bluuebunny/crossref_metadata_2025 huggingface dataset:
Severe dyslipidemia title: known by patients, but is it treated?
Authors: Marchal Martinez J , Martin Alcolea M , Garcia Ruano A , Torres Llergo J , Fernandez Anguita M , Fernandez Olmo R
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Patients with severe dyslipidemia (> 190 mg / dl) are considered in the clinical practice guidelines of high cardiovascular risk, therefore, diagnosis and treatment is essential, as well as the rest of the CV risk factors. But real-life records give us data of lack of control, justified by lack of adherence to treatment, underdiagnosis and therapeutic inertia among other factors. The aim of our work was to analyze patients knowledge about their dyslipidemia, treatment and the impact on their cardiovascular health.

Materials and methods

Patients with severe dyslipidemia (>190 mg/dl) from the familial hypercholesterolemia screening program were analyzed consecutively from February 1 – September 30, 2022. It was performed from Clinical Analysis, with an alarm system to detect severe dyslipidemia in people over 18 years of age in coordination with the Cardiovascular Prevention Unit of Cardiology and Genetics. All patients underwent a health questionnaire.

Results

n = 353. Mean age 52.2 years. 51.6% women (Table 1 baseline characteristics). 86.5% knew that they had dyslipidemia problems, mainly non-DM (85% vs 68%; p0.009), with familiy history (FH) of dyslipidemia (90% vs 81%;p 0.027) and older people (53.7 vs 47.1 years; p.001) But only 14.4% took treatment, patients with DM (31% vs. 13%; p0016), with FH of LDLhigh children (31% vs 12%; p 0.02), with personal history of CV disease (37% vs 13%; p 0.007) and BMI > 30 (20% vs 11%; p 0.017). 53.4% had taken treatment at some time, patients with hypertension (67% vs 49%;p 0.01), with family history of dyslipidemia (59% vs 44%; p 0.005), personal history of CV disease (87% vs 51%; p 0.005) and those over 40 years (55% vs 36%; p 0.016) 91.4% recognized the impact of dyslipidemia on the prognosis CV, mainly those with family history of dyslipidemia (94% vs 86%; p.017) and those under 40 years (100% vs 90.7%; p0.04).

Conclusions

A high percentage of patients recognize their dyslipidemia problem and the possible impact on their health, but less than 15% take lipid-lowering treatment.
Impact of COVID-19 situation on non COVID cardiological admissions
Authors: Del Castillo-Carnevali H , Alvarez J , Joan T O R R E S , Magnani S , Cremer D , Ruiz V , Alamar M , Moranta M E , Folgado P , Ripoll T , Gamez J M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The COVID-19 outbreak led to a redistribution of resources in order to provide care to coronavirus patients, taking those resources from other areas such as cardiology, specially from ambulatory patients.

Moreover, the fear to the contagious disease, made people to avoid seeking hospital aid. This two factors may have had impact on hospital parameters such as length of stay, readmissions or mortality, with short and mid term effect.

Scope: To demonstrate that the factors exposed in the introduction had led to more complex admissions, higher mortality rates, more readmissions and longer stays.

Methods

we performed a descriptive study comparing hospital parameters from a secondary hospital in Spain using to different periods: a pre-COVID period (01/2019 to 02/2020) and a COVID period (03/2020-01/2022). Only non-COVID cardiological patients where analyzed. Data where extracted form the hospital database and benchmarking tool "Iasist".

Results

Despite the fact that %readmissions, length of stay (specially form patients awaiting surgery) and complications increased after the outbreak, there was not an increase in mortality . As additional finding, we observed a decrease in admissions complexity according to coding weight parameters.

Conclusions

Non COVID cardiological admissions have varied since the outbreak, some of those variations where expected such as increase in complications or readmissions, but there was no deleterious impact on mortality.
Follow-up results of a cohort of patients undergoing electrical cardioversion. Recurrence and associated factors in the medium to long term
Authors: Aguila Gordo D , Jimenez Diaz J , Piqueras Flores J , Negreira Caamano M , Martinez Del Rio J , Mateo Gomez C , Concepcion Suarez R , Freites Esteves A , Moron Alguacil A , Andres Sierra M , Jimenez Rubio B , Soto Perez M , Cubides Novoa A F , Blanco Lopez E , Soto Martin P
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Electrical cardioversion (ECV) is an effective therapeutic alternative for atrial fibrillation (AF) and atrial flutter (AFL); however, in the medium-long term, the recurrence rate is significant and the evidence is limited.

Methods

Retrospective, observational, single-center, retrospective registry of 154 consecutive cases of patients undergoing electrical cardioversion for AF or AF flutter of more than 48 hours of evolution. Recurrence, emergency visits, readmissions and new ECV were recorded during a mean follow-up of 34±11 months.

Results

The median time from diagnosis to ECV was 60 days. The success rate of ECV was 91.7%. The immediate recurrence rate (< 2 hours) was 3.9%. The incidence of recurrence during follow-up is shown in Table 1. Of the total number of recurrences, 12.7% were detected on Holter-ECG. During follow-up, 5.8% of the patients died, none due to cardiovascular causes, 33.1% of the patients were readmitted, 25.3% due to cardiovascular causes and 15.6% as a consequence of AF/AFL. A total of 17.5% of patients attended the emergency department for episodes of AF/AFL with rapid ventricular response. Up to 18.8% of patients underwent repeat ECV and 16.2% underwent pulmonary vein ablation; in contrast, 35.3% of patients opted for a rate control strategy. Previous ECV and atrial dilatation were associated with a higher (76.9% vs 52.6% p=0.02; 64.9% vs 24% p<0.001) and earlier recurrence of AF/AFL (18.2 months vs 29.9 months p=0.008; 24.1 months vs 41.1 months p=0.001). Treatment at discharge with antiarrhythmic drugs was not associated with less recurrence at 6, 12 months and final follow-up (Figure 1).

Conclusion

ECV is an effective therapy against AF and AFL, however, the recurrence rate in the medium-long term is high. Previous ECV and atrial dilatation are associated with a higher and earlier recurrence. Antiarrhythmic treatment had a neutral impact on the maintenance of sinus rhythm in the medium to long term.
Yoga as secondary prevention and cardiac rehabilitation in myocardial infarction
Authors: Prasad A , Dwivedi S , Sharma V
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

The prevalence of coronary artery disease is racing at a fast pace. The risk factors of myocardial infarction are old age, male sex, previous MI , diabetes, hypercholesterolemia, hypertension, unhealthy diet , smoking , physical inactivity and psychosocial stress. Interventional and pharmacological approaches are accessible these days for reduction of mortality and morbidity in myocardial infarction.

Yoga as a compliment is inexpensive and devoid of side effects which has been shown to reduce body weight, blood pressure, cholesterol, blood sugar & improve physical and mental well being due to relative parasympathetic excess.

Many studies performed earlier had small sample size and duration. Therefore, yoga is affordable and can be recommended along with conventional treatment to prevent and improve the outcome in MI cases.

Purpose

1. To study the effect of yoga on risk factors following myocardial infarction.

2. To study the effect of yoga on Beck's Depression Inventory score.

Methods

Our study that comprised of 300 patients were randomized into test group (n=150) who were subjected to conventional treatment and yoga and control group (n=150) subjected to conventional treatment only.

The study included patients diagnosed as myocardial infarction above 18 years with their consent to participate. Patients with hemodynamic instability, heart failure, pregnancy, prior yoga practice, arrhythmia ,cardiac pacemaker, autonomic neuropathy and musculoskeletal disease were excluded.

Initially, assessment of clinical & biochemical parameters and routine investigations were performed. Beck's depression score was calculated. Yoga was started on 4th day after MI (test group) and there were sessions of 10 minutes of pranayam , 15 minutes of shavasan and 15 minutes of transcendental meditation. The patients were followed after 24 weeks for assessment of clinical & biochemical parameters. Carotid doppler & depression score was evaluated.

The primary outcome included change in risk factors from baseline to the end of study period and secondary outcome was change in Beck's Depression score.

Results

After 24 weeks of intervention, a significant improvement was noted among yoga group in comparison to control group for BMI (p=0.04), heart rate (p=0.01), systolic & diastolic blood pressure (p<0.05), fasting & post prandial blood sugar (p<0.05), HbA1c (p=0.03), Beck's depression score (p=0.001) and lipid profile (p<0.05).In contrast, no improvement was seen for carotid intima media thickness.

Conclusion

On the basis of the study, it was concluded that conventional therapy with yoga has a positive impact on risk factors of MI and psychosocial stress. Therefore, yoga can be recommended to reduce morbidity and mortality after MI. Large trials with more number of cases and long term follow up are needed so that yoga as an intervention, can be added for secondary prevention and rehabilitation in myocardial infarction cases.
The associations between tricarboxylic acid cycle metabolites, and risk of major adverse cardiovascular events in acute coronary syndrome
Authors: Sanchez Gimenez R , Carrasquer A , Peiro O , Bonet G , Papandreu C , Bardaji A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiovascular disease and acute coronary syndrome (ACS) are one of the main causes of morbi-mortality caring a high health cost due to its consequences. Prognostic stratification in patients admitted with an acute coronary syndrome (ACS) is necessary to providing efficient follow-up and guiding intensive treatment to those at high risk of adverse cardiovascular events. Is crucial to identifying new molecular pathways to predict those patients with worst prognosis and find new molecular targets.

Purpouse

The aim of the study is to investigate the relation between TCA cycle disturbance and cardiovascular diseases.

Methods

In this prospective cohort study, we included 309 patients with ACS. During a mean follow-up of 6.7 years, 131 patients developed major adverse cardiovascular events (MACE) (myocardial infarction, hospitalization for heart failure, and all-cause mortality). Plasma concentrations of TCA cycle metabolites were profiled by liquid chromatography tandem mass spectrometry. Hazard ratios were estimated with multivariable Cox regression models.

Results

After adjustment for traditional cardiovascular risk factors and medications, participants in the highest tertile vs. the lowest tertile of baseline Isocitrate concentrations had a higher risk of MACE [(HR: 1.25; 95% CI: 1.03, 1.5) However, these associations were no longer significant, after additional adjustment for eGFR. eGFR mediated the associations of Isocitrate (75 %) No significant associations were found for other TCA metabolites.

Conclusions

High plasma TCA metabolites concentrations are related to the risk of developing MACE during the follow-up and this relationship is substantially mediated by renal function. Understanding the potential interplay of TCA metabolite’s renal function, and incident MACE, may contribute to novel prevention and treatment efforts in ACS.
Echocardiographic findings in COVID: incidence of carditis and correlations with COVID variants
Authors: Fazio G , Manfre V
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also referred to as COVID-19, was declared a pandemic by the World Health Organization in March 2020. The manifestations of COVID-19 are widely variable and range from asymptomatic infection to multi-organ failure and death. Like other viral illnesses, acute myocarditis and/or pericarditis has been reported to be associated with COVID-19 infection. The guidelines for the diagnosis of COVID-19 introduced the echocardiogram for diagnosis of carditis in these patients.

Pourpose

In our study we investigated the incidences of myocarditis and/or pericarditis in a consecutive series of 1540 Athletes undergo to agonistic certification.

Methods

From march 2020 to October 2022 we enrolled 1540 consecutive patients that was affected by COVID. Every patients was admitted to ambulatory of sport medicine of 2 Italian centers to perform a return to play agonistic certificate. All patients perfomed an echocardiogram during the evaluation. We subdivided the incidence of carditis depend on the period and the variant of the covid (alpha, beta, gamma, delta, epsilon). Overall, 69% males and 31%. females were enrolled with a mean age of 24.3 years (12-67 years). None presented note risk factor of a cardiac disease.

Results

The incidence of Echocardiographic abnormality was 3,2% in all period. By the echocardiogram we recognize 8 dilated cardiomiopathy (0,4%), 8 regional kinetic dysfunction (0,4%), 30 pericardial effusion (1,9%), 4 non-specific alterations (0,2%). Also we evaluated the incidence of the echocardiographic disease during the quarters and in correlation of COVID Variant. The results was showed in figure 1.

Conclusions

Based on our evaluation the incidence of echocardiographic findings in COVID was 3,2%, with a progressive reduction long the time, from alpha to omicron variants.
Cost-effectiveness analysis of ferric carboxymaltose (FCM) versus sucrosomial iron (SI) for the treatment of iron deficiency anemia (IDA) after cardiac surgery
Authors: Venturini E , Giallauria F
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

A recent study compared a short-term treatment to correct IDA using FMC or SI showing a significant improvement for both treatments on key hematological parameters and in functional capacity(1). Obviously the choice of oral supplementation, is safe and avoid intravenous administration. In addition, a pharmaco-economic analysis was conducted to evaluate the direct and indirect costs of the two treatments used in the referring study.

Methods

The cost analysis was performed on all 106 patients (P) included in the study, taking into account both direct and indirect costs. Direct costs include the cost for the products (FCM and SI) purchase, provided by the internal hospital pharmacy, the cost of the second dietary supplement (CardioSideral®), and direct costs of NaCl injection solution and disposable materials estimate by the internal hospital pharmacy. In this setting the patients who received intravenous iron was already hospitalized, so it is impossible to quantify the healthcare professional 's time and the cost of hospitalization (indirect costs). Transportation and lost productivity costs for P are also not applicable.

Results

Costs provided by internal hospital pharmacy of direct purchasing of the products are 42.6 € per vial of FSM and 42 € per unit of SI. Each patient of FCM group received 2 vials , corresponding to 85.20 €/patient; each patient of SI group received 40 doses, considering that 1 unit contains 160 doses, the costs per patient is 10.50 €. SI supplement costs 26.50 € per patient, but it is not in charge of the National Health Service (NHS). Costs of NaCl injection solution and other disposable materials are 0.987 €/patient (to be considered only for the FCM group). Table 1 summarizes the above costs and shows the potential saving per patient and for the hospital, considering only costs in charge of the NHS.

Conclusions

The pharmaco-economic analysis showed a potential saving of € 49.18 per patient, considering only the direct costs of purchasing the products, and an average annual saving of € 4086.72 € every approximately 55 patients admitted to inpatient cardiac rehabilitation after cardiac surgery, with IDA. For outpatient patients, should also be considered the indirect costs sustained by the hospital, which would further increase the gap between these two types of iron treatment. In conclusion, SI is undoubtedly more cost-effective than FCM, treating IDA after cardiac surgery.
Functional capacity and risk of major cardiovascular events in a kidney transplant recipients: a medium to long term follow-up cohort study
Authors: Quinto G , Di Bella C , Parise E , Borasio N , Grassi M , Ortolan S , Vecchiato M , Battista F , Neunhaeuserer D , Furian L , Ermolao A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Kidney transplant recipients (KTRs) have an increased cardiovascular risk and lower cardiorespiratory fitness (CRF). This is associated with increased all-cause mortality and can drastically reduce quality of life. Therefore, assessment of functional capacity and consequently an individualized physical exercise prescription are important respectively for prognostic and therapeutic purposes.

Purpose

Evaluate whether functional capacity, expressed as maximum oxygen consumption (VO2peak/Kg) and physical activity level are independent determinants of the risk of major cardio-vascular events (MACEs) in a KTRs population in the medium to long term.

Methods

In this retrospectively cohort study, 168 KTRs transplanted between 2014 and 2018 were enrolled. They underwent to a complete medical evaluation, a cardiopulmonary exercise testing and GPAQ questionnaire 3-12 months after transplantation. Laboratory blood samples and drug therapy data were collected. The average follow-up period was 6,13 ± 1,63 years. In July 2022, an anamnestic questionnaire (in order to investigate MACEs) and GPAQ questionnaire were submitted by telephone to all patients. Cox regression analyses were performed to evaluate predictors of MACEs adjusting for potential confounders.

Results

During the study, MACEs occurs in 15 patients (8.93%). Subjects who underwent MACE had a functional capacity significantly lower than those who had no events. Moreover, patients with MACE also had levels of physical activity significantly reduced compared with the ones without events (Table I). Data shows that VO2peak/Kg is a protective marker for risk of MACEs (Hazard Ratio 0.836; 95%CI= 0.715-0.978; p=0.025), independently of gender, age, hypertension, dyslipidaemia, obesity, diabetes mellitus, eGFR, physical activity level and presence of major cardiovascular events before transplantation. Moreover, classifying severity of functional capacity reduction through reference values reported for a matched healthy population, rate of MACEs significantly increases in groups of patients with worse CRF compared to healthy subjects (p=0.027).

Conclusions

In KRTs, better functional capacity after transplantation seems to be an independent modifiable protective factor for MACEs in the medium to long term. Cardiopulmonary exercise testing should thus be recommended for cardiovascular screening, evaluation of CRF and tailored exercise prescription to reduce the risk of major cardiovascular events.
Autoimmune disease and new-onset atrial fibrillation: A UK Biobank study
Authors: Tilly M J , Geurts S , Zhu F , Bos M M , Ikram M A , De Maat M P M , De Groot N M S , Kavousi M
Published: May 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Senior Scientist Grant from the Dutch Heart Foundation.

Background and Aims

The underlying mechanisms of atrial fibrillation (AF) are largely unknown. Inflammation may underlie atrial remodeling. Autoimmune diseases, and their accompanying increased (systemic) inflammation, may therefore be associated with new-onset AF.

Purpose

To assess the association of various autoimmune diseases with new-onset AF in the general population. Additionally, we aimed to investigate the causal relationship between the aforementioned conditions.

Methods

Participants from the population-based UK Biobank were screened for rheumatic fever, gastrointestinal autoimmune diseases, autoimmune diseases targeting the musculoskeletal system and connective tissues, and neurological autoimmune diseases. Between 2006 and 2022, participants were followed for incident AF. Cox proportional hazards analyses were conducted to calculate hazard ratios (HR) and 95% confidence intervals (CI) to quantify the associations. Moreover, using large publicly available summary data of genome-wide association studies, two-sample Mendelian randomization (MR) analyses, inverse variance weighted method, were performed to assess the potential causality between the genetic predisposition to various autoimmune diseases and AF. Further sensitivity analyses in the form of weighted median estimator, MR-Egger, and MR-PRESSO were performed.

Results

494,072 participants free from AF at baseline were included (median age 58.0 years, 54.8% women). After a median of 12.8 years, 27,194 (5.5%) participants were diagnosed with new-onset AF. Rheumatic fever without heart involvement (HR, 95%CI: 1.47, 1.26-1.72), Crohn’s disease (1.23, 1.05-1.45), ulcerative colitis (1.17, 1.06-1.31), rheumatoid arthritis (1.39, 1.28-1.51), polyarteritis nodosa (1.82, 1.04-3.09), systemic lupus erythematosus (1.82, 1.41-2.35), and systemic sclerosis (2.32, 1.57-3.44) were associated with a larger AF risk. In sex-stratified analyses, rheumatic fever without heart involvement, multiple sclerosis, Crohn’s disease, seropositive rheumatoid arthritis, psoriatic and enteropathic arthropathies, systemic sclerosis and ankylosing spondylitis were associated with larger AF risk in women, whereas only men showed a larger AF risk associated with ulcerative colitis. Two-sample MR analyses showed no significant associations between any of the included autoimmune diseases and AF.

Conclusions

Various autoimmune diseases are associated with new-onset AF, more distinct in women. Lack of causal associations between autoimmune diseases and AF could suggest that inflammation itself, rather than the autoimmune disease, is the major risk marker for incident AF. Our findings further elaborate on the pathophysiological differences in autoimmunity and AF risk between men and women.
Effect of resistance training on HbA1c and other cardiovascular risk factors in patients with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials
Authors: Michielsen M , Raats E N I D , Bos G , De Wilde C , Decorte E , Cornelissen V
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Obesity, hypertension, hyperlipidemia, and other cardiovascular risk factors are commonly clustered in patients with diabetes type II (T2DM). As a result, patients with T2DM are at increased cardiovascular (CV) risk. Exercise therapy is recommended in the prevention and management of patients with T2DM. In the last decade, dynamic resistance training has attracted more interest as an exercise therapy in the management of patients with diabetes. Though, the primary outcome in these intervention trials has mostly been glycated hemoglobin (HbA1c). Given the high prevalence of other CV risk factors in patients with T2DM, knowledge on the impact of dynamic resistance training on the overall CV risk profile of these patients is important.

Purpose

To perform a systematic review with meta-analysis to investigate the effects of resistance training on HbA1c and other traditional cardiovascular risk factors in patients with T2DM.

Methods and analyses

A systematic search was conducted in the electronic databases MEDLINE, Embase, SPORTdiscus and PEDro from the earliest date available until the first of September 2021 to identify peer reviewed randomized controlled trials investigating the effect of resistance training on HbA1C in adults with T2DM. Primary outcome was HbA1C. Secondary outcomes included traditional CV risk factors (i.e. blood pressure, blood lipids, body composition) and physical fitness (muscle strength, exercise capacity). Effect sizes were calculated using random effect models. Data are reported as weighted mean and 95% confidence limits.

Results

Fourteen trials could be included in the meta-analysis. Resistance training was found to significantly reduce HbA1c [-0.35 % (95% CL -0.61 to -0.11)], systolic blood pressure [-4.6 mmHg (95%CL -8.7 to -0.39)], diastolic blood pressure -2.25 (95%CL -4.45 to -0.048)) and body fat (-0 0.038). Muscle strength was significantly improved in the three studies reporting this outcome. Other cardiovascular risk factors including fasting plasma glucose, high-density-lipoprotein, low-density-lipoprotein, triglycerides and peak oxygen uptake capacity (VO2 peak) remained unchanged after resistance training in patients with T2DM.

Conclusion

The available data suggests that resistance training can exert favorable effects on HbA1C but also on blood pressure, body composition and muscle strength of patients with type 2 diabetes. Further research is needed to determine the impact of different resistance training characteristics such as volume, frequency and type of training on the overall CV risk profile of patients with type 2 diabetes.
Association of right and left atrial strain with laboratory, anthropometric and echocardiographic markers - the influence of COVID-19 pandemic
Authors: Dubatowka M , Chlabicz M , Sowa P , Jamiolkowski J , Solomacha S , Zieleniewska N , Lapinska M , Moniuszko-Malinowska A M , Kaminski K A
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): National Centre of Science.

Background

The exploration for the impact of surviving a coronavirus disease of 2019 (COVID-19) on the cardiovascular system and cause-and-effect relationships is still a challenge for researchers.

Purpose

The aim of the study was to evaluate the parameters of right and left atrial deformation using strain imaging in echocardiography (ECHO) among undergoing COVID-19, their relationship to the survival of this disease, and to investigate whether there is a relationship between these parameters and laboratory, anthropometric and echocardiographic markers.

Methods

The study consisted of 134 patients of the study group - subjects examined 6-9 months after hospitalisation due to COVID-19 infection, and 134 control subjects - participants of the Bialystok PLUS project, examined before the pandemic (the assumed start date of the pandemic in Poland is 18 March 2020). The groups were matched for age and gender. In all subjects, an extensive medical history was taken, anthropometric measurements, a comprehensive panel of laboratory tests, blood pressure, pulse wave velocity (PWV) were measured. ECHO was performed including assessment of right (RA) and left atrial (LA) strain parameters.

Results

Individuals after COVID-19 had significantly lower RA strain parameters, such as: global longitudinal strain (40.5±13.8% vs. control group 47.2±13.4%, p<0.000) and global circumferential strain (26.9±16.5% vs. 32.8±16.5%, p=0.014), while no differences were found for LA strain. Significantly lower values of parameters characterising LV diastolic function, i.e. E/A (p=0.003) and septal e' velocity (p=0.012), were also observed in COVID survivors. Troponin (hs-TnT) (p<0.000) and CRP protein (hs-CRP) (p=0.011) levels were significantly higher in the survivors group, while total cholesterol (p=0.001) and LDL fractions (p<0.000) were significantly lower. Subjects after COVID-19 also had significantly higher neck, waist, hip circumferences (p=0.013; p=0.045, p=0.001 respectively) and body mass index (BMI) (p=0.045). The groups did not differ in metabolic markers (fasting glucose, glycated haemoglobin, HOMA-IR index). A multivariate linear regression analysis was conducted to assess which parameters might be related to the RA strain parameters. The results were shown in the table 1.

Conclusions

COVID-19 infection results in worsening of right atrial strain parameters. This phenomenon requires deeper analysis.
Assessing the need for rehabilitation programme for individuals living with atrial fibrillation
Authors: Alhotye M , Evans R , Ng A , Singh S
Published: May 2023

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Saudi Arabia cultural Bureau.

Introduction

Individuals living with Atrial Fibrillation (AF) can experience a variety of symptoms such as palpitation, dyspnea, fatigue and dizziness which lead to reduced physical activity levels and quality of life.(1) Current management of AF mainly focus on pharmacological treatments and invasive procedures, while no routine prescription of exercise or rehabilitation programme is offered.

Aims

To understand the severity of symptoms that individuals with AF may experience and their preference of a structured rehabilitation programme.

Methods

A cross-sectional survey was conducted through the phone and face to face between 20th of September and 20thof December 2021 for individuals with documented AF. The survey included fifteen multiple-choice closed questions and free text spaces for additional comments.

Results

Overall, 50 individuals (54% male, mean (SD) age 62 (15) years) with a clinical diagnosis of AF were approached and participated in the study. The majority of participants reported they had a severe shortness of breath 27 (54%) and 25 (50%) reported a severe levels of anxiety related to living with AF. In addition, 20 (40%) reported a severe levels of tiredness and 20 (40%) demonstrated a mild palpitations. Moreover, 8 (16%) reported a severe feeling of faint or lightheaded, while chest pain was the least symptom which only 3 (6%) rated it as a severe. (Figure 1). 47 (94%) of participants reported their desire to participate into a programme which could help managing their symptoms, and 35 (70%) reported their preference to receive the programme at home, while 30 (60%) reported a preference for a web-based rehabilitation programme with support from healthcare professionals (HCPs). (Figure 2).

Conclusion

The responses indicate a need for a rehabilitation programme for individuals living with AF. Shortness of breath, anxiety and tiredness were the main bothersome symptoms. Home-based rehabilitation was the most preferred way to deliver the programme followed by using digital interventions.
Meditation as a stress management strategy in cardiac rehabilitation for coronary artery disease patients: a randomized controlled trial
Authors: Vitorino Monteiro A , Pinto R , Lemos Pires M , Borges M , Pinto F , Zuzarte P , Abreu A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

There is a growing body of empirical research that shows that psychological risk factors such as stress, type D personality, anger and hostility can lead to depression, anxiety, social isolation, and low socio-economics status. Psychological risk factors increase the risk of coronary artery disease (CAD) and contribute to a poorer quality of life (QoL) and worst cardiovascular prognosis. Stress, anxiety, and depression deteriorate the cardiovascular (CV) system through psycho-neuro-immunoendocrinology system and behavioural pathways. Meditation, as a form of body–mind interaction for primary and secondary prevention in CV disease has been discussed critically in the past and has been growing as a therapeutic practice. However, in CV rehabilitation programmes, more studies are needed to demonstrate meditation as a complementary therapy for CV patients.

Purpose

To evaluate the benefits of meditation as a stress management strategy, in a traditional CV rehabilitation programme, in terms of stress, anxiety, depression and QoL for people with CAD.

Methods

Eighty CAD patients were invited to join the meditation programme, 48 (60%) accepted and attended the initial assessment and 32 (40%) declined participation. The patients who accepted were attending for at least 6 months a 3x week exercise-based CV rehabilitation programme (usual care) and were randomized (1:1) into two distinct groups: the intervention group (IG) with meditation practice for 4 months and the control group (CG), usual care. In the IG, for one month, participants had a weekly session of 90 minutes consisting of Conscient breathing and Compassion Meditation (Karuna). During the next 3 months, all participants at the IG were asked to practice daily for 20 minutes alone or with the support material (video), with a weekly follow-up call. At the end of the 4th month, it was offered to the CG the same meditation programme. Outcome measures were assessed at the beginning (M0) and 4 months after (M1) including stress (Perceived Stress Scale), anxiety (Beck Anxiety Inventory), depression (Beck Depression Inventory) and QoL (HeartQoL questionnaire).

Results

Forty patients (65 ± 8 years, 80% male) completed all study requirements and were included in analyses. The IG reduced 44% of the depression levels when compared to the CG (-44.0 ± 32.0% vs -2.9 ± 5.0%; p<0.001). There were 30% (p=0.04) and 31% (p=0.05) reductions in anxiety and stress levels in the IG, respectively. The emotional dimension of QoL increased 60% in the IG, p<0.001. In contrast, physical QoL did not change between groups.

Conclusion

Meditation has proved to be an additional practice with effective reduction on stress, anxiety, and depression levels, as well as increasing QoL for patients with CAD who are attending a long-term CV rehabilitation programme.
Estimating cardiorespiratory fitness in heart failure patients with self-reported questionnaires
Authors: Van Leunen M , Van Hooff M , Meijer R , Spee R F , Lu Y , Schep G , Kemps H M C
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiorespiratory fitness (CRF), assessed by peak oxygen uptake (VO2peak), is a powerful predictor of cardiovascular morbidity and mortality. However, performance of a cardiopulmonary exercise test (CPET) is often not feasible or desirable in (older) frail patients, because of physical limitations, transport difficulties, costs and the additional exposure to risks. Other CRF assessment tools, such as questionnaires, are potential alternatives, but have not been validated in frail elderly populations with chronic cardiovascular disease.

Purpose

The purpose of this study was to investigate the accuracy of two self-reported questionnaires, the FitMáx©-questionnaire and The Fitness Calculator, for assessment of CRF in chronic heart failure (CHF) patients.

Methods

CHF patients referred for CPET as part of a cardiac rehabilitation programme were eligible for the study. VO2peak was measured with a symptom limited maximal CPET. Participants completed two questionnaires to estimate VO2peak: the FitMáx-questionnaire and The Fitness Calculator. The FitMáx-questionnaire consists of three questions on walking, cycling and climbing stairs [1], and The Fitness Calculator is based on the HUNT3 study [2] and is currently advised by the American heart association as a non-exercise estimate for CRF [3].

Results

29 CHF patients (21 men, 64.2 years ± 12.0) were included with mean VO2peak of 15.7 ± 4.2 mL/kg/min at CPET. Correlation analysis indicated a moderate association between VO2peak assessed by the FitMáx-questionnaire and measured by CPET (r = 0.52) with a mean bias of 1.7 mL/kg/min (95% CI -6.0 – 9.4, p = 0.03). No association was found between VO2peak assessed by CPET and The Fitness Calculator (r = 0.24), mean bias 14.6 mL/kg/min (95% CI -0.5 – 29.7, p <.01).

Conclusion

The FitMáx©-questionnaire is a moderately accurate tool for estimating CRF in the CHF population. For use in individual patients, efforts should be made to improve the accuracy in this specific patient group. To establish its clinical utility, additional research is needed to evaluate its reproducibility and sensitivity to detect interventional changes in this population.
Prevalence of abnormal cardiovascular magnetic resonance findings in athletes recovered from COVID-19
Authors: Tsampasian V , Catumbela R W , Androulakis E , Gati S , Papadakis M , Vassiliou V S
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Athlete’s heart is characterised by structural and functional cardiac adaptations that stem from high level athletic training1. There is evidence showing that non-specific myocardial fibrosis as shown in cardiac magnetic resonance (CMR) studies is more frequently encountered in athletes compared to sedentary individuals2. With the spread of COVID-19 pandemic, concerns were raised as to whether athletes would be at increased risk of myocardial involvement and subsequent adverse events. This systematic review and meta-analysis aims to assess the prevalence of CMR derived myocardial tissue characterisation abnormalities in athletes with COVID-19 infection.

Methods

PubMed, Cochrane and Web of Science databases were systematically searched from inception to 15th of September 2022. The statistical analyses were conducted using the Stata software (StataCorp. 2019. Stata Statistical Software: Release 16. College Station, TX: StataCorp LLC).

Results

We identified 476 articles out of which 12 studies with a total of 3,338 athletes were included in the meta-analysis 3–14. The median of the time period between the participants’ positive COVID test and their CMR scan ranged across the studies from 16 to 44 days. The pooled prevalence of LGE in athletes infected with COVID-19 was 5.85% (95% CI 2.17, 10.92, p <0.001) (figure 1). Publication bias by Egger’s linear regress test was not significant (p = 0.16). Two studies with a total of 292 athletes compared the presence of LGE between athletes with COVID-19 and healthy control athletes 4,6. This showed a statistically significant higher prevalence of LGE in athletes infected with COVID-19 (figure 2).

Conclusion

CMR has an important role in the evaluation of highly trained individuals. This meta-analysis demonstrates that COVID-19 infection is associated with high prevalence of LGE and abnormal T1/T2 values in highly trained athletes. Whether this remains in the longer-term and whether it might associate with adverse events remains to be seen and further case control studies are needed in order to understand the implications of COVID-19 infection in the risk assessment of athletes.
The association between air pollution and the occurrence of atrial fibrillation (EP-PARTICLES study)
Authors: Kurasz A , Dobrzycki S , Kuzma L
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Science Centre Poland NCN (UMO-2021/41/B/NZ7/03716).

Background

Atrial fibrillation (AF) is the most common arrhythmia and environmental conditions are one of its risk factors. The "Polish smog" that occurs in Eastern Poland - due to its composition and the conditions in which it is formed - is characterized by extremely adverse health effects.

Aim

To assess the relationship between Polish smog and the occurrence of AF episodes.

Material and methods

The study area included voivodeship cities of Eastern Poland. Data on hospitalizations for 2016-2020 were obtained from regional departments of the National Health Fund. In the statistical analysis, a case-crossover study (CCO) method was used.

Results

During the analyzed period, a total of 40,471 hospitalizations for AF were recorded, including 18,139 emergency ones. The main pollutant affecting the occurrence of AF episodes was NO2 – a 10 μg/m3 increase in NO2 concentrations (OR=1.047, 95% CI 1.026-1.068; P<0.001) resulted in an increase in emergency hospitalizations for AF. The effect of NO2 on AF was greater in the cold season than in the warm season (ORcold=1.562 95%CI 1.222-1.997, P<0.001 vs ORwarm=1.055 95%CI 1.018-1.093, P<0.001; P<0.001). No age and sex differences in the influence of NO2 were observed. However, when it comes to the lag effect, the impact of NO2 was significantly greater among men than women on lag1 ORman=1.036 95%CI 1.007-1.066, P=0.01 vs ORwomen=0.978 95%CI 0.951-1.006, P=0.12; P<0.001).

Conclusions

Variations in air pollution levels, especially NO2, can increase the risk of acute AF incidents. We associate the more pronounced adverse health effects noted during the heating season with the particularly toxic effects of Polish smog.
Gender disparities in Cardiac Rehabilitation - Are we concealing apples from Eve?
Authors: Martins A M , Aguiar-Ricardo I , Alves Da Silva P , Cunha N , Gregorio C , Abrantes A , Mourato C , Sequeira C , Pinto F J , Abreu A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cardiovascular disease is a leading cause of death in both men and women and cardiac rehabilitation (CR) is recommended as part of secondary prevention for these patients. Despite this, there are still important asymmetries when it comes to enrolment of women in CR programs.

Purpose

To determine differences between referral and outcomes of cardiac rehabilitation programs among women.

Methods

Prospective cohort study which included consecutive pts who were participating in a centre-based CR program lasting 8 weeks from 2019 to 2021. We analyzed prevalence of risk factors, lab echocardiographic and CPET data in women who were enrolled in the program. Statistical analysis was performed with Mann-Whitney and Wilcoxon tests Results: From a total of 349 patients, 60 women completed a CR program – 17,8% of pts – representing a far smaller percentage when accounting to acute coronary syndrome events in our center in those 2 years (31% women). Mean age of female participants was 60 ± 11,8 years; 74% had hypertension, 64% dyslipidemia, 19% diabetes and only 40% had never smoked. There were no significant differences when compared to male, except for thyroid disease which was more frequent among women (p<0.01). Regarding lab data we noticed an improvement of LDL-c, total cholesterol, HDL-c, although only NTproBNP showed a statistically significant reduction (p=0.001). There was also an improvement of LVEF, once again without statistical significance (in contrast to the male population).

After completion of the program, there was an improvement regarding CPET duration and workload (p<0.001 and p=0.019). Interestingly there was no difference in terms of peak VO2/kg, a data that goes in line with some reports of less impact of exercise based CR in this parameter in women.

Moreover, there were no differences between genders in terms of outcome, namely admissions or cardiovascular death.

Conclusion

Women still have a lower rate of enrolment in CR programs, despite results showing a similar benefit to men. CR effectiveness by CPET should include other parameters besides VO2 peak. Strategies should be developed to improve women participation in CR.
Chronotropism in CPET - Is incompetence limiting functional capacity?
Authors: Alves Da Silva P , Aguiar-Ricardo I , Martins A M , Brito J , Cunha N , Gregorio C , Mourato C , Caldeira E , Miguel S , Sequeira C , Pinto F J , Abreu A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Chronotropic incompetence (CI) is defined as the inability to reach 80% of the expected reserve frequency for age during exertion, and it is frequently observed in stress tests of patients undergoing cardiac rehabilitation programs due to a combination of factors, that include the use of betablockers. Despite the theoretical basis for suggesting that a lower peak heart rate is related to a lower tolerance to exertion, we lack data correlating the CI to the maximal functional capacity, measured in cardiopulmonary tests as the maximal oxygen volume consumption (peak VO2).

Purpose

To correlate the impact of CI on functional capacity in patients (pts) undergoing a cardiac rehabilitation program and try to find the best value of chronotropic incompetence that could predict a worse prognosis.

Methods

Prospective cohort study which included consecutive pts who were submitted to cardiopulmonary exercise test (CPET) during 5 years in a tertiary hospital. Demographic data were analyzed and medication with beta blocker was registered. CI and chronotropic index were calculated using the equation (220-age) for estimating maximum HR. ROC curve method and Kaplan-Meier survival analysis were used to evaluate the cut-off efficacy.

Results

We analyzed 358 CPET and 74,1% patients (n=206) were under beta blocker therapy (7,6% high dose). The majority of the patients had CI (83.5%); CI was more frequent in pts under BB therapy although it didn’t reach statistical significance (p=0.12). A low maximum predicted heart rate (mpHR) was associated with low peak VO2 (p=0.02) and a mpHR < 61% was the best value to predict peak VO2< 12mL/(kg.min) (AUC=0.746, S=72; E=65), despite not showing association with cardiovascular events.

Regarding the chronotropism, 96.9% of the pts were categorized as having a low chronotropic index . A CI < 0.38 was the best cut-off to predict a peak VO2<12 mL/(kg.min) (AUC=0.81, S=72, E 76) and it was predictor of all-cause hospitalizations (p=0.015).

Conclusion

This study shows a high percentage of pts with CI. A low cronotropic index was associatated with low peak VO2 and was a predictor of all-cause hospitalizations.
Cancer and Acute coronary syndrome
Authors: Marijana Knezevic Pravecek M K P , Blazenka Miskic B M , Katica Cvitkusic Lukenda K C L
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Cardiovascular disease and Cancer are the leading causes of mortality in the world. This is due to the aging of the population and the fact that most of the classic cardiovascular risk factors also predispose to cancer. Cardiovascular disease is the most common cause of late morbidity and mortality among cancer survivors. The incidence of cancer and acute coronary syndrome in the same patient requiring PCI is increasing significantly. The reported prevalence of cancer among patients with acute coronary syndrome ranges between 3% and 17%.

In our institution in the past ten months, the prevalence of cancer among patients with ACS who underwent PCI was about 10% (3% in active cancer treatment). Patients with cancer and ACS 41% of patients presented as STEMI, 44% as NSTEMI and 15% as unstable angina. Multivessel coronary disease was confirmed in 36%, Takatsubo was diagnosed in 4%, %=% of patient were treated with percutaneous coronary intervention and stents implantation. They were treated with DAPT; in 39% ticagrelor, 10% prasugrel, others clopidogrel. It was found that lung, prostate, stomach, pancreas and breast cancer are the most common types associated with ACS, which corresponds to our observations.

A proinflammatory and hypercoagulable state with increased platelet activation and aggregation commonly occurs in cancer, increasing the prevalence of ACS. New cancer treatments have significantly improved cancer survival, on the other hand, this has at the same time led to an increase in the incidence of CVD. In the general population, NSTEMI is the most common clinical presentation of ACS in cancer patients. MINOCA and Takotsubo syndrome can also occur in cancer patients, more often in women.

Percutaneous coronary intervention improves the survival rate of ACS patients, lowering early and late cardiac events. One of the most relevant issues strongly limiting the invasive strategy in cancer patients is the prospect of dual antiplatelet therapy required after PCI. The presence of cancer should not limit the effective and safe treatment of ACS but requires a strict assessment of the risk of bleeding and thrombosis, in both cases with pharmacological and interventional treatment.