Dimitrios Doudesis

University of Edinburgh | UoE · Centre for Cardiovascular Science

Background Guidelines recommend N-terminal pro-B-type natriuretic peptide (NT-proBNP) thresholds for the diagnosis of acute heart failure but performance of these thresholds in different age groups is uncertain and could be improved using machine learning methods that incorporate age as a continuous measure. Purpose To evaluate the diagnostic perf...

Background Many hospitalised patients require rehabilitation during recovery from acute illness. We use routine data from Electronic Health Records (EHR) to report the quantity and intensity of rehabilitation required to achieve hospital discharge, comparing patients with and without COVID-19. Methods We performed a retrospective cohort study of c...

Background Guidelines recommend the use of risk scores to select patients for further investigation after myocardial infarction has been ruled out but their utility to identify those with coronary artery disease is uncertain. Methods In a prospective cohort study, patients with intermediate high-sensitivity cardiac troponin I concentrations (5 ng/...

Background Frailty is increasingly present in patients with acute myocardial infarction. The electronic Frailty Index (eFI) is a validated method of identifying vulnerable older patients in the community from routine primary care data. Our aim was to assess the relationship between the eFI and outcomes in older patients hospitalised with acute myoc...

Background: Guidelines recommend the use of risk scores to select patients for further investigation after myocardial infarction has been ruled out but their utility to identify those with coronary artery disease is uncertain. Methods: In a prospective cohort study, patients with intermediate high-sensitivity cardiac troponin I concentrations (5 ng...

Background Guidelines recommend the use of risk scores to select patients for further investigation after myocardial infarction has been ruled out but their utility to identify those with coronary artery disease is uncertain. Methods In a prospective cohort study, patients with intermediate high-sensitivity cardiac troponin I concentrations (5 ng/...

Importance Whether the diagnostic classifications proposed by the universal definition of myocardial infarction (MI) to identify type 1 MI due to atherothrombosis and type 2 MI due to myocardial oxygen supply-demand imbalance have been applied consistently in clinical practice is unknown. Objective To evaluate the application of the universal defi...

BACKGROUND Collaboration for the Diagnosis and Evaluation of Acute Coronary Syndrome (CoDE-ACS) is a validated clinical decision support tool that uses machine learning with or without serial cardiac troponin measurements at a flexible time point to calculate the probability of myocardial infarction (MI). How CoDE-ACS performs at different time poi...

Objective To evaluate the impact of implementing a high sensitivity assay for cardiac troponin I on long term outcomes in patients with suspected acute coronary syndrome. Design Secondary observational analysis of a stepped wedge, cluster randomised controlled trial. Setting 10 secondary and tertiary care centres in Scotland, UK. Participants 48...

Aims: Whether a single cardiac troponin measurement can safely rule out myocardial infarction in patients presenting within a few hours of symptom onset is uncertain. The study aim was to assess the performance of troponin in early presenters. Methods and results: In patients with possible myocardial infarction, the diagnostic performance of a s...

Background Many hospitalised patients require rehabilitation during recovery from acute illness. We use routine data from electronic health records (EHR) to report the quantity and intensity of rehabilitation and compared this in patients with and without COVID-19. Methods We performed a retrospective cohort study of consecutive adults in whom COVI...

Although guidelines recommend fixed cardiac troponin thresholds for the diagnosis of myocardial infarction, troponin concentrations are influenced by age, sex, comorbidities and time from symptom onset. To improve diagnosis, we developed machine learning models that integrate cardiac troponin concentrations at presentation or on serial testing with...

Background: In suspected myocardial infarction (MI), guidelines recommend using high-sensitivity cardiac troponin (hs-cTn)-based approaches. These require fixed assay-specific thresholds and timepoints, without directly integrating clinical information. Using machine-learning techniques including hs-cTn and clinical routine variables, we aimed to...

Background Important disparities in the treatment and outcomes of women and men with atrial fibrillation (AF) are well recognized. Whether introduction of direct oral anticoagulants has reduced disparities in treatment is uncertain. Methods and Results All patients who had an incident hospitalization from 2010 to 2019 with nonvalvular AF in Scotla...

Background Despite poor cardiovascular outcomes, there are no dedicated, validated risk stratification tools to guide investigation or treatment in type 2 myocardial infarction. Objectives The goal of this study was to derive and validate a risk stratification tool for the prediction of death or future myocardial infarction in patients with type 2...

Background Important disparities in the treatment and outcomes of women and men with atrial fibrillation are well recognized. Whether introduction of direct oral anticoagulants has reduced disparities in treatment is uncertain. Methods All patients who had an incident hospitalization from 2010 to 2019 with non-valvular atrial fibrillation in Scotl...

Background Implementation of a high-sensitivity cardiac troponin I assay with the sex-specific 99th centile as the diagnostic threshold identifies more patients with myocardial injury and infarction, but whether this impacts on long-term clinical outcomes is unknown. Purpose In a prespecified analysis of a stepped-wedge cluster-randomised controll...

Background High-sensitivity cardiac troponin has enabled the rapid rule-out and rule-in of myocardial infarction at presentation. However, increases in cardiac troponin may not be detectable early after symptom onset, and uncertainty remains as to how time of symptom onset influences diagnostic performance. Purpose To evaluate the impact of time f...

Background Guidelines recommend fixed cardiac troponin thresholds for the assessment of patients with suspected acute coronary syndrome, however, performance varies in important patient groups as concentrations are influenced by age, sex and comorbidities. This limitation can be addressed using machine learning algorithms. Methods Machine learning...

Background: The 99th centile of cardiac troponin, derived from a healthy reference population, is recommended as the diagnostic threshold for myocardial infarction, but troponin concentrations are strongly influenced by age. Our aim was to assess the diagnostic performance of cardiac troponin in older patients presenting with suspected myocardial...

Importance: Type 2 myocardial infarction occurs owing to multiple factors associated with myocardial oxygen supply-demand imbalance, which may confer different risks of adverse outcomes. Objective: To evaluate the prevalence and outcomes of different factors associated with oxygen supply-demand imbalance among patients with type 2 myocardial inf...

Objectives To evaluate the diagnostic performance of N-terminal pro-B-type natriuretic peptide (NT-proBNP) thresholds for acute heart failure and to develop and validate a decision support tool that combines NT-proBNP concentrations with clinical characteristics. Design Individual patient level data meta-analysis and modelling study. Setting Four...

Introduction In patients with suspected acute coronary syndrome, cardiac troponin is used to identify those at high and low risk of future cardiovascular events. The ability of high-sensitivity assays to quantify low levels of cardiac troponin has led to the development of algorithms which allow the early rule-out or rule-in of myocardial infarctio...

Background Diagnostic pathways for myocardial infarction rely on fixed troponin thresholds, which do not recognise that troponin varies by age, sex, and time within individuals. To overcome this limitation, we recently introduced a machine learning algorithm that predicts the likelihood of myocardial infarction. Our aim was to evaluate whether this...

Background Despite the growing interest in health data science education, it is not embedded in undergraduate medical curricula and little is known about best teaching practices. This paper presents a highly innovative course in a UK university that introduces undergraduate medical students to data science. It also discusses a study on student pers...

Background: Whilst the 99th percentile is the recommended diagnostic threshold for myocardial infarction (MI), some guidelines also advocate the use of higher troponin thresholds to rule-in MI at presentation. It is unclear whether the magnitude or change in troponin concentration can differentiate causes of myocardial injury and infarction in prac...

Background Patients with suspected acute coronary syndrome in whom myocardial infarction has been ruled-out are at risk of future adverse cardiac events. However, the optimal approach to risk stratify and investigate these patients is uncertain. Methods We performed a prospective cohort study of 250 patients presenting to the Emergency Department...

Background Cardiac troponin concentrations are influenced by age and comorbidities with values above the 99th centile diagnostic threshold more common in older patients without myocardial infarction. Despite this, rule-in thresholds for myocardial infarction are applied universally regardless of age or comorbidities. Purpose We sought to evaluate...

Background B-type natriuretic peptide (BNP) and mid-regional pro-atrial natriuretic peptide (MRproANP) testing are recommended to aid in the diagnosis of acute heart failure. However, the application of these biomarkers for optimal diagnostic performance is uncertain. Methods We performed a systematic review and harmonised individual patient-level...

Background Patients with suspected acute coronary syndrome in whom myocardial infarction has been excluded are at risk of future adverse cardiac events. Objectives This study evaluated the usefulness of high-sensitivity cardiac troponin I (hs-cTnI) to select patients for further investigation after myocardial infarction has been excluded. Methods...

Background: Dual antiplatelet therapy (DAPT) has important implications for clinical outcomes in coronary disease. However, the optimal DAPT duration remains uncertain. Methods and Results: We searched four major databases for randomised controlled trials comparing long-term (≥12 months) with short-term (≤6 months) or shorter (≤3 months) DAPT in p...

Background: Whilst the 99th percentile is the recommended diagnostic threshold for myocardial infarction, some guidelines also advocate the use of higher troponin thresholds to rule-in myocardial infarction at presentation. It is unclear whether the magnitude or change in troponin concentration can differentiate causes of myocardial injury and infa...

Background Accurate diagnosis in patients with suspected coronavirus disease 2019 (COVID-19) is essential to guide treatment and limit spread of the virus. The combined nasal and throat swab is used widely, but its diagnostic performance is uncertain. Methods In a prospective, multi-centre, cohort study conducted in secondary and tertiary care hos...

Introduction: Dual antiplatelet therapy (DAPT) is the cornerstone of pharmacological treatment for patients with acute coronary syndrome (ACS) and in those undergoing percutaneous coronary intervention for stable coronary disease. Despite widespread use, the optimal duration of DAPT remains uncertain. We present an updated meta-analysis comparing o...

Background 3 billion people worldwide rely on polluting fuels and technologies for domestic cooking and heating. We estimate the global, regional, and national health burden associated with exposure to household air pollution. Methods For the systematic review and meta-analysis, we systematically searched four databases for studies published from...

Introduction The myocardial-ischemic-injury-index (MI3) is a promising machine learned algorithm that predicts the likelihood of myocardial infarction in patients with suspected acute coronary syndrome. Whether this algorithm performs well in unselected patients or predicts recurrent events is unknown. Methods In an observational analysis from a m...

Background N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing can aid in the evaluation of patients with suspected acute heart failure. Current approaches are based on thresholds selected to give good negative and positive predictive value, however the optimal means to utilise NT-proBNP is uncertain. Methods Embase, Medline and Cochrane...

Background Accurate diagnosis in patients with suspected coronavirus disease 2019 (COVID-19) is essential to guide treatment and limit spread of the virus. The combined nasal and throat swab is used widely, but its diagnostic performance is uncertain. Methods In a prospective, multi-centre, cohort study conducted in secondary and tertiary care hos...

Asthma preventer medication non-adherence is strongly associated with poor asthma control. One-dimensional measures of adherence may ignore clinically important patterns of medication-taking behavior. We sought to construct a data-driven multi-dimensional typology of medication non-adherence in children with asthma. We analyzed data from an interve...