bluuebunny/crossref_metadata_2025 huggingface dataset:
Unexplained exercise-related dyspnea in type 2 diabetes predicts pulmonary arterial hypertension during exercise
Authors: Gojevic T , Van Ryckeghem L , Jogani S , Frederix I , Bakelants E , Petit T , Stroobants S , Dendale P , Bito V , Hansen D , Verwerft J
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Purpose

To evaluate whether type 2 diabetes mellitus (T2DM) patients who suffer from unexplained exercise-induced dyspnea display cardiac dysfunction during exercise.

Background

Patients with type 2 diabetes mellitus (T2DM) frequently suffer from unexplained dyspnea. It is not fully understood whether these patients have a worse exercise capacity and cardiac dysfunction than non-dyspneic patients. If so, it would be clinically relevant to evaluate cardiac function in T2DM patients with unexplained dyspnea and initiate treatment accordingly.

Methods

47 T2DM patients with unexplained dyspnea and 50 asymptomatic T2DM patients underwent echocardiography with simultaneous cardiopulmonary exercise testing (CPETecho). Left ventricular (LV) function (cardiac output, LV ejection fraction, stroke volume), estimated LV filling pressures (E/e’) and mean pulmonary artery pressures (mPAP) were assessed at rest, low- and high-intensity exercise by using colloid contrast. Breath-by-breath analyses were used to monitor exercise intensity and evaluate exercise capacity (V̇O2peak).

Results

The groups had similar characteristics and glycemic control (p>0.05). LV function and E/e’ were similar between groups during all stages of exercise (p>0.05). However, mPAP increased disproportionally (mPAP/CO > 3) during exercise in 62% of the patients with dyspnea. The mPAP/CO slope was significantly steeper in the patients with, as opposed to without dyspnea (Pinteraction=0.013). Moreover, a steeper mPAP/cardiac output slope (β= -1.86, 95% CI -2.75, -0.98) was an independent predictor of lower V̇O2peak (multivariate model R²:0.54).

Conclusion

In T2DM patients with unexplained exertional dyspnea, simultaneous cardiopulmonary exercise testing and echocardiography frequently reveal a reduced exercise capacity associated with exercise-induced pulmonary arterial hypertension. Dyspneic T2DM patients possibly have early left atrial and LV diastolic dysfunction. Timely preventive and therapeutic interventions may improve clinical outcomes in these patients.
High fibrinogen-to-albumin ratio with type 2 diabetes mellitus is associated with poor prognosis in patients undergoing percutaneous coronary intervention: 5-year findings from a large cohort
Authors: Wang P , Yuan D , Yuan J
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): the National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences

Background

Inflammation plays a crucial role in coronary atherosclerosis progression, and growing evidence has demonstrated that the fibrinogen-to-albumin ratio index (FAR) is associated with the severity of coronary artery disease (CAD). However, the long-term risk of cardiovascular events remains indistinct in patients with different level of FAR and different glycemic metabolism status. This study was to access 5-year clinical outcomes of diabetic and non-diabetic patients who underwent percutaneous coronary intervention (PCI) with different level of FAR.

Methods

We consecutively enrolled 10,724 patients with CAD hospitalized for PCI and followed up for major adverse cardiac and cerebrovascular events (MACCE) covering all-cause mortality, non-fatal myocardial infarction, non-fatal ischemic stroke and unplanned coronary revascularization. FAR was computed using the following formula: Fibrinogen (mg/dL) / Albumin (g/L). According to the optimal cut-off value of FAR, which was determined by the surv_cutpoint function of the R package survminer via RStudio software (version 2021.09.0), patients were divided into higher level of FAR (FAR-H) and lower level of (FAR-L) subgroups, and were further categorized into for groups as FAR-H with DM and non-DM, and FAR-L with DM and non-DM.

Results

5,298 patients (58.36 ± 10.36 years, 77.7% male) were ultimately enrolled in the present study. A total of 1,099 (20.7%) MACCEs were documented during the 5-year follow-up. The optimal cut-off value of FAR was 0.0783 by the surv_cutpoint function. Compared to ones with FAR-H and DM, patients with FAR-L and non-DM, FAR-H and non-DM, FAR-L and DM had decreased risk of MACCEs [adjusted hazard ratio (HR): 0.75, 95% confidence interval (CI) 0.64-0.89, p = 0.001; HR: 0.006, 95% CI 0.66-0.93, p = 0.006; HR: 0.81, 95% CI 0.68-0.97, p = 0.019]. Notably, non-diabetic patients with lower level of FAR also had lower all-cause mortality risk than those in the FAR-H/DM group (HR: 0.41, 95% CI 0.27-0.63, p < 0.001). Multivariate Cox proportional hazards regression analysis also indicated the highest risk of MACCEs in patients with FAR-H and DM than others (p for trend = 0.005). In addition, subgroup analysis revealed consistent effects on 5-year MACCE across various subgroups.

Conclusion

Diabetic patients with higher level of FAR had the worse 5-year outcomes compared with patients in other three groups. The level of FAR may help to identify high-risk individuals in this specific population.
Physical activity and psychological status of hypertensive and healthy individuals: in the era of COVID-19
Authors: Karaduz B , Sener YZ , Vardar Yagli N , Calik Kutukcu E , Tokgozoglu L
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

Hypertension is an important and common reason of cardiovascular diseases. Hypertension can prevent, delay and/or manage with lifestyle modifications like regular physical activity participiation, stress management. During COVID-19 pandemic physical inactivity, increased stress and anxiety levels impair disease management of hypertensive individuals and becomes a serious risk factor for healthy individuals.

Purpose

We aimed to investigate and compare physical activity, anxiety and depression level of hypertensive and healthy individuals.

Methods

Forty hypertensive and forty healthy individuals were included in the study (Mean age: 51,15±6,96 years and 49,75±8,41 years, respectively). Patients informed about the study and invited during their cardiology visit and called by a physiotherapist in lockdown periods. In phone call, working status, quarantina compliance, sociodemographic status were asked. Physical activity levels were assessed with International Physical Activity Questionnnaire-Long Version (IPAQ), anxiety and depression levels were examined with Hospital Anxiety and Depression Scale (HAD). Patients categorized as inactive, minimally active and active according to METs results of IPAQ and classified as increased depression and/or anxiety according to HAD results.

Results

Working status, quarantina compliance and gender were similar between groups (p>0,05). Anxiety and depression scores were similar but number of people who had increased depression were higher in hypertensive group. Considering physical activity, transport, vigorous domestic activities, leisure time vigorous activities and total physical activity levels were statistically different between groups (p<0,01, p=0,002, p=0,002,respectively) and hypertensive individuals were less active. When we compared physical activity categorization, in hypertensive group 12,5% were active, 47,5% were minimally active and 40% were sedentary and in healthy group 32,5% were active, 50% were minimally active and 17,5% were sedentary and physical activity status were statistically significant (p=0,029).

Conclusion(s)

According to our results, hypertensives were more inactive and deprressed than healthy controls. Quarantine periods become very inactive periods for all populations but this is very crucial for especially risky populations. To prevent upcoming cardiovascular diseases and complications of hypertension physical activity and psychosocial support can implement by healthcare providers.
Use of traditional medicine and control of hypertension in 12 Sub-Saharan African countries: the EIGHT cross-sectional study
Authors: Lassale C , Gaye B , Diop IB , Azizi M , N'guetta L , Antignac M , Jouven X
Published: May 2022

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Camille Lassale is supported by a fellowship from “La Caixa” Foundation (ID 100010434). The fellowship code is LCF/BQ/PR21/11840003

Background

Use of traditional medicine (TM), is widespread in Sub-Saharan Africa as treatment option for a wide range of disease. We aimed to describe the profile of TM users and estimate the association with blood pressure (BP) and control of hypertension among hypertensive patients in a pan-African study.

Methods

We included 2128 participants in the cross-sectional EIGHT study, who attended an outpatient consultation in the cardiology departments of 12 Sub-Saharan African countries (Benin, Cameroon, Congo, Democratic Republic of the Congo, Gabon, Guinea, Côte d’Ivoire, Mauritania, Mozambique, Niger, Senegal, Togo). We describe patients’ characteristics according to TM use. We modelled the odds of uncontrolled hypertension, severe hypertension, and complications of hypertension by multivariable mixed logistic regression, and the linear association with systolic and diastolic BP by linear regression, all adjusted for age, sex, individual wealth index, adherence to hypertension conventional treatment, and country.

Results

A total of 512 (24%) of participants reported using TM, and this percentage varied drastically across countries from 10% in the Congo to 48% in Guinea. TM users were more likely to be male, with poor treatment adherence, reporting missing treatment because it is too expensive, and presenting any complication of hypertension. TM use was associated with greater odds of hypertension (OR=1.30; 95% confidence interval: 0.99, 1.70), severe hypertension (OR=1.34; 1.04, 1.74) and of any complication of hypertension (OR=1.27; 1.01, 1.60), driven by renal complication (OR=1.57; 1.07, 2.29). Use of TM was associated with a 3.87 mmHg higher systolic BP and 1.75 mm Hg higher diastolic BP compared to no use.

Conclusions

In this cross-sectional study of patients with hypertension in 12 Sub-Saharan African countries, we identified that the use of traditional medicine was associated with a poorer control of hypertension and more complications.
Determination of hypertriglyceridemic gene score in patients with familial dysbetalipoproteinemia
Authors: Satny MS , Vrablik MV , Altschmiedova TA , Todorovova VT , Hubacek JH , Kyselak OK , Soska VS
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): The study was supported by the Charles University, project GA UK No. 70220.

Introduction

Familial dysbetalipoproteinemia (FD also known as hyperlipopproteinemia type III) is an AR inherited disease associated with APOE polymorphism. The typical genotype of FD is APOE2/2 and the phenotype is mixed DLP arising in the context of other unknown metabolic or genetic factors. The aim of this work was to determine the hypertriglyceridemic (HTG) score in patients with FD, as a possible determinant of FD development.

Methods

A total of 13 single-nucleotide polymorphisms (SNPs), which are related to the development of HTG in the Czech population, were analyzed in 101 patients with FD and 90 controls with the APOE2/2 genotype (from a large biobank post-MONICA and HAPIEE studies). Genetic analyzes of SNPs were performed using RFLP or real-time PCR. The data were processed by descriptive statistics methods.

Results

A total of 8 SNPs out of 13 examined were associated with the development of DLP, resp. HTG in patients with FD compared to controls (strongest SNPs in APOE and APOA5 genes; P <0.005). Unweighted gene scores (sum of risk alleles) were different between the two groups (P <0.01).

Conclusion

Cumulation of risk genetic variants, assessed by an unweighted score, can distinguish between individuals with the APOE2/2 genotype and those at risk of developing FD.
Unmasking the prevalence of cardiac amyloidosis in the real world: first insights from the phase 2 of the AC-TIVE study, an italian nationwide survey
Authors: Porcari A , Merlo M , Pagura L , Rapezzi C , Sinagra G
Published: May 2022

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Pfizer

Introduction

Clinicians need to identify patients with cardiac amyloidosis (CA) at an early stage, due to the availability of disease modifying therapies. Some echocardiographic findings may rise the suspicion of CA, also in patients with mild or no symptoms, orienting second level diagnostic tests.

Purpose

To investigate the prevalence of CA in consecutive patients ≥55 years undergoing clinically indicated, routine transthoracic echocardiogram (TTE) in Italy with echocardiographic signs suggestive of CA.

Methods

This is a prospective multicentric study conducted in Italy. It comprises two phases: 1) an observational phase consisting in a national survey on prevalence of possible echocardiographic red flags of CA in consecutive patients ≥55 years undergoing routine TTE (1), and 2) a CA diagnostic phase. Preliminary results of phase 2 are herein presented. Patients who presented a CA-suggestive TTE (i.e. at least one red flag of CA in hypertrophic, non-dilated left ventricles) in the phase 1 were further evaluated (1). Those who consented to proceed in the study, underwent clinical evaluation, electrocardiography, blood and urine tests and scintigraphy with bone tracer. Diagnosis of transthyretin related-CA (ATTR-CA) was made in presence of grade 2 -3 Perugini uptake at scintigraphy and absence of monoclonal protein. The study was registered at ClinicalTrials.gov.

Results

Of the 5315 screened echocardiograms, 381 exams (7.2%) were classified as CA-suggestive (1). Two-hundred-twelve of the 381 patients with a CA-suggestive TTE proceeded to the phase 2 of the study. The main reasons for the 169 non-entering patients into the phase 2 were death [n=53] and refusal to participate [n=85]. Sixty-five of these 212 patients (31%; 17% considering also the 169 non-entering patients into the phase 2 and assuming they did not have CA) had a circumstantiated diagnosis of CA. In detail, ATTR-CA was diagnosed in 53 (25%) and AL-CA in 12 (5.7%) patients.

Conclusion

Among a cohort of consecutive unselected patients ≥55 years with echocardiographic findings suggestive of CA, the real prevalence of disease ranged from 17% up to 31%. Although ATTR-CA was predominant, AL-CA was diagnosed in a significant amount of cases. TTE has a fundamental role in screening patients, raising the suspicion of disease and orienting diagnostic work-up for CA.
Effect of one-day intermittent fasting on 24-hour blood pressure profile in hypertensive and normotensive patients with overweight and obesity
Authors: Isayeva ANNA , Matiashova LOLITA
Published: May 2022

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): National Academy of Medical Science of Ukraine

Background

The modification of eating behavior is an integral part of cardiovascular disease prevention. Intermittent fasting is a modern approach towards diet correction. However, insufficient data exists on its effect and safety on daily blood pressure and lipids.

The aim of this paper was to assess the response of blood pressure, blood lipids and creatinine to acute intermittent fasting (IF) in hypertensive and normotensive patients with overweight and obesity.

Methods

A cohort of 65 hypertensive patients and 45 young normotensive patients with overweight and obesity included. All patients were monitored for 24 hours by Ambulatory Blood Pressure monitoring by ABMP50 Machine. All hypertensive patients were on stable antihypertensive therapy for at least 3 months and had met target office blood pressure levels. Fasting glucose (FG), blood lipids, creatinine, uric acid and high sensitive C-reactive protein (hCRP) were measured before and after fasting. All patients were asked to fast (F) for 16 hours for the first time in their lives. At the end of the fasting period, all participants in the study rated their subjective state from 1 to 10. Statistical analyses were conducted by IBM SPSS Statistics 22.

Results

The reaction of blood pressure on intermitted fasting was similar in both groups. Decrease of day systolic blood pressure (SBP) as well as increase of night diastolic blood pressure (DPB) was observed in both groups (TABLE 1). No significant changes of daily BP were observed in normotensive patients. Daily heart rate increased in 1st group by 1,5% (p=0.003) and decreased in 2nd group by 4,2% (p=0,002). At the same time daily SBP decreased in the group of hypertensive patients. The hypertension group (65 patients) rated their subjective state higher than 5 points and expressed that fasting was easy for them, age median 57 (51:61) years old. The normotensive group rated themselves below 5 points and expressed the difficulty of fasting and low quality of sleep, age median 26 (25:45) years old. The median BMI in 1st group 32,1 (30:35) in 2nd group 27,4 (25:30) kg/m2. The mean FG before fasting in the 1st group was 5,45(±0,61) mmol/l in the 2nd group was 4,75 (±0,55) mmol/l and after IF in the 1st group 5,36 (±0,73) mmol/l in the 2nd group 4,58 (±0,64) mmol/l (p>0.05). In hypertension group the mean of hCRP decreased from 9.95±8.02 to 4.68±2.88 (p=0.04). The level of blood creatinine and GFR had not significant changes.

Conclusion

One-day intermittent fasting leads to a change in blood pressure, does not cause hypotension, and is tolerated favorably in obese patients with hypertension on stable antihypertensive therapy.
Fear of movement (kinesiophobia) after cardiac hospitalization: predictors and impact on participation in cardiac rehabilitation
Authors: Keessen P , Visser B , Van Duijvenbode ICD , Latour CHM , Jorstad HT , Scholte Op Reimer WJM
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Dutch Research Council (NWO) RAAK-PRO grant

Background

Fear of movement (kinesiophobia) after cardiac hospitalization is associated with low physical activity levels and reduced quality of life. Participation in cardiac rehabilitation (CR) improves psychological wellbeing and relieves kinesiophobia. However, little is known about the predictors of kinesiophobia and the impact of kinesiophobia on participation in CR.

Purpose

To identify predictors of kinesiophobia after (acute) cardiac hospitalization and to assess the impact of kinesiophobia on participation in CR.

Methods

We performed a longitudinal study in patients with coronary artery disease, acute heart failure or atrial fibrillation. At hospital discharge we collected demographic variables, cardiac disease history and administered questionnaires about kinesiophobia, cardiac anxiety, depression and psychological complexity (severity of psychological problems). Kinesiophobia was measured with the Tampa Scale for Kinesiophobia (TSK), scores >28 are considered `high levels of kinesiophobia’. At 3 months patients were followed up to evaluate participation in CR. We investigated (1) predictors of kinesiophobia at hospital discharge and (2) the impact of kinesiophobia on participation in CR at 3-months follow up, using two multivariable logistic regression models with backward elimination to identify predictors.

Results

In 149 patients (22% women), mean age 64.1 (±10.1) high levels of kinesiophobia were measured in 61 patients (40,9%). Higher age decreased the odds for kinesiophobia: OR: 0.95 (95%CI:0.89 – 0.99). Two variables increased the odds for kinesiophobia: higher levels of psychological complexity: OR: 1.27 (95%CI 1.01- 1.60) and cardiac anxiety: OR: 1.10 (95%CI: 1.02 – 1.19). The odds for participating in CR were decreased by kinesiophobia: OR: 0.91 (95%CI: 0.84 – 0.99) and higher age: OR: 0.92 (95%CI:0.86-0.98).

Conclusion(s)

Kinesiophobia at hospital discharge is associated with psychological complexity and negatively impacts participation in CR. This study emphasizes the need for early screening to identify those who are at risk of developing kinesiophobia which in turn can lead to non-adherence to CR.
How well can wearables in children and adolescents with congenital heart disease represent their exercise capacity?
Authors: Hock J , Willinger LW , Hager AH , Ewert PE , Mueller JM
Published: May 2022

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Stiftung KinderHerz

Background

Wearables enjoy great popularity in children and adolescents. They suggest objectively measuring subjects’ physical activity (PA) or at least give a hint of how it is. But is there a correlation between step-count, moderate to vigorous physical activity (MVPA), and peak oxygen uptake (peakV’O2)?

Purpose

This study investigates this question in children with various congenital heart diseases (CHD).

Methods

From September 2017 to September 2021 sixty-six patients (13 ± 3 years, 20 girls) measured their daily step-count and MVPA via Garmin fit jr. over one week and underwent a cardiopulmonary exercise test (CPET) to quantify their peakV’O2. CHD severity was complex in 50%, moderate in 39%, and simple in 11%. The distribution consisted of 18% with a left heart defect, 50% with a right heart defect, 5% with a Fontan circulation, 9% with an isolated shunt, and 18% with transposition of the great arteries. The correlation was performed via first Spearman’s correlation and secondly partial correlation, adjusted for age, sex height, and weight. Results are presented in median [IQR25;IQR75].

Results

Median steps on a weekly average were 7,576 [6,100;10,888] and MVPA 68 [52;95] minutes. PeakV’O2 was 33 [28;39] ml/min/kg, represented as 77 [68;91] % of predicted, which corresponds to slight impairment. Step-counts slightly correlates with peakV’O2 (r=0.277, p=0.024). However, correlation vanished after adjusting for anthropometrics (step-count: r=0.244, p=0.056). MVPA and peakV’O2 did not correlate at all.

Conclusions

Objectively measured PA and exercise capacity are poorly associated. Since both are independent constructs, it is necessary to assess both in a clinical setting - PA in the context of cardiovascular prevention and peakV’O2 as the strongest predictor for morbidity and mortality.
Heterogeneity among countries in primary cardiovascular prevention guidelines: missed opportunities for adherence and improved outcomes
Authors: Santilli F , Blaha MJ , Li L , Li X , Na SH , Shi Z
Published: May 2022

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Bayer AG

Background

· Specialty-driven guidelines identify risk factors for cardiovascular (CV) events that may potentially be modified by lifestyle or pharmacotherapy.

Purpose

· Worldwide, the control of modifiable risk factors in people at high cardiovascular disease (CVD) risk remains poor. Our hypothesis is that differences in multiple, specialty-driven guidelines do not help, and may hinder, the accurate assessment of CV risk factors and their appropriate management in the individual patient that has multiple risk factors or comorbidities.

Methods

· We conducted a review of the most recent guidelines for CVD prevention, diabetes, hypertension, dyslipidaemia and chronic kidney disease used in Europe, Italy, the USA, China and South Korea to establish the commonalities and differences between risk factor targets, risk modifiers and treatment approaches.

Results

· The use of low dose aspirin in patients at high risk of CVD varies between regions, and between those with and without type 2 diabetes (T2D). In addition, the use of concomitant proton pump inhibitor (PPI) treatment, that may reduce the gastrointestinal bleeding risk and therefore allow more people to be included for low dose aspirin treatment consideration, is variable (see table).

· There are also differences in the definitions of risk stratification, targets for major risk factors and the use of coronary artery calcium score (CAC) to identify high-risk, asymptomatic patients.

· The LDL-C targets for patients with T2D at high CV risk vary from <1.8 mmol/L (<70 mg/dL)1,2,10 to <2.6 mmol/L (<100mg/dL);9 and those for patients with T2D at very high CV risk vary from <1.4 mmol/L (<55 mg/dL)1,2 to <1.8 mmol/L (<70 mg/dL).9

· Although CAC score is identified as a risk modifier in most guidelines, its use to guide treatment decisions in patients with ≥7.5% to <20% 10-year ASCVD risk is recommended in only two guidelines.4,6

Conclusion(s)

· We suggest that physicians cannot synthesise specialty-based recommendations for a single patient with multiple comorbidities within a limited consultation time, and that this may be a major factor in the lack of progress in managing CV risk factors.

· A more unified, consistent and global approach to primary prevention of CV disease across specialties may lead to greater guideline adherence, greater patient understanding and acceptance of therapy, and improved outcomes.
Sexual dysfunction in women with increased cardiovascular risk
Authors: Vetkova M , Angelov A
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Normal sexual function is considered as an essential aspect of quality of life. Distortions of the sexual activity can result in psychosocial conflicts, separation, depression and even increased morbidity and mortality. Sexual dysfunction (SD) is age related, progressive and more prevalent among women than men. An increased prevalence of SD has been reported in females with risk factors for cardiovascular (CV) disease.

Aim

To evaluate SD among women with increased CV risk compared with the general female population using Female Sexual Function Index (FSFI).

Methods

107 women with hypertension and/or diabetes mellitus (DM) and 75 healthy women were enrolled in the study. All participants completed questionnaires, evaluating their sociodemographic characteristics, health status, physical activity and sexual function (FSFI).

Results

Mean subject age was 50,4±6,62 y. in the group with increased CV risk and 47,1±6,97 y. in the control group, respectively (p<0,001). There were no significant differences between the groups due to the other baseline sociodemographic characteristics – marital status, educational level, employment and income. Higher prevalence of menopause in the group with increased CV risk was found (63,6% vs 37,3%, p<0,001). Dyslipidemia (52,9% vs 28,9%, p<0,01), obesity (34,6% vs 8%, p<0,001) and family history of premature coronary artery disease (20,6% vs 8,1%, p=0,02) were significantly more prevalent in females with increased CV risk. There was no significant difference between the groups due to the prevalence of smoking (72,9% vs 64%, NS). The majority of the study population had minimal or no everyday physical activity. No significant difference in physical activity between both groups was observed. According to FSFI, women with increased CV risk more often had SD (64% vs 33,3%, p<0,001). The scores in all domains of sexual function – desire, arousal, lubrication, orgasm, satisfaction and pain, were significantly lower in women with hypertension and/or DM compared with the control group. These trends seemed more prominent in premenopause females. No significant difference in the FSFI score was found between both groups in postmenopausal women. The FSFI score was significantly lower in the subgroup of premenopausal women with increased CV risk compared with premenopausal participants in the control group (21,02±10,98 vs 28,24±5,37, p<0,001).

Conclusion

Females with hypertension and/or DM more often have other CV risk factors like dyslipidemia, obesity and family history of premature coronary artery disease. They also have increased prevalence of SD, especially in premenopausal women. Screening for increased CV risk should be discussed in premenopausal women with SD.
Overall benefits of smoking cessation in patients with ASCVD are underestimated
Authors: Van Trier T , Snaterse M , Hageman SHJ , Ter Hoeve N , Sunamura M , Moll Van Charante EP , Galenkamp H , Deckers JW , Visseren FLJ , Scholte Op Reimer WJM , Peters RJG , Jorstad HT
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

New risk prediction models estimate and employ individual ‘treatment benefit’, which can be used to motivate patients with atherosclerotic cardiovascular disease (ASCVD) to quit smoking and to adhere to beneficial pharmacological interventions. However, this treatment benefit is usually calculated for a limited set of cardiovascular outcomes, i.e. years gained without myocardial infarction or stroke, while ignoring non-cardiovascular health benefits and pharmacological side- and adverse effects. Importantly, treatment effect size of medication is smaller in persistent smokers compared to non-smokers, because of the higher overall mortality of the smokers. By disregarding non-cardiovascular outcomes, the overall benefit of smoking cessation will be underestimated.

Purpose

We estimated and compared the treatment benefits – expressed as ‘gain in years without major cardiovascular events’ – of smoking cessation versus persistent smoking with targeted pharmaceutical interventions in patients with established ASCVD treated with anti-platelet agents, statins and anti-hypertensive drugs.

Methods

We pooled individual-level risk factors data from six large, recent prospective studies: RESPONSE 1 and 2, OPTICARE, EUROASPIRE IV and V and HELIUS. We included patients aged ≥45 years who persisted in smoking ≥6 months after acute coronary syndrome or revascularisation. The primary outcome was SMART-REACH estimated treatment benefit expressed as gain in years without a myocardial infarction or stroke. We compared the cardiovascular treatment benefit of smoking cessation versus the use of one or more pharmaceutical treatments: bempedoic acid, colchicine and PCSK9 inhibitors.

Results

We included 989 smokers with established ASCVD (23% female), with mean age of 60 (SD 8) years at median 1.2 (IQR 1.0-2.0) years post-index event. A mean of 4.81 (95%CI 4.73-4.89) event-free years would be gained through smoking cessation. Persistent smoking with maximal pharmaceutical treatment resulted in a comparable gain of 4.83 (95% CI 4.72-4.93) event-free years.(Figure)

Conclusion

The estimated lifetime treatment benefit of smoking cessation appeared to be comparable to the use of several pharmaceutical treatments combined, even when the analysis was limited to major cardiovascular events. This substantial health benefit underscores smoking cessation to be one of the most important actions to improve the overall health of patients with established ASCVD. To accurately compare treatment options, overall benefits and harms should be considered, in addition to the patients’ preferences, in a shared decision making process.
Long-term cardiovascular health and physical functioning of non-hospitalised ex-COVID-19 patients: a case-control study
Authors: Van Der Sluijs KM , Bakker EA , Schuijt TJ , Joseph J , Thijssen DHJ , Eijsvogels TMH
Published: May 2022

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Dutch Heart Foundation (Nederlandse Hartstichting)

Background/Introduction

SARS-CoV-2 and the associated coronavirus disease 2019 (COVID-19) has substantial acute effects on cardiovascular health and physical functioning, but the long-term effects are less clear, especially in individuals that recover from COVID-19 at home, representing ~95% of all cases.

Purpose

We compared cardiovascular health and physical functioning of non-hospitalised ex-COVID-19 patients versus age- and sex-matched healthy peers.

Methods

We recruited non-hospitalised adults with PCR-proven COVID-19 and age- and sex-matched controls for this case-control study. Duration of COVID-19 illness and presence of residual complaints were inquired. Cardiovascular health status and physical functioning were assessed through a series of measurements: blood pressure, blood biomarkers (NT-proBNP, high-sensitive cardiac troponin I, C-reactive protein), carotid-femoral pulse wave velocity (ARTSENS), handgrip strength, 4-metre gait speed, habitual physical activity (days per week with at least 30 minutes of moderate physical activity) and quality of life based on the 12-item short form.

Results

We included 101 ex-COVID-19 patients (median age 59.0 [54.5-65.5], 59 (58.4%) male) at a median of 5.0 [4.0-7.0] months post-infection and 101 age- and sex-matched controls (median age 58.0 [54.0-64.5], 58 (57.4%) male). Median duration of COVID-19 illness was 8.0 days [6.0-14.0] and 32.3% of the cases reported residual complaints at the time of inclusion. We found no differences between ex-COVID-19 patients and controls in blood pressure (134-81 vs. 133-81 mmHg, p=0.40 and p=0.30 for systolic and diastolic pressures respectively), concentrations of NT-proBNP (8.50 vs. 7.00 pmol/L, p=0.22), high-sensitive cardiac troponin I (4.11 vs. 3.38 ng/L, p=0.06), C-reactive protein (4.00 vs. 4.00 mg/L, p=0.93) and carotid-femoral pulse wave velocity (6.63 vs. 7.01 m/s, p=0.30). Ex-COVID-19 patients showed higher handgrip strength compared to controls (43 kg vs. 38 kg, p=0.004), but 4-metre gait speed (2.62 vs. 2.56 s, p=0.33), habitual physical activity levels (6.0 vs. 6.0 days, p=0.16) and reported quality of life (86.4% vs. 88.6%, p=0.10) were not different between groups.

Conclusion(s)

Cardiovascular health and physical functioning parameters were not different between non-hospitalised ex-COVID-19 patients and age- and sex-matched controls at five months post-infection. This suggests that individuals who recovered from COVID-19 at home do not have an increased cardiovascular risk or impaired physical functioning in the long-term.
Post-discharge light physical activity indicates recovery in acutely hospitalized older adults
Authors: Terbraak M , Kolk MS , Macneil Vroomen JL , Twisk JWT , Buurman BM , Van Der Schaaf M
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Netherlands Organization for Health Research and DevelopmentThe Dutch Research Council

Introduction

Physical activity levels might be a simple overall physical marker of recovery in acutely hospitalized older adults; however, cut-off values post discharge are lacking.

Purpose

We aim to identify cut-off values for post-discharge physical activity that indicate recovery among acutely hospitalized older adults and stratified for frailty.

Methods

Prospective observational cohort study including acutely hospitalized older adults (≥70 years) during hospitalization and at home. Frailty was assessed using Fried’s criteria. Steps and intensity of physical activity were assessed using Fitbit up to one week post discharge. The primary outcome was recovery at 3-months post discharge. ROC-curve analyses were used to determine cut-off values, and logistic regression analyses to calculate odds ratios (ORs).

Results

The analytic sample included 174 participants with a mean (standard deviation) age of 79.2 (6.7) years of whom 84/174 (48%) were frail and 67 (39%) had cardiac disease. At 3-months, 109/174 participants (63%) had recovered. In all participants, determined cut-off values were 1369 steps/day (OR: 2.5, 95% confidence interval [CI]: 1.3–4.6) and 76 minutes/day of light intensity activity (OR: 3.0, 95% CI: 1.6–5.8). In frail participants, cut-off values were 1043 steps/day (OR: 3.3, 95% CI: 1.3–8.4) and 72 minutes/day of light intensity activity (OR: 4.2, 95% CI: 1.6–10.8). Determined cut-off values were not significantly associated with recovery in non-frail participants.

Conclusions

We recommend at least 1369 steps per day and 76 minutes of light activity to help older patients’ recovery from an acute hospitalization.
Association of cardiac structural abnormalities, cardiometabolic health, and development of chronotropic incompetence
Authors: Prana Jagannatha G , Dwi Adelia Yasmin AAA , Surya Pradnyana IWA , Kamardi S
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

Recent studies suggest chronotropic incompetence is statistically correlated with poor cardiometabolic health, systemic inflammation, and heart structural abnormalities. All may lead to exercise intolerance, impaired quality of life, and death due to cardiovascular disease (CVD). Unfortunately, there’s still a lack of data regarding which factors are associated with chronotropic incompetence.

Purpose

The purpose of this study was to identify the cardiometabolic risk factors, electrocardiographic (ECG), and echocardiographic (Echo) parameters that associated with chronotropic incompetence.

Methods

All patients who underwent cardiac treadmill stress test, ECG, and Echo in our hospital were included in this study, enrolled from 2018 until 2020. Patients were separated into two groups, patients with chronotropic incompetence and those without chronotropic incompetence. Chronotropic incompetence is defined as a maximum heart rate that can’t reach 85% age-predicted maximum heart rate. SPSS version 21 was used for data analysis. Pearson chi-square test was used to compare categorical variables based on clinical baseline characteristic, and cardiometabolic risk factors. We are using the Mann-Whitney U test to evaluate the association between ECG and Echo findings with chronotropic incompetence.

Results

Among 136 subjects of this study, the mean age was 54.7 years, 71.3% were male and 37.5% had chronotropic incompetence. Baseline characteristics and cardiometabolic factors such as T2DM (PR 2.29; 95%CI 1.16–3.37), HbA1C (PR 3.13; 95%CI 2.31-4.22), dyslipidemia (PR 1.773; 95%CI 1.170–2.687), total cholesterol (PR 2.396; 95%CI 1.650-3;481), and LDL (PR 1.853, 95%CI 1.229-2.794) were significantly associated with chronotropic incompetence (all p-value <0.05), while other factors were not significantly related. In ECG and Echo parameters, patients with chronotropic incompetence were found to had high Cornell product (1823.6±429.6vs1476.9±273.8), lower LVIDd (42.8±0.89 vs 45.2±0.72, p=0.029), lower LVIDi (24.6±0.37 vs 25.5±0.31, p=0.025), higher left ventricular mass (175.6±3.27 vs 125.1±2.63, p<0.001), higher E/E’ ratio (17.3±0.29 vs 13±0.35, p<0.001), and higher LAVI (47±1.98 vs 31.6±1.09, p<0.001) compared with patients without chronotropic incompetence.

Conclusion(s)

There are association between chronotropic incompetence with cardiometabolic factors and structural abnormalities that indicate increased LV filling pressure. The development of chronotropic incompetence may be predicted by assessing these factors
Prevalence and impact of high BMI in CAD patients
Authors: Eid O , Eid R , Styliou T , Diakonikolaou S , Christou V , Karataraki F , Abdelrahman R , Moutiris J
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

High body mass index (BMI) is a precursor to coronary artery disease (CAD) and an aggravator of the other co-existing CAD risk factors such as diabetes and hypertension. Lifestyle changes (e.g. balanced diet and exercise) in patients with high BMI are usually overlooked, although they contribute positively to prevention and improvement of CAD.

Purpose

The aim of this study is to calculate the prevalence of overweight and obesity in known CAD patients in both genders, in correlation with diabetes, hypertension, exercise and diet in CAD patients and to compare the findings to EUROASPIRE IV conducted in 2015 (1).

Methods

This study retrospectively included 362 patients (88% male; mean age 67 years) with a history of CAD (MI, PCI or CABG) from the registry of Cyprus heart survey in a hospital, in Nicosia from 2011 to 2014. Age, gender, date of myocardial infarction event, date of PCI or CABG surgery as well as CAD risk factors such as BMI, exercise, diet, hypertension and diabetes were noted on their visit to the cardiac clinic.

Results

Our study showed an overall similarity in BMI prevalence across both genders. The prevalence increased from 17.7% in patients with normal BMI (18.5-24.9) to the highest CAD prevalence of 49.2% which was seen in overweight (BMI = 25 –29.9) patients. However, there was a drop in the prevalence of obese (BMI = 30+) patients to 32.9%. This is supported by EUROASPIRE IV (1) which highlighted that CAD prevalence was higher in overweight patients (male = 83%; female = 80%) than obese patients (male = 36%; female = 44%) by nearly 2-fold. Furthermore, within the higher-than-normal BMIs, we recognized more non-diabetic CAD patients (115 overweight; 67 obese) in our study than diabetic CAD patients (62 overweight; 55 obese). On the contrary, hypertensive CAD patients (106 overweight; 80 obese) were more frequent than non-hypertensive CAD patients (71 overweight; 43 obese). Overweight patients split in nearly half when it came to exercise and diet (96 exercise, 82 do not; 90 diet, 88 do not). While in obese patients there was a higher proportion of patients not exercising or following a diet (47 exercise, 72 do not; 32 diet, 87 do not). According to EUROASPIRE IV (1), obesity contributed to higher prevalence of diabetes as patients did not lose weight.

Conclusion

Overweight and obese patients make up a large percentage of CAD patients. High BMI had a negative additive effect with hypertension but not with diabetes on the risk prevention in CAD patients which mismatches with the EUROASPIRE IV (1) findings. Despite BMI being a modifiable risk factor, not adhering to a diet or exercise was noticed in overweight and obese patients, which in return weakens their prevention of CAD.
Misleading qualification of active smokers based on carbon monoxide measurement of exhaled air
Authors: Ramotowski B , Forys WJ , Budaj A
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Centre of Postgraduate Medical Education

Background

Carbon monoxide (CO) concentration of exhaled air is widely used in clinical trials in assessment of active smoking due to its feasibility and cost-effectiveness. The concentration of nicotine metabolite cotinine in urine is used as an objective index of smoking.

Purpose

We aimed to compare self-reported smoking and smoking cessation (SC) with results of CO and cotinine concentration.

Methods

Patients after coronary angiography (n=62) were included in SC programme with a brief counselling. The self-reported smoking and SC was verified with urine cotinine assessment (NicAlert) and CO level in exhaled air (MicroCO). The criterium of SC was non-smoking (<1 cigarette ) in the last 7 days, NicAlert ≤2, MicroCO test≤6 parts per million (ppm).

Results

The mean age of patients was 61 ± 7.7 years, 49 (79%) patients were men, with median load of smoking 10 pack-years. 40 patients were assessed with both methods at baseline and follow-up visit. At baseline all the patients declaring at least 10 cigarettes daily had Nic Alert 6, but MicroCO indicated non-smoking in 25 (62,5%) patients. At follow up visit after 1 month, 35 (56,5%) patients declared SC and there was numerically higher level of misleading results of CO concentration in the whole group (p=0.077) and significantly higher in the group of patients who self-reported continuation of smoking (p=0.009)(Table 1).

Conclusion

Despite widespread and cost-effective measurement of CO the result should be carefully interpreted. It accurately indicates non-smoking patients, but the measurement in active smokers might be misleading with a significant group of patients with false negative results. To accurately assess active smokers the CO measurement should be supported with other method such as measurement of cotinine levels.
High glycemic variability attenuates diastolic function in diabetic heart failure with preserved ejection fraction
Authors: Adhikara IM , Paratte AR , Susanti VY , Anggraeni VY
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Suboptimal glycemic control characterized by high glucose variability pose inherent risks for the development of diabetic cardiomyopathy. The tangible association between type 2 diabetes mellitus (T2DM) and Heart Failure with Preserved Ejection Fraction (HFpEF) also has been widely studied. However, whether glycemic variability (GV) may independently associated with left ventricular (LV) diastolic dysfunction in T2DM patients with HFpEF remained elusive.

Purpose

To investigate association between GV and diastolic dysfunction in T2DM patients with HFpEF.

Methods

A cross-sectional study utilizing electronic medical record database from 2018 to 2021. Total of 66 patients with T2DM and HFpEF without coronary artery disease were enrolled. Baseline characteristics, clinical and laboratory variables, medication and echocardiography data were obtained. GV were calculated from standard deviation of multiple blood glucose measurement prior to echocardiography. Subjects were divided into two groups according to mean GV; high and low GV respectively. Diastolic function was analyzed applying echocardiographic parameters.

Results

LV Ejection Fraction (LVEF) was significantly lower in high GV (≥ 49.45 mg/dL) as compared to patients with low GV (65.48±9.47 vs 68.20±8.12, p=0.0408) despite similar baseline characteristics. Furthermore, high GV displayed a significant positive correlation with E/e’ (Pearson’s correlation r = 0.441; p=0.044). More importantly, univariate analysis using Fisher’s exact test revealed that High GV significantly associated with diastolic dysfunction (odds ratio: 8.16; 95% confidence interval = 1.143–95.97; p=0.0451).

Conclusion

High GV was significantly associated with lower LVEF and diastolic dysfunction. Optimal glycemic control represented by low GV may become an appealing approach to prevent HFpEF progression in T2DM patients.