bluuebunny/crossref_metadata_2025 huggingface dataset:
Air pollution and cardiovascular mortality in Poland: a panel time-series analysis of 80 million person-years (EP-PARTICLES study)
Authors: Kuzma L , Kurasz A , Swieczkowski M , Dobrzycki S
Published: November 2023

Introduction

Air pollution is one of the leading environmental risk factors affecting the population worldwide. Studies so far mostly analysed urban and industrial areas excluding smaller towns and villages due to a lack of monitoring stations and recognition of these areas as potentially free from pollution. Our analysis focuses on Eastern Poland, one of the poorest regions of the EU, with a population of nearly 8 million people with almost half living in rural areas. We investigate the impact of "Polish smog" a new type of air pollution which - due to its composition and the conditions in which it is formed - is characterized by extremely adverse cardiovascular health effects.

Purpose

Analysis of the short and mid-term impact of air pollution on cardiovascular (CV) mortality.

Methods

We collected daily data on air pollution from the Voivodeship Inspectorate for Environmental Protection for the years 2010-2020 and used an algorithm developed in collaboration with the Department of Atmospheric and Climate Modeling at the Polish Academy of Sciences to model the average daily concentrations of pollutants in locations without available data. Causes of death with ICD-10 codes from I00 to I99 were extracted for analysis. We estimated county-specific associations of air pollution concentration with mortality using panel standard time-series with Poisson distribution regression models, adjusting for weather conditions, and short- and long-term trends in mortality. Odds ratios (ORs) with interquartile ranges (IQRs) were reported for each type of air pollutant and lag structure was analysed.

Results

We observed 831,246 deaths, including 377,344 due to CV diseases. The overall standardized death rate (SDR) was 533.3 cases/100,000 inhabitants/year, with an increasing trend over each year. The IQR increase in concentrations of PM2.5 (OR=1.034, 95%CI 1.029-1.04, P<0.001), benzo(a)pyrene (BaP) (OR=1.015, 95%CI 1.011-1.02; P<0.001), SO2 (OR=1.008, 95%CI 1.006-1.01; P<0.001), and NO2 (OR=1.013, 95%CI 1.01-1.016; P<0.001) were associated with an increase in CV mortality on the day of the exposure and this effect was persistent up to LAG6. The detrimental influence of pollutants was also observed in the mid-term [lag0-30 (BaP-OR=1.028, 95%CI 1.022-1.034; P<0.001), (PM2.5-OR=1.056, 95%CI 1.047-1.064; P<0.001), (SO2-OR=1.014, 95%CI 1.011-1.017; P<0.001), (NO2-OR=1.037, 95%CI 1.031-1.043; P<0.001)].

Conclusion

The mortality rate due to CV diseases continues to rise. Our study highlights the negative impact of air pollution, both in the short and long term. Areas previously assumed to be free from pollution may actually be at high risk, emphasizing the need for careful monitoring of air quality. Further research should focus on identifying the most vulnerable areas and developing effective strategies to prevent the adverse health effects of air pollution on public health.
Did COVID-19 pandemic affect deaths from cardiovascular diseases in Japan?
Authors: Kokubo M , Shimizu A , Kamihara T , Hirashiki A , Arai H
Published: November 2023

Background

According to the vital statistics report by the Ministry of Health, Labour and Welfare, the total number of deaths in Japan had decreased in 2020 (1,384,544) for the first time in 11 years, and underlying reasons include the decrease of approximately 16,000 deaths from respiratory diseases. The number of deaths subsequently increased in 2021 (1,439,809), and this increase was attributable in part to the outbreak of the Delta variant of the coronavirus disease 2019 (COVID-19). To the best of our knowledge, effects of the COVID-19 pandemic and the new normal of life with COVID-19 (e.g., avoiding crowds, wearing masks, and practicing hand hygiene) on the number of deaths from cardiovascular diseases, which have been the second leading cause of death in Japan, have not been studied thus far.

Purpose

To investigate the association between deaths from cardiovascular diseases and COVID-19 in Japan.

Methods

Data from the demographic survey conducted by the Ministry of Health, Labour and Welfare and analyzed, Japan was retrospectively analyzed.

Results

The number of deaths from cardiovascular diseases decreased in 2019 (207,714) and 2020 (205,596) when compared with those recorded in the previous year; however, the deaths started to increase again in 2021 (Fig 1.). Next, we analyzed deaths at ≥65 years of age. With reference to 2017, the rate of increase in the number of deaths in individuals aged ≥85 years was ≥10%, showing that the increased total number of deaths was due to the increase of deaths in those aged ≥85 years. Among causes of death, heart failure showed a particularly large increase. Deaths in other age groups showed almost no changes or decreases, except for deaths in individuals aged 70–74 years showing a ≥20% increase (Fig 2.). Thus, we looked into changes in the number of deaths in groups of individuals aged 65–69, 70–74, and 75–79 years. Deaths from acute myocardial infarction showed particularly large decreases in both ranges of 65–69 years and 75–79 years. As the number of deaths at 65–69 years of age tended to decrease, deaths from other heart diseases also decreased more or less. As the number of deaths at 75–79 years of age showed almost no changes, deaths from ischemic heart disease and heart failure increased slightly. In contrast to the data for the younger and older age groups, deaths at 70–74 years from almost all causes including acute myocardial infarction, heart failure, ischemic heart diseases, and arrhythmia increased in number.

Conclusion

The number of deaths from heart diseases decreased in 2020 compared to that in the prior year; however, the decrease was not fully explainable on the basis of the COVID-19 pandemic because deaths from heart diseases already tended to decrease in 2019. Furthermore, the number of deaths from heart diseases increased in people aged 70–74 years as well as those aged ≥85 years. The underlying reason is currently unknown; thus, continued monitoring is necessary.figure1figure2
Effect of high-gravity acceleration forces and anti-gravity maneuver for cardiac function in fighter pilots
Authors: Soh M , Park J , Shin J
Published: November 2023

Background

Environmental factors such as hypoxia and gravity affect to the human cardiovascular system. It’s more important for fighter pilots who are exposed to high altitude, harsh gravitational (G) acceleration, and perform anti-G maneuvers similar to the Valsalva maneuver. Experimental studies examining how high gravitational acceleration and anti-gravity maneuver affect cardiac function are rare.

Purpose

This study aimed to investigate the effect on cardiac function of fighter pilots exposed to high G acceleration forces.

Methods

From July 2019 to June 2020, fighter pilots underwent regular health check-up and echocardiogram. Data from trainees who did not experience a flight were used for control group. Echocardiographic data included left ventricle (LV) chamber size, systolic function, and diastolic function, as well as right ventricle systolic pressure (RVSP), inferior vena cava (IVC) collapsibility, and the tricuspid annular plane systolic excursion (TAPSE) to evaluate right heart function. The multiple linear regression analysis for TAPSE was performed with total flight time as an independent continuous variable in fighter pilots.

Results

We enrolled 29 fighter pilots (41±10years-old; male, 100%; mean flight time 1821±1186 hours) and 16 trainees (36±17years-old; male, 100%). There was no significant difference in age, blood pressure, LVEF, RVSP, and the IVC collapsibility between fight pilots and trainees. In multivariate linear regression analysis for fighter pilots, TAPSE was affected by total flight time with positive correlation.

Conclusion

The experience of fighter pilots exposed to the high G acceleration forces and anti-G maneuver might be associated with right heart function change, but not associated with the prominent cardiac structural changes.
Prognostic significance of left atrial volume index after myocardial infarction
Authors: Trninic D , Jovanic J J
Published: November 2023

Background

Left atrial (LA) volume has been characterized as a strong predictive factor of cardiovascular and cerebrovascular occurrences after myocardial infarction (MI).

Purpose

The aim of our study was to examine the prognostic significance of the left atrial volume index (LAVI) in the occurrence of atrial fibrillation, heart failure and stroke after MI.

Methods

Our study is prospective and includes one hundred patients with acute MI, who underwent primary percutaneous angioplasty immediately after admission to the hospital.. LA volume was measured 48 hours after admission to the hospital, using the Biplane Simson method, which was indexed to body surface area. The patients were followed for 12 months on average.

Results

The average value of LAVI was higher in patients who had heart failure, atrial fibrillation and stroke after MI. AMI patients who developed heart failure during the observed period had a mean LAVI of 29.9ml/m2 ±6.7, and patients without heart failure had a mean LAVI of 24.0ml/m2 ± 2.0 (p <0.001). Mean LAVI in patients with atrial fibrillation was 33.6ml/m2 ±8.1, and without atrial fibrillation 25.1ml/m2 ± 2.9 (p <0.001). Patients who had a stroke during the observed period had a mean LAVI 35ml/m2 ± 6.9, and patients without a stroke had a mean LAVI 26.3ml/m2 ±5.2 (p <0.001). The results of the univariable logistic regression are presented.

Conclusion

LAVI value has a statistically significant effect on predicting the occurrence of heart failure, atrial fibrillation and stroke after MI. LAVI is a strong predictive factor after myocardial infarction.
VE/VCO2 slope in cardiopulmonary exercise testing was associated with left ventricular diastolic dysfunction in patients with reduced ejection fraction
Authors: Ojima S , Kubozono T , Kawasoe S , Kawabata T , Salim A A , Ikeda Y , Ohishi M
Published: November 2023

Background

Heart failure with reduced ejection fraction (EF) was well-known as a poor prognosis. VE/VCO2 slope and peak oxygen uptake (VO2) by cardiopulmonary exercise testing (CPET) is a useful parameter for predicting cardiovascular disease prognosis. Furthermore, though there are some reports that CPET parameters are associated with indicators of diastolic dysfunction, each of these indicators has some limitations. Recently, recommendations for the evaluation of left ventricular diastolic function by echocardiography were reported from the ASE/EACVI. However, there are no reports to examine the association between exercise tolerance indices and diastolic dysfunction based on these recommended variables.

Purpose

To examine the relationship between CPET parameters and diastolic dysfunction using the recommendation from ASE/EACVI in cardiovascular diseases patients with reduced EF

Methods

We recruited 214 patients who performed both CPET and echocardiography. EF<50% was 115 patients. All patients underwent 0W warm-up and 10W ramp on an upright electrical bicycle ergometer. We defined peak VO2<14 ml/min/kg as low peak VO2, and VE/VCO2>34 as high VE/VCO2 slope. Diastolic dysfunction was assessed using the recommendations for the evaluation of diastolic function by ASE/EACVI. We used this recommendation algorithm to estimate grading LV diastolic function in patients with depressed LVEF. Grading 3 shows the most severe diastolic dysfunction.

Results

Mean age was 55±15 years old, and the portion of women was 30%.

The portion of Grading 3 diastolic dysfunction was 18%. In univariable logistic regression analysis for diastolic dysfunction, Log BNP, and high VE/VCO2 slope were significantly associated with diastolic dysfunction. In multivariable logistic regression analysis, each Model, LogBNP and high VE/VCO2 slope were independent factors for severe diastolic dysfunction [adjusted age and sex, Model 1: LogBNP (OR 2.42, CI 1.44-4.05, p<0.001), low PeakVO2. Model2: LogBNP (OR 2.23, CI 1.31-3.78, p=0.003), high VE/VCO2 slope (OR 3.30, CI 1.06-10.3, p=0.039)].

We performed receiver operating characteristics (ROC) curve analysis on the ability of BNP, and VE/VCO2 slope. The area under the ROC curve (AUC) for BNP was 0.77, with the discriminating sensitivity and specificity at 0.67 and 0.86, respectively (cut-off value 234 pg/mL). On the other hand, the AUC for the high VE/VCO2 slope was 0.75, with the discriminating sensitivity and specificity at 0.81 and 0.67, respectively (cut-off value 30).

Conclusion

In patients with depressed EF, high VE/VCO2 slope was significantly associated with diastolic dysfunction assessed by the recommendations from the ASE/EACVI.
Impact of short-term exercise training on QT dispersion and double product in diabetic patients after surgical aortic valve replacement
Authors: Stoickov V , Deljanin Ilic M , Tasic I , Stoickov M , Golubovic M , Stoickov I , Kostic S , Stoickov F
Published: November 2023

Background

QT dispersion (QTd) represents the heterogeneity in the repolarization of the ventricular myocardium and electrical instability of the myocardium, reflecting the increased tendency towards ventricular arrhythmias. Abnormally high QTd has been correlated with risk of cardiac death.

Purpose

The aim of this study was to establish the influence of short-term exercise training on QT dispersion and double product (DP), in diabetic patients after surgical aortic valve replacement (SAVR).

Methods

The study involved 147 patients after SAVR, in the sinus rhythm without AV blocks or branch blocks. Average age of patients was 59.3 years. 45 patients were with diabetes mellitus, and 102 were without diabetes. Patients were similar as to age and baseline stress test duration. In all subjects clinical examination, standard ECG and exercise test on treadmill according to Bruce protocol, were performed and after that patients were included in program of physical training for three weeks. Patients were instructed to follow a training program using the bicycle ergometer (10 min, 2 times a day), gymnastic exercises and walking. The patients continued to take the same medicaments in same doses. From standard ECG corrected QT dispersion (QTdc) was calculated.

Results

Before starting with the program of physical training, patients with diabetes had significantly higher values of QTdc (83.4 ± 15.3 vs 74.6 ± 16.9 ms; p<0.005) in comparison to those without diabetes. After three weeks, significant reduction of QTdc was found (from 83.4 ± 15.3 to 77.3 ± 15.4 ms; p<0.02 in patients with diabetes and from 74.6 ± 16.8 to 68.7 ± 17.1 ms; p<0.005 in patients without diabetes). After three weeks, significant reduction of DP was found (from 11763.8 ± 779.9 to 11314.8 ± 635.8 beat/min x mmHg; p<0.005 in patients with diabetes and from 114376.4 ± 792.3 to 10034.2 ± 521.3 beat/min x mmHg; p<0.001 in patients without diabetes). In diabetic patients, after program of physical training, significant reduction of glycemia was found (from 7.0 ± 2.3 to 5.9 ± 1.5 mmol/L; p<0.005), of total cholesterol from 5.2 ± 1.3 to 4.6 ± 1.1 mmol/L (p<0.025), of LDL cholesterol from 3.2 ± 0.8 to 2.8 ± 0.6 mmol/L (p<0.05). After three weeks, both groups of patients in the exercise test reached a significantly longer time (p<0.001).

Conclusions

The study showed that patients with diabetes have a higher value QTdc, probably due to diffuse interstitial fibrosis. Short-term exercise training has favourable effects on QT dispersion and double product in patients after SAVR. In patients without diabetes physical training had more favourable effects on the followed parameters. Physical training led to the significant decrease of myocardial oxygen uptake at rest and probably decreased the possibility of arrhythmia events.
Telerehabilitation after acute coronary syndrome warrants a similar improvement in physical performance as stationary rehabilitation regardless of the age profile of the compared groups
Authors: Rechcinski T , Bralewska B , Wykrota J , Wadolowska E , Cieslik-Guerra U , Szymczyk E , Kurpesa M , Kasprzak J D
Published: November 2023

During the COVID-19 pandemic, the availability of cardiac rehabilitation (CR) was limited. On the other hand, during the epidemic hazard period, patients after acute coronary syndromes (ACS) required careful control and ensuring their improvement after the coronary event.

The aim of this study was to assess whether CR conducted during the epidemic threat in remote mode ensures similar improvement in physical performance as rehabilitation conducted in stationary mode before the pandemic COVID-19.

Material and methods

In this one-center study, the demographic and clinical profiles in the groups of patients after ACS who completed a stationary CR before COVID-19 era or telerehabilitation during the COVID-19 pandemic were compared. The workload on the initial and final exercise tests (ExT) obtained by patients was assessed, as well as the values of differences between the final and initial ExT were compared. 359 patients (pts) participating in stationary CR before October 2020 and 60 pts - in telerehabilitation after July 2021 were included. Both, stationary and tele- CR were performed according to the guidelines of Working Group for Cardiac Rehabilitation of the national cardiac society. Telemedic platform was used to control ECG, blood pressure and body mass of pts participating in telerehabilitation. Statistical analysis included U Mann-Whitney test, T Student test and chi square test.

Results

The improvment of physical performance did not differ significantly between both groups. The pts who completed telerehabilitation were significantly older than those who completed stationary CR. The values of other parameter, like percent of females, BMI, percent of pts with arterial hypertension and diabetes mellitus type 2 or ejection fraction of left ventricle did not differ significanty between compared groups. The results of statistical analysis are presented in the table below.

Conclusions

In our center, telerehabilitation after acute coronary syndrome guaranteed an equally good improvement in physical capacity, which was observed in stationary rehabilitation patients, regardless of the difference in the age profile of the compared groups. These results encourage popularization of the cardiac rehabilitation mode with the remote control of the ECG, blood pressure and body weight.Comparison of the study groups
Effectivity and adherence of secondary prevention on clinical outcome of rheumatic heart disease in high-burden setting: a systematic review and meta-analysis
Authors: Mendel B , Kohar K K , Yumnanisha D A Y , Taher M A T , Prakoso R P , Siagian S N S
Published: November 2023

Background

Rheumatic heart disease (RHD) is often diagnosed late in low-resource settings due to limited health-seeking behavior and varied presentations. Optimal delivery of regular antibiotics prescribed as secondary prevention is vital to preventing disease progression. However, poor adherence of secondary prevention remains a significant challenge to these populations.

Objective

To assess the efficacy and adherence of patients to secondary prevention of rheumatic heart disease.

Methods

This systematic review and meta-analysis was carried out according to the PRISMA statement. Literature search was performed on four databases using keywords "Rheumatic heart disease", "secondary prevention", and their synonyms. Adherence and disease progression were the primary outcome. The overall proportion was estimated with R software (version 4.1.3) using a random-effects model of proportional meta-analysis.

Results

Thirteen studies were included in this study. Benzathine Penicillin G (BPG) injection every 4 weeks was the most common secondary prophylaxis regimen used. In 2052 patients, only 46% (27-66%) patients received >80% BPG prophylaxis injection. The effectiveness of secondary prophylaxis was powerful, evidenced by only 7% (2-12%) patients having disease progression of rheumatic heart disease.

Conclusions

BPG was found to be effective in the secondary prevention of rheumatic heart disease. Nonetheless, patient adherence to injection remains extremely low. Methods to improve patient adherence are imminently required.Figure 1Figure 2
Detection of hidden cases of familial hypercholesterolemia in the Netherlands: a central laboratory data-driven strategy
Authors: Ibrahim S , Nierman M C , Nurmohamed N S , Hovingh G K , Reeskamp L F , Stroes E S G
Published: November 2023

Introduction

Familial hypercholesterolemia (FH) is a common genetic disorder in which patients are at high risk for premature coronary artery disease (CAD) due to lifelong exposure to low-density lipoprotein cholesterol (LDL-C). Although early diagnosis and lipid lowering therapy (LLT) are essential to prevent adverse cardiovascular outcomes, FH patients remain globally underdiagnosed and undertreated, warranting novel screening methods to identify these patients. In the present study we aimed to evaluate whether existing central laboratory data can be utilized as a new method to detect undiagnosed FH patients. Additionally, we investigated the extent of underdiagnosis and undertreatment among patients with severe hypercholesterolemia in the Netherlands.

Methods

In this single-center, cross-sectional study, we selected individuals with at least one previously measured LDL-C plasma level ≥99.5th percentile for age and sex, from a central laboratory database containing lipid profiles of approximately 600.000 primary care patients. First, a blood sample was obtained to get more recent lipid values. Participating patients were subsequently asked to fill out a detailed questionnaire on medical and family history. Using these data, we calculated the Dutch Lipid Clinic Network (DLCN) criteria for each patient for the clinical diagnosis of FH.

Results

We identified a total of 5,100 patients with severe hypercholesterolemia (at least one LDL-C ≥99.5th percentile for age and sex) from the central laboratory database. Out of these, 1,206 patients (24%) participated in this study. Mean ± SD LDL-C corrected for LLT was 5.72 ± 1.83 mmol/L, 785 patients (65.1%) used LLT, and 150 patients (12.4%) had CVD in their medical history. In total, 131 patients (11%) had a persistent LDL-C ≥99.5th percentile for age and sex. DLCN criteria for phenotypic FH (DLCN score ≥6) were met by 302 patients (25%) of whom 39 patients (12.9%) had undergone prior genetic testing according to clinical guidelines. Of the 302 clinically diagnosed FH patients only 1 (0.3%) met the European Society of Cardiology (ESC) guideline recommending LDL-C targets <1.8 mmol/L in FH patients.

Conclusion

These data highlight the significant underdiagnosis and undertreatment of FH in the Netherlands, despite the fact that this country has a relatively high FH identification rate. We demonstrate that the use of central laboratory data is an effective strategy for identifying previously undetected cases of FH and eagerly await the genetic confirmation of the newly identified FH patients in this study, which will provide valuable insights into the genetic basis of this disorder and help further improve patient care.
Women's heart clinics to prevent cardiovascular disease in women with pregnancy-related risk factors: a prospective study
Authors: Marschner S , Mukherjee S , Watts M , Min H , Beale A L , O'brien J , Juneja A , Tremmel J , Zaman S
Published: November 2023

Background

A woman’s risk of cardiovascular disease (CVD) is substantially increased after a diagnosis of hypertensive disorders of pregnancy (HDP), gestational diabetes (GDM), or have had a small for gestational age (SGA) baby. However, evidence for models of care that mitigate CVD risk in women with these pregnancy-related conditions is lacking.

Purpose

To assess the effectiveness of a Women’s Heart Clinic (WHC) on blood pressure (BP) and lipid control in women with past pregnancy-related cardiovascular risk factors.

Method

A six-month prospective cohort study of women aged 30-55 years with a past pregnancy diagnosis of HDP, GDM or an SGA baby. All women attended a multidisciplinary WHC comprising a cardiologist, a cardiac nurse, and a dietician, located in three cardiovascular healthcare service centers in Australia. Women were assessed at their first attendance of the WHC and at 6 months. The co-primary endpoints were: 1) BP<140/90mmHg or <130/80mmHg if diabetes mellitus and 2) total cholesterol to high density lipoprotein-cholesterol ratio (TC:HDL-C)<4.5.

Results

156 women were recruited with a mean age of 41.0±4.2 years, 68.6% Caucasian, 20.5% South/East Asian and 80.5% university educated. Women were a mean of 3.9±2.9 years from last delivery with 23.1% past HDP only, 60.3% GDM only, 13.5% both HDP and GDM and, 3.2% with an SGA baby. All women attended a WHC at least once, with 69.5% reviewed by a dietician. The proportion meeting BP target increased (69.2% to 80.5%, p=0.004); with no significant change in women meeting lipid targets (80.6% to 83.7%, p=0.182). Women had significant reductions in mean systolic BP (-6.9mmHg, 95% confidence interval (CI): -9.1,-4.7, p<0.001), body mass index (-0.6kg/m2, CI: -0.8,-0.3, p<0.001), LDL-cholesterol (-4.2mg/dL, CI: -8.2,-0.2, p=0.042) and total cholesterol (-4.6mg/dL, CI: -9.1,-0.2, p=0.042). Heart-healthy lifestyle significantly improved with increased fish/olive oil (36.5% to 51.0%, p=0.012) and decreased fast food consumption (33.8% to 11.0%, P<0.001), with more women meeting exercise recommendations (84.0% to 92.9%, p=0.025).

Conclusion

Women at high risk for CVD due to past pregnancy-related conditions experienced significant improvements in multiple cardiovascular risk factors, after attending a Women’s Heart Clinic. This female-specific cardiovascular healthcare model has the potential to improve long-term CVD outcomes for women.Figure 1:Visual abstract
Mortality and predictors of death in women and men with congestive heart failure due to ischemic and nonischemic cardiomyopathy
Authors: Mansur A D P , Del Carlo C H , Avakian S D , Ianni B M , Fernandes F , Cesar L A M , Bocchi E A , Pereira-Barreto A C
Published: November 2023

Background

Heart failure (HF) is one of the leading causes of death from cardiovascular disease. Studies have shown that women have better survival than men, despite the higher number of hospitalizations among women. However, little is known about differences in mortality and predictors of death in women and men with heart failure due to ischemic (iCMP) and nonischemic (niCMP) cardiomyopathy.

Purpose

To analyze the mortality and predictors of death in women and men with iCMP and niCMP cardiomyopathy.

Methods

From February 2017 to September 2020, we analyzed mortality and predictors of death in women and men with CHF by iCMP and niCMP. Baseline data included clinical features and echocardiographic findings. Statistical analyses were performed using the Kaplan-Meier (K-M) method and Cox proportional hazards methods to analyze mortality rates in women and men. We used the Score Chi-Square of Cox regression to search for death predictors for women and men.

Results

We studied 7,487 patients, mean age of 64.3 ± 14.2 years, 4,417 (59%) males. Women with iCMP and niCMP had, respectively, higher mean age (p<0.0001), higher mean left ventricular ejection fraction (LVEF) (p<0.001), and smaller left ventricular diastolic diameter (LVDD) (p< 0.001). The mean dose of carvedilol was similar in both genders for iCMP and niCMP. Over a 3-year follow-up period, 420 (15.7%) men and 325 (14.7%) women with niCMP died (p=NS), and in iCMP, 519 (29.8%) men and 211 men died. (24.5%) women (p=0.004). Higher mortality was observed in women with iCMP compared to men with iCMP (p<0.0001). The cumulative incidence of death was higher in men (K-M: log-rank p<0.0001) with iCMP, but similar for niCMP (Figure). Cox regression for death adjusted for age, sex, previous myocardial infarction (MI), diabetes, previous stroke, chronic kidney disease (CKD), atrial fibrillation (AF), HF phenotype (systolic, diastolic, or mildly reduced ejection fraction), and LVEF showed that CKD, AF, diabetes, stroke, LVEF, and age, in descending order of Score Chi-Square, were the main predictors of death for niCMP and CKD, stroke, diabetes, AF, LVEF, age, and MI for iCMP.

Conclusions

Women had a better prognosis than men in iCMP, but similar mortality in niCMP. Gender was not an independent variable of death. Secondary prevention of cardiovascular events from the main predictors of death can significantly reduce the death rate in women and men with CHF by iCMP and niCMP.
A female acronym is not enough: underrepresentation of women in cardiovascular trials
Authors: Spiering A E , Van Ommen A M L N , Onland-Moret N C , Den Ruijter H M
Published: November 2023

Introduction

Cardiovascular disease is the leading cause of death for women worldwide. Yet, women are often underrepresented in clinical trials of cardiovascular disease compared to population prevalence. Reasons for underrepresentation are multifactorial, and often attributed to trial criteria. Yet, women may also decide not to participate for more subconscious reasons, such as the perception of the trial acronym. Trial acronyms are used in patient communication and are often chosen to have a certain meaning, which can be perceived as gendered. We hypothesize that masculine trial names are associated with underrepresentation of women in clinical trials.

Purpose

To investigate if the perceived gender of the trial acronym, and other study characteristics affect the representation of women in cardiovascular clinical trials.

Methods

We performed a systematic search of ClinicalTrials.gov to collect information on randomized clinical trials testing drug interventions for cardiovascular disease. We extracted trial characteristics and acronyms from primary outcome publications. We conducted a survey among 148 cardiovascular patients (both women and men) recruited via an online patient forum and asked them whether they perceived trial acronyms names as more masculine, feminine or neutral. We defined female underrepresentation as those trials where the proportion of included women divided by the proportion of women in the disease population was below 0.8. We analyzed female underrepresentation and study setting, participant characteristics, and female first and last authorship.

Results

We identified 148 eligible clinical trials of which 29.9% of participants were women. Women were underrepresented in 61.5% of trials (Figure 1). Only 45.3% of publications reported sex-stratified results. The proportion of trials in which women were underrepresented increased between 1992 and 2022 from 48.3% to 70.5%. A total of 148 patients (67.6% women, mean age 61 y) evaluated the trial acronyms for their perceived gender. The majority (70.9%) of trial names was perceived as neutral, 17.6% as masculine and 11.5% as feminine. Female representation was not associated with the perceived gender of the trial name (OR 0.92, 95% CI 0.63 – 1.35) (Figure 2A). Trials had a higher odds of female underrepresentation if they recruited at an in-patient setting (OR 2.47, 95% CI 1.14 – 5.58), or if their participants were in the second-highest age group between 64.0 and 66.3 years (OR 3.93, 95% CI 1.25 – 14.18). Trials had lower odds of female underrepresentation if the last author was a woman (OR 0.10, 95% CI 0.01 – 0.49).

Conclusion

Female representation in cardiovascular clinical trials remains poor but is not depending on the perceived gender of the trial acronym. Female representation varies with recruitment type, participant age and last author gender, which are important starting points to improve participation rates of women.
Sex differences in patients with MINOCA: baseline characteristics and prognosis
Authors: Rodriguez Montes P , Fraile Sanz A , Izquierdo Coronel B , Gil Mancebo N , Alvarez Bello M , Martin Munoz M , Perela Alvarez C , Nieto Ibanez D , Abad Romero R , Olsen Rodriguez R , Espinosa Pascual M , Awamleh Garcia P , Mata Caballero R , Moreno Vinues C , Alonso Martin J J
Published: November 2023

Background

The difference between men and women regarding the diagnosis and treatment of cardiovascular diseases has been an object of study during the last few years, with an underrepresentation of female patients in old studies. The epidemiology, diagnosis, and treatment of patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) has not yet been wholly elucidated up to this day. The aim of this study is to compare the characteristics and prognosis of MINOCA patients based on sex.

Methods

We analyzed all consecutive patients with MINOCA diagnosed at a University Hospital between 2016 and 2022. MINOCA diagnostic criteria compelled at the ESC Clinical Guidelines and the AHA Scientific Statement have been followed.

Results

Our sample comprises 107 patients with MINOCA, 61 male (57%) and 46 female (43%), but once the age of 80 years old was reached, MINOCA was more prevalent in women. We found the female population to have a higher prevalence of stress (usually chronic stress) and transient ischaemic attacks. On the contrary, men usually have more night shifts, psychiatric disorders, and a higher prevalence of smoking. We found no significant differences in cardiovascular risk factors (hypertension, dyslipidemia, or DM), clinical presentation, or other symptoms at admission. (Table 1). High-sensitivity troponin peak concentration was higher in women. As for the main MINOCA physiological mechanisms, we found a significantly higher prevalence of vasospasm in men and coronary artery dissection in women. There were no significant differences regarding coronary embolism, type II acute myocardial infarction (AMI), plaque rupture, or unknown mechanisms. Regarding prognosis, with a median follow-up of 45 [20-65] months, no significant differences were found between both groups for the development of in-hospital complications or mortality, nor cardiovascular readmissions, reinfarction or death from any cause (Table 2).

Conclusion

Unlike the previous popular perception of this disease, there are more MINOCA male patients than females in our sample, and psychiatric disorders are more prevalent in men. In octogenary people, MINOCA was more prevalent in women. At admission, symptoms and electrocardiographic parameters were very similar between both groups, while cardiac biomarkers reached higher levels in women, unrelated to coronary artery extension or the severity of left ventricular dysfunction.
Autopsy findings and cardiac arrest rhythms in young obese patients with sudden cardiac death of uncertain etiology
Authors: Goel V , Han H C , Ha F , Fendel K , Teh A , Sanders P , Farouque O , Lim H
Published: November 2023

Background

Obesity is associated with an increased risk of sudden cardiac death (SCD) which can be particularly devastating in young adults. In a significant proportion of SCD cases in the young, a specific cause cannot be identified.

Purpose

The aim of this retrospective analysis was to describe the demographics, pathological changes and cardiac arrest rhythm in young obese individuals with SCD of otherwise unknown etiology.

Methods

Between July 2000 and December 2018, the National Coronial Information System (NCIS) identified cases of young obese (body mass index ≥ 30) individuals with SCD between 17-35 years of age (SCD-obesity). Autopsy reports of individuals with SCD where known causes had been excluded were compared to 2 matched control cohorts of death due to motor vehicle accidents (MVA) (first group matched for age, sex, height and weight (MVA-BMI-matched) and second group matched for age and sex (MVA-age-matched)). Additionally, electrocardiographic rhythms at cardiac arrest were obtained through state-wide ambulance services for SCD-obesity individuals.

Results

We identified 409 cases of SCD in young obese individuals, of which 94 cases met the inclusion criteria (figure 1). Mean age was 28.44±5.6 years (range 17-35). SCD-obesity individuals were commonly males (71%). SCD-obesity individuals had significantly higher cardiac masses (521g vs 417g, p<0.001) compared to the MVA-BMI-matched cohort. SCD-obesity individuals also had significantly increased left ventricular wall thickness (15.6mm vs 13.5mm, p<0.001) and increased rates of left ventricular fibrosis (73% vs 52%, p=0.045) compared to the MVA-BMI-matched cohort. ECG rhythm strips were available for 71 (72%) SCD-obesity cases, of which 16 (23%) were unwitnessed. Asystole was noted on 7 (46.67%) of witnessed cases, and 6 (40%) had a ventricular tachycardia or fibrillation (figure 2).

Conclusions

SCD-obesity individuals had increased cardiac organ masses, left ventricular wall thickness and cardiac fibrosis. The cardiac arrest rhythm recorded in witnessed cases were predominantly asystole and ventricular arrythmia. Future studies are needed to determine the pathological mechanisms explaining these abnormalities in young obese sufferers of SCD.Figure 1:Case identificationFigure 2:Results
Pregnancy-related cardiovascular events in marfan syndrome
Authors: Poveda Velazquez P , Ibrahim B , Llamas Gomez H , De Frutos F , Tome Esteban M T
Published: November 2023

Background

Some studies have suggested an increased risk of aortic dissection (AoDis) during pregnancy and higher rate of cardiovascular (CV) events on the long-term in Marfan syndrome (MFS) patients.

Purpose

To analyse the rate of CV events during pregnancy and follow up in our cohort of MFS patients.

Methods

We prospectively collected data of a cohort of women with MFS that attended our dedicated clinic between the years 2000-2021. This included demographics, clinical characteristics and pregnancy. CV events were defined as AoDis, urgent AoSurg or CV death. Patients with a previous event before the first pregnancy were excluded.

Results

We identified 148 women with a mean age at last follow up of 40±16 years and a mean follow up of 11 years (IQR 25-75: 4-17 years). Sixty-nine patients fell pregnant (130 pregnancies, median 2, range 1-4 pregnancies, age at delivery 29±5y) and 79 were never pregnant.

Amongst the 69 ever pregnant patients, 2 patients had a type A AoDis during pregnancy (one was unaware of the MFS diagnosis; the other was under follow up with a pre-pregnancy aortic root of 34mm/Z-score 1.5 and at third trimester of 36 mm/Z-score 2.2). No maternal deaths were recorded. Pregnancy related rate of CV events was 2.9% and 1.5% in women with known MFS diagnosis before pregnancy.

Ever-pregnant patients were older at diagnosis (32±17y vs 20±14y, p<0,001) and at the end of follow up (49±14y vs 33±13, p<0,001) compared to never-pregnant patients. Ectopia lentis was significantly higher in never-pregnant patients (45.3% vs 25%, p=0.03). There were no statistically significant differences in time of follow up or other clinical features of MFS. Only 36% of the ever-pregnant cohort were diagnosed before pregnancy.

During follow up, 14 patients from the ever-pregnant group and 16 patients from the never-pregnant group underwent prophylactic AoSurg (p=0,72). Never-pregnant patients were younger at age of elective AoSurg (35±14y vs 45±13y, p=0.031). Eleven (7.4%) patients experienced a CV event (7 type A and 4 type B AoDis), 7 in the ever-pregnant group and 4 in the never pregnant group (p=0.09). Age at CV event was similar in the ever-pregnant and never-pregnant groups (48±11y vs 40±8y, p=0.26)

In the ever-pregnant group, 3 patients experienced ³2 CV events during follow up compared to none in the never-pregnant group (p=0.1).

Conclusion

In our cohort of ever pregnant MFS patients, 2.9% of patients experienced a pregnancy related CV event.

On the long term, never-pregnant patients were younger at age of elective AoSurg but there were no differences between the groups in prophylactic AoSurg or CV events.
Aortic root dimensions in pregnant marfan syndrome women
Authors: Poveda Velazquez P , Ibrahim B , Llamas Gomez H , De Frutos F , Tome Esteban M T
Published: November 2023

Background

Some studies suggest that aortic root dimensions may increase significantly during pregnancy in patients with Marfan syndrome (MFS).

Purpose

To analyse the aortic root (AoRoot) dimensions during pregnancy and presence of significant AoRoot enlargement (SARE) in our cohort of pregnant MFS patients.

Methods

Prospective data of clinically and genetically confirmed women with MFS followed up during pregnancy in our dedicated clinic between the years 2004-2021 was collected, including demographics, pregnancy and cardiovascular events (CVE) during pregnancy and at follow up. AoRoot dimensions were collected before, during and 3 months after pregnancy. SARE was defined as difference ≥3mm before and after pregnancy. Aortic dilation (AoDil) was defined as Z-Score >2. AoRoot rate was calculated with AoRoot change since pregnancy to end of follow up divided by the follow up since pregnancy. Patients with a previous CVE before pregnancy were excluded.

Results

AoRoot dimensions during pregnancy and after pregnancy were available in 23 pregnancies (17 patients). Mean age at delivery was 32±5years old, mean follow up since pregnancy 8±6 years and complete follow up 14±9 years.

Mean AoRoot before and after pregnancy was similar (35±4mm, range 28-42mm vs 36±4mm, range 29-42mm, p=0.172). Ten patients were on medical treatment with beta-blockers during pregnancy. These patients were younger at diagnosis (17±10y vs 25±5y, p=0,039) and had larger pre-pregnancy AoRoot dimensions (38±4mm vs 34±3mm, p=0,024) than patients on no medication. AoRoot dimensions after pregnancy were similar in both groups (p=0,087). There were no statistically significant differences in SARE during pregnancy.

No CVE were observed during pregnancy. One patient had a type A AoDis 10 days after delivery. Pre-pregnancy AoRoot was 34mm (Z-score 1.5) and at third trimester 36 mm (Z-score 2.2). Risk factors included family history of AoDis.

SARE was observed in 5 (21.7%) pregnancies. Mean pre-pregnancy AoRoot was 35±3mm (Z-Score 1.6, range 30-38mm) and after pregnancy 39±4mm (Z-Score 2.9, range 34-42mm) and mean AoRoot increase before and after pregnancy 3.2±0.5mm (range 3-4mm). No pregnancy-related CVE were recorded.

During follow up, the AoRoot growth rate after pregnancy was 0.05±0.07mm/year in the whole cohort. Twelve patients fulfilled criteria for AoDil before pregnancy (AoRoot 39±2mm, Z-Score 3.4) and 4 developed AoDil after pregnancy (AoRoot 39±1mm, Z-Score 2.9). Rate of AoRoot growth was similar in both groups. During follow up, 2 patients underwent prophylactic aortic surgery.

Conclusion

In our cohort, AoRoot dimensions remained similar before and 3 months post-partum. One patient experienced a pregnancy related type A AoDis with normal AoRoot size during pregnancy.

SARE was observed in 5 patients but no pregnancy-related CVE were registered in this group.

The rate of AoRoot growth after pregnancy was 0.05±0.07mm/year in the whole cohort.
Long-term cardiovascular risk of pre-eclampsia
Authors: Pivato C A , Inversetti A , Cristodoro M , Latini A C , Condorelli G , Stefanini G , De Simone N
Published: November 2023

Background/introduction

Pre-eclampsia is a complication of the second and third trimesters of pregnancy characterized by hypertension and endothelial dysfunction causing multiorgan damage. In 2017 few studies suggested an association between pre-eclampsia and long-term cardiovascular diseases. However, since those first studies, the literature has grown exponentially.

Purpose

To assess the association between a history of pre-eclampsia and subsequent cardiovascular diseases, including 1) cardiovascular death, 2) coronary heart disease, 3) heart failure, and 4) stroke.

Methods

Following PRISMA guidelines, from inception to September 2022, we performed a systematic review of PubMed, MEDLINE, Scopus, and EMBASE. Randomized, cohort or case-control studies in English were included if fulfilling the following criteria: 1) the association between pre-eclampsia and subsequent cardiovascular disease was adjusted for at least maternal age, smoking, and obesity; 2) the presence of a control group; 3) minimum one-year follow-up. Pooled Relative Risk (RRs) and 95% confidence intervals (CIs) were used as effect estimates and calculated with a random-effects model. The primary endpoint was cardiovascular death. The secondary endpoints were coronary heart disease, heart failure, and stroke.

Results

Twenty-one studies met the inclusion criteria, including 478,708 women with a history of pre-eclampsia and 10,533,530 without. Pre-eclampsia was associated with a higher risk of cardiovascular disease death (RR 1.97, 95% CI 1.64-2.35, I2 60%, p<0.00001), coronary heart disease (RR 2.11, 95% CI 1.60-2.77, I2 85%, p<0.00001), heart failure (RR 2.47, 95% CI 1.70-3.59, I2 82%, p<0.00001), and stroke (RR 1.64, 95% CI 1.45-1.85, I2 43%, p<0.00001). Sensitivity analysis excluding those studies with a follow-up of less than 10 years evidenced similar results.

Conclusions

Compared to women who experienced a normal pregnancy, those suffering from pre-eclampsia have about double the risk of cardiovascular disease, including cardiovascular death, coronary heart disease, heart failure, and stroke. This risk becomes evident already in the first ten years after pregnancy. As such, obstetricians should counsel pre-eclamptic women on the importance of an early assessment and risk factors management in a multidisciplinary team with cardiologists.
The incidence of coronary artery disease after liver transplant: a meta-analysis
Authors: Tabulo Z , Hagstrom H , Braunschweig F , Lewinter C
Published: November 2023

Purpose

to investigate the incidence of coronary artery disease (CAD) events after liver transplant.

Background

Liver transplant (LT) can cure end-stage liver failure. CAD is a known complication after LT surgery. The incidence of CAD after LT is not well-established on short- and long-term perspectives.

Methods

We performed data searches in the PubMed till December 31, 2022. Inclusion criteria were observational trials evaluating new events of CAD in LT patients. Exclusion criteria were lack of follow-up CAD events after LT. Our primary outcome was the composite incidence of new myocardial infarctions (MIs), revascularisation due to CAD, and angina. The incidence of CAD was calculated through a generalised mixed effect meta-analysis. Sensitivity analyses were the incidence of MI, distinction of the short-term(≤12 months) and long-term(>12 months) incidences rates(new cases/months) of CAD, and univariate meta-regressions of study baseline characteristics and the CAD incidence.

Results

A total of 426 studies were retreated from PubMed (Figure 1). Of these, 23 studies were eligible for the meta-analysis. Age of patients ranged from 50 to 67 years. Female participants differed between 20 to 42%. CAD was prevalent in 1 to 60% before liver transplant.

The incidence of CAD was 3% (95% CI, 2 to 5%). The incidence of MI was 1% (95% CI, 1 to 3%). The incidence rate was 4.40 (95% CI, 1.74 to 11.15) for follow-ups ≤ 12 months as compared to 0.22 (95% CI, 0.13 to 0.37) for follow-ups > 12 months (Figure 2). Meta-regressions showed prevalent CAD and number of study particants to be significantly associated with higher versus lower CAD incidence after LT (P = 0.03 & P < 0.001).

Conclusion

The CAD incidence after LT was 3%. Despite high heterogeneity among studies, existing CAD before LT is a signifant risk factor for new CAD events. Incidence rates showed the CAD to be higher close to LT surgery.Figure 1:Flow chartFigure 2:incidence rates of CAD