Objective: The emergence of artificial intelligence (AI) chatbots has created new opportunities. This study aims to assess how well online AI chatbots, capable to interact in multiple languages, could respond in accordance with the 2023 ESH Guidelines. Design and method: We structured 20 questions, both in English and Greek, covering issues that were included in the 2023 ESH Guidelines recommendations. The questions were fed to four free online chatbots that can interrogate questions in multiple languages. The responses were recorded and evaluated by three experienced cardiologists with special interest in hypertension. To assess consistency, each question was asked three times, though only the first response was included in the accuracy analysis. All questions were preceded by ’According to the 2023 ESH Guidelines for the management of arterial hypertension’. A response was considered ’accurate’ if it included all essential information, ’inaccurate’ if it was not in accordance with the guidelines and ’incomplete’ if any essential information was missing. Results: In total there were 160 responses recorded (80 in Greek and 80 in English). A total of 62 (38.8%) responses were deemed accurate with significant difference between the languages (30% for Greek vs 47.5% for English responses), ranging from only 2 out of 20 (10% for YOU.COM in Greek) to 13 out of 20 (65% for BARD in English). Eighty-five (53.1%) of the responses were judged as inaccurate and 13 (8.1%) as incomplete. There were two questions that got no accurate responses from any chatbot (in either language). Moreover, 138 out of the 160 regenerated responses were consistent with the initial answer (86.3%). No chatbot would have replied accurately to every question even if the regenerated responses were to be considered. Conclusions: The study resulted in a variation of accuracy of the responses generated by four popular AI chatbots when asked about issues covered in the 2023 ESH Guidelines. The observed accuracy is lower for Greek. While the use of chat-based AI in medicine is still in its early stages and current models are not intended for medical use, the potential for such technology is significant.

Objective: Diabetes and Hypertension are two of the most common conditions connected to obesity, the development of cardiovascular disease and higher mortality rates. However, the relationship of these two conditions remains unclear. Obesity is an independent risk factor for insulin resistance, a hallmark of prediabetes. The aim was to study insulin resistance in obese hypertensive patients. Design and method: 120 obese outpatients (BMI>30, 57% males) without Diabetes Mellitus (DM) when included in the study, where compared to 80 obese hypertensive patients (56% males), without DM. Homeostatic Model Assessment for Insulin Resistance Index (IR-HOMA) was used as an insulin resistance marker. Results: Hypertensive and obese patients showed a significant increase of IR-HOMA (5,17 vs 3,2 p=0,022), as well as increased fasting glucose, insulin and HBA1c levels, in contrast to obese normotensive patients. Conclusions: Hypertension may be another independent risk factor for DM in obese patients.

Abstract Background/Introduction The emergence of artificial intelligence (AI) models has created new opportunities in the medical field. The potential of AI chatbots to deliver timely, reliable medical information is one of its promising features. Purpose Our goal was to assess how well online AI chatbots could respond in accordance with the 2023 ESH Guidelines for the management of arterial hypertension. Methods We structured 20 questions covering issues that have been included in the recommendations of the 2023 ESH Guidelines. Fifteen questions required simple answers (e.g. What is the systolic blood pressure threshold for initiation of drug therapy in patients ≥80 years? Should we use cuffless blood pressure devices for the evaluation of hypertension in clinical practice?). The questions were fed to nine free online chatbots. The responses were recorded and evaluated by three experienced cardiologists with special interest in hypertension. To assess consistency, each question was asked three times, though only the first response was included in the accuracy analysis. All questions were preceded by "According to the 2023 ESH Guidelines for the management of arterial hypertension". A response was considered "accurate" if it included all essential information, "inaccurate" if it was not in accordance with the guidelines, and "incomplete" if any essential information was missing. Results In total there were 180 responses recorded. A total of 82 (45.6%) responses were deemed accurate, ranging from only 4 out of 20 (20% for deepai.org) to 16 out of 20 (80% for Google-PaLM) (see Figure). Eighty (44.4%) of the responses were judged as inaccurate and 18 (10%) as incomplete. Only one question got accurate responses from all nine chatbots and there were three questions with accurate replies from only one chatbot (different chatbot for each question). Moreover, 293 out of the 360 regenerated responses were consistent with the initial answer (81.1%). No chatbot would have replied accurately to every question even if the regenerated responses were to be considered. Conclusion(s) The study resulted in a variation in the accuracy of the responses generated by nine popular online AI chatbots when asked about issues covered in the recommendations of the 2023 ESH Guidelines on arterial hypertension. While the use of chat-based AI in medicine is still in its early stages and current models are not intended for medical use, the potential for such technology is significant. The debate is still ongoing about what level of accuracy is thought to be acceptable.

Background Data on health status outcomes after spontaneous coronary artery dissection (SCAD) are limited. Methods and findings Using the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study we compared patients with SCAD and other acute myocardial infarction (AMI) at presentation (baseline), 1-month, and-12 months using standardized health status instruments. Among 3572 AMI patients ≤ 55 years, 67 had SCAD. SCAD patients were younger (median age (IQR) 45 (40.5–51) years vs. 48 (44–52) in other AMI, p = 0.003), more often female (92.5% vs. 66.6%), have college education (73.1% vs. 51.7%) and household income >$100,000 (43.3% vs. 17.7% (All p<0.001). SCAD patients at baseline had higher mean ± SD Short Form-12 [SF-12] physical component scores [PCS] (48.7±10.2 vs. 43.8±12.1, p<0.001) and mental component scores [MCS] (49.6±12.4 vs. 45.4±12.5, p = 0.008), and at 12-months [PCS (50.1±9.0 vs. 44.3±12.3, p<0.001) and MCS (53±10.1 vs 50.2±11.0, p = 0.045)]. The Euro-Quality of Life Scale [EQ-5D] VAS and EQ-5D index scores were similar at baseline, but higher at 12-months for SCAD (EQ-5D VAS: 82.2±10.2 vs. 72.3±21.0, p<0.001; EQ-5D index scores; 90.2±15.3 vs. 83.7±19.8, p = 0.012). SCAD patients had better baseline Seattle Angina Questionnaire [SAQ] physical limitation (88.8±20.1 vs. 81.2±25.4, p = 0.017). At 12-months SCAD patients had better physical limitation (98.0±8.5 vs. 91.4±18.8, p = 0.007), angina frequency (96.4±8.8 vs. 91.3±16.8, p = 0.018) and quality of life scores (80.7±14.7 vs 72.2±23.2, p = 0.005). Magnitude of change in health status from baseline to 12-months was not statistically different between the groups. After adjustment for time and comorbidities there remained no difference in most health status outcomes. Conclusions SCAD patients fare marginally better than other AMI patients on most health status instruments and have similar 12-month health status recovery. Better pre-event health status suggests a need to modify exercise prescriptions and cardiac rehabilitation protocols to better assist this physically active population to recover.

Data on depression and stress among patients with spontaneous coronary artery dissection (SCAD) are limited. Using data from the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study, which prospectively enrolled 3,572 acute myocardial infarction (AMI) patients between 18 and 55 years of age, we identified 67 SCAD cases. We compared Patient Health Questionnaire-9 (PHQ-9) and 14-item Perceived Stress Scale (PSS-14) scores obtained at baseline, 1 month, and 12 months between SCAD and AMI of all other causes. Using longitudinal linear mixed-effects analysis, we compared depression and stress scores between SCAD and other AMI, adjusting for time and selected covariates. Patients with SCAD had lower baseline PHQ-9 scores (6.1 +/- 6.0 vs 7.7 +/- 6.4 for other patients with AMI, p = 0.03), similar 1-month scores, and lower 12-month scores (3.2 +/- 4.3 vs 4.9 +/- 5.5, p = 0.004). At baseline and 1 month, patients with SCAD had similar PSS-14 scores to those of other patients with AMI. At 12 months, patients with SCAD had lower scores (18.4 +/- 8.8 vs 21.5 +/- 9.3 for other patients with AMI, p = 0.009). After adjustment for cardiovascular risk factors, co-morbidities, and clinical acuity, no differences in PHQ-9 or PSS-14 scores remained between SCAD and other AMI. Similar results were obtained in a subgroup analysis of only women with SCAD and other AMI. In conclusion, patients with SCAD had a relatively lower burden of depression and perceived stress than other patients with AMI, potentially because of fewer co-morbidities and favorable socioeconomic factors. However, given high depression and stress burden in both SCAD and other patients with AMI, routine screening can help identify and treat these patients. (C) 2022 Elsevier Inc. All rights reserved.

Quantitative flow ratio (QFR) has been validated as an accurate surrogate of standard wire‐based fractional flow reserve. The clinical and angiographic outcomes of the Fantom sirolimus‐eluting bioresorbable coronary scaffold (BRS) have been previously studied and reported. We investigate the functional performance of the Fantom BRS.

Abstract Introduction Prophylactic use of benzodiazepine and opioids (fentanyl, morphine) is an established method for tackling radial artery spasm, in patients undergoing left cardiac catheterization procedures. Meperidine (Pethidine) is a synthetic opioid with elimination half life of 2–4 hours and duration of action of only 2–3 hours, making it ideal for in-lab administration. Purpose We aimed to test primarily the role of pethidine administration in preventing radial artery spasm and secondarily to assess patient discomfort during transradial coronary interventions. Methods This is a prospective, randomized, double blinded study. Patients were randomized to either pethidine 0,25mg administration (Group A) or normal saline (Group B) i.v. 10 minutes before the beginning of the procedure. As standard prophylactic measures against spasm, both groups received verapamil 5mg and nitroglycerin 100μg, after sheath introduction in the radial artery. Artery spasm was assessed clinically by the difficulty in advancing or exchanging catheters, as reported by the operator (CHUGH scale). A Visual Analog Scale (VAS) was used to estimate the patient-perceived discomfort, one hour after the end of the procedure. Results 66 patients were included, 42 in Group A and 24 in Group B. Mean age of the patients was 65.9 years, mean duration of the procedure was 27 minutes and 24% of patients proceeded to PTCA overall. Operators reported no problems in catheter manipulations (CHUGH 0) in 67% of patients from Group A vs 38% of pts from Group B. 64% Group A patients and 21% Group B patients reported no symptoms (VAS 0). Pethidine administration had a negative correlation with VAS (r: −0.418, p: 0.001) and CHUGH Scale (r: −0.295, p: 0.016) scores. Conclusion Pethidine low dose administration before radial artery catheterization, shows a positive trend in preventing spasm and reducing procedure-related patient discomfort. Larger studies are required to evaluate the role of pethidine as an alternative prophylactic measure against artery spasm in transradial cardiac interventions. Funding Acknowledgement Type of funding sources: None.

Drug-eluting stents have become the mainstay of percutaneous coronary interventions, but late and very late stent thrombosis remain a concern. Drug-coated balloons (DCBs) have the advantage of preserving the antirestenotic benefits of drug-eluting stents while minimizing potential long-term safety

The determination of a coronary stenosis and its severity in current clinical workflow is typically accomplished manually via physician visual assessment (PVA) during invasive coronary angiography. While PVA has shown large inter-rater variability, the more reliable and accurate alternative of Quantitative Coronary Angiography (QCA) is challenging to perform in real-time due to the busy workflow in cardiac catheterization laboratories. We propose a deep learning approach based on Convolutional Neural Networks (CNN) that automatically characterizes and analyzes coronary stenoses in real-time by automating clinical tasks performed during QCA. Our deep learning methods for localization, segmentation and classification of stenosis in still-frame invasive coronary angiography (ICA) images of the right coronary artery (RCA) achieve performance of 72.7% localization accuracy, 0.704 dice coefficient and 0.825 C-statistic in each respective task. Integrated in an end-to-end approach, our model's performance shows statistically significant improvement in false discovery rate over the current standard in real-time clinical stenosis assessment, PVA. To the best of the authors' knowledge, this is the first time an automated machine learning system has been developed that can implement tasks performed in QCA, and the first time an automated machine learning system has demonstrated significant improvement over the current clinical standard for rapid RCA stenosis analysis.

Importance Although physician visual assessment (PVA) of stenosis severity is a standard clinical practice to support decisions for coronary revascularization, there are concerns about its accuracy. Objective To compare PVA with quantitative coronary angiography (QCA) as a means of assessing stenosis severity among patients undergoing percutaneous coronary intervention (PCI) in China. Design, Setting, and Participants A cross-sectional study (2012-2013) of a random subset of 1295 patients from the China Patient-centered Evaluative Assessment of Cardiac Events (PEACE) Prospective PCI Study was carried out. The PEACE Prospective PCI study recruited a consecutive sample of patients undergoing PCI at 35 hospitals in 18 provinces of China. The coronary angiograms of this subset of participants were reviewed using QCA by 2 independent core laboratories blinded to PVA readings. Main Outcomes and Measures Differences between PVA and QCA assessments of stenosis severity for lesions for which PCI was performed and variation of these differences among hospitals and physicians, stratified by the diagnosis of acute myocardial infarction (AMI). Results In patients without AMI, the mean (SD) age was 62 (10) years, and 217 (31.5%) were women; in patients with AMI, the mean (SD) age was 60 (11) years, and 153 (25.2%) were women. The mean (SD) percent diameter stenosis by PVA was 16.0% (11.5%) greater than that by QCA in patients without AMI and 10.2% (12.3%) in those with AMI (P < .001 for both comparisons). In patients without AMI, of 837 lesions with 70% or more stenosis by PVA, 427 (50.6%) were less than 70% by QCA; in patients with AMI, similar patterns were observed to a lesser extent. Among patients without AMI, only 4 (0.47%) lesions were additionally assessed with fractional flow reserve. Among 30 hospitals, the difference between PVA and QCA readings of stenosis severity varied from 7.6% (95% CI, 0.4%-14.7%) to 21.3% (95% CI, 17.1%-24.9%) among non-AMI patients. Across 57 physicians, this difference varied from 6.9% (95% CI, −1.4%-15.3%) to 26.4% (95% CI, 21.5%-31.4%). Conclusions and Relevance For coronary lesions treated with PCI in China, PVA reported substantially higher readings of stenosis severity than QCA, with large variation across hospitals and physicians. These findings highlight the need to improve the accuracy of information used to guide treatment decisions in catheterization laboratories.

AIMSThe aim of this registry was to monitor practice patterns and outcomes in patients treated with Absorb bioresorbable vascular scaffolds (BVS) during the early phase of usage in the UK.METHODS AND RESULTSA total of 1,005 patients with de novo coronary lesions were treated using careful implantation techniques at 24 centres. Follow-up at one year was obtained in 99%. An independent clinical events committee and angiographic core lab adjudicated all events. Patient age was 52 years and 46% presented with acute coronary syndromes. Lesion complexity was B2/C in 47.4%, with an average of 1.4±0.6 BVS implanted and a BVS length of 28±14.3 mm. A single BVS was implanted in 71.3%. High pressure post-dilatation was performed in 94.9%, with 50% using intravascular imaging. Device success was achieved in 98.7% and procedure success in 97.3% of patients. At one year, the device-oriented endpoint target lesion failure was 3.2%, and the patient-oriented endpoint major adverse cardiac events was 3.4%. Definite ST occurred in 1.4%. By multivariable analysis, scaffold size of 2.5 mm predicted ST at one year (OR 3.27, 95% CI: 1.28-8.37; p=0.014).CONCLUSIONSWith careful patient selection and technique, TLF rates following BVS implantation in real-world practice are comparable with contemporary drug-eluting stents. ST rates remain high, with small vessel size identified as a contributory factor.

Fully bioresorbable coronary scaffolds are designed to overcome the limitations of metallic stents. Potential benefits include restoration of endothelial function and vasomotion, complete resorption over time and no side branch jailing. The sirolimus-eluting bioresorbable FANTOM scaffold is visible

Drug eluting stents (DES) have become the mainstay of percutaneous coronary interventions (PCI). However, late and very late stent thrombosis remain a concern. We investigate whether the Paclitaxel Drug-Coated Chocolate Heart Balloon (DCB) is a safe and effective alternative to DES in the treatment

Inherited cardiomyopathies are a known cause of heart failure, although the pathways and mechanisms leading from mutation to the heart failure phenotype have not been elucidated. There is strong evidence that this transition is mediated, at least in part, by abnormal intracellular Ca2+ handling, a key ion in ventricular excitation, contraction and relaxation. Studies in human myocytes, animal models and in vitro reconstituted contractile protein complexes have shown consistent correlations between Ca2+ sensitivity and cardiomyopathy phenotype, irrespective of the causal mutation. In this review we present the available data about the connection between mutations linked to familial hypertrophic (HCM), dilated (DCM) and restrictive (RCM) cardiomyopathy, right ventricular arrhythmogenic cardiomyopathy/dysplasia (ARVC/D) as well as left ventricular non-compaction and the increase or decrease in Ca2+ sensitivity, together with the results of attempts to reverse the manifestation of heart failure by manipulating Ca2+ homeostasis.

Lesion length has been an important factor in predicting a worse outcome after percutaneous coronary interventions (PCI); however, the safety and efficacy of second‐generation drug eluting stents in very long coronary lesions has not been validated in large scale randomized controlled trials.