bluuebunny/crossref_metadata_2025 huggingface dataset:
Sex-specific differences in exercise-based rehabilitation of patients with Post-COVID-19 Syndrome
Authors: Schmitz B , Garbsch R , Schaefer H , Kotewitsch M , Mooren J , Waranski M , Teschler M , Vereckei K A , Boell G , Mooren F C
Published: June 2024

Background

Post-COVID-19 Syndrome (PCS) involves multiple lead symptoms, including reduced physical performance, fatigue, dyspnea, cognitive impairment, and psychological distress. While it has been shown that exercise-based rehabilitation in PCS is effective, sex-specific differences are underreported.

Purpose

To compare the effects of exercise-based rehabilitation on pulmonary function, cardiopulmonary exercise capacity, and health-related outcomes in long-term female and male PCS patients.

Methods

A prospective cohort study was performed with PCS patients attending center-based rehabilitation. Cardiopulmonary exercise testing (CPET) and spirometry were conducted at admission and before discharge. Questionnaires were used to assess health-related quality of life, fatigue, wellbeing, and workability for up to 6 months.

Results

145 patients (women, n=52 [36%]) with a mean age of 50.2 ± 10.7 years (women, 47.1 ± 12.7 years; men, 52.0 ± 9.1 years; p=0.018) were referred to rehabilitation 262.0 ± 128.8 days (women, 285.5 ± 140.6 days; men, 248.8 ± 112.0 days; p=0.110) after acute infection. Diagnosed lead symptoms were fatigue/exercise intolerance (81.4%), shortness of breath (74.5%), and cognitive dysfunction (52.4%). Men presented with lower relative baseline exercise capacity (68.8 ± 13.3%) compared to women (82.0 ± 14.3%, p<0.001), but female PCS patients showed greater improvement in submaximal workload (p=0.026). By contrast, men exhibited higher values for FEV1/VC, MEF, and PEF and lower VC at baseline (p≤0.038), while FEV1/VC showed greater improvements in women (p=0.027). Higher fatigue and lower wellbeing were detected in women at baseline which correlated with impaired pulmonary function (p<0.05). Disease perception including fatigue, health-related quality of life, wellbeing and workability improved for up to six-month after rehabilitation.

Conclusions

Exercise-based rehabilitation improves pulmonary function, cardiopulmonary fitness, and disease burden in women and men with long-term PCS. While women with PCS may benefit from intensified respiratory muscle training, rehabilitation in men with PCS should set a strong focus on physical exercise training. Clinical assessment for all PCS patients should include CPET and pulmonary function tests and assessments of fatigue to document limitations and tailor therapeutical strategies.
Increased nation-wide uptake after establishment of comprehensive outpatient cardiac centres in Slovenia: an interrupted time-series
Authors: Jug B , Furlan T , Ravnikar T , Farkas Lainscak J , Lainscak M , Novakovic M , Dosenovic Bonca P , Fras Z
Published: June 2024

Dedicated centres providing outpatient comprehensive cardiac rehabilitation (CR) programmes were established in seven (out of 15) Slovenian regional hospitals between 2017 and 2020. Implementation encompassed referral pathways, CR centre accreditation, and full reimbursement for mandatory programme content (initial and end-of-programme assessment, exercise training, risk factor and secondary prevention management, patient education and psychosocial support). In the present analysis, we sought to assess the impact of dedicated CR centres initiation on nation-wide CR uptake in patients with myocardial infarction.

Data on patients hospitalised for myocardial infarction in Slovenia between 2015 and 2021 were retrospectively obtained from the Health Insurance Institute of Slovenia by linking the national hospital database and CR reimbursement claims. The impact of CR centres set-up on nation-wide CR uptake (monthly aggregated proportion of eligible patients attending CR, as ) was assessed by interrupted time series analysis with segmented regression.

Of the 11,815 eligible patients, 3,819 (32.3%) attended CR. Comprehensive outpatient CR programmes initiation in 2017 was associated with a 9.7% [95%CI 6.3, 13.1] increase in level and 0.41% per month [95%CI 0.22, 0.6] increase in trend of nation-wide CR uptake, which was partially reversed by the coronavirus pandemic outbreak (–7.2% [95%CI –13.8, –0.6] drop in level). See Figure.

In conclusion, systematic initiation of comprehensive regional outpatient CR programmes increased nation-wide CR uptake (which was, however, partially reversed by the coronavirus pandemic).
Rehabilitation programs in the recovery treatment of patients who have suffered an acute coronary syndrome with chronic heart failure and iron deficiency
Authors: Nesterak R , Nesterak R V , Sovtus V I , Vakalyuk I P , Babliuk L A , Hryhoryshyn R S , Barchyk Y V
Published: June 2024

An important aspect of the recovery treatment of patients who suffer from acute coronary syndrome is the prevention of the development of chronic heart failure along with iron deficiency.

The academic paper aimed to study the effectiveness of rehabilitation programs for chronic ischemic heart failure with iron deficiency within the recovery period after acute coronary syndrome.

We examined 145 patients with chronic heart failure and iron deficiency 3–6 months after acute coronary syndrome, including 74 patients after percutaneous coronary intervention and 71 patients with conservative treatment of acute coronary syndrome. Fifty-two patients with iron deficiency underwent an original recovery treatment program, which included physical training, dosed exercises, diet therapy, and psychological monitoring. Medicinal support included the use of ferric carboxymaltose. Fifty-six patients entered the control group.

We evaluated clinical signs of coronary heart disease and chronic heart failure, indicators of exercise tolerance test, dynamics of tolerance to physical exertion, indicators of echocardiography, and questionnaires on the quality of life. The blood level indicators of iron, ferritin, transferrin saturation of iron, fibronectin, glutathione peroxidase, glutathione reductase, and glutathione transferase were analysed.

The results we have come out to. Controlled use of rehabilitation programs was accompanied by a reduction in clinical signs of heart failure, improvement in quality of life indicators and tolerance to physical exertion. The indicator of the 6-minute test increased from 185.40±15.40 m to 324.90±18.4 m; the emission fraction increased from 47.8±1.4% to 52.5±1.9% under the conditions of reducing the volume indicators of the left ventricle. Along with this, we noted an improvement in the function of iron transport with the correction of the transferrin saturation with iron and the ferritin level.

Conclusions: The use of complex rehabilitation programs in the recovery period after acute coronary syndrome with chronic heart failure and iron deficiency prevents the progression of post-infarction dilatation and remodelling of the heart's left ventricle, contributes to the correction of iron deficiency, increases tolerance to physical exertion, and improves the quality of life of patients.
Comparative performance of mortality prediction using different reference value equations for peak oxygen uptake in cardiopulmonary exercise testing
Authors: Braga F , Milani M , Magalhaes J , Facio M R , Domecg F , Paiva J , Monteiro A , Moraes G , Fonseca B , Milani J G P O , Cipriano Junior G
Published: June 2024

Background

Cardiorespiratory fitness (CRF) is a well-established health indicator with significant prognostic value for all-cause mortality. Peak oxygen uptake (VO2peak) measured through cardiopulmonary exercise testing (CPET) is considered the gold standard method. As VO2peak is influenced by sex and age, it is compared to reference standards, and the percent-predicted value achieved (%VO2peak) is considered a more reliable indicator for individual assessment. However, various reference value equations for VO2peak exist, demonstrating international heterogeneity. Additionally, the new Brazilian prediction equation (BE) has not been evaluated for prognostic performance, and the cut-off value for risk stratification remains unknown.

Purpose

To compare the predictive performance for mortality stratification of three VO2peak reference value equations: Wasserman[1], FRIEND[2], and the Brazilian equation[3].

Methods

A cohort of patients underwent CPET at a private center in Rio de Janeiro state, Brazil, between May 2018 and January 2023. Survival status was determined using death certificates. CRF was assessed by %VO2peak for each prediction equation. Prognostic performances were evaluated using the area under the curve (AUC) of the receiver operating characteristic curve (ROC). The standard error of AUC was calculated using the method of Hanley & McNeil. The optimal cut-off point for %VO2peak in each reference value equation was determined based on the ROC curve's ideal combination of sensitivity and specificity for predicting mortality.

Results

A total of 2,684 individuals (62.4% men; 52.9 ± 14.5 years) were included, with a median follow-up of 451 days (IQR = 422). During this period, 31 deaths (1.15%) were identified. The AUC was 0.812 (95%CI: 0.743 - 0.882) for Wasserman, 0.796 (95% CI: 0.710 - 0.882) for FRIEND, and 0.753 (95% CI: 0.661 - 0.846) for Brazilian equation. The AUC for Wasserman was significantly higher than that of Brazilian equation (p = 0.018). No differences were observed between Wasserman and FRIEND, and between FRIEND and Brazilian equation. The optimal cut-off points were: %VO2peak ≤ 84% [Sens: 80.7%; Spec: 69.4%) for Wasserman; %VO2peak ≤ 82% [Sens: 77.4%; Spec: 57.3%] for FRIEND; and %VO2peak ≤ 76% [Sens = 80.7%; Spec = 57.75%] for Brazilian equation.

Conclusions

In this sample, all reference value equations demonstrated good performance in predicting mortality. The Brazilian equation, although developed for treadmill assessment, exhibited similar accuracy to the FRIEND equation and slightly lower accuracy than Wasserman's equation. The lower cut-off value for the Brazilian equation may be attributed to ergometer specificity, as reference value are generally higher for treadmills.
Cardiopulmonary exercise testing in correlation with magnetic resonance imaging in patients with cardiac amyloidosis
Authors: Ermolaev N , Willixhofer R , Kronberger C , Rettl R , Binder C , Duca F , Nitsche C , Poledniscek M , Gregshammer B , Ahmadi-Fazel D , Kammerlander A , Kastner J , Bergler-Klein J , Badr-Eslam R
Published: June 2024

Introduction

Cardiac magnetic resonance imaging (cMRI) stands as a crucial non-invasive diagnostic tool for monitoring disease progression in individuals with cardiac amyloidosis (CA). Limited functional capacity (FC), assessed by cardiopulmonary exercise testing (CPET) has been described in CA in several studies. The aim of this study was to identify potential concurrent relationships between the two diagnostic modalities.

Methods

112 patients diagnosed with cardiac amyloidosis (CA) were evaluated. Patients were aged 77 ± 7 years with 86% being male. Each participant underwent both cMRI and CPET under best medical therapy and prior to initiation of disease specific therapy.

Results

A mean peak oxygen consumption (VO2) of 15 ± 4 ml/kg×min, with a physical performance of 80 ± 29 watts, a ventilation to carbon dioxide relationship (VE/VCO2) slope of 39 ± 8, and a peak oxygen pulse (O2 pulse) of 11 ± 4 ml/beat were assessed. Furthermore, on cMRI, left ventricle ejection fraction (LVEF) with a mean of 49 ± 12 %, a left ventricular stroke volume (LVSV) of 85 ± 26 ml and a right ventricle ejection fraction (RVEF) of 46 ± 12 % were obtained.

Pearson correlation showed a significant correlation between peak VO2 and LVEF (r = 0.421, P-value < 0.001). Further, a significant correlation was observed between the peak O2 pulse and LVSV (r = 0.411, P-value < 0.001). Moreover, correlations were established between RVEF and both measures of physical performance (r = 0.473, P-value < 0.001) and VE/VCO2 Slope (r = 0.415, P-value < 0.001), as demonstrated in Table 1.

Conclusions

The assessed correlations between CPET variables and cMRI parameters suggest that CPET may serve as a valuable method for assessing the prognosis and diagnosis of CA. Table 1
Impact of left ventricular ejection fraction on cognitive function in chronic heart failure: insights from key-prognostic CPET parameters
Authors: Besnier F , Gagnon C , Berube B , Sellier F , Vachon F , Iglesies-Grau J , Gayda M , Dionne V , Benhalima H , Nigam A , Juneau M , L'allier P , Bouabdallaoui N , Rouleau J L , Bherer L
Published: June 2024

Background

Cognitive impairment is a common comorbidity in chronic heart failure patients (CHF) that negatively affects prognosis. Previous studies reported that higher cardiorespiratory fitness (VO2peak), measured with a cardiopulmonary exercise stress test (CPET), is associated with better cognitive performance in CHF. The impact of reduced or preserved left ventricular ejection fraction (LVEF) and the cardiorespiratory parameters during exercise on cognition remain to be studied.

Objectives

To compare cognition in CHF patients with reduced LVEF versus those with mildly reduced or normal LVEF (R-LVEF ≤40% vs N-LVEF >40%). To examine if key-prognostic CPET parameters predict cognitive performance in each CHF subtype.

Methods

68 patients with CHF (67±8 years old) performed a CPET (VO2peak, VE/VCO2 slope, Myers score. All have significant prognostic value). Cognitive assessment included global cognition (Montreal Cognitive Assessment for general cognition; MoCA), processing speed and executive function (Stroop) and memory (Rey auditory verbal learning test). LVEF was measured by echocardiography.

Results

Mean LVEF were 32.7±6.2% and 52.6±6.8% for R-LVEF and N-LVEF (p<0.001). Age, NYHA class, VO2peak, VE/VCO2 slope, and Myers’ CPET score were similar between groups (p>0.05). After adjusting for age, sex, and education, MoCA scores were not statistically different between groups (23.5±4.6 vs 25.3±2.9 p=0.24 respectively for R-LVEF and N-LVEF). The Stroop switching task revealed a significantly lower performance in R-LVEF vs N-LVEF (89.7±32.1s vs 74.4±16.4s, p=0.028), as well as at the fifth repetition of the verbal learning test (9.3±2.8 vs 11.1±2.2, p=0.015). A trend was observed for the immediate recall on the memory task (6.4±3.5 vs 8.3±3.1 p=0.061). Simple linear regressions showed that VO2peak (mL.kg.min) (R=0.50, p<0.001), VE/VCO2 slope (R=-0.33, p=0.024), and Myers CPET score (R=-0.43, p=0.003) significantly predicted MoCA score in R-LVEF but not in N-LVEF. VO2peak (mL.kg.min) (R= -0.47 p=0.001), VE/VCO2 slope (R= -0.37 p=0.015), and Myers’ CPET score (R= 0.32 p=0.034) predicted Stroop switching performance in R-LVEF only.

Conclusion

Global cognition, executive function (switching), and verbal memory (encoding) were lower in CHF with reduced LVEF versus those with mildly reduced/normal LVEF despite similar key-prognostic CPET parameters. Key-prognostic CPET parameters predicted global cognition and executive function in CHF participants with reduced LVEF. Future studies are needed to better understand cognitive deficits in CHF and potential intervention to mitigate their impact in patient’s quality of life.
Longitudinal insights into coronary plaque amongst master athletes
Authors: Fyyaz S , Merghani A , Al-Turaihi S , Chatrath N , Bhatia R , Maclachlan H , Finocchiaro G , Papatheodorou S , Parry-Williams G , David S , O'driscoll J , Papadakis M , Alfakih K , Sharma S
Published: June 2024

Introduction

Cross-sectional studies of master athletes with a low risk atherosclerotic risk profile demonstrate a greater prevalence of high coronary artery calcium (CAC) scores, coronary plaque and luminal stenoses than matched controls. We sought to assess the progression of coronary disease amongst an ostensibly fit cohort of lifelong athletes compared with controls.

Methods

72 male master-athletes and 24 controls of similar age without cardiovascular risk factors at baseline underwent evaluation with health questionnaire, cardiopulmonary exercise testing (CPET) and computed tomography coronary angiography (CTCA) with CAC score at baseline and at 8 year follow-up. Athletes were required to continue running at least 10km/week.

CTCA was interpreted in accordance with established guidelines assessing luminal stenosis severity and plaque morphology (i.e. calcified, mixed or non-calcified). CAC was calculated using the Agatston method and adjusted for age and sex. A 3-vessel plaque score was calculated based on the coexisting presence of any plaque in the LAD, LCX or RCA irrespective of severity.

Results

Athletes remained well matched with respect to cardiovascular risk factors at follow-up, weighed significantly less, had higher HDL cholesterol, and achieved significantly greater CPET metrics with respect to maximum workload, peak VO2 and % predicted peak VO2 (p<0.001). Athletes were more likely to demonstrate a peak systolic blood pressure exceeding 220mmHg on exercise than controls.

There were no significant differences between athletes and controls with respect to CAC scores, proximal or 3-vessel plaque at baseline or follow-up. Albeit only athletes demonstrated CACS >300 and 400 AU and luminal stenoses >50% at baseline. Amongst athletes, 80% of plaques were of calcified at baseline versus 20% in controls (p<0.001). The dominant plaque morphology in controls was mixed plaque (67%).

At follow-up, athletes demonstrated a similar proportion of calcific and mixed plaque accounting for 48% and 43% of plaques respectively. However, controls continue to demonstrate significantly more mixed-morphology plaque (67%, p=0.027).

Discussion

Plaque composition amongst athletes changes with increasing age with an increasing prevalence of mixed plaque compared with calcific plaque at baseline, whereas the relative proportion of plaques amongst control subjects remained stable. This may suggest exercise induces plaque stabilising effects which is progressively offset with increasing age. Further longitudinal studies are required to understand cardiovascular event rates relative to plaque composition in athletes. Table.  Plaque composition.
Prevalence of arterial (pre-)hypertension and white coat hypertension in competitive athletes according to the classification of the ESC vs. JNC guidelines of arterial hypertension
Authors: Bierschneider E , Schmidt T , Vassiliadis A , Zacher J , Riemer L , Predel H G
Published: June 2024

Background

Arterial hypertension (aHT) is the most common risk factor for cardiovascular disease in competitive sports. The exact prevalence of aHT and prehypertension (preHT) in the cohort of high-performance athletes is unclear due to an often insufficiently standardized measurement methodology and different threshold definitions (ESC vs. JNC). Furthermore, the prevalence of white coat hypertension is unknown.

Methods

Retrospective analysis (n=302, f=39%; 19.8±4.9 years old) of sports medical examinations at one of the Olympic Training Centres in Germany. Detailed information of the athletes’ population can be found in Table 1. Arterial blood pressure values obtained by standardized blood pressure measurement were analysed at 4 different times: At rest (RR1), in the resting phase before the start of bicycle ergometry (RR2), at 100 watts (RR3) and at maximum exertion (RR4). The classification into the categories normotensive, prehypertensive and hypertensive was based on the respective definitions of the ESC and JNC.

Results

The prevalence of aHT in RR1 was high and differed significantly depending on the guideline definition (32%ESC vs. 69%JNC, p<0.001). The further course showed, however, that in the majority of cases aHT could no longer be confirmed in RR2 (20/95ESC and 84/208JNC with aHT in RR2). The observed white coat hypertension was significantly more common in male athletes (m=45.2%ESC vs. f=27.2%ESC, p<0.001). During the exercise test (RR3), only 10 athletes (6%) were still abnormal (≥ 180mmHg systolic). The measured values of preHT were similar (RR1: 29.1% ESC vs. 18.5% JNC; preHT not confirmed in RR2 at: 67/88ESC vs. 41/56JNC). White coat hypertension was present here regardless of gender (m=62.5%ESC vs. f=59.4%ESC). Further results and the relation to the different sports can be seen in Fig. 1.

Conclusion

The prevalence of aHT varied considerably, depending on the respective guideline classification, measurement setting and gender. In competitive athletes the office measurement (RR1) frequently led to false-positive elevated BP values. By changing the measurement setting (RR2), the prevalence of aHT decreased significantly indicating a high number of white coat hypertension in RR1. These results reflect the current diverse study situation on the prevalence of aHT and illustrate the difficulty to make a generally valid statement on this basis. A standardized measurement methodology as well as the consideration of gender and the different guideline classifications are necessary to define the prevalence of aHT in the cohort of athletes. Further studies are requested.
Prevalence of atherosclerotic coronary artery disease in master athletes with exercise-induced ventricular arrhythmias: implications for pre-participation screening
Authors: Graziano F , Millin A , Cozza E , Mattesi G , Pergola V , Motta R , Micchi A , Ciccio' C , Zamboni F , Zorzi A
Published: June 2024

Background

The leading cause of sudden cardiac death in master athletes (≥35 years) is coronary atherosclerotic disease (CAD). During pre-participation screening (PPS), the primary indication for investigating CAD in this population is ST-segment depression at exercise test (ET); a second most debated indication is represented by high-risk premature ventricular beats (PVBs), which are considered another potential marker of ischemic heart disease. However, the prevalence of coronary artery disease in master athletes with PVBs is still unknown.

Purpose

The aim of this study was to evaluate the prevalence of CAD in master athletes who underwent coronary computed tomography (CCT) due to high-risk PVBs during PPS (emerging indication), and to compare this population to age-, gender- and risk factors-matched group of athletes who underwent CCT due to ST segment depression during ET (traditional indication).

Methods

We retrospectively enrolled master athletes with no baseline ECG abnormalities and no previous history of heart disease who underwent CCT due to non-common PVBs during PPS. We compared them with a control group of athletes with ST-segment depression during PPS. The entity of the disease was assessed using the CAD-RADs scoring system (0= no plaque, 1=minimal stenosis 1-24%, 2=mild stenosis 25-49%, 3= moderate stenosis 50-69%, 4A= severe stenosis 70-99%, 4B= severe stenosis 70-99% left main stem >50% or 3 vessels ≥70%, 5= total occlusion).

Results

The population resulted to be composed by 70 Caucasian athletes, median age 53 (44-59 years, 88% male), 73% practiced endurance sports. Thirty-five of them underwent CCT for ST-segment depression and 35 for high-risk PVBs. A CAD-RADs of 0 was detected in 63% of athletes, 1-2 in 25.6%, 3 in 5.7%, and 4A-4B in 5.7%. A CAD was found in 37% of athletes investigated for PVB at ET and the same prevalence was found among subjects with ST-depression (p=0.8). Between athletes with moderate-severe CAD, 75% had one or more cardiovascular risk factors, while 25% had no risk factors.

Conclusions

The prevalence of CAD in master athletes resulted to be equivalent in case of PVBs and ST-segment depression and, in the majority of cases, was a mild disease. Despite a coronary artery stenosis >50% was detected just on 12% of athletes who underwent CCT for these indications, however in both groups (PVB and ST-segment depression) the severity of CAD increased with the rise of cardiovascular risk factors. Therefore, the systematic execution of CCT among master athletes with non-common PVBs does not seem justified, but the indication should be reserved for selected cases with cardiovascular risk factors.
Pro-inflammatory cytokines are elevated two-years after acute severe COVID-19: a pre-vaccine, two-years, five-point longitudinal assessment of individuals with Long COVID
Authors: Luz Goulart C , Alex Bezerra Da Silva Maciel A B S M , Anna Gabriela Rezende A G R , Jefferson Valente J V , Bernardo Maia Da Silva B M S , Vanderson Sampaio V S , Allyson Guimaraes A G , Guilherme Peixoto Tinoco Areas G P T A , Fernando Fonseca De Almeida E Val F F A V
Published: June 2024

Introduction

Coronavirus disease 2019 (COVID-19) may cause Long covid, which affects millions of people worldwide. It may include cardiovascular, respiratory, cognitive and musculoskeletal alterations, altogether resulting in decreased functional outcomes and physical activity intolerance. One hypothesis is a lingering pro-inflammatory profile. Acute COVID-19 manifests with elevated plasma proinflammatory cytokines, including interleukin 1β (IL-1β) and tumor necrosis factor α (TNF-α). These cytokines have been associated to cardiovascular problems previously. However, no study has been carried out that followed these patients for 24 months and demonstrated the pro-inflammatory response from acute COVID-19 to post-acute sequelae of COVID-19 (PASC).

Objective

To assess the level of pro-inflammatory cytokines (IL-1 β and TNF-α) at the following times: acute phase (Day 1, Day 7, Day 14), convalescent phase (Day 120) and PASC (24 months, post-acute phase, D720).

Methods and results

Clinical and laboratory exploratory cohort nested study of surviving participants after pre-vaccine, acute SARS-CoV-2 infection with severe clinical presentation in a city, Amazonas, Brazil. This study consisted of a longitudinal assessment of participants up to 24 months after acute infection. The measurement of circulating cytokines in the patients' serum samples was performed using the Flow Cytometry CBA (Cytometric Bead Array) technique with the Cytometric Bead Array (CBA) Human Inflammatory Cytokine Kit (Becton, Dickinson and Company BD Life Sciences – Biosciences 2350, Qume Drive, San Jose) following the guidelines described by the manufacturer. 80 adult patients were included. Average age 55±14 years, 45/80 (56%) of the sample were women and 33/50 (41%) had systemic arterial hypertension at baseline. Regarding the prevalence of Long covid after 2 years of primary infection, 51/80 (63%) reported having remained with one or more symptoms. The most common symptoms were fatigue (63.7%), heart palpitation (38.7%) and dyspnea on exertion (36.6%). The pro-inflammatory cytokine profile of the study participants is characterized in Figure 1. The longitudinal assessment of cytokine levels among participants showed significantly higher levels of IL-1β between D1 and D120 (p<0.0001); D1 and D720 (p<0.0001). In relation to TNF-α on D7 and D720 (p<0.001).

Conclusion

Our results indicate that even after more two years of COVID-19 infection the cytokine profile from this evaluation showed substantially elevated levels of IL-1β and TNF-α in participants with PASC, which could ultimately lead to new or worsening cardiovascular problems in this population.
Lipoprotein(a), are its levels really invariable?
Authors: Del Valle Tabernero P , Diaz Rojo A , Gadella Fernandez A , Berenguel Senen A , Gonzalez Pigorini A , Boillot C , Ramon Ensenat J , Villafafila Martinez L , Martinez Palomares J M , Navarro Pelegrini N , Aguinaga Mendibil A , Morante Perea M C , Cabello Rodriguez A , Gigante Miravalles E , Rodriguez Padial L
Published: June 2024

Background

In the studies available today lipoprotein(a), Lp(a), has been described as a genetic determined cardiovascular risk factor that usually stays constant through time and therefore it´s not affected by drug therapy or lifestyle changes.

Purpose

This study tries to evaluate the presence of changes in Lp(a) levels depending on the moment of extraction (acute event vs ambulatory stable period) seen as now a days there are no clear guidelines about when is the best moment to evaluate this particular cardiovascular risk in our patients.

Methods

Based on a cohort of 344 patients included in the cardiac rehabilitation program of our hospital in between December 2022 and October 2023. We assessed the changes in Lp(a) levels of the 80 patients, admitted after an acute coronary event, that had a Lp(a) determination upon admission for the primary event and at the first ambulatory visit during cardiac rehabilitation.

Results

Of the 80 patients that were included in the final analysis 21,3% were women, 57,5% active smokers, 52,5% hypertensive, 22,5% diabetic, 53,8% dyslipidemic, 27,5% suffer from obesity and 11,3% had a previous history of coronary disease. Regarding the primary event that led to referral to cardiac rehabilitation 47,5% suffered an STEMI and 43,75% had more than one coronary artery affected.

When analyzing the Lp(a) levels upon admission and during cardiac rehabilitation a statistically significant difference was found regarding the presence of changes (Wilcoxon p = 0,000; Z = -3,896). We observed a median of change of 4,9 with an interquartile range of 51. The minimum change observed was of – 90 nmol/L and the maximum of +206 nmol/L.

In the adjacent figure (picture 1) we can appreciate the individual changes in each and every one of the patients included in the analysis.

Conclusions

Based on the results observed in our sample we can conclude that there is a statistically significant difference between Lp(a) levels upon admission for an acute event and Lp(a) levels during cardiac rehabilitation in the ambulatory setting. However, there is still need for more studies to seek clarification upon the matter of when is the best clinical state/moment to evaluate cardiovascular risk, due to this biomarker, in our secondary prevention patients.
Lp(a) and vascular inflammation: data from perivascular fat attenuation index measurements
Authors: Simantiris S , Antonopoulos A S , Skoumas I , Andrikou I , Grigoriou K , Dima I , Antoniades C , Cokkinos D , Tousoulis D , Tsioufis K , Vlachopoulos C
Published: June 2024

Introduction/Purpose

Elevated lipoprotein(a) [Lp(a)] values consist an independent cardiovascular risk factor. So far, there are no approved pharmaceutical treatments available to reduce Lp(a) in clinical practice, while antisense oligonucleotides which can induce a drastic reduction of Lp(a) are under phase III clinical study. Based mainly on in-vitro studies, Lp(a) induces inflammation in the vascular wall through deposition in the endothelium, activation of the endothelium, and attraction of monocytes to the vascular wall. However, the relationship of Lp(a) with vascular inflammation is not well documented by clinical data. In the present study, we investigated the relationship of Lp(a) levels with coronary inflammation based on the perivascular fat attenuation index (FAI) from coronary computed tomography angiography (CCTA) images.

Materials and methods

In the present study, 40 participants under optimal hypolipidemic treatment who underwent CCTA for clinical reasons were enrolled. Exclusion criteria included history of autoimmune disease with active systemic therapy, chronic treatment with any anti-inflammatory agents, active malignancy, and history of acute coronary syndrome, reperfusion, or NYHA class III/IV heart failure. CCTA images were analyzed for vascular inflammation based on the FAI of perivascular adipose tissue around the right coronary artery.

Results

The group of participants was divided into 2 subgroups, one with Lp(a)≥ 50 mg/dl (n=14) and one with Lp(a)< 50 mg/dl (n=26). There was no statistically significant difference between the 2 subgroups in the incidence of classic cardiovascular risk factors or LDL cholesterol levels. However, patients with elevated Lp(a) had greater FAI values around the right coronary artery (-69.17 vs. -75.26 HU, p= 0.02) (Figure 1).

Conclusions

Higher serum Lp(a) values were associated with increased FAI values around the right coronary artery on CCTA images. These pilot findings highlight the potential role of Lp(a) in vascular inflammation, which should be further explored in future studies.
Sarcopenic obesity - a hidden problem in cardiovascular risk
Authors: Bernardes P , Marinheiro R , Sousa A R , Ferreira C , Madeira M , Ferreira J , Coelho R , Quintal J , Pohle C , Rato Q , Seixo F
Published: June 2024

Introduction

Sarcopenic obesity is defined as the coexistence of body fat accumulation and muscle loss. It seems to be a more severe disorder than obesity alone.

Purpose

We aimed to determine the prevalence of probable sarcopenic obesity among the Portuguese elderly and the association between sarcopenic obesity and cardiovascular (CV) risk.

Methods

A prospective study based on the information collected through the application of the SARC-F questionnaire. SARC-F was used as a screening tool to identify probable sarcopenic patients (SARC-F ≥4). Obesity was defined as a body mass index (BMI) ≥ 30 Kg/m2.

Results

We prospectively evaluated 215 participants, aged 65-90 years, recruited at a local cardiovascular screening event in May 2023; 54% were male.

We found that 26% were probable sarcopenic and 27,4% had a BMI > 30 kg/m2. The prevalence of sarcopenic obesity in our population was 13% and 61% of them were women. Also, there was a significant association between a higher body mass index and sarcopenia for SARC-F ≥4 (OR: 4,1; p-value < 0,001).

There wasn’t a statistically significant difference in the prevalence of hypertension (64.3% vs 54.8%, p= 0,461), diabetes mellitus (64.3% vs 51.6%, p= 0,325), smoking (39.3% vs 35.5%, p= 0,763), hypercholesterolemia (64.3% vs 38.7%, p= 0,05) and sedentary lifestyle (100% vs 97%, p= 0,338) between individuals with probable sarcopenic obesity and obese adults with no sacopenia.

Cardiovascular risk, assessed by SCORE2 and SCORE2-OP, in the probable sarcopenic obesity group was statistically significantly higher than in obesity group with SARC-F <4 (U = 91, p-value < 0,001). Image 1.

Discussion and Conclusion

Using SARC-F as a screening tool for sarcopenia, this study found a similar prevalence of sarcopenic obesity, when comparing to the global numbers of this major health challenge.

Although there wasn’t a statistically significant difference in the prevalence of individual risk factors between groups, we conclude sarcopenic obese patients had a higher cardiovascular risk score when compared with obese patients, which is in agreement with its close relationship with cardiovascular disease.

Since sarcopenia is not taking into account when cardiovascular risk is assessed, we demonstrate that screening tests for sarcopenia may be useful to add information to CV risk. More studies are needed to assess if sarcopenia is associated with an effective higher CV risk in a long-term follow-up, in addition to the tools that are used nowadays.
Evaluating the prevalence, screening, and management of diabetes mellitus in general cardiology patients
Authors: Pinter J , Lakos B , Szikszai E A , Farkas A S , Farkas A
Published: June 2024

Introduction

Diabetes mellitus (DM) is a major cardiovascular risk factor that not only increases the incidence but also adversely affects the prognosis of various cardiovascular morbidities. Current literature lacks comprehensive data on the glycaemic status among the typical patient population in general cardiology wards.

Purpose

This study assessed the prevalence, screening practices, and treatment trends of dysglycaemia (comprising both DM and preDM) in patients hospitalized in a general cardiology department.

Methods

Data from 952 consecutive patients admitted to our Cardiology Ward between January 1, 2017, and December 31, 2019, were retrospectively analysed. The diagnostic criteria for DM and preDM were based on the rigorous guidelines recommended by the American Diabetes Association. McNemar test was utilized when comparing treatment modifications post-therapy revision.

Results

The age of the patients was 69.2±12.8 years (mean±SD) in the cohort. The most common cardiovascular diagnoses among our patients were hypertension, ischaemic heart disease, heart failure, and atrial fibrillation. At admission, 36% of the patients had already been diagnosed with dysglycaemia. Treatment revision in known diabetic patients, due to suboptimal DM treatment, resulted in a significant reduction in the usage of insulin and sulphonylurea (from 34% to 27% and from 23% to 10%, respectively; p<0.01), and a notable increase in SGLT2-I therapy (5% to 12%; p<0.01) at discharge. 54% of patients without a prior carbohydrate metabolism disorder diagnosis underwent HbA1c testing or an oral glucose tolerance test, revealing 233 new cases of DM or preDM, accounting for 71% of the 329 screened patients. Consequently, 60% of the hospitalized patients had DM or preDM diagnosis at discharge. Metformin therapy was commenced in 50% of the newly diagnosed dysglycaemic patients.

Conclusions

The present study indicates that nearly two-thirds of hospitalized cardiology patients suffer from dysglycaemia, with many cases undetected or not being on optimal medical treatment prior to hospital admission. Our results highlight the critical need for systematic diabetic screening in cardiology patients, and also emphasise the necessity to update the medical therapies for diabetic patients by transitioning to more optimal antidiabetic treatment. Our findings underscore the need for adopting a cardiometabolic approach in routine cardiology care.
Effects of rotating shift work schedule on blood pressure dipping profile in healthy nurses
Authors: Ioannidis A , Tsaloglidou A , Papadopoulos C , Pantelas N , Tsounis D , Giournta A M , Gournaki E , Sidera C , Markidou E , Kafkia T
Published: June 2024

Background/Introduction

The impact of rotating shift work on cardiovascular health has been a subject of increasing interest, particularly in professions such as nursing where irregular work hours are common. The prevalence of non-dipping blood pressure (BP) in healthy population is estimated to be around 10-20%.

Purpose

This study aims to investigate the effects of a rotating shift work schedule on the BP dipping profile in a cohort of healthy nurses.

Methods

A cross sectional observational study was conducted among a group of healthy nurses working in an intensive care unit. Ambulatory blood pressure monitoring (ABPM) was employed to assess the participants' BP profiles on the non-working day following a morning, afternoon, or night shift. The wake and sleep periods used were reported in sleep diaries and confirmed by a smartwatch that has demonstrated accuracy in detecting sleep and awake status.

Results

The sample of the study consisted of 22 nurses (19 female and 3 male) with mean age 42±8.2 years. A total of 46 ABPM recordings were interrogated with average 24-hour, average asleep and average awake BPs within normal limits for both systolic and diastolic BP. The average sleep time was 6.4±0.7 hours. The mean decrease in systolic and diastolic BP was 12.4±5.1% and 13.2±5.4 % respectively with smaller reductions after a night shift (see Picture 1). Nine nurses (40.9%) presented a non-dipper profile in at least one ABPM recording, even though no nurse was a constant non-dipper.

Conclusion(s)

Healthy nurses working on a rotating shift schedule manifest a blunted BP dipping profile. The findings suggest that rotating shift work may contribute to disruptions in BP parameters, potentially increasing the risk of cardiovascular complications. Further research is needed to elucidate the underlying mechanisms and to develop targeted interventions aimed at mitigating these adverse effects on the cardiovascular health of shift-working professionals.
Exploring predictors and correlations of COVID-19 impact in revascularized patients
Authors: Musayev O , Dashdemirov R , Ibrahimov F , Musayev K , Alimli Z , Gafarova M , Mushtagzadeh N
Published: June 2024

Background/Introduction

In the context of the global COVID-19 pandemic, this retrospective study delves into the repercussions of the virus on individuals with a history of revascularization. Our investigation centers on understanding the correlation between COVID-19 status and an extensive spectrum of risk factors, elucidating their impact on clinical outcomes in COVID-positive populations.

Purpose

To highlight the multifaceted impact of COVID-19 on individuals with a history of revascularization, emphasizing the correlation between COVID-19 status, diverse risk factors, and clinical outcomes. This study underscores the imperative for tailored risk assessment and management strategies, particularly in a primary care setting.

Methods

A cohort of 1768 patients, revascularized two years prior to the pandemic, was categorized into COVID-negative (n=1148) and COVID-positive (n=620) groups. Comprehensive retrospective data on various risk factors, including hypertension, diabetes, smoking status, stroke history, family history, and chronic kidney disease (CKD), were collected. Clinical outcomes, meticulously documented, encompassed hospitalization, mortality, repeat revascularization, and control coronary angiography (CAG). Statistical analyses, including correlation assessments, were conducted, focusing on the COVID-positive subgroup.

Results

Within the COVID-positive subgroup of 620 revascularized patients, our analysis uncovered significant correlations between COVID-19 status and risk factors. Notably, increased hospitalization rates showed significant associations with stroke (ρ = 0.125**, p= 0.002), diabetes (ρ = 0.140**, p = 0.000), and CKD (ρ = 0.095*, p= 0.018). Additionally, a higher risk of death correlated with stroke (ρ = 0.080*, p = 0.047) and chronic kidney failure (ρ = 0.200**, p = 0.000).

Conclusion(s)

This study contributes to the growing body of knowledge in preventive cardiology by highlighting the intricate interplay between COVID-19, risk factors, and clinical outcomes in individuals with a history of revascularization. The observed correlations underscore the necessity for tailored risk assessment and management strategies in the primary care of this vulnerable population during the ongoing pandemic.
LDL-C target attainment in the secondary prevention of atherosclerotic cardiovascular disease in Albania: barriers and strategies to reach the goals
Authors: Rrapo A , Gina M , Cabeli A , Pane E , Kondi L , Berbiu E , Goda A
Published: June 2024

Background

Even though the ESC guidelines tend to be more demanding towards the lipid management and recommend lower LDL-C targets, studies have consistently shown very low rates of achieving dyslipidemia treatment goals and a large gap between clinical practice and guideline-recommended practice.

Aim of the study

To investigate the implementation of guidelines and the achievement of LDL-C target in secondary prevention (according to ESC 2019 guidelines), in a group of patients 6 months after an acute coronary syndrome (ACS); identification of barriers for not achieving the target: assessment of adherence, and optimization of lipid lowering therapy.

Materials and methods

We enrolled patients with ACS admitted in the cardiology unit of a university hospital during the period February-June 2022, and collected the data from medical records. Follow-up of patients was carried out through phone calls 6 months after discharge from the hospital, evaluating changes in the lipid profile and therapy. For analysis purpose, we divided the patients in two groups according the achievement of treatment goal.

Results

We enrolled 571 patients in the study, but were able to reach only 435 patients for a phone interview after six months, and only 257 of these patients performed the required lipid profile. At discharge, 95.7% of patients were prescribed statin monotherapy (84% high-intensity statin); 3.9% of patients were prescribed the statin + ezetimibe combination. In 0.4%, lipid lowering therapy was not prescribed. At the 6-month follow-up, fewer patients were being treated with statins (91.05% of patients were receiving statin monotherapy) and even fewer with high-intensity statins (62.3%); 4.7% of patients were taking the statin + ezetimibe combination; 4.25% of patients were not receiving lipid-lowering therapy (LLT). In 257 patients included in the study, only 55 of them (21.4%) reached LDL-C target after 6 months. Overall adherence to treatment was 94.2%, 100% in the group that reached the LDL-C target compared to 92.6% in the group that didn't reach the treatment goal. Optimization of LLT was performed in 14% of the cases. 58.2% of the patients in the group that reached the treatment goal had the LLT optimized after being discharged, compared to only 2% in the group that didn’t reach the target. Of the 36 patients who had the therapy optimized, 88.9% reached the LDL-C target. Optimization increases the likelihood of achieving the LDL-C goal by 14 times.

Conclusions

The results of our study show that most coronary patients have a less than optimal management of LDL-C, with only a small part of them achieving treatment goals. Lack of intensification of statin therapy and underutilization of combination therapy suggest gaps between real-world practices and guideline recommendations. Strategies directed at both the health care system and providers are needed to attain secondary prevention goals.
impact of different cardiometabolic risk factors in MASLD: rethinking overweight/obesity criteria
Authors: Zeng G , Wang P Z , Yuan J Q
Published: June 2024

Background/introduction

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a newly proposed nomenclature that requires any one of five cardiometabolic risk factors (CMRF) including hypertension, hyperglycemia, hypertriglyceridemia, low high-density lipoprotein cholesterol (HDL-C) and overweight/obesity as a prerequisite for diagnosis. However, the specific impact of these CMRFs on all-cause and cardiovascular mortality in the MASLD population is not well understood.

Purpose

To assess the prognostic impact of CMRFs in MASLD using data from the third National Health and Nutrition Examination Surveys 1988-1994 (NHANES □).

Methods

A total of 11,397 nonpregnant adults (20-74 years) with complete ultrasound measures, key covariates, data for MASLD definition and mortality status from NHANES □ were included in our analysis. The definition of MASLD and CMRFs definitions aligned with the Delphi consensus statement. The mortality status of the participants was obtained through the linkage to the National Death Index until December 31, 2019.

Results

Of 2,644 categorized MASLD participants, the prevalence of hypertension, hyperglycemia, hypertriglyceridemia and low HDL-C was similar (45.1%-57.4%), The prevalence of overweight/obesity was higher at 88.6%. During a median follow-up period of 26.1 years, hypertension, hyperglycemia and hypertriglyceridemia were all significantly associated with the increased risk of all-cause mortality and cardiovascular mortality after multivariable adjustment. Low HDL-C was significantly associated with risk of all-cause mortality and borderline significantly associated with risk of cardiovascular mortality. Conversely, overweight or obesity was not associated with mortality risk (all-cause HR: 1.01, 95%CI: 0.77-1.32; cardiovascular HR: 1.04, 95%CI: 0.63-1.72). When overweight/obesity was stratified into WC-based or BMI-based types, Neither WC-based nor BMI based overweight/obesity were associated with mortality risk. Compared to non-MASLD individuals without any CMRFs, MASLD patients with only overweight or obesity was not associated with mortality risk (all-cause HR: 0.84, 95%CI: 0.51-1.39; cardiovascular HR: 0.78, 95%CI: 0.28-2.18). However, patients with the other four components had higher mortality risk, regardless of obesity status.

Conclusions

hypertension, hyperglycemia, hypertriglyceridemia and low HDL-C are positively associated with higher mortality risk. The criteria for defining overweight and obese in MASLD should be reconsidered in the context of CMRFs. Figure 1