics and big data technologies, will generate novel insights, and allow development of translational tools that can improve patient care and outcomes. The Cardiac Analytics and Innovation (CardiacAI) project has established a research-ready electronic medical records data resource to enable collaborative and translational cardiovascular research. The CardiacAI data repository prospectively extracts de-identified electronic medical record (EMR) data from two local health districts (LHD) in New South Wales (NSW), Australia. These data are linked with Australian population health data to ascertain longitudinal hospitalisation and death outcomes. The data are stored within a secure, cloud-based storage and analytics platform. The CardiacAI data repository is a not-for-profit data resource that promotes collaboration and responsible sharing of data. The CardiacAI data repository is a resource for Australian healthcare providers, clinicians and researchers seeking to improve cardiovascular care. The project is expanding to include data from stroke hospitalisations and two additional NSW LHDs, and is actively exploring linkage with ECG signal data, medical imaging data and community-based healthcare. The CardiacAI project has the potential to unlock a wealth of novel insights and translational tools that improve secondary prevention and treatment of CVD.Comment: Author Notes: Blanca Gallego and Sze-Yuan Ooi are co-senior authors of this paper. Blanca Gallego is the senior technical author and Sze-Yuan Ooi is the senior clinical autho

Impact of incomplete percutaneous revascularization in patients With multivessel coronary artery disease: a systematic review and meta-analysis

Background: Up to half of patients undergoing percutaneous coronary intervention have multivessel coronary artery disease (MVD) with conflicting data regarding optimal revascularization strategy in such patients. This paper assesses the evidence for complete revascularization (CR) versus incomplete revascularization in patients undergoing percutaneous coronary intervention, and its prognostic impact using meta‐analysis. Methods and Results: A search of PubMed, EMBASE, MEDLINE, Current Contents Connect, Google Scholar, Cochrane library, Science Direct, and Web of Science was conducted to identify the association of CR in patients with multivessel coronary artery disease undergoing percutaneous coronary intervention with major adverse cardiac events and mortality. Random‐effects meta‐analysis was used to estimate the odds of adverse outcomes. Meta‐regression analysis was conducted to assess the relationship with continuous variables and outcomes. Thirty‐eight publications that included 156 240 patients were identified. Odds of death (OR 0.69, 95% CI 0.61‐0.78), repeat revascularization (OR 0.60, 95% CI 0.45‐0.80), myocardial infarction (OR 0.64, 95% CI 0.50‐0.81), and major adverse cardiac events (OR 0.63, 95% CI 0.50‐0.79) were significantly lower in the patients who underwent CR. These outcomes were unchanged on subgroup analysis regardless of the definition of CR. Similar findings were recorded when CR was studied in the chronic total occlusion (CTO) subgroup (OR 0.65, 95% CI 0.53‐0.80). A meta‐regression analysis revealed a negative relationship between the OR for mortality and the percentage of CR. Conclusion: CR is associated with reduced risk of mortality and major adverse cardiac events, irrespective of whether an anatomical or a score‐based definition of incomplete revascularization is used, and this magnitude of risk relates to degree of CR. These results have important implications for the interventional management of patients with multivessel coronary artery disease

Sex-Specific Variances in Anatomy and Blood Flow of the Left Main Coronary Bifurcation: Implications for Coronary Artery Disease Risk

Studies have shown marked sex disparities in Coronary Artery Diseases (CAD) epidemiology, yet the underlying mechanisms remain unclear. We explored sex disparities in the coronary anatomy and the resulting haemodynamics in patients with suspected, but no significant CAD. Left Main (LM) bifurcations were reconstructed from CTCA images of 127 cases (42 males and 85 females, aged 38 to 81). Detailed shape parameters were measured for comparison, including bifurcation angles, curvature, and diameters, before solving the haemodynamic metrics using CFD. The severity and location of the normalised vascular area exposed to physiologically adverse haemodynamics were statistically compared between sexes for all branches. We found significant differences between sexes in potentially adverse haemodynamics. Females were more likely than males to exhibit adversely low Time Averaged Endothelial Shear Stress along the inner wall of a bifurcation (16.8% vs. 10.7%). Males had a higher percentage of areas exposed to both adversely high Relative Residence Time (6.1% vs 4.2%, p=0.001) and high Oscillatory Shear Index (4.6% vs 2.3%, p<0.001). However, the OSI values were generally small and should be interpreted cautiously. Males had larger arteries (M vs F, LM: 4.0mm vs 3.3mm, LAD: 3.6mm 3.0mm, LCX:3.5mm vs 2.9mm), and females exhibited higher curvatures in all three branches (M vs F, LM: 0.40 vs 0.46, LAD: 0.45 vs 0.51, LCx: 0.47 vs 0.55, p<0.001) and larger inflow angle of the LM trunk (M: 12.9{\deg} vs F: 18.5{\deg}, p=0.025). Haemodynamic differences were found between male and female patients, which may contribute, at least in part, to differences in CAD risk. This work may facilitate a better understanding of sex differences in the clinical presentation of CAD, contributing to improved sex-specific screening, especially relevant for women with CAD who currently have worse predictive outcomes.Comment: 14 pages, 5 figure

Ankyrin-B syndrome: a case of sinus node dysfunction, atrial fibrillation and prolonged QT in a young adult

Ankyrin-B protein is involved in regulating expression and localisation of cardiac ion channels and transporters. Mutations of the ANK2 gene in the rare condition Ankyrin-B syndrome result in loss of function of the ankyrin-B protein which in turn leads to abnormal regulation of intracellular sodium and calcium and a predisposition to cardiac arrhythmia including torsades de pointes. We describe a rare case of this condition characterised by sinus node dysfunction, atrial fibrillation and prolonged QT syndrome in a young patient with a family history of sudden death. The management of Ankyrin-B syndrome may include avoidance of QT prolonging medications, insertion of a permanent pacemaker for sinus node dysfunction, or a cardioverter defibrillator for those at high-risk of sudden death from torsades de pointes

Mobile phone technologies in the management of ischemic heart disease, heart failure, and hypertension: Systematic review and meta-analysis

Background: Cardiovascular disease (CVD) remains the leading cause of death worldwide. Mobile phones have become ubiquitous in most developed societies. Smartphone apps, telemonitoring, and clinician-driven SMS allow for novel opportunities and methods in managing chronic CVD, such as ischemic heart disease, heart failure, and hypertension, and in the conduct and support of cardiac rehabilitation. Objective: A systematic review was conducted using seven electronic databases, identifying all relevant randomized control trials (RCTs) featuring a mobile phone intervention (MPI) used in the management of chronic CVD. Outcomes assessed included mortality, hospitalizations, blood pressure (BP), and BMI. Methods: Electronic data searches were performed using seven databases from January 2000 to June 2019. Relevant articles were reviewed and analyzed. Meta-analysis was performed using standard techniques. The odds ratio (OR) was used as a summary statistic for dichotomous variables. A random effect model was used. Results: A total of 26 RCTs including 6713 patients were identified and are described in this review, and 12 RCTs were included in the meta-analysis. In patients with heart failure, MPIs were associated with a significantly lower rate of hospitalizations (244/792, 30.8% vs 287/803, 35.7%; n=1595; OR 0.77, 95% CI 0.62 to 0.97; P=.03; I2=0%). In patients with hypertension, patients exposed to MPIs had a significantly lower systolic BP (mean difference 4.3 mm Hg; 95% CI −7.8 to −0.78 mm Hg; n=2023; P=.02). Conclusions: The available data suggest that MPIs may have a role as a valuable adjunct in the management of chronic CVD

Burden of cardiovascular diseases in older adults using aged care services

Objective: To quantify the burden of cardiovascular diseases (CVD) in older adults using community and residential care services. Methods: The study population comprised people aged 45+ from the 45 and Up Study (2006–09, n = 266,942) in Australia linked with records for hospital stays, aged care service and deaths for the period 2006–14. Follow-up time for each person was allocated to three categories of service use: no aged care, community care and residential care, with censoring at date of death. We calculated the prevalence at baseline and entry to aged care, and incidence rates for major CVD and six cardiovascular diagnoses, seven cardiovascular interventions (collectively CV interventions), cardiovascular-related intensive care unit stays and cardiovascular death. Results: The prevalence of major CVD at entry into community care and residential care was 41% and 58% respectively. Incidence per 1,000 person-years of all major CVD hospitalisations and CV interventions, respectively, was 182.8 (95% CI: 180.0-185.8) and 37.0 (95% CI: 35.6–38.4) for people using community care, and 280.7 (95% CI: 272.2–289.4) and 11.7 (95% CI: 9.8–13.9) for people using residential care. Similar trends were observed for each of the CVD diagnoses and interventions. Crude incidence rates for cardiovascular deaths per 1,000 person-years were 1.4 (95% CI: 1.3–1.5) in no aged care, 13.3 (95% CI: 12.6–14.1) in community care, and 149.7 (95% CI: 144.4–155.2) in residential care. Conclusion: Our findings demonstrate the significant burden of CVD in people using both community-based and residential aged care services and highlights the importance of optimising cardiovascular care for older adults.NSW Health–Central Coast Local Health District funded this retrospective observational data linkage study which was part of the Exploring the Relationship between Social Care, Primary and Secondary Health Service Use and Adverse Health Outcomes (SHOut) project, which draws data from the Sax Institute’s 45 and Up Study

Digital health technology in the prevention of heart failure and coronary artery disease

Coronary artery disease and heart failure are leading causes of morbidly and mortality, resulting in a substantial economic burden globally. Guidelines from the European Society of Cardiology and American Heart Association place adherence to medication and healthy lifestyle behaviors at the core of cardiovascular disease primary and secondary prevention strategies. The growing collective burden of cardiovascular disease is likely to eventually outgrow the available resources allocated for traditional care provision, such as nurse-led outreach services. Novel strategies are required to address this growing need. Worldwide, more than 6.5 billion people own smartphones and opportunities to deliver healthcare digitally for patients with cardiac conditions are expanding exponentially. Multiple randomized controlled trials have now demonstrated that various modes of noninvasive digital health technology, including teleconsultations, smartphone applications (apps), wearables, remote monitoring, and predictive analytics can influence patient behaviors in both the primary and secondary prevention of coronary artery disease and prevention and management of heart failure. The purpose of this narrative review is to critically analyze pivotal trials and discuss examples of successfully deployed mobile digital technology in the prevention of heart failure hospitalizations, and in the primary and secondary prevention of coronary artery disease

Solvent-Free Synthesis of MIL-101(Cr) for CO₂ Gas Adsorption: The Effect of Metal Precursor and Molar Ratio

MIL-101(Cr), a subclass of metal–organic frameworks (MOFs), is a promising adsorbent for carbon dioxide (CO2) removal due to its large pore volume and high surface area. Solvent-free synthesis of MIL-101(Cr) was employed in this work to offer a green alternative to the current approach of synthesizing MIL-101(Cr) using a hazardous solvent. Characterization techniques including XRD, SEM, and FTIR were employed to confirm the formation of pure MIL-101(Cr) synthesized using a solvent-free method. The thermogravimetric analysis revealed that MIL-101(Cr) shows high thermal stability up to 350 °C. Among the materials synthesized, MIL-101(Cr) at the molar ratio of chromium precursor to terephthalic organic acid of 1:1 possesses the highest surface area and greatest pore volume. Its BET surface area and total pore volume are 1110 m2/g and 0.5 cm3/g, respectively. Correspondingly, its CO2 adsorption capacity at room temperature is the highest (18.8 mmol/g), suggesting it is a superior adsorbent for CO2 removal. The textural properties significantly affect the CO2 adsorption capacity, in which large pore volume and high surface area are favorable for the adsorption mechanism

Synthesis of Cu-BTC metal-organic framework for CO2 capture via solvent-free method: Effect of metal precursor and molar ratio

The Cu-BTC (Copper-1,3,5-benzene tricarboxylate) is one of the representative metal organic frameworks (MOFs) that has shown outstanding performance for carbon dioxide (CO2) adsorption. However, its conventional synthesis duration is relatively long, and the process requires the addition of bulk amounts of organic solvents. Herein, an enhanced solvent-free synthesis strategy was demonstrated in this work for the Cu-BTC synthesis. For this enhanced method, Cu-BTC was synthesized in 3 hours by mechanically grinding the mixture of copper (Cu) metal precursor and BTC organic linker without using solvent. The as-synthesized Cu-BTC samples were analyzed using various characterization techniques to examine and confirm their properties. The thermal stability result revealed that the self-synthesized Cu-BTC could sustain high temperature up to 290°C. Among the samples synthesized at different mole ratios, the Cu-BTC sample with the Cu to BTC mole ratio of 1.5:1 showed the highest BET surface area and the most significant pore volume of 1044 m2 g–1 and 0.62 cm3 g–1, respectively. Its CO2 adsorption capacity was comparable with those fabricated using the solvent-based method, i.e., 1.7 mmol g–1 at 30°C and 1 bar. The results also showed that the synthesized Cu-BTC exhibited regenerative ability up to five adsorption-desorption cycles