Cardiovascular System Commons^™

A 12-Lead Ecg Database To Identify Origins Of Idiopathic Ventricular Arrhythmia Containing 334 Patients, Jianwei Zhang, Guohua Fu, Kyle Anderson, Huimin Chu, Cyril Rakovski

Mathematics, Physics, and Computer Science Faculty Articles and Research

Cardiac catheter ablation has shown the effectiveness of treating the idiopathic premature ventricular complex and ventricular tachycardia. As the most important prerequisite for successful therapy, criteria based on analysis of 12-lead ECGs are employed to reliably speculate the locations of idiopathic ventricular arrhythmia before a subsequent catheter ablation procedure. Among these possible locations, right ventricular outflow tract and left outflow tract are the major ones. We created a new 12-lead ECG database under the auspices of Chapman University and Ningbo First Hospital of Zhejiang University that aims to provide high quality data enabling detection of the distinctions between idiopathic ventricular …

Follow Up Care For Heart Failure Patients And Association With Hospital Readmission, Supraja Thunuguntla, Michael Machiorlatti, Sonya Rivera, Juan Cortinas Galvan, Jose Campo Maldonado

School of Medicine Publications

Background:

The CDC reports 6.5 million adults in the US have Heart failure (HF) with yearly costs topping 30 billion. HF patients admitted to Valley Baptist (VB) are readmitted 26% of the time, which is close to the national average of 23% [1]. Standard of care for HF patients is remote nursing care for 30 days from discharge. A hospitalization for any reason within 30 days is considered a “readmission”. On October 1, 2019 at VB remote nursing care changed from weekly house visits to weekly phone calls. The aim of the study is to evaluate the effectiveness of this …

Predicting Bleeding And Thrombosis Complications In Patients With Continuous Flow Left Ventricular Assist Devices, Kyle Zacholski, William Kuan, Justin Mccann Mccann, Aric Schadler, Aaron Cook, Sara Parli, Adam Sieg

The VAD Journal

Background: Left ventricular assist device (LVAD) therapy has been proven to relieve heart failure symptoms and improve survival, but is not devoid of bleeding and/or thrombotic complications. Risk stratification tools have been utilized in other cardiovascular disease populations to estimate the risk of bleeding and thrombosis with and without anticoagulation, including the HAS-BLED, HEMORR₂HAGES, CHADS₂ and CHA₂DS₂-VASc models. The study objective was to evaluate the predictive value of available risk models for bleeding and thrombotic complications in patients with an LVAD within one year of implantation.

Methods: This was a retrospective, single-center analysis …

Syllabus For Clinical Exercise Physiology (Kine 4700), Phillip Drouet

Q2S Enhancing Pedagogy

The syllabus has newly developed learning objectives that will prepare students entering the field of clinical exercise physiology. This course will cover the etiology and pathophysiology of many chronic diseases that plague the population. Assessments of chronic diseases include but are not limited to understanding symptomology will also be covered. Due to the limitations in time the most prevalent chronic disease will be covered and students will have to present on a disease that was not presented in class. The practical application portion of this course will take place during a lab section. Here students will have the opportunity to …

Optimal Multi-Stage Arrhythmia Classification Approach, Jianwei Zhang, Huimin Chu, Daniele Struppa, Jianming Zhang, Sir Magdi Yacoub, Hesham El-Askary, Anthony Chang, Louis Ehwerhemuepha, Islam Abudayyeh, Alexander Barrett, Guohua Fu, Hai Yao, Dongbo Li, Hangyuan Guo, Cyril Rakovski

Mathematics, Physics, and Computer Science Faculty Articles and Research

Arrhythmia constitutes a problem with the rate or rhythm of the heartbeat, and an early diagnosis is essential for the timely inception of successful treatment. We have jointly optimized the entire multi-stage arrhythmia classification scheme based on 12-lead surface ECGs that attains the accuracy performance level of professional cardiologists. The new approach is comprised of a three-step noise reduction stage, a novel feature extraction method and an optimal classification model with finely tuned hyperparameters. We carried out an exhaustive study comparing thousands of competing classification algorithms that were trained on our proprietary, large and expertly labeled dataset consisting of 12-lead …

Steps-T Program Improves Endovascular Treatment Outcomes Of Acute Ischemic Stroke; A 6-Year Study, Ameer E. Hassan, Rani R. Rabah, Laurie Preston, Wondwossen G. Tekle

School of Medicine Publications

Background: Early endovascular recanalization of occluded vessels in acute ischemic stroke (AIS) is a major contributor to good clinical outcome. We report the analysis of all AIS patients throughout a 6-year experience following the deployment of a quality initiative aiming at improving care, speed and maintaining quality for AIS treatment.

Methods: Using a prospectively collected endovascular database at a comprehensive stroke center between 2012 and 2017, workflow/outcomes were recorded. There were no exclusion criteria. During the first year, a quality program employing “digital-object” technology, staff education, and workflow improvement was implemented to reduce time-to-treatment. Using electronic recording, workflow times were …

A 12-Lead Electrocardiogram Database For Arrhythmia Research Covering More Than 10,000 Patients, Jianwei Zhang, Jianming Zhang, Sidy Daniako, Hai Yao, Hangyuan Guo, Cyril Rakovski

Mathematics, Physics, and Computer Science Faculty Articles and Research

This newly inaugurated research database for 12-lead electrocardiogram signals was created under the auspices of Chapman University and Shaoxing People’s Hospital (Shaoxing Hospital Zhejiang University School of Medicine) and aims to enable the scientific community in conducting new studies on arrhythmia and other cardiovascular conditions. Certain types of arrhythmias, such as atrial fibrillation, have a pronounced negative impact on public health, quality of life, and medical expenditures. As a non-invasive test, long term ECG monitoring is a major and vital diagnostic tool for detecting these conditions. This practice, however, generates large amounts of data, the analysis of which requires considerable …

Left Ventricular Strains During Late Filling In A Preclinical Model, Saar Peles

Honors Undergraduate Theses

Understanding the mechanisms governing left ventricular function and dysfunction is critical to analyze cardiovascular disorders and gaining insights into possible therapies. Left ventricular function can be evaluated using Magnetic Resonance Imaging (MRI). Cardiac displacements and corresponding strains are then computed from the imaging data. In measuring and assessing the left ventricle’s motion, images are taken either in the short axis (top-down) or long axis (side) views. In this project, we will use DENSE MRI data, which measures the displacements of individual tissue voxels during the cardiac cycle.

After extracting the myocardial tissue by segmenting the MR images, strains are computed …

Effects Of A Strength Training Intervention And Quality Of Life: Case Study On A Sedentary Adult Female, Lucas Frazier

Williams Honors College, Honors Research Projects

The purpose of the project is to evaluate physiological and quality of life changes in a

sedentary, senior-aged (55 or older) female using a six-week strength training

intervention. This case study will instruct how to perform a push-pull-legs split

routine by going to the gym three times per week. Prior to the six week intervention,

both quantitative and qualitative variables will be collected to assess baseline data,

including the subject’s resting heart rate, resting blood pressure, grip strength, one-

repetition maximum on seven whole body exercises (dumbbell bicep curl, tricep

pushdown, barbell bench press, wide-grip lat pull-down, seated dumbbell press, …

Enhancement Of The Syncardia Total Artificial Heart For Pediatric Use, Margaret Clark, Madison Marks

Williams Honors College, Honors Research Projects

Pediatric patients with disorders and diseases of the heart have limited options with regards to implantable devices. Many of these implants are ventricular assist devices, which is not always suitable for a patient. Total artificial hearts (TAHs) have supported many adult patients until transplantation, and we believe that they could do the same for pediatric patients. SynCardia has the only Food and Drug Administration (FDA) approved TAH devices. Since SynCardia is the only company with FDA approved TAHs, we decided to modify the design of the SynCardia TAH for use in pediatric patients without compromising the function of the current …

Individualizing Patient Care During Percutaneous Coronary Intervention To Reduce Operator Risk Adjusted Bleeding Rates: A Pre/Post Interventional Study, Sarah Brown

DNP Projects

OBJECTIVE: It is well documented that the most common problems associated with diagnostic and interventional angiography are major bleeding and vascular complications. While previous research and the American College of Cardiology (ACC) recommend the use of bleeding risk stratification tools, there is little evidence related to the use of bleeding avoidance strategies in the high-risk for bleeding population. This study aims to determine if individualizing access site and anticoagulation strategies based on bleeding risk stratification would positively impact NCDR Risk-Adjusted Bleeding Rates.

METHODS: This was a single-center pilot study utilizing retrospective chart reviews with pre/post design. Data was collected on …

Bioenergetic Functions In Subpopulations Of Heart Mitochondria Are Preserved In A Non-Obese Type 2 Diabetes Rat Model (Goto-Kakizaki), Nicola Lai, C. M. Kummitha, F. Loy, R. Isola, C. L. Hoppel

Electrical & Computer Engineering Faculty Publications

A distinct bioenergetic impairment of heart mitochondrial subpopulations in diabetic cardiomyopathy is associated with obesity; however, many type 2 diabetic (T2DM) patients with high-risk for cardiovascular disease are not obese. In the absence of obesity, it is unclear whether bioenergetic function in the subpopulations of mitochondria is affected in heart with T2DM. To address this issue, a rat model of non-obese T2DM was used to study heart mitochondrial energy metabolism, measuring bioenergetics and enzyme activities of the electron transport chain (ETC). Oxidative phosphorylation in the presence of substrates for ETC and ETC activities in both populations of heart mitochondria in …

Endothelial Iqgap1 Regulates Leukocyte Transmigration By Directing The Lbrc To The Site Of Diapedesis, David P. Sullivan, Prarthana J. Dalal, Fanny Jaulin, David B. Sacks, Geri Kreitzer, William A. Muller

Publications and Research

Transendothelial migration (TEM) of leukocytes across the endothelium is critical for inflammation. In the endothelium, TEM requires the coordination of membrane movements and cytoskeletal interactions, including, prominently, recruitment of the lateral border recycling compartment (LBRC). The scaffold protein IQGAP1 was recently identified in a screen for LBRC-interacting proteins. Knockdown of endothelial IQGAP1 disrupted the directed movement of the LBRC and substantially reduced leukocyte TEM. Expression of truncated IQGAP1 constructs demonstrated that the calponin homology domain is required for IQGAP1 localization to endothelial borders and that the IQ domain, on the same IQGAP1 polypeptide, is required for its function in TEM. …

There Is No Association Between The Number Of Stent Retriever Passes And The Incidence Of Hemorrhagic Transformation For Patients Undergoing Mechanical Thrombectomy, Ameer E. Hassan, Hari Kotta, Umar Shariff, Laurie Preston, Wondwossen G. Tekle, Adnan Qureshi

School of Medicine Publications

Background: Previous research has focused on the association between hemorrhagic transformation (HT) incidence and pre-procedural variables (i.e., baseline variables) rather than the association between HT incidence and endovascular treatment (EVT) procedural variables (e.g., stent retriever passes).

Objective: To assess the association, if any, that exists between the number of stent retriever passes per procedure and the incidence of HT for patients undergoing mechanical thrombectomy.

Methods: An endovascular database from a comprehensive stroke center was used to collect data on EVT patients treated with Trevo, Solitaire, or Penumbra stent retrievers from the years 2012 to 2017. Statistical analyses were conducted on …

The Late Stage Of Copi Vesicle Fission Requires Shorter Forms Of Phosphatidic Acid And Diacylglycerol, Seung-Yeol Park, Jia-Shu Yang, Zhen Li, Pan Deng, Xiaohong Zhu, David Young, Maria Ericsson, Ruben L. H. Andringa, Adriaan J. Minnaard, Chunmei Zhu, Fei Sun, D. Branch Moody, Andrew J. Morris, Jun Fan, Victor W. Hsu

Internal Medicine Faculty Publications

Studies on vesicle formation by the Coat Protein I (COPI) complex have contributed to a basic understanding of how vesicular transport is initiated. Phosphatidic acid (PA) and diacylglycerol (DAG) have been found previously to be required for the fission stage of COPI vesicle formation. Here, we find that PA with varying lipid geometry can all promote early fission, but only PA with shortened acyl chains promotes late fission. Moreover, diacylglycerol (DAG) acts after PA in late fission, with this role of DAG also requiring shorter acyl chains. Further highlighting the importance of the short-chain lipid geometry for late fission, we …

Evaluating The Epidemiology And Management Of Bovine Congestive Heart Failure, Adam Bassett

School of Veterinary and Biomedical Sciences: Dissertations, Theses, and Student Research

A form of congestive heart failure is increasingly reported as a cause of death in feedlot cattle located at moderate altitude (≤ 1,524 m.). Significant knowledge gaps exist in the epidemiology and management of this form of bovine congestive heart failure (BCHF) regarding frequency and timing of BCHF cases and ways in which beef cattle producers and veterinarians can mitigate this condition. These knowledge gaps present major barriers to understanding the mechanism of BCHF and mitigating the consequences of BCHF. The purpose of this thesis is to summarize current knowledge about BCHF, define gaps in knowledge for which more research …

Analyzing The Structural Properties Of Pulmonary Arterial Networks, Megan J. Chambers

Biology and Medicine Through Mathematics Conference

No abstract provided.

Atypical Presentation Of Stemi With Cardiac Tamponade Related To Malignancy, Matthew J. Johnson, Rohan Penmetcha

Rowan-Virtua Research Day

Cardiac tamponade and myocardial infarction are rare as the initial presentation of a malignancy. Here, we describe a case with an atypical presentation of a myocardial infarction due to a thrombus in the right coronary artery occurring in the setting of a pericardial effusion causing tamponade physiology related to malignancy. We present this unique case of myocardial infarction and cardiac tamponade as this was not caused by a type-A aortic dissection. In conclusion, we suggest that malignancy be considered in the differential diagnosis when these findings present together.

Using Peripheral Venous Pressure Waveforms To Predict Key Hemodynamic Parameters, Ali Zohair A Alalawi

Graduate Theses and Dissertations

Analysis of peripheral venous pressure (PVP) waveforms is a novel method of monitoring intravascular volume. Two cohorts were used to study the hemodynamics change of the body state and its influence on the PVP using (1) dehydration setting with infants suffering from pyloric stenosis and (2) hemorrhage setting during a craniosynostosis elective surgery. The goal of this research is to develop a minimally invasive method of analyzing the PVP waveforms and find correlations with volume loss.

Twenty-three pyloric stenosis patients PVP were acquired at five stages and were divided into euvolemic, normal fluid volume, and hypovolemic, significant fluid loss. Seven …

A Perfusion Decellularization Heart Model - An Interesting Tool For Cell-Matrix Interaction Studies, Mihai Meșină, Ion Mîndrilă, Cristian Mesina, Cosmin Vasile Obleagă, Octavian Istrătoaie

Journal of Mind and Medical Sciences

Objective. In this paper, we present a technique for whole human, pig, or rat heart decellularization in order to obtain a tool for cell-matrix interaction studies and to obtain the extracellular matrix scaffold with applications to the study of cardiac connective tissue architecture for tissue bioengineering.

Material and methods. In order to achieve tissue decellularization we present two separate protocols, the first for large animal hearts (e.g., pig hearts) and human hearts, the second for smaller hearts (e.g., rat hearts). We have performed the cardiac decellularization technique on 20 pig hearts, 5 human hearts, and 20 rat hearts.

Results. The …

An Anatomical And Functional Analysis Of Digital Arteries, Katie Highsmith

Student Scholar Showcase

Blood flow to the tissue of the hands and digits is efficiently regulated by vasoconstriction and vasodilation. Through a series of cadaveric dissection, we examined arteries in the hands and digits, including ulnar artery, radial artery, palmar arteries, and digital arteries, for their distribution (branching) patterns and morphological parameters (e.g., thickness, length between branches, external and internal diameters). Using data directly collected from three female cadavers as input variables to our mathematical model, we simulated vasoconstriction (-20% and -10% diameter) and vasodilation (+10% and +20 diameter) to evaluate the extent of changes in blood volume and flow within the arteries. …

Arterial Distribution Of The Human Aorta: An Examination Of The Evolutionary, Developmental, And Physiological Bases Of Asymmetry., Brandon Oddo, Cooker Storm

Seaver College Research And Scholarly Achievement Symposium

The study of anatomy contends that “form follows function”; a disciplinary theme purporting that anatomical structures (i.e., cells, tissues, and organs) have a shape that serves its proper function. With this in mind, it is unclear why human arterial distribution off the aortic arch is asymmetrical, while the corresponding venous anatomy is symmetrical. We investigated the evolutionary, developmental, and physiological bases for the asymmetry of aortic arch branches in humans. First, we investigated the cardiovascular anatomy of ancestral species to determine if, and at what level, anatomical divergence (from aortic symmetry to asymmetry) occurs. Second, we examined the formation of …

Aortoduodenal Fistula Forms From Primary Aortic Stump Graft In A Two-Time Multi-Visceral Transplant Patient With Presentation Of Gastrointestinal Bleed And Bowel Perforation: A Case Report, Brielle Corrente

Graduate Student Research Symposium

Usually not diagnosed until open laparotomy, aortoduodenalfistulas (ADF) are one of the rarest complications of intestinal transplant surgery. With an incidence rate of only 0.04% at autopsy and only 250 documented cases since the early 1800’s, aortoduodenal fistulas are the most deadly complications of intestinal transplantation with a mortality rate of 100% without surgical intervention. A 39 year old, two-time multi-visceral transplant African American female patient suffered from a primary aortoduodenal fistula formation in a primary modified multi-visceral transplant aortic stump graft site. With emergency open laparotomy repair, revascularization of the secondary multi-visceral transplant was performed, saving the life of …

Differential Localizations Of Protein Phosphatase 1 Isoforms Determine Their Physiological Function In The Heart, Ruijie Liu, Christian Miller, Christiana D'Annibale, Kimberly Vo, Ashley Jacobs

Peer Reviewed Articles

Protein phosphatase 1 isoforms α, β, and γ (PP1α, PP1β, and PP1γ) are highly homologous in the catalytic domains but have distinct subcellular localizations. In this study, we utilized both primary cell culture and knockout mice to investigate the isoform-specific roles of PP1s in the heart. In both neonatal and adult cardiac myocytes, PP1β was mainly localized in the nucleus, compared to the predominant presence of PP1α and PP1γ in the cytoplasm. Adenovirus-mediated overexpression of PP1α led to decreased phosphorylation of phospholamban, which was not influenced by overexpression of either PP1β or PP1γ. Interestingly, only cardiac-specific knockout of PP1β resulted …

Oral Saline Consumption And The Exercise Pressor Reflex, John J. Del Vecchio, Evan L. Matthews Dr., Peter A. Hosick Dr.

Research Data

The Volume Pilot Study data represents information from participants' health history questionnaire and measurements of changes in blood pressure, heart rate, hemoglobin, hematocrit, serum sodium, and plasma volume during blood draws taken every 30 minutes for 3 hours.

The HG and CPT information was taken in the second part of the study. This data includes participant demographics and various cardiovascular measurements taken during baseline (5min), handgrip exercise (2min), post-exercise ischemia (2min), and recovery (2min). It also includes cardiovascular measurements taken during the cold pressor test which includes baseline (2min), cold pressor test (2min), and recovery (2min)

Three-Dimensional Echocardiographic Analysis Of The Equine Aortic Valve, Amber Mcelhinney

Honors Theses and Capstones

This research focused on 3D echocardiography of the aortic valve (AV) in horses. Aortic regurgitation (AR) can be a common finding in older horses, and in severe cases can result in decreased performance and even sudden cardiac death. Standard AR diagnosis includes 2D echocardiography from the right side of the horse. Three-dimensional echocardiography (3DE) records a pyramid of tissue, showing structures in the heart difficult to visualize in 2D methods, and can be more accurate as it does not rely as heavily on placement of the transducer. Nine images of normal AV’s were assessed, and still frames of anatomical structures …

Effects Of Acute Hypoxia On Danio Rerio, Karly Crail

Williams Honors College, Honors Research Projects

The purpose of this research experiment was to determine the effects of acute hypoxia on the embryonic zebrafish (Danio rerio) cardiovascular system and assess the critical oxygen level at which embryonic function is compromised. This goal was achieved by exposing embryos to decreasing oxygen concentrations, (6.0 mg/L-0 mg/L) and observing the heart under an inverted microscope. Data analysis was conducted to determine end systolic volume, end diastolic volume, stroke volume, heart rate, and cardiac output. It was hypothesized that hypoxia would stimulate cardiac activity, because in early developmental stages, tissues are supplied with oxygen through bulk diffusion, and …

Coarctation Of Aorta In Children., Arpan R. Doshi, Sathish Chikkabyrappa

Manuscripts, Articles, Book Chapters and Other Papers

Coarctation of aorta (CoA) is a discrete narrowing in aorta causing obstruction to the flow of blood. It accounts for 6-8% of all congenital heart diseases. With advances in fetal echocardiography rate of prenatal diagnosis of coarctation of aorta has improved but it still remains a challenging diagnosis to make prenatally. Transthoracic echocardiography is mainstay of making initial diagnosis and routine follow-up. Cardiac magnetic resonance imaging (MRI) and computed tomography (CT) are great advanced imaging tools for two-dimensional and three-dimensional imaging of aortic arch in complex cases. Based on type of coarctation, size of patient, severity of lesion, and associated …

Innocent Heart Murmur., Arpan R. Doshi

Manuscripts, Articles, Book Chapters and Other Papers

Heart murmur is the most common reason for a referral to a pediatric cardiologist. Virtually all children have a heart murmur during their childhood. Less than 1% of murmurs are pathological in children. Innocent/functional heart murmur is the most common type of heart murmur. There are multiple theories proposed to identify etiology of innocent heart murmur with varying consensus, but everybody agrees that innocent heart murmur does not carry any morbidity or mortality risk. Even today, heart murmur is associated with high physician uncertainty and parental anxiety. Extensive cardiac evaluation for such a benign finding is also associated with high …

Equalization Of Four Cardiovascular Risk Algorithms After Systematic Recalibration: Individual-Participant Meta-Analysis Of 86 Prospective Studies, Lisa Pennells, Stephen Kaptoge, Angela Wood, Mike Sweeting, Xiaohui Zhao, Ian White, Stephen Burgess, Peter Willeit, Thomas Bolton, Karel G. M. Moons, Yvonne T. Van Der Schouw, Randi Selmer, Kay-Tee Khaw, Vilmundur Gudnason, Gerd Assman, Philippe Amouyel, Veikko Salomaa, Mika Kivimaki, Borge G. Nordestgaard, Michael J. Blaha, Lewis H. Kuller, Hermann Brenner, Richard F. Gillum, Christa Meisinger, Ian Ford, Matthew W. Knuiman, Annika Rosengren, Debbie A. Lawlor, Henry Volzke, Cyrus Cooper, Alejandro Marin Ibañez, Edoardo Casiglia, Jussi Kauhanen, Jackie A. Cooper, Beatriz Rodriguez, Johan Sundstrom, Elizabeth Barrett-Connor, Rachel Dankner, Paul J. Nietert, Karina W. Davidson, Robert B. Wallace, Dan G. Blazer, Cecilia Bjorkelund, Chiara Donfrancesco, Harlan M. Krumholz, Aulikki Nissinen, Barry R. Davis, Sean Coady, Peter H. Whincup, Torben Jorgensen, Pierre Ducimetiere, Maurizo Trevisan, Gunnar Engstrom, Carlos J. Crespo, Tom W. Meade, Marjolein Visser, Daan Kromhout, Stefan Kiechl, Makoto Daimon, Jackie F. Price, Agustin Gomez De La Camara, J. Wouter Jukema, Benoit Lamarche, Altan Onat, Leon A. Simons, Maryam Kavousi, Yoav Ben-Shlomo, John Gallacher, Jacqueline M. Dekker, Hisatomi Arima, Nawar Shara, Robert W. Tipping, Ronan Roussel, Eric J. Brunner, Wolfgang Koenig, Masaru Sakurai, Jelena Pavlovic, Ron T. Gansevoort, Dorothea Nagel, Uri Goldbourt, Elizabeth L. M. Barr, Luigi Palmieri, Inger Njolstad, Shinichi Sato, W. M. Monique Verschuren, Cherian V. Varghese, Ian Graham, Oyere Onuma, Philip Greenland, Mark Woodward, Majid Ezzati, Bruce M. Psaty, Naveed Sattar, Rod Jackson, Paul M. Ridker, Nancy R. Cook, Ralph B. D'Agostino Sr., Simone G. Thompson, John Danesh, Emanuele Di Angelantonio

Publications and Research

Aims: There is debate about the optimum algorithm for cardiovascular disease (CVD) risk estimation. We conducted head-to-head comparisons of four algorithms recommended by primary prevention guidelines, before and after ‘recalibration’, a method that adapts risk algorithms to take account of differences in the risk characteristics of the populations being studied.

Methods & Results: Using individual-participant data on 360737 participants without CVD at baseline in 86 prospective studies from 22 countries, we compared the Framingham risk score (FRS), Systematic COronary Risk Evaluation (SCORE), pooled cohort equations (PCE), and Reynolds risk score (RRS). We calculated measures of risk discrimination and calibration, and …