bluuebunny/crossref_metadata_2025 huggingface dataset:
Identification of upper thermal thresholds during development in the endangered Nechako white sturgeon with management implications for a regulated river
Authors: Earhart Madison L , Blanchard Tessa S , Morrison Phillip R , Strowbridge Nicholas , Penman Rachael J , Brauner Colin J , Schulte Patricia M , Baker Daniel W
Published: May 2023

Climate change-induced warming effects are already evident in river ecosystems, and projected increases in temperature will continue to amplify stress on fish communities. In addition, many rivers globally are impacted by dams, which have many negative effects on fishes by altering flow, blocking fish passage, and changing sediment composition. However, in some systems, dams present an opportunity to manage river temperature through regulated releases of cooler water. For example, there is a government mandate for Kenney dam operators in the Nechako river, British Columbia, Canada, to maintain river temperature <20°C in July and August to protect migrating sockeye salmon (Oncorhynchus nerka). However, there is another endangered fish species inhabiting the same river, Nechako white sturgeon (Acipenser transmontanus), and it is unclear if these current temperature regulations, or timing of the regulations, are suitable for spawning and developing sturgeon. In this study, we aimed to identify upper thermal thresholds in white sturgeon embryos and larvae to investigate if exposure to current river temperatures are playing a role in recruitment failure. We incubated embryos and yolk-sac larvae in three environmentally relevant temperatures (14, 18 and 21°C) throughout development to identify thermal thresholds across different levels of biological organization. Our results demonstrate upper thermal thresholds at 21°C across physiological measurements in embryo and yolk-sac larvae white sturgeon. Before hatch, both embryo survival and metabolic rate were reduced at 21°C. After hatch, sublethal consequences continued at 21°C because larval sturgeon had decreased thermal plasticity and a dampened transcriptional response during development. In recent years, the Nechako river has reached 21°C by the end of June, and at this temperature, a decrease in sturgeon performance is evident in most of the traits measured. As such, the thermal thresholds identified here suggest current temperature regulations may not be suitable for developing white sturgeon and future recruitment.
Case report: large left ventricular aneurysm with contained rupture and haemopericardium
Authors: Willett Aimee , Glenn Zachary , Rose-Malkamäki Madison , Arshi Arash
Published: May 2023

Background

Recent advancements in cardiology have significantly decreased the incidence of post-myocardial infarction mechanical complications. When these sequelae occur, they can have high morbidity and mortality and may require aggressive intervention.

Case summary

We describe a case of contained rupture of a large left ventricular aneurysm (LVA) presenting with syncope in a 60-year-old male with late presentation myocardial infarction (MI) 6 weeks prior on home triple antithrombotic therapy (TAT). Urgent pericardiocentesis along with imaging techniques including ultrasound, computed tomography angiography (CTA), and cardiac magnetic resonance imaging (MRI) were used for initial diagnosis. Definitive treatment was achieved with excision and repair of the LVA with return to prior functional status 1 month after intervention.

Discussion

Highlights of this report emphasize the importance of differential diagnosis consideration of LVA with contained rupture in patient populations with prior late presentation MI and TAT. High clinical suspicion and thorough diagnostic workup with appropriate imaging are important to guide appropriate treatment interventions.
Reflections on teaching Derek Walcott’s Omeros: slow reading approaches to the postcolonial epic
Authors: Sazzad Rehnuma
Published: May 2023

Through slow reading Walcott’s Omeros, this article contributes to three different discursive fields that illustrate various techniques associated with the slow reading: innovative pedagogical practice, Walcott scholarship, and postcolonial and diasporic writings. This article particularly focuses on how Walcott’s epic generates a tacit invitation for the serene acceptance of the stranger, since it is part of the postcolonial, diasporic, and historical reality of the contemporary world.
Modifiable cardiovascular risk factors and genetics for targeted prevention of dementia
Authors: Juul Rasmussen Ida , Frikke-Schmidt Ruth
Published: May 2023

Dementia is a major global challenge for health and social care in the 21st century. A third of individuals >65 years of age die with dementia, and worldwide incidence numbers are projected to be higher than 150 million by 2050. Dementia is, however, not an inevitable consequence of old age; 40% of dementia may theoretically be preventable. Alzheimer’s disease (AD) accounts for approximately two-thirds of dementia cases and the major pathological hallmark of AD is accumulation of amyloid-β. Nevertheless, the exact pathological mechanisms of AD remain unknown. Cardiovascular disease and dementia share several risk factors and dementia often coexists with cerebrovascular disease. In a public health perspective, prevention is crucial, and it is suggested that a 10% reduction in prevalence of cardiovascular risk factors could prevent more than nine million dementia cases worldwide by 2050. Yet this assumes causality between cardiovascular risk factors and dementia and adherence to the interventions over decades for a large number of individuals. Using genome-wide association studies, the entire genome can be scanned for disease/trait associated loci in a hypothesis-free manner, and the compiled genetic information is not only useful for pinpointing novel pathogenic pathways but also for risk assessments. This enables identification of individuals at high risk, who likely will benefit the most from a targeted intervention. Further optimization of the risk stratification can be done by adding cardiovascular risk factors. Additional studies are, however, highly needed to elucidate dementia pathogenesis and potential shared causal risk factors between cardiovascular disease and dementia.
Prevalence of myocardial injury in patients after acute ischaemic stroke according to standard criteria
Authors: Mihalovic Michal , Mikulenka Petr , Línková Hana , Neuberg Marek , Štětkářová Ivana , Peisker Tomáš , Lauer David , Tousek Petr
Published: May 2023

This study examined the prevalence of acute and chronic myocardial injury according to standard criteria in patients after acute ischaemic stroke (AIS) and its relation to stroke severity and short-term prognosis. Between August 2020 and August 2022, 217 consecutive patients with AIS were enrolled. Plasma levels of high-sensitive cardiac troponin I (hs-cTnI) were measured in blood samples obtained at the time of admission and 24 and 48 h later. The patients were divided into three groups according to the Fourth Universal Definition of Myocardial Infarction: no injury, chronic injury, and acute injury. Twelve-lead ECGs were obtained at the time of admission, 24 and 48 h later, and on the day of hospital discharge. A standard echocardiographic examination was performed within the first 7 days of hospitalization in patients with suspected abnormalities of left ventricular function and regional wall motion. Demographic characteristics, clinical data, functional outcomes, and all-cause mortality were compared between the three groups. The National Institutes of Health Stroke Scale (NIHSS) at the time of admission and the modified Rankin Scale (mRS) 90 days following hospital discharge were used to assess stroke severity and outcome. Elevated hs-cTnI levels were measured in 59 patients (27.2%): 34 patients (15.7%) had acute myocardial injury and 25 patients (11.5%) had chronic myocardial injury within the acute phase after ischaemic stroke. An unfavourable outcome, evaluated based on the mRS at 90 days, was associated with both acute and chronic myocardial injury. Myocardial injury was also strongly associated with all-cause death, with the strongest association in patients with acute myocardial injury, at 30 days and at 90 days. Kaplan–Meier survival curves showed that all-cause mortality was significantly higher in patients with acute and chronic myocardial injury than in patients without myocardial injury (P < 0.001). Stroke severity, evaluated with the NIHSS, was also associated with acute and chronic myocardial injury. A comparison of the ECG findings between patients with and without myocardial injury showed a higher occurrence in the former of T-wave inversion, ST segment depression, and QTc prolongation. In echocardiographic analysis, a new abnormality in regional wall motion of the left ventricle was identified in six patients. Chronic and acute myocardial injury with hs-cTnI elevation after AIS are associated with stroke severity, unfavourable functional outcome, and short-term mortality.
Triggers, characteristics, and hospital outcome of patients with Takotsubo syndrome: 10 years experience in a large university hospital centre
Authors: Polednikova Karolina , Kozel Martin , Linkova Hana , Novackova Marketa , Trinh Minh Duc , Tousek Petr
Published: May 2023

A unique clinical feature of Takotsubo syndrome (TTS) is the stress trigger factor. Different types of triggers exist, generally divided into emotional and physical stressor. The aim was to create long-term registry of all consecutive patients with TTS across all disciplines in our large university hospital. We enrolled patients on the basis of meeting the diagnostic criteria of the international InterTAK Registry. We aimed to determine type of triggers, clinical characteristics, and outcome of TTS patients during 10 years period. In our prospective, academic, single centre registry, we enrolled 155 consecutive patients with diagnoses of TTS between October 2013 and October 2022. The patients were divided into three groups, those having unknown (n = 32; 20.6%), emotional (n = 42; 27.1%), or physical (n = 81; 52.3%) triggers. Clinical characteristics, cardiac enzyme levels, echocardiographic findings, including ejection fraction, and TTS type did not differ among the groups. Chest pain was less common in the group of patients with a physical trigger. On the other hand, arrhythmogenic disorders such as prolonged QT intervals, cardiac arrest requiring defibrillation, and atrial fibrillation were more common among the TTS patients with unknown triggers compared with the other groups. The highest in-hospital mortality was observed between patients having physical trigger (16% vs. 3.1% in TTS with emotional trigger and 4.8% in TTS with unknown trigger; P = 0.060). Conclusion: More than half of the patients with TTS diagnosed in a large university hospital had a physical trigger as a stress factor. An essential part of caring for these types of patients is the correct identification of TTS in the context of severe other conditions and the absence of typical cardiac symptoms. Patients with physical trigger have a significantly higher risk of acute heart complications. Interdisciplinary cooperation is essential in the treatment of patients with this diagnosis.
Health promotion interventions in informal caregivers and their impact on health promoting behaviors in patients with cardiovascular disease
Authors: Kurpas D , Szlenk-Czyczerska E
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Health behaviors are considered a key element in the prevention of cardiovascular disease. Less than optimal self-care for cardiovascular disease is associated with adverse health outcomes and lower quality of life. Support from an informal caregiver is important for patients with cardiovascular disease. The caregiver, as the person who directly cares for the chronically ill patient, has the greatest influence on the development of the patient's attitude toward health.

Purpose

The purpose of this study was to analyze the factors that influence the intensity of health behaviors among informal caregivers of patients with cardiovascular disease and to evaluate the effects of health-promoting interventions among caregivers on the health behaviors of their charges.

Methods

The study was conducted with 193 patients with chronic cardiovascular disease and their 161 informal caregivers. The author interviewed them using a questionnaire and the Health Behavior Inventory (HBI). Spearman's rank correlation coefficient test and logistic regression were used for the analyzes.

Results

The strongest predictors influencing lower health behavior expression in informal caregivers were male gender (p < 0.001), level of relationship with patient (p = 0.016), professional activity (p = 0.028), lack of expectations of the PHC physician (p = 0.028), family nurse practitioner (p = 0.003), and social worker (p = 0.008), and lower client health care efficiency (p = 0.036). Higher severity of caregiver health behaviors was associated with higher odds of better client health care efficiency (odds ratio (OR) 1.60 (1.06;2.56).

Conclusions

Comprehensive caregiver education using modern technologies (Internet) and advanced ICT systems to promote health behaviors and specifically for the above caregivers could provide innovative solutions to promote and sustain health behavior change in patients with cardiovascular disease. A breakthrough is now needed in health and social care, where digital health solutions show promise but have not yet been fully implemented.
Left atrial strain as an independent predictor of sinus rhythm maintenance after catheter ablation for paroxysmal atrial fibrillation in HFpEF patients
Authors: Katbeh A S I M , De Potter T , Geelen P , Van Camp G , Vanderheyden M , Bartunek J , Penicka M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The early AF treatment by radio-frequency catheter ablation is very important for improving clinical outcome in patients with history of atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF). Left atrial (LA) strain showed to be a useful index to monitor atrial function in AF and HFpEF states. However, the accuracy of LA strain to predict the long-term maintenance of sinus rhythm (SR) in HFpEF patients with paroxysmal AF undergoing catheter ablation is still under debate.

Aims

To define the best echocardiography derived parameters to predict the long-term maintenance of SR in paroxysmal AF patients with high probability of HFpEF undergoing catheter ablation.

Methods

We prospectively enrolled (between September 2017 and May 2019) 200 consecutive patients (62 ± 10 years, 58% males) with dyspnea (NYHA≥II), paroxysmal AF and preserved LV ejection fraction (≥50%). All patients had a H2FPEF score suggesting high probability of HFpEF. During sinus rhythm, all patients underwent comprehensive transthoracic echocardiography at baseline, including assessment of left ventricular (LV) global longitudinal strain (GLS), left atrial (LA) reservoir strain (LASr), LA conduit strain (LAScd) and LA contractile strain (LASct) using two-dimensional speckle tracking in apical views.

Results

After 42+/-8 months follow-up, a total of 34 (17%) patients had a documented recurrence of AF. Patients with AF recurrence had lower LASr (22.2% vs. 28.3%, p < 0.001) and LASct (10.9% vs. 13.2%, p < 0.01) compared to patients who keep on SR. Among speckle tracking derived LA phasic strain indices, LASr showed the largest area under the curve (AUC = 0.8, p < 0.001) and the strongest independent predictive value (LASr > 22%) of long-term maintenance of SR with sensitivity of 80% and specificity of 66% (Figure 1). Other parameters of LA function, LA diameter, maximum or minimum LA volume index, LV GLS or ejection fraction, and indices of LV diastolic function had lower area under the curve. Using multivariable logistic regression, only LASr (OR 0.89, 95% CI 0.81-0.97, p=0.013) was independently associated with long-term SR maintenance while other LA size and function indices were not.

Conclusion

In HFpEF patients with paroxysmal AF undergoing catheter ablation, LASr is more accurate predictor of SR maintenance than other standard echocardiographic parameters in long-term follow-up.

Figure 1: Receiver-operating characteristic curves of left atrial reservoir strain (LASr), LA conduit strain (LAScd) and LA contractile strain (LASct), LA emptying fraction (LAEF), LA expansion index (LAEI), LA end-systolic (LAES) and end-diastolic (LAED) volume index (VI) to predict long-term maintenance of sinus rhythm.
Impact of wearable devices with feedbacks for increasing daily walking activity and physical capacities in cardiovascular patients: a meta-analysis of randomized controlled trials
Authors: Heizmann A , Chapelle C , Laporte S , Roche F , Hupin D , Le Hello C
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Despite the known benefits of physical activity, patients with cardiovascular disease do not practice enough nor maintain a regular physical activity for their health [1-4] . Walking is one of the easiest ways to stay physically active and can be implemented easily in everyday life [5]. Wearable physical activity monitoring devices have the potential to help increase physical activity through self-monitoring and feedback.

Purpose

To review randomized controlled trials using wearable physical activity monitoring device as an intervention to increase daily walking activity and improve physical capacities in cardiovascular diseases (CVD) patients.

Methods

Design: Systematic review and meta-analysis of randomized controlled trials (RCTs).

Data Sources: PubMed, Embase, Web of Science.

Eligibility criteria: Randomized controlled studies including patients over 18 years of age with CVD comparing an intervention group using a wearable physical activity monitoring device with feedback to usual care or to a control group receiving no feedback on their physical activity and reporting a change in the daily number of steps and/or a change in the distance covered in the 6-minute walking test (6MWT) or a change in peak oxygen uptake (VO2 peak).

Outcomes: Primary outcome was daily number of steps, secondary ouctomes were distance covered in the 6-minute walking test (6MWT) and/or peak oxygen uptake (VO2 peak).

Results

Sixteen RCTs were included. The intervention of wearing a physical activity monitoring device with feedback significantly improved daily number of steps compared with controls (standardized mean difference ((SMD) 0.85; 95% CI [0.42; 1.27], p < 0.01). The effect was greater when the duration of the intervention was less than 3 months (SMD 1.0; 95% CI [0.18; 1.82], p < 0.01) than when the duration of the intervention was 3 months or longer (SMD 0.71; 95% CI [0.27; 1.16], p < 0.01) but no significant interaction was found between subgroups (p = 0.55). Six MWT distance and VO2 peak showed only small effects (SMD 0.34 (95% CI [-0.11; 0.80], p = 0.02) and SMD 0.53 (95% CI [0.03; 1.03], p = 0.07), respectively).
Usefulness of impedanciometry for the assessment of obesity in a high risk dyslipidemia screening unit
Authors: Navarro Melero S , Duran Torralba C , Cortez Quiroga G A , Cubillas Quero A , Huertas Escribano M J , Rus Mansilla C
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Residual risk is related to future events in already treated patients. In addition, obesity increases cardiovascular risk. Body mass index (BMI) is the OMS-defined measure for the diagnosis of obesity, but not the only one, as body fat percentage (%BF) allows a more accurate estimation of visceral fat.

Objective

To identify the clinical utility of adding body fat percentage (%BF) measured by impedanciometry to the assessment of obesity, and to compare the residual lipid profile of obese versus non-obese patients according to the measurement methods.

Methods

Prospective observational study, which analysed 213 patients included in a High Risk Dyslipidemia Screening Unit. Three groups were classified: group A (BMI <30 and %BF <25%-35% according to gender; group B (BMI <30 but %BF ≥25% -35%) and group C (BMI ≥30 and %BF ≥25-35%). Clinical characteristics, screening unit inclusion variables and residual lipid profile were analysed, as well as the association with early coronary heart disease and with the development of cardiovascular disease among the three groups.

Results

Of the 213 patients included, 91 belonged to Group A (non-obese patients), 80 belonged to Group C (obese according to BMI and %BF) and 42 patients belonged to Group B (classified as obese according to %BF but with BMI <30). When comparing the three groups, it was observed that the patients in group B had a residual lipid profile more similar to that of group C patients. They had higher levels of TG, remnant cholesterol and VLDL; with lower levels of HDL (p<0.05), with no statistically significant differences in the levels of Lp(a), ApoB, LDL and non-HDL in relation to those in group A. Fifty percent of group B patients developed coronary heart disease, compared to 56% of group C and 36% of group A patients (p= 0.029). There were no differences in the development of early coronary heart disease. There were 31.6% of patients with BMI<30 who were reclassified as obese according to %BF. If we classified the obese according to BMI, 45.5% developed cardiovascular disease and 45.2% developed early coronary heart disease. If we reclassify the obese according to %BF, the percentage rises to 65.7% and 65.6% respectively. All data are shown in table 1.

Conclusion

Adding the % of BF by impedanciometry for the diagnosis of obesity in a high risk dyslipidemia screening unit allows the identification of an important percentage of patients with a higher cardiovascular risk and a worse residual lipid profile. BMI is insufficient as a single parameter for the assessment of obesity and for stratifying cardiovascular risk.
The impact of cardiac SPECT in risk stratification for women with suspected coronary artery disease in a very high cardiovascular risk country
Authors: Vitola B , Mintale I , Trusinskis K , Erglis A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Risk stratification has become increasingly important in the management of women with coronary artery disease (CAD). Population based cross-sectional study of cardiovascular risk (CVR) factors in Latvia revealed that women in age 25 -74 are in a very high CVR group: more than 60% of women have dyslipidemia, 30% have arterial hypertension (AH) and are overweight.

Purpose

To evaluate CVR factor profile in women with suspected CAD and performed cardiac single photon emission computed tomography (SPECT) and to prove the need of perfusion imaging for women in a very high cardiovascular risk population.

Methods

Cardiac SPECT for women with suspected CAD and positive or non-informative exercise test was performed in a single center from 2018 till 2022. The patients were analyzed by risk factors and perfusion test result, divided into 2 groups: normal myocardial perfusion or true myocardial perfusion defect.

Results

466 patients without known CAD were analyzed. The mean age of cohort patients was 59.3±10.9 years. 28 (6.0%) patients had no CVR factors, 90 (19.3%) women had only 1, but the rest of them (348, 74.7%) had 2 or more CVR factors. Dyslipidemia was present in 358 (76.8%), AH in 282 (60.5%) and type 2 Diabetes mellitus (T2DM) in 27 (5.8%) patients. More than half of patients (n=303, 65.0%) were overweight (BMI>25.0 kg/m2). 65 (13.9%) women were current or ex-smokers.

True myocardial perfusion defect was detected in 96 patients (20.6%). There was no statistically significant difference between CVR risk factor count and cardiac SPECT result (p=0.229), although there were patients with significant perfusion defect without any risk factor present. However, significant correlation between risk factors and detection of obstructive coronary artery disease (CAD) after positive cardiac SPECT was found (p<0.001).

Totally in study was detected 71 patients with suspected ischemia with non-obstructive CAD (INOCA), but further investigation with intracoronary physiology measurements – coronary flow reserve (CFR), index of microvascular resistance (IMR) and acetylcholine provocation test is required to define INOCA endotype.

Conclusions

The cardiac SPECT is an appropriate diagnostic method for women patients with suspected CAD. Even in patients with no CVR factors, but with positive or non-informative exercise test, the CAD is present, therefore they should be referred to cardiac SPECT in a very high CVR country. In patients with significant perfusion defect and absence of obstructive CAD, the performance of intracoronary physiology measurements is required.
History of cerebrovascular events is associated with a higher risk of significant left anterior descending artery stenosis
Authors: Paralta De Figueiredo M , Carias M , Picarra B , Rocha De Almeida A , Claudio F , Rocha R , Trinca M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Acute coronary syndrome (ACS) remains a frequent cause of hospital admission, with its prognosis depending on many factors, one being the location of the culprit lesion. It is established that anterior myocardial infarction, caused mostly by left anterior descending artery occlusion is associated with a worse prognosis and higher morbimortality. Therefore, identifying patients at a higher risk of significant LAD lesions could potentially impact outcomes.

Purpose

We aim to identify if having personal history of cerebrovascular events could be related to more severe LAD stenosis.

Methods

We retrospectively analysed a population of 988 patients (L) admitted with ACS and divided them into two groups: those who had significant stenosis of the left anterior descending artery (LAD) documented in coronary angiography, defined as a stenosis above 50% (L1), and those who had no significant stenosis of the LAD (L2), which included those with no stenosis or stenosis under 50%. We then compared the prevalence of previous cerebrovascular events, defined as stroke or TIA, between both groups. Age, sex, personal history of smoking, hypertension, dyslipidaemia and diabetes mellitus were also documented.

Results

L1 was comprised of 553 patients (56,0% of the population). When comparing between groups, results show that L1 had a significantly higher prevalence of previously documented stroke or TIA (1,4% vs 0,2%, p=0,026; odds ratio: 7,628, 95% CI [0,922; 63,120]) than L2. Regarding age, sex and history of hypertension, dyslipidaemia and diabetes, there were no relevant differences and no impact on the severity of the LAD stenosis.

Conclusions

Patients with ACS and previous history of cerebrovascular events have a sevenfold-increased risk of having significant LAD stenosis on coronary angiography. This could potentially impact pre-procedure risk stratification and timing of percutaneous intervention.
In patients with acute coronary syndromes, left ventricular dysfunction is associated with an increased risk of cardiac arrest
Authors: Carias M , Paralta De Figueiredo M , Picarra B , Rocha De Almeida A , Claudio F , Rocha R , Trinca M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

In patients with acute coronary syndromes (ACS), the occurrence of intra-hospital cardiac arrest is a medical emergency with a challenging approach, especially when it is unpredictable, and remains associated with higher morbimortality. The correct identification of patients at a greater risk and closer monitoring could potentially improve outcomes.

Purpose

This study aims to characterise if the establishment of left ventricular (LV) dysfunction after ACS is related with a higher incidence of intra-hospital cardiac arrest.

Methods

We analysed a population of 894 patients (D) admitted with ACS and divided them into two groups: those who had LV systolic dysfunction, defined as left ventricular ejection fraction (LVEF) under 50% (D1), and those who had no systolic dysfunction (D2). We then compared the incidence of cardiac arrest between both groups. Age, sex, personal history of smoking, hypertension, dyslipidaemia, diabetes mellitus, stroke/TIA and myocardial infarction were also documented.

Results

D1 consisted of 398 patients (44,5% of the population). There were no statistically relevant differences regarding age, sex and prevalence of hypertension, dyslipidaemia, diabetes, previous stroke/TIA or myocardial infarction between the groups. However, D1 had a significantly higher incidence of intra-hospital cardiac arrest (4,5% vs 1,2%, p=0,002; odds ratio: 3,868, 95% CI [1,521;9,840]) than D2.

Conclusions

The development of LV dysfunction in patients with ACS seems to be a better predictor of cardiac arrest, contrasting with age, sex and personal history of smoking, hypertension, dyslipidaemia, diabetes mellitus, stroke/TIA and myocardial infarction, which have no significant impact on this outcome. Further characterizing if there is a correlation between decreasing LVEF and increasing rates of cardiac arrest could be of interest.
The effectiveness of different educational interventions in reducing the prehospital delay of patients with coronary artery disease: a systematic review
Authors: Idyan Z , Lai Y H , Lin Y J , Chen M R
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

Recognizing symptoms of coronary artery disease (CAD) is important and challenging for CAD patients. Failure in detecting the related symptoms may lead to prehospital delay and decelerate the golden time of ischemic reperfusion.

Purpose

The purpose of the systematic review aims to evaluate types of education programs (through randomized control trial) of their effectiveness on reducing prehospital delay regarding CAD.

Method

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was adopted to proceed this review. We searched from Pubmed, Cochrane Library, Scopus, CINAHL and EMBASE using a combination of free text words and Medical Subject Headings guided by the PICO framework. The abstracts and full-text screening were peer-reviewed by two reviewers.

Results

A total of 722 records were identified through database searching of which 11 randomized controlled trials were finally included into this review (n = 38773). The Cochrane Risk of Bias assessment tool 2.0 was utilized to examine the methodological quality of the included studies. Eight out of 11 studies conducted one by one individualized-educational intervention program (n = 11007); two studies used mass media campaign for the general public education program (n = 24753), and one study used the community-based educational intervention model (n = 3031). Of the three types of education models, the one to one individualized-educational intervention was found to be the most effective model to have reduce prehospital delay time shorter ranged from 30-60 minutes in the experimental groups while comparing to the control groups.

Conclusion

Individualized-educational program is found to be the most effective intervention to reduce prehospital delay for CAD patients. Health care providers are encouraged to apply one to one educational program in term of reducing prehospital delay for CAD patients both in clinical and community setting. Moreover, family members of high-risk patients are suggested to be included in a step-by-step action plan that eliminates the wait and see approach to reach medical support.
Exercise hemodynamics and metabolisms in (very) sportive patients after orthotopic heart transplantation
Authors: Schmidt T , Bjarnason-Wehrens B , Mommertz S , Hannig M , Brand P , Predel H G , Reiss N
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Purpose

After orthotopic heart transplantation (HTX), patients benefit with improved survival and quality of life, but exercise physiology becomes complicated and exercise capacity usually remains limited at 60-70% of predicted values. However, there are also patients who return to demanding or competitive sports even after HTX. For these patients, optimal exercise hemodynamics and metabolisms are crucial. It was the aim of this study to investigate this question more closely in (very) sportive patients after HTX.

Methods

6 patients after orthotopic HTX (1 female, 54±16 yrs old, BMI 23.6±2.8, 11±7 yrs post-transplant) from different sports disciplines (Cycling [2x], Triathlon, Hockey, Table-Tennis, Scuba Diving) could be included (Table 1). We performed cardiopulmonary exercise test (CPET) on a bicycle ergometer using a ramp protocol (15 watts/minute) and consecutive inertgas rebreathing (IGR) on different exercise steps (rest, light, moderate, heavy) of each 4-5 minutes. The hemodynamic measurements and blood gas analysis were conducted at the last minute of each IGR step. The study was approved by the local ethics committee.

Results

For CPET: one patient reached extraordinary exercise capacity with a peak load of 345 watts (182% of pred.) and a peak VO2 of 58.9 ml/kg/min (163% of pred.). Corresponding values at first ventilatory threshold (VT1) were 280 watts and 44.1 ml/kg/min. The results of the other patients showed a more homogenic profile: Mean peak load was 172±44 watts (104±14% of pred.) and peak VO2 was mean 25.6±4.5 ml/kg/min (91±14% of pred.). Values at VT1 were 108±27 watts and 18.0±2.5 ml/kg/min.

Selected IGR results for all patients are displayed in Table 2. The hemodynamic measurements revealed a steadily increase in cardiac output (CO), cardiac index (CI), arteriovenous oxygen difference (avDO2), heart rate and systolic blood pressure from rest to the different exercise steps. However, an increase in stroke volume (SV) beyond light to moderate exercise often remained limited (peak SV 101±14 ml/beat). Also, peak CO (13.9±1.8 l/min) remained slightly below predicted values (89% of pred.).

Conclusion

Hemodynamic measurements revealed satisfying exercise adaptions and adequate prerequisites for intensive physical activities in selected patients even after HTX. However, compared to healthy athletes, SV was clearly limited to normal values (<120 ml/beat). The deficit in CO occurs with moderate to heavy exercise levels could be partially compensated by increased avDO2 due to excellent peripheral function. Therefore, regular exercise training is crucial for this target group.
High risk dyslipidemia: can we predict early coronary disease?
Authors: Cortez Quiroga G A , Rus Mansilla C , Duran Torralba M C , Cruz Romero L , Eliche Mozas P , Cubillas Quero A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

The AHA/ACC guidelines on the management of blood cholesterol (2013 and 2018) classified the LDL-c >190 mg/dL as high-risk patients, with the indication of high-intensity statins (c-LDL reduction greater than 50%). Recently the 2019 ESC guidelines(1) also classify these patients as high cardiovascular (CV) risk.

Objective

Determine factors associated with the development of early coronary disease (ECD) in patients with high-risk dyslipidemia (HRD).

Methods

Observational retrospective cohort of 160 patients with historical maximum LDL-c ≥190 mg/dL without secondary cause. We compared the clinical characteristics, the baseline blood test with maximum LDL-c (BT1), and the effects of lipid-lowering treatment on the last blood test (BT2), between patients with ECD (53 patients Group A) and patients without cardiovascular events (107 patients Group B).

Results

Group A, presented maximum LDL-c at a younger age, had dyslipidemia of longer evolution time, had a higher proportion of men, smokers, diabetics, and had a higher number of associated risk factor's (Table 1).

In the BT1 they presented greater proportion of HDL-c values below 45 mg/dL (35.3% vs 12.3%, p=0.001), and a higher proportion of remnant cholesterol (Non HDLc - LDLc = >30 mg/dL, 51% vs 33.3%, p=0.037). Patients with ECD received high-intensity lipid-lowering treatment, statin + ezetimibe (73.6% vs 29.8%, p<0.0001), IPCSK9 (7.5% vs 2.9%, p=0.18), and achieving LDL-c goals (32.1% vs 13.6%, p=0.006) and Non HDL-c (47.2% vs 14.6%, p<0.0001) according to cardiovascular risk. There were no variation between BT1 and BT2 in HDL-c levels in both groups.

In the Cox regression model, male sex (HR 2.8 (1.4-5.7), p=0.003), tobacco (HR 2.5 (1.3-4.7), p=0.005), and the relation between Non HDL-c/HDLc (>4.5 male, >4 female, in primary prevention) in BT1 (HR 1.65, (1.15-1.86) p=0.02) increase independently the risk of ECD in patients with HRD.

Conclusion

In patients with HRD the presence of male sex, tobacco, increase relation between Non HDLc/HDLc, diabetes, a greater number of cardiovascular risk factors, most atherogenic blood test (HDLc <45 mg/dL and remnant cholesterol) have been associated with the development of ECD. We have had some apreciated 5.45 (± 4) years since the BT1 to prevent ECD.
Semi-supervised deep neural networks for left atrial segmentation from cardiac MRI
Authors: Qiu Y , Meng J
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Left atrium size and function is an important but less studied prognostic marker for many cardiovascular diseases [1]. Cardiac Magnetic Resonance Imaging (MRI) can capture atrial structure with a high temporal and spatial resolution. However, diagnoses and accurate measurement of volumes from MRI often rely on time-consuming manual processing, or needs correction of software segmentation error by clinicians. Robust, automated methods are highly desirable to assist morphological analysis of dynamic changes in the heart. Ultimately this facilitates the wider application of cardiac MRI in early identification and prevention of potential cardiovascular disease.

Purpose

To introduce a semi-supervised teacher-student deep neural networks (requiring less labelled data) for accurate segmentation of left atrium from cardiac MRI images, and compare their performance with conventional supervised learning.

Methods

The basic structure for a mean teacher deep neural network is shown in Fig.1. Network training starts in a supervised manner. At each MRI batch input, both the student and the teacher model evaluate the images with applied noise. The student network is updated by gradient descent and segmentation loss is obtained by comparing its prediction with the label. The exponential moving average (EMA) of the student weight is then migrated to update the teacher network. Consistency loss between the student’s and teacher’s prediction (filtered by uncertainty map in Uncertainty-Aware Mean Teacher, UA-MT [2]) is obtained to jointly update the student. Unlabeled images continually improve the network without using supervised loss.

We compared three semi-supervised teacher-student networks UA-MT, Hierarchical Consistency Regularized Mean Teacher (HCR-MT) and Semi-supervised Contrastive Consistency model (SCC), with the supervised network TransUNnet [3], using benchmark cardiac MRI dataset from MICCAI 2018 Atrial Segmentation Challenge [4]. Out of 20 MRI scans (1760 images), 16 scans were used for training, and 4 scans for testing. For semi-supervised learning, 75% of the training set was used as labelled data and 25% was assumed to be unlabeled. In the supervised learning, all labels were enabled.

Results

Example segmentation results from three semi-supervised models are shown in Fig 2. For comparison, the fully supervised TransUNnet produced an accuracy of 76%. Benefiting from effective teacher-student learning, the semi-supervised models achieved a superior accuracy of 89%, while also requiring less labelled data.

Conclusion

The proposed teacher-student deep neural network facilitates effective semi-supervised learning, and outperforms supervised TransUNet in segmenting the left atrium in cardiac MRI. Our semi-supervised approach uses less training data, reducing tedious and time-consuming manual labelling tasks, ultimately unlocking the ability to effectively utilise the full power of deep learning in medical applications.
Family history of cardiovascular disease in athletes: 2 sports medicine clinics, 4 systems of preparticipation screening, 7 years of work. Is it time for a change?
Authors: Jiravska Godula B , Pesova P , Sovova M , Moravcova K , Ozana J , Sovova E , Jiravsky O
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): IGA-internal grant agency Palacky University,Olomouc.

Introduction

Searching for a positive family history (FH) of cardiovascular disease (CVD) or sudden cardiac death (SCD) is a standard part of preparticipation screening (PPS) of athletes. This is despite the fact that there is no evidence to support either a mortality or cost-effective benefit of this practice.

It is generally accepted that the use of a questionnaire method of family history investigation will expedite and refine the process of obtaining adequate responses required for the PPS.

There are a number of PPS systems currently in use around the world, of which four standardized PPS systems are very commonly used (AHA; 5thPPE; IOC = Lausanne Questionnaire; FIFA), each with its own questionnaire that is distinct from the other systems.

A positive finding of a family history of CVD/SCD in an athlete during PPS is an accepted indication for (sports) cardiology investigation. However, there is no evidence to define the scope of this examination and validate the mortality or cost-effective benefit of this practice.

Purpose

1. To determine the number of athletes with positive FH in the entire cohort using questionnaires from the four PPS systems mentioned above.

2. Evaluate differences in frequency analysis of each questionnaire.

3. To identify question wording issues and to highlight overly "soft" criteria in each PPS system.

4. Propose optimization of FH data collection and follow-up.

Methods and file

Between 2015 and 6/2022, 14083 patients were screened at 2 centers. There were 13879 athletes with traceable FH (3768 females -27.1%), aged 14 (IQR 5) years.

Results

180 athletes (1.3%) had positive FH according to at least one PPS system. The IOC system generated the fewest positive responses, followed by the AHA and FIFA, and the 5thPPE system clearly generated the most positive responses (by 80% compared to IOC). See Table 1. Clearly the "softest" question is the query about any heart disease/heart problems/ in 5thPPE, this alone is responsible for the majority of positive responses above the response levels of the other systems.

Conclusion

Investigating positive FH CVD/SCD is an established part of the athlete's PPS. There is up to 80% variation when using the 4 globally accepted PPS questionnaires. The lack of evidence for their use, as well as the lack of evidence for other cardiac retrospective investigations, coupled with their complexity and difficulty for patients to understand, is a challenge to research in this field.
Temporal trends in cardiac rehabilitation participation and its core components: a nationwide study from the Netherlands
Authors: Bakker E A , Vonk T , Maessen M F H , Hopman M T E , Snoek J A , Aengevaeren V L , Franklin B A , Eijsvogels T M H
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiac rehabilitation (CR) is an important secondary prevention strategy for individuals with cardiovascular diseases (CVD)(1). Nevertheless, CR participation rates remain low(2). In the past decade, more attention has been given to CR referral and participation following the development and implementation of (inter)national multidisciplinary CR guidelines(1).

Purpose

To assess time trends in Dutch CR participation rates between 2013-2019, as well as its distinct components (e.g., admission session, exercise training, nutrition counselling, and psychological help).

Methods

CVD patients with a clinical indication for CR were enrolled in this observational study. Health insurance claim data was used to identify CR participation and its components. Temporal trends were analysed using logistic restricted cubic spline regression.

Results

106,212 CVD patients were included, of which 38,954 patients (37%) participated in CR. Participation rates significantly increased from 28% in 2013 to 41% in 2016 but stabilized thereafter. The time trends of participation to CR were mostly similar across different subgroups of age, (Figure 1A), sex (Figure 1B), CVD diagnosis (Figure 1C), and cardiothoracic surgery/procedure (Figure 1D). Participation rates were the highest in younger patients (<50 years; 52%, and 50-65 years; 50%), men (48%), patients with an ST-segment elevation myocardial infarction (73%), and coronary artery bypass grafting (82%). In contrast, participation rates were the lowest in older patients (≥85 years; 8%), women (30%) and in patients with heart failure (11%). Most CR participants received an admission session (97%) and exercise training (82%) during their CR program, whereas nutrition counselling (14%) and psychological help (10%) were underutilized (Figure 2).

Conclusion

CR participation rates increased, but stabilized after 2016. Age, sex, CVD diagnosis and cardiothoracic surgery/procedures affected CR participation rates. Future research and renewed implementation strategies are needed to increase CR referrals, enrolment and participation in specific CVD subgroups and to enhance its potential effectiveness by a higher utilization of modules related to dietary and psychosocial counselling.
Gender difference in the association between prediabetes and post-myocardial infarction prognosis
Authors: Chattopadhyay S , George A , Soman B , John J , Sathyapalan T
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Higher incident coronary heart disease in females with prediabetes compared to males is seen in the general population. This interaction in post-MI patients for recurrent events is largely unexplored.

Purpose

Explore the interaction between sex and newly diagnosed glycaemic abnormalities in terms of its association with recurrent cardiovascular events.

Methods

Retrospective analysis of a cohort of MI-survivors without known diabetes who had pre-discharge OGTT. MACE (death and non-fatal MI) had fasting (FPG) and 2-hour post-load plasma glucose (2h-PG), were recorded. Cox regression models adjusted for confounders were used. The modifying effect of sex on the association between MACE and, glycaemic groups or fasting or post-load glucose levels was tested by adding an interaction term combining gender and glycaemic category prediabetes (pDM) and new diabetes (NDM) (pDM*sex and NDM*sex) or glucose levels (FPG*sex and 2h-PG*sex) to the base model to additionally adjust for sex-specific confounding.

Results

Crude MACE was higher in women with pDM (35.8% v 16.7%, p=0.001) and men with NDM (29.6% v 17.3%, p=0.003) compared to normal glucose tolerance (NGT). Adjusted MACE was higher only in women with pDM (HR 2.15, 95% CI 1.24 to 3.72, p=0.007) and only in men with NDM (HR 1.57, 95% CI 1.01 to 2.42, p=0.044) compared to NGT. In pDM group, risk of MACE was higher in women compared to men (HR 1.72, 95% CI 1.13 to 2.60, p=0.011), (p for interaction=0.040) but not NDM (HR 0.83, 95% CI 0.43 to 1.60, p=0.575), (p for interaction=0.378). Increasing 2h-PG, but not FPG, was associated with MACE in both sexes with no sex interaction. Compared to NGT, IGT, not IFG, predicted MACE in women, (HR 2.08, 95% CI 1.21 to 3.57, p=0.008) but not in men, (p for interaction=0.043). 2h-PG determined NDM predicted MACE in men (HR 1.59, 95% CI 1.04 to 2.44, p=0.034) but not in women without sex interaction, (p for interaction=0.365) (Fig 2).

Conclusion

Female sex adversely modifies the association between 2h-PG determined pDM and post-MI MACE.