Heart attack symptoms are sometimes similar to non-heart-related conditions, making diagnosis tricky. UK researchers have turned to machine learning to provide doctors with a fast and accurate way of diagnosing heart attacks that has the potential to shorten the time needed to make a diagnosis and provide more efficient and effective treatment to patients.

Currently, the gold-star method for diagnosing a heart attack is to measure levels of the protein troponin in the blood. Troponin is released when the heart muscle is damaged; levels usually increase sharply within three to 12 hours after a heart attack, peaking after about 24 hours. Many hospitals worldwide have adopted diagnostic pathways that include assessing troponin levels when someone is admitted with a suspected heart attack. But they have some limitations: they require the fixed-time collection of blood samples which can be a challenge in the emergency department setting; they only categorize patients as being a low, intermediate or high risk of a heart attack without considering other important information such as when the symptoms began or electrocardiogram (ECG) findings; and, they don’t take into account the influence of sex, age and comorbidities.

Now UK researchers have developed an AI-based machine learning algorithm that is fast and accurate. Named the Collaboration for the Diagnosis and Evaluation of Acute Coronary Syndrome (CoDE-ACS), the algorithm was designed to calculate the probability of a heart attack for an individual patient. The researchers used data from 10,286 patients who presented with possible heart attacks across six countries worldwide. The machine learning algorithm was “taught” using the patient’s sex, age, ECG findings and medical history, in addition to troponin levels, to identify the probability that a heart attack had occurred. Compared to existing methods, the researchers found that CoDE-ACS could rule out a heart attack in more than double the number of patients, with an accuracy of 99.6%.

The researchers say that their CoDE-ACS algorithm could prevent unnecessary hospital admissions in patients unlikely to have had a heart attack or those at low risk of suffering heart muscle damage or death following a heart attack. They say this would make emergency treatment more efficient and effective, identifying which patients are safe to go home and which need to stay for further tests.

“For patients with acute chest pain due to a heart attack, early diagnosis and treatment saves lives,” said Nicholas Mills, corresponding author of the study. “Unfortunately, many conditions cause these common symptoms, and the diagnosis is not always straightforward. Harnessing data and artificial intelligence to support clinical decisions has enormous potential to improve care for patients and efficiency in our busy Emergency Departments.”

Source: https://newatlas.com/

Researchers from Sanford Burnham Prebys have discovered a group of proteins that could be key for cellular reprogramming, a growing topic in regenerative medicine. So far, scientists have been using the technology to repair damaged or injured body tissues. In this study, the scientists successfully reprogrammed damaged heart cells to repair heart injuries in mice after a heart attack. The findings could be pivotal for treating not just heart diseases, but Parkinson’s and neuromuscular diseases as well.

“Even if a person survives a heart attack, there could still be long-term damage to the heart that increases the risk of heart problems down the line,” says lead author Alexandre Colas, Ph.D., an assistant professor in the Development, Aging and Regeneration Program at Sanford Burnham Prebys, in a media release. “Helping the heart heal after injury is an important medical need in its own right, but these findings also pave the way for wider applications of cell reprogramming in medicine.”

The four proteins identified are called AJSZ, and they help address the barriers to reprogramming. The team was able to block the proteins, lessening scarring, and leading to an improvement in overall heart function by 50 percent. Even though these findings are relative to heart cells, the researchers say that the proteins are universal to all cell types. “This is helping us solve a very big problem that a lot of researchers are interested in,” says Colas. “Even more important, this breakthrough is a significant step forward on our way to turning these promising biological concepts into real treatments.”

In the near future, the team hopes to take this great discovery and start applying it to real-life patients by identifying different ways to block AJSZ function swiftly and effectively. The best option right now is using a small molecule drug to do so, Colas explains. “We need to find a way to inhibit these proteins in a way we can control to make sure we are only reprogramming the cells that need it,” the researcher concludes. “We will be screening for drugs that can help us inhibit these proteins in a controlled and selective manner in the coming months.”

Source: https://www.sbpdiscovery.org/

A simple eye test that predicts death from cardiovascular disease has been developed by British scientists. It combines artificial intelligence (AI) with scans of the retina – a membrane at the back of peepers that contains light sensitive cells. The technique could lead to a screening programme – enabling drugs and lifestyle changes to be prescribed decades before symptoms emerge. Lead author Professor Alicja Regina Rudnicka, of St George’s University of London, said the test is inexpensive, accessible and non-invasive. People at risk of stroke, heart attack and other circulatory conditions could undergo RV (artificial intelligence enabled retinal vasculometry) during routine visits to the optician.

Prof Rudnicka said: “It has the potential for reaching a higher proportion of the population in the community because of ‘high street’ availability. “RV offers an alternative predictive biomarker to traditional risk-scores for vascular health – without the need for blood sampling or blood pressure measurement. “It is highly likely to help prolong disease-free status in an ever-aging population with increasing comorbidities, and assist with minimising healthcare costs associated with lifelong vascular diseases.”

An algorithm called QUARTZ was developed based on retinal images from tens of thousands of Britons aged 40 to 69. It focused on the width, area and curvature, or tortuosity, of tiny blood vessels called arterioles and venules. The performance of QUARTZ was compared with the widely used Framingham Risk Scores framework – both separately and jointly.

The health of all the participants was tracked for an average of seven to nine years, during which time there were 327 and 201 circulatory disease deaths among 64,144 UK Biobank and 5,862 EPIC-Norfolk participants respectively. In men, arteriolar and venular width, tortuosity, and width variation emerged as important predictors of death from circulatory disease. In women, arteriolar and venular area and width and venular tortuosity and width variation contributed to risk prediction.

The predictive impact of retinal vasculature on circulatory disease death interacted with smoking, drugs to treat high blood pressure, and previous heart attacks. Overall, these predictive models, based on age, smoking, medical history and retinal vasculature, captured between half and two-thirds of circulatory disease deaths in those most at risk.

Source: https://www.mirror.co.uk/

King’s College London researchers are turning to the same technology behind the mRNA COVID-19 vaccines to develop the first damage-reversing heart attack cure. They used mRNA to deliver the genetic instructions for specific proteins to damaged pig hearts, sparking the growth of new cardiac muscle cells. “The new cells would replace the dead ones and instead of forming a scar, the patient has new muscle tissue,” lead researcher Mauro Giacca said. Researchers are turning to the same technology behind Pfizer and Moderna’s vaccines to develop the first damage-reversing heart attack cure.

Diseases of the heart are the leading cause of death around the world; the WHO estimates that 17.9 million people died from cardiovascular disease in 2019, representing almost a third of all deaths. Of those, 85% are ultimately killed by heart attacks and strokes. Heart attacks occur when blood flow to parts of the heart is blocked, often due to fat or cholesterol build up. The cardiac muscle cells — marvelous little powerhouses that keep you beating throughout your entire life — are starved of oxygen and can be damaged or killed. Left in its wake is not the smoothly pumping cardiac muscle, but instead scar tissue.

“We are all born with a set number of muscle cells in our heart and they are exactly the same ones we will die with. The heart has no capacity to repair itself after a heart attack,” explained Giacca.

At least, until now. To develop their heart attack cure, the researchers turned to mRNA, which delivers the instructions for protein creation to cells. Whereas the Pfizer and Moderna vaccines instruct cells to make the spike protein of SARS-CoV-2, priming the immune system against the virus, the same technology can deliver a potential heart attack cure by carrying the code for proteins that stimulate the growth of new heart cells, PharmaTimes reported. In an experiment with pigs (a close match for the human heart), the mRNA treatment stimulated new heart cells to grow after a heart attack — regenerating the damaged tissues and creating new, functional muscle rather than a scar.

According to BioSpace, harnessing mRNA in this way has been dubbed “genetic tracking,” named for the way the mRNA’s progress is tracked via the new proteins it is creating. The technique is being explored to create vaccines for pathogens like HIV, Ebola, and malaria, as well as cancers and autoimmune and genetic diseases. While thus far their heart attack cure has only been successfully tested in porcine pumpers, the team hopes to begin human clinical trials within the next couple years. “Regenerating a damaged human heart has been a dream until a few years ago,” Giacca said, “but can now become a reality.”

Source: https://www.freethink.com/

Researchers at Mount Sinai have created a new artificial intelligence algorithm that can identify slight changes within the heart and accurately predict an incoming heart attack symptoms or heart failure. The AI algorithm could learn how to identify subtle changes in electrocardiograms (also known as ECGs or EKGs) to predict whether a patient was experiencing heart failure.

Researchers implemented natural language processing programs to help the computer extract data from the written reports and enabling it to read over 700,000 electrocardiograms and echocardiogram reports obtained from 150,000 Mount Sinai Health System patients from 2003 to 2020. Data from four hospitals was used to train the computer, whereas data from a fifth one was used to test how the algorithm would perform in a different experimental setting.

“We showed that deep-learning algorithms can recognize blood pumping problems on both sides of the heart from ECG waveform data,” said Benjamin S. Glicksberg, PhD, Assistant Professor of Genetics and Genomic Sciences, a member of the Hasso Plattner Institute for Digital Health at Mount Sinai, and a senior author of the study published in the Journal of the American College of Cardiology: Cardiovascular Imaging. “Ordinarily, diagnosing these type of heart conditions requires expensive and time-consuming procedures. We hope that this algorithm will enable quicker diagnosis of heart failure.”

“However, recent breakthroughs in artificial intelligence suggest that electrocardiograms—a widely used electrical recording device—could be a fast and readily available alternative in these cases. For instance, many studies have shown how a “deep-learning” algorithm can detect weakness in the heart’s left ventricle, which pushes freshly oxygenated blood out to the rest of the body. In this study, the researchers described the development of an algorithm that not only assessed the strength of the left ventricle but also the right ventricle, which takes deoxygenated blood streaming in from the body and pumps it to the lungs.”

A cheap, single pill taken once a day that combines four common drugs is safe and reduces the risk of events such as heart attacks, strokes and sudden death in people over the age of 50, research has found. The study, the first large-scale trial to date, looked at the effectiveness of a so-called polypill – a four-in-one therapy containing drugs to lower cholesterol and blood pressure that was first proposed more than 15 years ago. The researchers found those taking the polypill had a more than 30% lower risk of serious heart problems than those just offered advice.

While different formulations have been studied, previous trials have only been conducted in small groups of people and over short periods of time. These studies have primarily looked at the impacts of cholesterol on blood pressure, relying on models to predict the impact on cardiovascular events such as strokes – meaning the full potential of the polypill has remained unclear. The latest study tackled both of these problems.

“There has been a lot of talk about using this simple, fixed-dose combination drug for prevention of cardiovascular disease and I think we have shown that as a strategy it can work,” said Prof Tom Marshall, a co-author of the study from the University of Birmingham, adding that the pills might cost as little as a few pence per day. The new study involved more than 6,800 participants aged 50-75 from rural Iran – an area where almost 34% of premature deaths are down to coronary heart disease, and 14% are caused by strokes.

Writing in the Lancet, researchers from the UK, US and Iran reported that 3,417 people were given only minimum care, such as help with controlling blood pressure or cholesterol if needed, as well as lifestyle advice on topics such as diet, exercise and smoking. A similar number of people were, in addition to this, also given the polypill. More than 90% of those involved in the study did not have cardiovascular disease at the outset. Participants were followed up for five years. Over that time, 202 people taking the polypill had a major cardiovascular event, such as heart attack, heart failure, or stroke, compared with 301 in the “advice” group.

The authors say that translated as a 34% lower risk of having such an event, compared with the “advice” group, once factors including age, sex, diabetes and high blood pressure were taken into account.

There were also signs that, at least early on, the polypill reduced some aspects of high blood pressure, while it also led to a small fall in “bad” cholesterol. Both groups showed similar low levels of problematic events including internal bleeding and peptic ulcers. Overall, the results suggested that two major cardiovascular events would be avoided for every 69 people taking the tablet for 5 years. The polypill includes aspirin, which the team acknowledge is controversial as it can increase the risk of bleeding: the latest trial did not include people who were at high risk of such problems.

Source: https://www.theguardian.com/

A new drug-delivery technology which uses red blood cells (RBCs) to shuttle nano-scale drug carriers, called RBC-hitchhiking (RH), has been found in animal models to dramatically increase the concentration of drugs ferried precisely to selected organs, according to a study published in Nature Communications this month by researchers from the Perelman School of Medicine at the University of Pennsylvania. This proof-of-principle study points to ways to improve drug delivery for some of the nation’s biggest killers, such as acute lung disease, stroke, and heart attack.

“The vast majority of drugs fail because they spread throughout the body, landing in nearby organs where they can cause intolerable side effects, as opposed to directly targeting the areas that are really in need,” said first author Jake Brenner, MD, PhD, an assistant professor of Pulmonary Medicine and Critical Care and of Pharmacology. “By massively increasing the drug concentrations that are hitting specific tissues, the RBC hitchhikers should decrease potential side effects and improve the efficacy of drugs delivered to target organs.”

The team showed that RH can safely transport nano-scale carriers of drugs to chosen organs by targeted placement of intravascular catheters, in mice, pigs, and in ex vivo human lungs, without causing RBC or organ toxicities.

“Red blood cells are a particularly attractive carrier due to their biocompatibility and known safety in transfusions,” said senior author Vladimir Muzykantov, MD, PhD, a professor of Systems Pharmacology and Translational Therapeutics. “In just a few short years since we began this work, we are now on the brink of mapping out ways to test it in clinical trials.”

The researchers found that RH drug carriers injected intravenously increased drug uptake by about 40-fold in the lungs compared to absorption of freely circulating drug carriers in blood. In addition, injecting the RH drug carriers into the carotid artery (a major blood vessel in the neck that delivers blood to the brain, neck, and face) delivers 10 percent of the injected dose to the brain, which is about 10 times higher than what is achieved through older methods such using antibodies to guide drugs to their intended targets. Such impressive drug delivery to the brain could be used to treat acute strokes, the fourth leading cause of death in the U.S.

Development of RH technology has also revealed a potentially fundamental process that hold enormous clinical promise. “The body’s largest surface area of cell-to-cell interaction is observed between red blood cells and blood vessel linings, so it is intriguing to think that our RH technology has uncovered a phenomenon in which RBCs naturally transport cargo on their surfaces,” said Muzykantov.

Source: https://www.pennmedicine.org/