Meta-analysis for cardiovascular risk stratification based on noninvasive left anterior descending velocity reserve

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Fountas ◽  
A Djordjevic-Dikic ◽  
B Beleslin ◽  
V Voudris ◽  
G Athanassopoulos
Keyword(s):  
Cardiovascular Risk ◽  
Risk Stratification ◽  
Prospective Studies ◽  
Meta Analysis ◽  
Suspected Coronary Artery Disease ◽  
Systematic Research ◽  
P Value ◽  
Cardiovascular Risk Stratification ◽  
Established Risk Factor ◽  
Increased Risk

Abstract Introduction Left anterior descending velocity reserve (LADVR) by transthoracic echocardiography (TTE) has been proposed for cardiovascular risk stratification in observational prospective studies. Aim of the current study was to interrogate the prognostic consistency and coherence of the existing LADVR data by the means of meta-analysis of relevant studies. Methods A systematic research through electronic databases was performed for prospective studies with patients with known or suspected coronary artery disease (CAD) who had LADVR data. The exposure was abnormal values of LADVR as defined in each study and the outcome was the occurrence of cardiovascular event or death (CE-D). Statistical index considered were the risk ratio (RR) for CE-D of patients with abnormal vs. normal LADVR, as obtained from Cox proportional hazard models. A meta-analysis of these studies using random-effects model was performed to evaluate the pooled prognostic value of abnormal LADVR. Results Fifteen studies with 13050 patients (59.7% male; mean age 64.2 years; mean follow-up 25.1 months) were included in this meta-analysis. Every study used adjustments for every established risk factor for CE-D (age, hypertension, diabetes, dyslipidemia, smoking habits, wall motion abnormalities during stress echo). The abnormal value of LADVR was associated with an increased risk of CE-D (RR=3.33, 95% CI: 2.54–4.37, p-value <0.001). Moderate heterogeneity was observed between studies (Q=35.83, p-value=0.001, I2=60.9%) which was further investigated with sensitivity analysis, subgroup analysis and meta-regression. Conclusions Meta-analytic data for the cardiovascular risk stratification based on dichotomous LADVR data provide robust evidence for efficient prognostic yield. The current results support the broader clinical application of the LADVR. LADVR meta-analysis forestplot Funding Acknowledgement Type of funding source: None

scholarly journals Prediction of coronary artery calcium scoring from surface electrocardiogram in atherosclerotic cardiovascular disease: a pilot study

2020 ◽  
Vol 1 (1) ◽  
pp. 51-61
Author(s):  
Peter D Farjo ◽  
Naveena Yanamala ◽  
Nobuyuki Kagiyama ◽  
Heenaben B Patel ◽  
Grace Casaclang-Verzosa ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Risk Stratification ◽  
Coronary Artery Calcium ◽  
Invasive Coronary Angiography ◽  
Area Under The Curve ◽  
Suspected Coronary Artery Disease ◽  
Major Adverse Cardiovascular Events ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cardiovascular Risk Stratification

Abstract Aims Coronary artery calcium (CAC) scoring is an established tool for cardiovascular risk stratification. However, the lack of widespread availability and concerns about radiation exposure have limited the universal clinical utilization of CAC. In this study, we sought to explore whether machine learning (ML) approaches can aid cardiovascular risk stratification by predicting guideline recommended CAC score categories from clinical features and surface electrocardiograms. Methods and results In this substudy of a prospective, multicentre trial, a total of 534 subjects referred for CAC scores and electrocardiographic data were split into 80% training and 20% testing sets. Two binary outcome ML logistic regression models were developed for prediction of CAC scores equal to 0 and ≥400. Both CAC = 0 and CAC ≥400 models yielded values for the area under the curve, sensitivity, specificity, and accuracy of 84%, 92%, 70%, and 75%, and 87%, 91%, 75%, and 81%, respectively. We further tested the CAC ≥400 model to risk stratify a cohort of 87 subjects referred for invasive coronary angiography. Using an intermediate or higher pretest probability (≥15%) to predict CAC ≥400, the model predicted the presence of significant coronary artery stenosis (P = 0.025), the need for revascularization (P < 0.001), notably bypass surgery (P = 0.021), and major adverse cardiovascular events (P = 0.023) during a median follow-up period of 2 years. Conclusion ML techniques can extract information from electrocardiographic data and clinical variables to predict CAC score categories and similarly risk-stratify patients with suspected coronary artery disease.

scholarly journals The incidence and prevalence of cardiovascular diseases in gout: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Peter Cox ◽  
Sonal Gupta ◽  
Sizheng Steven Zhao ◽  
David M. Hughes
Keyword(s):  
Systematic Review ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Cardiovascular Diseases ◽  
Small Sample Size ◽  
Meta Analysis ◽  
Random Effect ◽  
Small Sample ◽  
Future Research ◽  
Increased Risk

AbstractThe aims of this systematic review and meta-analysis were to describe prevalence of cardiovascular disease in gout, compare these results with non-gout controls and consider whether there were differences according to geography. PubMed, Scopus and Web of Science were systematically searched for studies reporting prevalence of any cardiovascular disease in a gout population. Studies with non-representative sampling, where a cohort had been used in another study, small sample size (< 100) and where gout could not be distinguished from other rheumatic conditions were excluded, as were reviews, editorials and comments. Where possible meta-analysis was performed using random-effect models. Twenty-six studies comprising 949,773 gout patients were included in the review. Pooled prevalence estimates were calculated for five cardiovascular diseases: myocardial infarction (2.8%; 95% confidence interval (CI)s 1.6, 5.0), heart failure (8.7%; 95% CI 2.9, 23.8), venous thromboembolism (2.1%; 95% CI 1.2, 3.4), cerebrovascular accident (4.3%; 95% CI 1.8, 9.7) and hypertension (63.9%; 95% CI 24.5, 90.6). Sixteen studies reported comparisons with non-gout controls, illustrating an increased risk in the gout group across all cardiovascular diseases. There were no identifiable reliable patterns when analysing the results by country. Cardiovascular diseases are more prevalent in patients with gout and should prompt vigilance from clinicians to the need to assess and stratify cardiovascular risk. Future research is needed to investigate the link between gout, hyperuricaemia and increased cardiovascular risk and also to establish a more thorough picture of prevalence for less common cardiovascular diseases.

Endothelial function and cardiovascular risk stratification in menopausal women

Climacteric ◽  
2010 ◽  
Vol 13 (1) ◽  
pp. 45-54 ◽  
Author(s):  
S. L. Mulvagh ◽  
T. Behrenbeck ◽  
B. A. Lahr ◽  
K. R. Bailey ◽  
T. G. Zais ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Risk Stratification ◽  
Endothelial Function ◽  
Cardiovascular Risk Stratification ◽  
Menopausal Women

scholarly journals Platelet function and cardiovascular risk in adult HIV-infected patients on HAART: a protocol for a systematic review and meta-analysis

BMJ Open ◽  
2017 ◽  
Vol 7 (12) ◽  
pp. e019468 ◽  
Author(s):  
Bongani Brian Nkambule ◽  
Zibusiso Mkandla ◽  
Tinashe Mutize ◽  
Phiwayinkosi Vusi Dludla
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Cardiovascular Risk ◽  
Platelet Activation ◽  
Meta Analysis ◽  
People Living With Hiv ◽  
Qualitative Synthesis ◽  
Cvd Risk ◽  
Increased Risk ◽  
Statistical Heterogeneity

IntroductionThe incidence of cardiovascular disease (CVD) is now at least threefold higher in HIV-infected patients as compared with the general population. Although platelet activation and reactivity are implicated in the development of CVDs in HIV-infected patients, its precise role remains inconclusive. We aim to assess the association between platelet activation and selected cardiovascular risk factors in HIV-1-infected individuals on highly active antiretroviral treatment (HAART).MethodsThis will be a systematic review and meta-analysis of published studies evaluating the association between platelet activation and CVD risk factors in HAART-treated adults. The search strategy will include medical subject headings words for MEDLINE, and this will be adapted to Embase search headings (Emtree) terms for the EMBASE database. The search will cover literature published between 1 January 1996 to 30 April 2017. Studies will be independently screened by two reviewers using predefined criteria. Relevant eligible full texts will be screened; data will be extracted, and a qualitative synthesis will be conducted. Data extraction will be performed using Review Manager V.5.3. To assess the quality and strengths of evidence across selected studies, the Grading of Recommendations Assessment Development and Evaluation approach will be used. The Cochran’s Q statistic and the I2statistics will be used to analyse statistical heterogeneity between studies. If included studies show high levels of homogeneity, a random effects meta-analysis will be performed using R statistical software.Ethics and disseminationThis will be a review of existing studies and will not require ethical approval. The findings will be disseminated through peer-reviewed publication and presented at local and international conferences. An emerging patient management dilemma is that of the increased incidence of CVD in people living with HIV on HAART. This review may inform treatment and cardiovascular risk stratification of HIV-infected patients at increased risk of developing CVD.PROSPERO registration numberCRD42017062393.

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