bluuebunny/crossref_metadata_2025 huggingface dataset:
Personalized pre-interventional risk stratification of mortality, length of stay and hospitalization costs in transcatheter aortic valve implantation using a machine learning algorithm a pilot trial
Authors: Zisiopoulou M , Berkowitsch A B , Redlich L R , Walther T W , Fichtlscherer S F , Leistner D L
Published: June 2024

Introduction

Risk stratification based on Euroscore II (ESII) is currently used by clinicians to assist their decision to perform transcatheter aortic valve implant (TAVI) procedures. ESII is a generic, non-TAVI-specific metric. We investigated if a TAVI-specific predictive model could achieve improved predictive pre-interventional accuracy of 1-year mortality compared to ESII.

Patients & Methods: In this prospective pilot study, 284 participants with severe aortic valve stenosis who underwent TAVI were enrolled. Standard clinicals metrics (ASA, NYHA, ESII) and patient-reported outcome measures (EuroQol-5D-VAS, Kansas City Cardiomyopathy Questionnaire, Clinical Frailty Scale-CFS) were assessed one day before TAVI. Using these data, we tested predictive models (logistic regression, decision tree algorithm- DTA) with 1-year mortality as the dependent variable.

Results

Logistic regression yielded the best prediction, with ASA and CFS as the strongest predictors. Our logistic regression model score showed significantly better prediction accuracy than ESII (AUC = 0.659 vs. 0.800; p = 0.002). By translating our results to a DTA, cut-off score values regarding 1-year mortality risk emerged: < 0.02 points for low, 0.02 – 0.15 for intermediate, > 0.15 for high risk. Treatment costs and length of stay significantly increased in high-risk patients.

Conclusions & significance

A novel TAVI-specific model predicts 1-year mortality, LoS and costs after TAVI using simple, established, transparent and inexpensive metrics before implantation. Based on this preliminary evidence, TAVI team members and patients can make informed decisions based on a few key metrics. Validation of this score in larger patient cohorts is needed. Comparison of ROC curves
Physical functioning predicts cognition in systolic heart failure
Authors: Besnier F , Gagnon C , Sellier F , Berube B , Vachon F , Dupuy E , Iglesies-Grau J , Gayda M , Dionne V , Benhalima H , Nigam A , L'allier P , Bouabdallaoui N , Rouleau J L , Bherer L
Published: June 2024

Background

Physical and cognitive deficits often coexist as comorbidities in individuals with chronic heart failure (CHF). Commonly used in clinical settings, the 6-minute walking test (6MWT), Timed-Up and Go (TUG) and the 10m walking speed (WS) are functional tests that have demonstrated associations with global cognition and specific cognitive domains such as processing speed and executive functions in the elderly. However, there is limited understanding regarding their association with cognition in individuals with chronic heart failure (CHF) with reduced or preserved left ventricular ejection fraction (LVEF).

Objectives

To compare cognition and physical functions in CHF patients with reduced LVEF versus those with mildly reduced or normal LVEF (R-LVEF ≤40% vs N-LVEF >40%). To examine if functional tests predict cognitive performance in each CHF subtype.

Methods

42 patients with CHF (66.8±8.1 years old) performed the 6MWT, TUG, and 10m walking test. Neuropsychological tests involved the Montreal Cognitive Assessment (MoCA), the Stroop task and the Rey auditory verbal learning test to assess global cognition, executive functions, processing speed, and episodic memory. LVEF was measured by echocardiography.

Results

mean LVEF were 32.3±6.9% and 52.6±7.7% for R-LVEF and N-LVEF (p<0.001). Age, education, NYHA class, 6MWT, TUG and WS were similar between groups (p>0.05). After adjusting for age, sex, and education, there was no group difference in the MoCA (23.2±3.9 vs 24.9±3.9 p=0.22 respectively for R-LVEF and N-LVEF). The Stroop inhibition and the Stroop switching task revealed significantly lower performances in R-LVEF vs N-LVEF (81.8±28.7s vs 62.6±13.5s p=0.013 and 89.5±32.8s vs 69.5±14.1s, p=0.016 respectively), as well as fewer words recalled on the fifth repetition of the verbal learning test and the immediate recall (9.2±2.7 vs 11.3±2.3, p=0.020 and 6.2±3.4 vs 8.5±2.6 p=0.013 respectively). Simple linear regressions showed that the 6MWT (R=0.46, p=0.002) and TUG (R= -0.52, p=0.007) significantly predicted MoCA scores in R-LVEF but not in N-LVEF. 6MWT (R= -0.39 p=0.013), TUG (R= 0.47 p=0.016) and WS (R= -0.46 p=0.003) also predicted performances in the Stroop switching condition in R-LVEF only.

Conclusion

Physical functions are similar between CHF patients with reduced LVEF versus those with mildly reduced or normal LVEF.Global cognition, executive function, and verbal memory (encoding) were lower in CHF with reduced LVEF versus those with mildly reduced/normal LVEF. Functional tests predicted global cognition and executive function in CHF participants with reduced LVEF. Future studies are needed to better understand the pathophysiology of cognitive and physical function deficits in CHF with reduced and preserved LVEF.
Fitness impact on left ventricle GLS and left atrial strain in cardiac rehabilitation of heart failure patients
Authors: Adam C , Marcu D T M , Mitu O , Mitu F
Published: June 2024

Background

Cardiac rehabilitation (CR) is an essential pillar of the management of patients with heart failure (HF), regardless of the degree of systolic dysfunction, having both a therapeutic and prognostic role. The improvement of symptoms and functional status together with the improvement of quality of life are some of the arguments that support the referral of all HF patients to centers specialized in such integrative, multidisciplinary programs.

Purpose

We aimed to evaluate the impact of physical training on echocardiographic parameters (left ventricle global longitudinal strain [LV GLS], left atrial strain) among HF patients on a CR program.

Methods

We conducted a prospective cohort study on 105 patients with HF admitted to a single tertiary referral center. According to the functional class assessed by cardiopulmonary exercise testing (CPET), we divided patients into two groups: mild to moderate functional limitation (n=46) and moderate-severe functional limitation (n=59).

Results

We analyzed demographics, anthropometrics, clinical and paraclinical parameters, focusing on echocardiographic parameters of systolic function (ejection fraction, LV GLS) and atrial function (left atrial strain). Patients with HF in the second group had lower mean values of EF (p=0.046), LV GLS (p=0.021) and left atrial strain (p=0.039). After completing the CR program, patients in the second group had an improvement of the parameters compared to baseline values. LV GLS and left atrial strain values were statistically significantly correlated with serum NT-proBNP values (p=0.009), peak oxygen uptake (p=0.013), pain-free walking distance (p=0.034) and maximum walking distance (p=0.029). Left atrial strain also positively correlates with peak oxygen uptake (p=0.047). GLS value less than -8.9% is also a predictor for the persistence of severe functional limitation in HF patients (AUC=0.648 , p=0.041) (Figure 1).

Conclusion(s)

CR program improves systolic dysfunction in HF patients, with low GLS values being a negative predictor of functional status.
Pulse wave velocity among urban and rural dwelling rwandans
Authors: Thomas A , Baggish A B , Nuhu N A , Ojambo R O
Published: June 2024

Background

Carotid-femoral arterial pulse wave velocity (PWV), a direct measure of aortic stiffness, predicts morbidity and mortality. At present, reference values for PWV are only available for Europeans and North / South American populations.

Purpose

To measure PWV in Central African people (Rwanda), to compare PWV among urban versus rural-dwelling Rwandans, and to compare these data with established European reference values.

Methods

PWV (SphygmoCor® XCEL) was measured in rural-dwelling Rwandans (RR, n = 41 ; Butaro Sector) and urban-dwelling Rwandans (UR, n= 37 ; Kigali). Anthropometric data including height, weight, and skinfold thickness measurements were collected for all participants.

Results

Compared to RR (age = 37 ± 11 y, 54% female), UR (age = 41 ±15 y, 46% female) demonstrated higher BMI (25.1 ± 6.6 vs. 21.0 ± 5.4 kg/m2, p < 0.001), percentage body fat (28.6 ± 9.7 vs. 21.0 ± 12.1%, p = 0.005), and a trend toward higher systolic blood pressure (134 ± 22 vs. 129 ± 19 mmHg, p =0.27). However, PWV was similar between groups (UR = 6.6 ± 1.7 vs. RR = 6.6 ± 1.2 m/s, p= 0.82). There were similar direct linear relationships between PWV and age among both UR (R=0.58, p < 0.001) and RR (R= 0.65, p < 0.001). Rwandans demonstrated overall lower PWV progression with aging compared to age-matched European reference standards (Figure).

Conclusion(s)

To our knowledge, we report the first data examining arterial stiffness in Central African people. Our data demonstrate no differences among PWV as a function of urban versus rural living but show significantly lower PWV values across the age spectrum compared to European populations. Further investigation into the physiologic determinants and prognostic implications of these findings is warranted.
Non-stenotic aortic valve fibro-calcific content association with clinical outcomes in coronary artery disease patients
Authors: Myasoedova V , Chiesa M , Valerio V , Moschetta M , Rusconi V , Massaiu I , Bertolini F , Mancini M E , Poggio P
Published: June 2024

Background

Aortic stenosis (AS) is the most common valve disorder, characterized by fibro-calcific remodeling of valve leaflets, which occurs even before hemodynamic changes. Progressive aortic valve calcification (AVC) leads to worse cardiovascular outcomes. However, the fibrotic component (AVF) of non-stenotic aortic valve leaflets and its role in negative outcomes have not yet been explored.

Purpose

To evaluate whether fibro-calcific content of aortic valve can be a predictor of outcomes in high risk CAD patients without AS.

Methods

We included 203 coronary artery disease (CAD) high-risk patients without AS who underwent cardiac contrast-enhanced computed tomography (CT). The calcium and fibrosis volumes were indexed by dividing the volume by the aortic annular area. The composite outcome, including all-cause mortality, cardiovascular mortality, acute heart failure, and re-infarction, was assessed at 5-year follow-up.

Results

The mean age of our cohort was 68.4±10 years, 24% had diabetes, 72% had dyslipidemia, 65% had hypertension, and 58% were former or current smokers. CT quantifications were as follows: AVC 51.6±94.8 mm3/cm2 and AVF 231.3±148.7 mm3/cm2. After 5 years of follow-up, 40 (23%) events occurred, where patients with AVC above the median (9.88[0-58.1] mm3/cm2) or AVC>0 were associated with an increased risk of adverse events (all p<0.05). The AVF component did not show any influence on negative outcomes in these patients.

Conclusion

AVC, but not AVF, assessed in CAD high-risk patients without AS, predicts the worst outcome. Our results on valvular fibrosis could be altered by treatments in secondary prevention. Studies in a population without pharmacological influence are needed to better understand the effect of AVF on the development and progression of valve pathology as well as outcomes.
Diagnostic pathways for women with suspected coronary artery disease including cardiac SPECT/CT. 6-year experience in Latvia
Authors: Vitola B , Mintale I , Trusinskis K , Kalnina M , Kedrova J , Erglis A
Published: June 2024

Introduction

Myocardial perfusion imaging with cardiac SPECT/CT is one of the most performed non-invasive cardiac imaging tests evaluating myocardial viability, assessing prognosis, and estimating the efficacy of therapy. The diagnostic algorithm should be applied individually for every patient group.

Purpose

To analyze the diagnostic pathways for women with suspected coronary artery disease (CAD) in Latvia including cardiac nuclear imaging and to investigate prescribed further diagnostic approaches to establish the diagnosis and appropriate treatment.

Methods

For women included in Latvian cardiac SPECT/CT registry the cardiac SPECT/CT was performed in a single University Hospital from 2018 till 2023. For all of them the previous exercise stress test was performed. The patients were divided into 2 groups: normal myocardial perfusion and true myocardial perfusion defect, defined as area of ischemia ≥ 10% of the left ventricle myocardium. Patients with perfusion defect were analyzed according to prescribed further diagnostic test or treatment option.

Results

916 women with known or suspected CAD were analyzed. True myocardial perfusion defect was detected in 175 patients (19.1%). The previous exercise stress test was positive only in 92 (52.6%) women with perfusion defect in SPECT/CT. As further diagnostic approach in 40 (22.9%) cases cardiac computed tomography angiography (CTA) was suggested and the invasive coronary angiography (ICA) - in 135 (77.1%) cases. The patients without performed further diagnostic tests were excluded. Analyzing results of all performed CTAs’ (n=32), stenosis in main coronary arteries were found in 2 cases (6.25%) and patients were referred to percutaneous coronary intervention (PCI). Of all performed ICA(n=113), in 71 (62.8%) women atherosclerosis in main coronary arteries was not observed and INOCA (ischemia with non-obstructive coronary arteries) as a primary diagnosis was suspected. In 34 (30.1%) patients the significant stenosis in main coronary arteries was present and PCI was performed, of whom 13 (38.2%) women were primarily diagnosed. 2 patients (1.8%) underwent coronary artery bypass surgery (CBP).

Conclusion

The diagnostic algorithm including cardiac SPECT/CT is valuable and highly recommended for the diagnostics of women with known or suspected CAD. Knowing the relatively low specificity of exercise stress test for women, the cardiac SPECT/CT should be performed as an initial diagnostic test for women with intermediate and high pre-test probability. In patients with defined perfusion defect, but non-obstructive coronary arteries – the invasive physiology testing should be performed to assess microvascular function.
Trends in antithrombotic treatment after cryptogenic stroke and prior transcatheter patent foramen ovale closure
Authors: Apostolos A , Papanikolaou A , Trantalis G , Drakopoulou M , Katsaros O , Ktenopoulos N , Simopoulou C , Oikonomou G , Koliastasis L , Aggeli C , Tsioufis C , Toutouzas K
Published: June 2024

Background

Approximately 35% of ischemic strokes worldwide are cryptogenic, with a significant proportion attributed to paradoxical embolism through a patent foramen ovale (PFO). Diagnosing PFO-related strokes involves excluding common causes like atrial fibrillation or carotid stenosis, often requiring time before deciding on transcatheter PFO closure. While current guidelines suggest dual antiplatelet therapy for 21 days followed by tailoring with a single antiplatelet agent, such as aspirin, the actual antithrombotic treatment administered in routine clinical practice remains unclear.

Purpose

This analysis aims to investigate the combinations of antithrombotic treatments—antiplatelet or anticoagulant—chosen by physicians for bridging the time gap between cryptogenic stroke onset and transcatheter PFO closure.

Methods

We included consecutively patients that have undergone transcatheter PFO closure at a tertiary hospital in our analysis. We analyzed baseline demographic details, comorbidities, and pharmaceutical characteristics.

Results

Data on pre-closure antithrombotic treatment were available for 67 patients, predominantly female (77.6%) with a mean age of 46.0 ± 4.3 years. Hypertension was present in 20 (29%) patients, dyslipidemia in 34 (50%), and diabetes mellitus in 6 (8%). Only one patient had known coronary artery disease before the cryptogenic stroke. Of the 55 (82%) patients receiving antithrombotic treatment, 50 (90%) were on antiplatelets, 2 on anticoagulants, and 3 on a combination of both. Among those receiving only antiplatelet agents, 34 (68%) received a single agent (aspirin or clopidogrel), and 16 (32%) received dual antiplatelet treatment (aspirin and clopidogrel). Patients on anticoagulation, with or without antiplatelet medication, were exclusively treated with a newer oral anticoagulant agent. No recurrent ischemic stroke occurred during the cryptogenic stroke or transcatheter PFO closure.

Conclusion

Despite current guidelines recommending a 21-day course of dual antiplatelet therapy followed by tailoring with aspirin or clopidogrel after an ischemic stroke, our findings highlight variations in the current practice of antithrombotic treatment for PFO-related strokes. Further studies in this population are essential to provide better guidance for neurologists and cardiologists managing cryptogenic strokes.
Could breathing frequency become a pragmatic means to monitor exercise intensity in atrial fibrillation and coronary heart disease?
Authors: Buckley J P , Terada T , Lion A , Reed J L
Published: June 2024

Introduction

Innovations Fund of the Alternate Funding Plan for the Academic Health Sciences Centre of the Ministry of Ontario, Canada; New Investigator Award in Clinical Rehabilitation from the Canadian Institute for Health Research; Heart and Stroke Foundation of Canada Emerging Research Leaders Initiative.

Aim

Moderate-intensity aerobic exercise, near to the 1st ventilatory threshold (VT1), in adults with atrial fibrillation (AF) and coronary heart disease (CHD) is recommended as a minimum level to derive safe and beneficial physiological gains. The irregular and rapid heart rate (HR) in AF or other heart rhythm disturbances in CHD create challenges for using HR to monitor exercise intensity. The aim of this study was to assess whether breathing frequency (BF) can be used to measure and monitor exercise intensity in people with AF and CHD.

Methods

An observation study of 30 AF participants with CHD (19M, 11F, 70.7 +/- 8.7 yrs) and 67 non-AF participants with CHD (38M, 29F, 56.9 +/-11.4 yrs) who performed incremental maximal exercise testing with continuous pulmonary gas exchange measures.

Results

Peak aerobic power (VO2 peak) in AF (17.8 +/- 5.0 ml.kg-1.min-1) was lower than in CHD (26.7 ml.kg-1.min-1) (p <.001). BF peak in AF and CHD were similar (p =.106); 34.6 +/- 5.4 and 36.5 +/- 5.0 breaths.min-1, respectively. In spite of a 14 year age difference, BFs at VT1, were similar in CHD patients with and without AF (23.2 +/- 4.6 and 22.4 +/-4.6 breaths.min-1 respectively). The same was true for BF at %VO2 peak (AF ~59%; CHD ~57%; p = .656).

Conclusion

In light of newly emerging affordable wearable technologies, this first study of its kind provides an encouraging potential and pragmatic approach for using BF to monitor exercise intensity in AF and CHD.
Exergaming system for promoting hospital early mobilisation and disease knowledge in heart failure patients: HEFMOB development and usability assessment study
Authors: Blasco-Peris C , Climent-Paya V , Carrion C , Manresa-Rocamora A , Baladzhaeva S , Fuertes-Kenneally L , Garcia-Alvarez M I , Sanz-Rocher A , Sempere-Ruiz N , Hernandez-Perez I , Sarabia J M
Published: June 2024

Aims

This study aimed to develop and test usability for an exergaming prototype with remote monitoring of biometric parameters and autonomous management for promoting hospital early mobilisation and disease knowledge in patients with heart failure (HF).

Methods

The study included two phases: 1) the design and development of the exergaming prototype encompassing a lower limb aerobic endurance game and an upper limb coordination and mobilization game, 2) its usability assessment. The usability evaluation involved several steps, starting from the initial assessment by the researchers, followed by a comprehensive analysis of the video recordings of 10 patients (4 females) with HF and reduced (4) or mildly reduced (6) ejection fraction engaging in individual sessions with the prototype. Finally, all 10 participants completed the System Usability Scale (SUS; scale ranging from 0 to 100) and Intrinsic Motivation Inventory (IMI; scale ranging from 0 to 35) to rate the usability of the exergaming prototype and the intrinsic motivation scale, respectively.

Results

During the usability assessment and after implementing experts’ improvements, participants successfully engaged with 63% and 32% of the elements of the two exergames. No participant experienced dizziness except for one patient who reported it at the curves in the road cycling tour. The mean IMI score of 25.1 (SD = 3.5) indicates a high level of interest and enjoyment following the prototype session. Additionally, with the SUS, the mean score of 71.5 (SD = 17.8) suggests that the users rated the system´s usability as excellent.

Conclusions

This study suggests that HEFMOB is a safe, engaging and user-friendly device for patients with HF. Future research is required to demonstrate the efficacy and effectiveness of HEFMOB conclusively. Figure 1. Prototype scheme diagram  Figure 2. Virtual road cycling tour
Beyond phase 2: The impact of phase 3 cardiac rehabilitation on physical activity
Authors: Vilela M , Joao Cravo J C , Ana Margarida Martins A M , Ana Beatriz Garcia A G , Pedro Silva P S , Daniel Cazeiro D C , Diogo Ferreira D F , Pedro Bartolo P B , Catarina Gregorio C G , Ana Abrantes A A , Nelson Cunha N C , Ines Ricardo I R , Fausto Pinto F P , Ana Abreu A A
Published: June 2024

Introduction

Phase 3 Cardiac Rehabilitation (CR) is a maintenance exercise program for which clinical benefits are less well defined comparing to phase 2.

Purpose

To assess impact of phase 3 CR on physical activity (PA) levels.

Methods

A single-center cohort study was conducted, involving patients (pts) who completed a phase 2 CR program at least 6 months prior to the study and who answered the International Physical Activity Questionnaire (IPAQ) short form version 2.0. The patients were divided in 2 groups according to progression to phase 3 program to a specialized CR center (group 1) and non-CR center (group 2). The populations were compared.

Results

A total of 110 pts were included (78% male; mean age 61,5±11 years). Regarding clinical data, 59% had hypertension, 10% were diabetic, 79% had dyslipidemia and 20% were smokers, 86% pts with ischemic heart disease. Concerning exercise program methodologies, only 25,5% of pts enrolled a structured phase 3 CR center (group 1).

Regarding the intensity of PA, the group 1 had a higher number of minutes (min) per week undertaking moderate to vigorous activity (211±108 min vs 147±132 min, p=0,028) and a higher energy requirement in total metabolic equivalents (METs) per week (1033±356 vs 734±684), p <0,001) comparing to group 2. Concerning the categorical score, a higher proportion of pts were attributed a moderately or higher level of total PA (OR 4.485 [CI 1.549-12.984]) after computing activity on all domains accessed by the IPAQ form in group 1. These positive outcomes were consistent across gender and body mass index categories.

The subgroup analysis of younger pts (<70years) showed similar results when evaluating min/week of moderate-vigorous PA, total MET/week (p=0,018 and p=0,002 respectively) and categorical score of total PA (OR 5.9 [CI 1.6-22.4]), while the older population did not exhibit significant differences.

Conclusion

These findings are promising, suggesting that continuing with a structured phase 3 program may contribute to sustained physical activity and potentially better overall cardiovascular health, especially for the younger population. This underscores the importance of continued research in this area, namely whether there are specific factors influencing the outcomes in different age groups.
Cardiac rehabilitation in young patients post acute coronary syndrome: the keystone in cardiovascular care
Authors: Abrantes A , Ana Beatriz Garcia A B G , Ana Margarida Martins A M M , Miguel Raposo M R , Catarina Gregorio C G , Joao Fonseca J F , Joao Cravo J C , Daniel Cazeiro D C , Marta Vilela M V , Paula Sousa P S , Pedro Alves Da Silva P A S , Nelson Cunha N C , Ines Aguiar-Ricardo I A R , Fausto J Pinto F J P , Ana Abreu A A
Published: June 2024

Introduction

Cardiac Rehabilitation (CR) programs are recommended as part of cardiovascular management for patients (pts) following an Acute Coronary Syndrome (ACS). However, despite the well-established benefits, pts are frequently under-referenced.

Purpose

To compare risk factor management and adverse outcomes in young pts with ACS undergoing either a CR program or standard care (SC).

Methods

Single center retrospective study of pts younger than 55 years, with an ACS from January 2017 to May 2023. Following a cardiac event, pts could undergo SC or integrate CR program alongside SC. Adverse outcomes were defined as re-infarction, cardiovascular admissions and death, major cardiovascular events (MACE) was a composite of prior variables. For risk factor management we assessed cLDL, HgA1C, obesity (BMI ≥ 30kg/m2) and smoking status at baseline and during follow-up (FUP). Propensity score matching based on age and sex was used to generate comparable groups. Student T, chi-square and linear regression were used for statistical analysis.

Results

We included 424 pts, 226 pts were selected based on propensity score matching (1:1), 86% males, mean age 47土6 years, 65% had 1 vessel disease and 84% underwent complete revascularization. At baseline, 51% of pts had hypertension, 66% dyslipidemia (mean cLDL 99±45 mg/dl), 15% diabetes, 70% smoker, 15% obese, with no differences between groups. During a FUP of 3.5土2 years, significant cLDL reduction was noted in both groups but CR pts had a 2.4 fold increased odd of meeting cLDL goal (<55 mg/dl) compared to SC pts (30 vs 17%, OR 2.4, CI1.7-4.6). In CR pts, a 12.5-fold lower odds of smoking was noted (OR 0.08, CI 0.03-0.17) and significantly lower obesity rates, with a 30% odd reduction of obesity (OR 0.7, CI 0.6-0.8) when compared to SC. During FUP, SC pts experienced significantly higher incidence of all adverse outcomes expect for death (MACE: 33vs4 p=<0.001; re-infarction: 17vs2 p=<0.001; CV admission: 27vs2, p=<0.001; death:6vs3, p=0.3). SC was an independent predictor of MACE, re-infarction and CV admission after adjustment for confounders.

Conclusion

These results highlight the pivotal role of CR in not only achieving optimal risk factor control but also in substantially reducing adverse outcomes in this young ACS population. Efforts should be intensified to enhance CR referral rates, particularly in the younger demographic, to optimize cardiovascular management and improve long-term outcomes post-ACS.
Exploring the effect of urban environment on cardiovascular health: a feasibility study using machine learning to predict heart rate variability responses to environmental attributes in CHF patients
Authors: Van Es V A A , De Lathauwer I L J , Lopata R G P , Kemperman A D A M , Van Dongen R P , Kemps H M C
Published: June 2024

Aims

The global shift towards urbanization has been associated with a rise in non-communicable diseases, including congestive heart failure (CHF). Understanding the influence of diverse living environments on physiological variables such as heart rate variability (HRV) in patients with chronic cardiac disease may contribute to more effective lifestyle advice and telerehabilitation strategies. This study aims to investigate the feasibility of machine learning (ML) models to predict autonomic nervous system (ANS) responses, quantified through HRV metrics, to environmental attributes in uncontrolled real-world settings. The goal is to validate whether this approach can help ascertain and quantify the presence of a connection between separate environmental attributes and cardiovascular health in patients with CHF.

Methods

20 participants, comprising 10 healthy subjects and 10 patients with CHF, irrespective of type or etiology, were enrolled in the study. Over a 3-week period, activities at specific GPS locations, along with heart rate (HR) data, were collected using smartwatches. Environmental attribute quantification was accomplished through semantic sementation of Google Street view (GSV) images. The collected data were utilized to train and test machine learning models for predicting ANS dynamics, as demonstrated by HRV metrics, associated with environmental attributes. The predictive performance of ML models was assessed using Spearman’s correlation coefficient (R), root mean square error (RMSE), prediction intervals, and Bland-Altman analysis.

Results

The findings demonstrate the satisfactory efficacy of ML models in predicting HRV metrics associated with vagal nerve activity (R > 0.8, p < 0.05 for HR; 0.8 > R > 0.5, p < 0.05 for RMSSD and SD1; 0.5 > R > 0.4, p < 0.05 for HF, and LF/HF). However, predictive accuracy for metrics reflecting overall autonomic activity exhibited limitations due to the intricate interplay between sympathetic and parasympathetic modulation.

Conclusion

This study highlights the potential of ML-based models to discern vagal dynamics influenced by living environments in healthy individuals and patients diagnosed with CHF. Ultimately, this strategy could offer rehabilitation and tailored lifestyle advice, leading to improved prognosis and enhanced overall patient well-being in CHF.
The impact of cardiorespiratory fitness on COVID-19 related outcomes: the ETHOS Study
Authors: Myers J , Kokkinos P , Cadenas-Sanchez C , Liappis A , Goraya N , Weintrob A , Pittaras A , Ladas A , Heimall M , Faselis C
Published: June 2024

Background

Comorbidities such as cardiovascular disease, diabetes, obesity and hypertension are associated with more severe COVID-19 outcomes, but the relative impact of cardiorespiratory fitness (CRF) on outcomes in COVID-positive patients is largely unknown.

Objective

To assess the association between objectively measured CRF and COVID-19-related health outcomes including mortality, hospitalization, and mechanical ventilation in non-COVID vaccinated patients.

Design, Setting and Participants. Retrospective analysis of 750,302 subjects (23,140 [mean age 65.8±12.0 years] with a positive COVID-19 test between March 2020 and September 2021) who underwent a maximal exercise test between 1999 and 2020.

Main Outcomes and Measures. Association between all-cause mortality, hospitalization due to COVID-19, and need for intubation with risk for severe COVID-19 outcomes after adjustment for 15 covariates. Subjects were stratified into five age-specific CRF categories (Least-fit, Low-fit, Moderate-fit, Fit and High Fit), based on peak metabolic equivalents achieved.

Results

During a median of follow-up of 100 days, 1,643 (7.1%) patients died, 4,995 (21.6%) were hospitalized, and 927 (4.0%) required intubation for COVID-19 related reasons. When compared to the Least-Fit subjects (referent), the Low-Fit, Moderately-Fit, Fit, and High-Fit subjects had hazard ratios for mortality of 0.82 (95% CI; 0.72-0.93), 0.73 (95% CI; 0.63-0.86), 0.61 (95% CI; 0.53-0.72), and 0.54 (95% CI; 0.45-0.65), respectively (Figure). Subjects who were more fit also had significantly lower need for hospital admissions and intubation. Similar patterns were observed for elderly subjects and subgroups with comorbidities including hypertension, diabetes, cardiovascular disease, and chronic kidney disease; for each of these conditions, those in the High-Fit category had mortality rates that were roughly half those in the Low-Fit category.

Conclusion

Among subjects positive for COVID-19, higher CRF had a favorable impact on survival, need for hospitalization, and need for intubation regardless of age, BMI, or the presence of comorbidities.
Differences of left ventricular morphology by gender and sports discipline in Japanese elite athletes
Authors: Ashikaga K
Published: June 2024

Background

The cardiac morphology of elite athletes is related to sports disciplines and race but there have been no studies of the effects of sports discipline in oriental athletes. This study aimed to assess left ventricular (LV) remodeling using transthoracic echocardiography, morphological characteristics, and determinants of LV remodeling in elite Japanese athletes.

Methods

We retrospectively reviewed elite Japanese athletes who underwent transthoracic echocardiography between January 2011 and December 2021. The athletes were divided into four sports discipline groups (skill, power, mixed, and endurance). We evaluated the differences in LV volume and LV mass between the groups for each sex. In addition, we evaluated the impact of age, sex, body surface area (BSA), and sports discipline on LV end-diastolic volume (LVEDV) and LV mass.

Results

Data of 1406 elite athletes were analyzed. The LVEDV and LV mass indexed to BSA in the endurance group (LVEDV BSA: 72.4 ± 11.6 mL/m2 in males and 68.7 ± 11.0 mL/m2 in females, LV mass/BSA: 121.4 ± 19.7 g/m2 in males and 107.5 ± 18.5 g/m2 in females) were significantly larger than that of any other groups (p < 0.05). Both values were affected by age, sex, BSA, and sport type (LVEDV: age, p = 0.049; other variables, p < 0.001) (LV mass: age, p = 0.040; other variables, p < 0.001).

Conclusion

In elite Japanese athletes, cardiac remodeling is proportional to the type of sport, with a greater effect in endurance sports.
Chronic adaptations to exercise in thin-walled chambers of the heart: a longitudinal study echocardiographic study of elite athletes
Authors: Aaroe M , Tischer S G , Christian Have Dall C H D , Jens Jacob Thune J J T , Hanne Kruuse Rasmusen H R
Published: June 2024

Background/Introduction

Longitudinal studies of cardiac detraining in former athletes are sparse, though studies of master endurance athletes have documented increased risk of atrial fibrillation[1]. Cardiac adaptations to exercise are characterized by uniform dilation of cardiac chambers due to increased volume load[2]. Examinations of finishers at long-duration events have demonstrated examples of acute right ventricular dilation and dysfunction[3]. This raises concerns regarding the susceptibility of thin-walled cardiac chambers to repetitive acute overload, posing a potential risk for the development of left atrial fibrosis and cardiac rhythm disorders over the long term.

Purpose

The aim of this investigation was to assess the pattern of inverse cardiac remodelling in retired elite athletes.

Methods

In this longitudinal study of elite athletes from sports of high cardiac demands we performed a 10-year follow-up examination, including a standard resting echocardiogram. Baseline echocardiograms was performed in 2009-2014. All measures of size were indexed to body surface area (BSA). Age adjusted ratios of left atrium maximum (maxLAVi), right ventricle end systolic area (RVEDVi) and left ventricle end diastolic volume (LVEDVi) were compared between baseline follow-up. Analysis of Covariance models was used to allow for adjustments for categorical variables and continuous covariates. Results are presented with 95% confidence intervals.

Results

MaxLAVi was increased at the time for follow-up examination compared to baseline (31.39ml/m2 CI: 29.28 -33.51ml/m2 to 33.32 ml/m2 CI: 31.06-35.58 ml/m2; p=0.04), while RVEDVi (14,57cm2 CI: 13.90-15.23 to 12.79 CI: 12.21-13.37cm2; p<0.01) and LVEDVi both dropped significantly (82.40ml/m2 CI: 79.34-85.45ml/m2 to 74.35ml/m2 71.50-77.21ml/m2; p<0.01). A comparison of cardiac chamber size ratios showed a significant increase in maxLAVi/RVEDVi ratio from baseline to follow-up examination (baseline: 2.21 CI: 2.05-2.38; follow-up: 2.63 CI: 2.47-2.79; p<0.01), this difference persisted when adjusting for age (p<0.01). MaxLAVi/LVEDVi ratio also increased (baseline: 0.38 CI: 0.36-0.41; follow-up: 0.45 CI: 0.42-0.47; p<0.01), however, when we adjusted for age, this difference was no longer significant (p=0.15). A comparison of ventricular size (RVEDVi/LVEDVi) showed no difference over the course of the study period (baseline: 5.80 CI: 5.47-6.13; follow-up: 5.91 CI: 5.63-6.19; p=0.31), adjusting for age did not affect this difference (p=0.12).

Conclusion

In our population of elite endurance athletes, both ventricles were smaller after the end of their sporting career, while LA increased in size. Cardiac chamber size ratios showed similarly a relative increase in LA size compared to either ventricle, though after adjusting for age no significant change was present between LA and LV.
Sex- and cardiac magnetic resonance imaging septal thickness demonstrate the strongest associations with maximal oxygen uptake and oxygen pulse in elite athletes: findings from the ELITE cohort
Authors: Van Steijn N , Beerman F , Van Hattum J C , Daems J J N , Van Diepen M A , Planken R N , Boekholdt S M , Moen M , Van Randen A , Snaterse M , Jorstad H T
Published: June 2024

Background

Prolonged and intensive physical exercise is associated with cardiac remodelling and more efficient gas exchange profiles. However, it remains unclear which morphological changes have the strongest associations with maximal oxygen uptake (VO2max) and maximal oxygen pulse (O2pulse) in elite athletes when using advanced imaging techniques like Cardiac Magnetic Resonance Imaging (CMR).

Purpose

To determine the associations between VO2max and O2pulse, and left- and right ventricular and atrial volumes, and ventricular mass and diameters.

Methods

We included healthy, elite athletes from the Evaluation of Lifetime participation in Intensive Top-level sport and Exercise (ELITE) cohort who had undergone a Cardio-Pulmonary Exercise Test (CPET) and CMR. Sex and CMR measures of cardiac remodelling were selected for univariate linear regression models for VO2max and O2pulse. Due to sample size, a maximum of 5 variables were retained in the multivariate models, according to their adjusted R2. Backward linear regression was used to identify independent predictors, avoiding multicollinearity by excluding variables with a Variance Inflation Factor of more than 5.

Results

We included a total of 108 athletes (59% female) with a median age of 27.0 years [23.0, 31.0]. Men had larger maximal left- (81.5 ml [66.4, 100.9] vs. 57.4 ml [46.0, 71.5], p <0.001) and right atrial volumes (140.3 [112.5, 159.3] vs. 101.00 [83.4, 122.0] mL, p <0.001), as well as left- (255.0 ± 37.5 vs. 198.1 ± 32.5 mL, p <0.001) and right ventricular end-diastolic volumes (270.2 [217.1, 294.8] vs. 255.0 ± 37.5 mL, p <0.001). Left ventricular mass (LVM) was higher in men (129.1 [111.7, 158.9] vs. 91.0 [74.8, 101.1], p <0.001). Men had higher VO2max (4.47 ± 0.75 vs. 3.16 ± 0.64 L/min, p <0.001) and higher O2pulse (24.6 ± 3.6 vs. 17.8 ± 3.6 mL, p <0.001) than female athletes. In the multivariate model, VO2max was associated with male sex (0.490, p = 0.002), interventricular septal end-diastolic diameter (IVSEDD) (0.107, p = 0.014), LVEDV (0.007, p <0.001) and LVM (0.006, p = 0.037). O2pulse was associated with male sex (3.120, p <0.001), IVSEDD (0.791, p <0.001), RVEDV (0.038, p <0.001) and right atrial minimal volume (0.021, p = 0.110).

Conclusion

Next to sex, septal thickness as measured on CMR is strongly associated with measures of maximal oxidative capacity, more so than cardiac cavity volumes. Our findings refine current understanding of cardiac remodelling and performance measures in elite athletes.
Does physical activity influence Brugada pattern at 12-lead holter 24-hour monitoring?
Authors: Tarditi F , Toso E , Koumantakis E , Jorfida M , Alunni G , Gaita F , Benso A , Giustetto C
Published: June 2024

Introduction

Brugada Syndrome (BrS) is a hereditary ion channel disease predisposing young patients to sudden death, characterized by a dynamic electrocardiogram (ECG) pattern with coved ST-segment elevation in right precordial leads, often not apparent at basal ECG assessments. Various factors, such as increased vagal tone, fever and the use of sodium channel-blocking medications, can either reveal or accentuate the pattern; the impact of physical activity (PA) remains unclear.

Purpose

To evaluate the effects of PA on Brugada (Br) ECG pattern through the assessment of serial Holter monitoring during a follow up of 5 years. The main endpoints were: 1- to investigate the potential accentuation of spontaneous type 1 ECG pattern in physically active Br patients compared to the sedentary group; 2- to verify if there is a significant difference in unmasking spontaneous type 1 ECG pattern between the two groups with induced type 1 ECG; 3- to determine the prevalence of major arrhythmic events during PA.

Methods

153 Brugada patients aged between 18 and 55 years were enrolled in the study. Data regarding demographic information, levels of PA, basal ECG and 12-lead Holter were prospectively collected. The cutoff between trained and untrained subjects was set at 4 hours per week, defining trained individuals as "recreational athletes" according to ESC Guidelines. To assess differences between groups, the Mann-Whitney U and Chi-squared test were performed, as appropriate. Logistic regression was employed to evaluate the association between PA and the presence of the pattern, adjusted for sex and age.

Results

153 patients were included in the analyses: 121 males (79.1%), median age of 35.2 years.

39 patients (25%) were trained, while 114 (75%) were untrained. Overall sample characteristics are shown in Table.1. 64 Br patients (41.8%) showed a spontaneous type 1 ECG, 89 (58.2%) had a drug-induced type 1 ECG. The median of the average heart rates at the first Holter was significantly lower in trained vs untrained (71 vs 75 bpm, p=0.025). No significant differences were observed regarding prevalence of type 1 pattern in both subgroups with spontaneous (p=0.606) or drug induced type-1 ECG (p=0.363), see Table.2. No significant association emerged between PA and presence of diagnostic Br pattern (OR:1.66; 95%CI:0.75-3.83; p=0.229). Male sex and age were confirmed as risk factors for identifying the pattern during Holter monitoring (OR:5.85; 95%CI:1.89-25.84; p=0.006; and OR per year of age: 1.04; 95% CI:1.00-1.09; p=0.059, respectively). At last, no symptoms or arrhythmic events occurred during PA.

Conclusion

in the sample population we observed that trained individuals with Br pattern showed significantly lower heart rate during Holter monitoring. However, there was neither a higher prevalence nor a significant unmasking of the type 1 pattern when compared to sedentary patients.

During sports activities, we did not observe any events.
Co-existence of hypovitaminosis D and diabetes mellitus triple the incidence of severe CAD in women
Authors: Aleksova A , Fluca A , Zandona L , Stenner E , Chicco A , Derin A , Pani B , Barbati G , Marketou M , D'errico S , Sinagra G , Janjusevic M
Published: June 2024

Background

Vitamin D deficiency is associated with the development of several diseases and metabolic syndromes. The lack of this steroid hormone alters calcium and glucose homeostasis, lipid metabolism and promotes oxidative stress, endothelial dysfunction and inflammation. Despite a higher prevalence of hypovitaminosis D in women, defined as vitamin D ≤ 20 ng/ml, little is known about vitamin D levels and the severity of coronary artery disease (CAD) and gender implication.

Purpose

To investigate the gender differences between hypovitaminosis D levels and the severe CAD incidence in individuals suffering from acute myocardial infarction (AMI).

Methods

Blood samples were collected from patients with AMI on hospital admission. CAD was defined as the presence of at least one coronary vessel stenosis greater than 50%, while severe CAD was defined as left main disease and/or three-vessel disease.

Results

In total, 1484 patients were included in the study. The mean age of the cohort was 66.25 (11.47) years and majority of patients were male (71.8%). Overall, 86.2% and 32.9% of patients had CAD and severe CAD, respectively. The median vitamin D concentration was 17.25 [10.3 - 24.7] ng/ml, and 59,7% of patients had hypovitaminosis D.

The prevalence of hypovitaminosis D was higher in women with severe CAD (74.1% vs. 58.1%, p=0.002), while no significant difference was observed in men (61.3% vs. 57.1%, p=0.193).

Hypovitaminosis D (OR: 1.85 [1.14 – 3.03], p=0.013), along with diabetes mellitus (DM) and older age, was found to predict severe CAD in female patients after correction for confounders as glomerular filtration rate <60 mL/min/1.73 m2, higher cholesterol levels and body mass index. However, hypovitaminosis D was not found to be an independent predictor of severe CAD in men. In female patients, individuals with both hypovitaminosis D and DM had more than three times higher risk of severe CAD diagnosis compared to women who had neither hypovitaminosis D nor DM (OR: 3.56 [1.8 – 7.03], p=0.021).

Conclusions

Hypovitaminosis D predicts severe CAD in women and not in man which is the novelty and strength of our research. Furthermore, our results stand that vitamin D deficiency and DM together triple the incidence of severe CAD in women.
Common carotid artery inima-media thickness trajectories over time are more strongly associated with incident cardiovascular disease than a one off measurement
Authors: Pavey H , Tschiderer L M , Seekircher L , Willeit P
Published: June 2024

Background

Atherosclerotic cardiovascular disease (CVD) remains the leading cause of mortality and morbidity globally. Several studies have previously looked into whether carotid artery intima-media thickness (CCA-IMT) measured at a single point in time is associated with CVD risk. More recent analyses have considered progression of CCA-IMT over time as a risk predictor, but measurement of progression is particularly prone to measurement error. Modelling the trajectories allows estimating the true strength of the aetiological association with CVD risk more accurately.

Purpose

The aim of the present study is (i) to model within-person trajectories of CCA-IMT incorporating repeat measurements taken over an extended period of time, thereby reducing measurement error, and (ii) to quantify the association of within-person CCA-IMT trajectories over time with the risk of a CVD event.

Methods

Individual participant data from studies within the Proof-ATHERO consortium were used for this analysis. The Proof-ATHERO consortium collates data from studies with information on atherosclerosis measures, CV risk factors and CV outcomes. Study-specific joint longitudinal and survival models were fitted to model the association between CCA-IMT trajectory and CVD risk, accounting for conventional CV risk factors including: age, sex, systolic blood pressure (SBP), high-density lipoprotein cholesterol (HDL-C), total cholesterol, smoking status, history of diabetes and history of CVD. Study-specific hazard ratios were pooled in a random effects meta-analysis.

Results

Data from 38 studies were analysed, involving 68,077 individuals and 153,643 CCA-IMT measurements. 51% of the individuals were female, the weighted mean (SD) age of participants at baseline was 61 (9) years, 13% of individuals had a history of CVD. Over a median (5th percentile, 95th percentile) follow-up of 7.3 (0, 28.6) years, 13,116 (19.3%) individuals suffered an incident CVD event. At baseline, the weighted mean (SD) CCA-IMT was 0.83 (0.19) mm, SBP was 135 (19) mmHg, HDL-C was 1.29 (0.40) mmol/L, total cholesterol was 5.49 (1.06) mmol/L; 26% were current smokers and 16% had a history of diabetes. Trajectories of CCA-IMT were independently associated with CVD risk after accounting for conventional CVD risk factors. The pooled adjusted hazard ratio for CVD (95% CI) per study-specific SD higher CCA-IMT value was 1.20 (1.14-1.27) (p<0.001). In comparison, a one off measurement of CCA-IMT at baseline was associated with a pooled hazard ratio of 1.11 (1.06-1.16) per study-specific SD higher value (p<0.001).

Conclusion

The association of CCA-IMT trajectories based on repeated measurements with incident CVD risk is stronger than the association of a one off measurement.