bluuebunny/crossref_metadata_2025 huggingface dataset:
Mechanical atrial recovery by speckle-tracking echocardiography in the prediction of recurrence at 2 years after successful cardioversion of persistent atrial fibrillation
Authors: Tomoaia R , Beyer R S , Dadarlat-Pop A , Zdrenghea D , Gavan D , Havrisciuc E , Fringu F , Pop D
Published: June 2024

Introduction

This study aimed to assess the significance of left atrial (LA) strain in patients with persistent atrial fibrillation (AF), undergoing electrical cardioversion (ECV) and to investigate their predictive value in determining AF recurrence (AFR) at 2-years.

Material and methods

60 patients who were admitted for persistent AF with a duration of less than 12 months were prospectively included. Echocardiography was performed in all patients prior to ECV and repeated at seven days during sinus rhythm (SR). Every patient underwent periodic follow-up over the next two years to determine whether the clinical endpoint of AFR had occurred.

Results

During the follow-up period, 42% of the patients developed AFR. On the initial echocardiography conducted during AF, there was no difference in any echocardiographic parameter between subjects exhibiting AFR and controls. However, reservoir strain (LASr SR) was significantly lower in patients who later developed AFR (7.3 ± 2.91 vs. 13.14 ± 5.35 %, p=0.0001). Contraction strain (LASct SR) was also significantly reduced in patients who later developed AFR (2.66 ± 1.18 vs. 5.93 ± 5.79 %, p=0.017). The multivariate regression analysis with adjustments for NT-proBNP values and the presence of diabetes showed that only LASr SR was an independent predictor of AFR (B = -0.32, p = 0.006). LASr SR values ≤ 12% demonstrated high accuracy (AUC=0.821, 95%CI 0.684 to 0.917), excellent sensitivity (100%), and moderate specificity (61%) in the prediction of AFR.

Conclusion

LA mechanics assessment may provide key information regarding the recovery of the LA function and the long-term risk of AFR. LASr before and after cardioversion
Heart in the midst of smog: the impact of air pollution on atrial fibrillation triggering (EP-PARTICLES Study)
Authors: Kurasz A , Lip G Y H , Swieczkowski M , Tomaszuk-Kazberuk A , Dobrzycki S , Kuzma L
Published: June 2024

Background

Atrial fibrillation (AF) is the most common arrhythmia and environmental conditions are one of its risk factors. With the ever-increasing burden of air pollution and the concomitant rise in atrial fibrillation cases, understanding and addressing this nexus holds significant implications for both clinical management and public health interventions.

Aim

To assess the relationship between air pollution and the occurrence of acute AF episodes.

Material and methods

The spatio-temporal analysis was performed on the EP-PARTICLES cohort constructed of residents of Eastern Poland (N= 8,077,671). Data on hospitalizations for 2011-2020 were obtained from regional departments of the National Health Fund. In the statistical analysis, a time series Poisson regression models were used. Results are presented as % increases of admissions - % IR, 95% confidence intervals - 95% CI.

Results

During the 10-year period, 311,645 hospitalizations due to AF were reported, including 252,566 acute admissions which were included in the final analysis. Each 10 µg/m3 increment of PM2.5 and NO2 concentration, 1 µg/m3 of SO2 and 10 ng/m3 of BaP concentration on the day of exposure resulted in a 1.13% (0.70%−1.55%), 1.65% (1.05%−2.26%), 0.11% (0.01%−0.21%), and 0.3% (0.04%−0.55%) increase in acute AF admissions, respectively. This effect persisted for up to 4 days and was more pronounced in women and older population. A 10 mg/m3 increase in PM2.5 increased AF admissions by 1.5% (95%CI 1.010-1.020) in less urbanized areas vs. 0.4% (0.996-1.012) in the highly urbanized ones. In a single-pollutant model, the relative risk in daily AF cases change per 10 μg/m3 increase in PM2.5 was 1.1%. This effect remained significant at the same level after the adjustment to BaP (1.011, 1006-1016), SO2 (1.011, 1.007-1.016), and NO2 (1.007, 1.003-1.012) in the two-pollutant model. PM2.5 showed a significantly stronger effect on AF during the days in which PM2.5 concentrations did not exceed WHO standards resulting in a 5.1% increase in AF admissions, in contrast to days when the norms were exceeded resulting in a 0.8% increase. Non-linear effects in the exposure-response functions were observed with steeper slopes of the pollutant-outcome associations in the lower ranges of exposures, which were far below the WHO air quality guidelines for daily mean of PM2.5 (15 mg/m3) and NO2 (10µg/m3). For the PM2.5 zero-emission scenario, we estimated 5,873 avoidable AF admissions (95% CI 3,679 to 8,047), as for NO2 - 3,295 avoidable AF admissions (2,108-4,477).

Conclusions

Air pollution, especially PM2.5 and NO2, acts as a triggering factor and is associated with acute AF incidents. The greater increase in acute AF episodes at pollutant concentrations below the WHO norms suggests that there is no safe level of pollution and any reduction in exposure, even at low levels, is crucial for effective cardiac prevention. Graphical abstract
Study on the impact of improved walking on peripheral arterial flow
Authors: Taquet A
Published: June 2024

Introduction

The study demonstrates that changes in the qualitative habits of human walking can improve peripheral arterial perfusion. The advised walking fashion requires little to no effort (1) and is coherent with the body’s natural development.

Purpose

Cardiovascular diseases stay silent for a long time (2). Their mechanical pathophysiological causes are underestimated (3, 4). This study proposes a precise mechanical solution of prevention for all, at lower risk, and sustainable.

Method

This study includes 39 patients. Each participant was their own witness. 31 women for 8 men aged between 17 and 72 years with a BMI from 16.6 to 32.49 kg/m2. The measurements, performed with a pulsed Echo-Doppler ultrasound, concern the maximum popliteal arterial velocity after walking 10 meters. The study compares the maximum popliteal arterial velocity after walking 10 meters in a usual fashion and after 10 meters in an optimized fashion, following mechanical tips to improve blood circulation. For a statistically valid comparison, patients follow a triple cross over distribution of groups.

Results

The maximum popliteal arterial velocity, after advised walking, were 2.1 times higher than the reference values obtained by walking in unaltered fashion (fig 1). This result was obtained with a p<0.0001, regardless of age, BMI, or gender and without significant increase in their heart rate (fig 2).

Conclusions

An improvement of popliteal arterial flow, after following mechanical tips, is obtained without modification of the heart rate, thus requiring less effort and being more accessible to all.

The patient develops less mechanical stress with each step, feel less pain and inflammation, and is thus more prone to pursue his new habits.

It is very often difficult to obtain the patient’s adhesion to change its habits (2). This study, using visual and auditory means such as the Echo-Doppler, provides educational resources to make the patient an actor of his health. Graphical representation of the results  Measurements of heart rate
Critical review of the studies identifying determinants of a change in fitness following a cardiac rehabilitation outpatient programme
Authors: Alotaibi J A S S A S , Doherty P
Published: June 2024

Purpose

To critically review the studies which identified the determinants of a change in fitness in patients enrolled in CR outpatient programmes and to conclude the determinants of a change in fitness from the analysis.

Method

The literature search was performed using Medline, CINAHL plus (EBSCO), Cochrane Library (Wiley), EMBASE, AMED and web of science. Inclusion criteria for studies were (1) having adult patients (<18) who participated in a CR programme after a cardiac event (2) reporting determinants, predictors, factors or characteristics that influence the change in physical fitness expressed as Vo2 max or peak, METs, or distance walked (3) having measured physical fitness objectively using incremental tests before and at the end of CR using a treadmill, cycle ergometer, step test or incremental shuttle walk test as these tests are the ones commonly used in a CR population (4) having used multivariable analysis to clearly demonstrate the independent association between the potential determinant and the change in fitness and (5) having been written in English.

Results

Seventeen studies met the inclusion criteria. Thirteen were observational studies, two were randomised clinical trials and two were meta-analyses. The determinants were identified namely age, gender, BMI, waist circumference, baseline fitness levels, diabetes, depression,total of comorbidities, reason for referral, number of sessions, time from referral to start of CR, self-reported physical function (36-sf), fasting glucose level, treadmill protocol, exercise intensity and handgrip strength.

Conclusion

There continues to be huge variation in the studies in terms of identifying the determinants of a change in fitness. In this review, there are some determinants which are highly likely to determinants of a change in fitness namely diabetes, self-reported physical function (SF[1]36), handgrip strength and exercise intensity. Other variables such as baseline fitness levels, age, comorbidities, time from referral to start, and waist circumference were categorised as likely to be determinants. However, the ability to draw conclusions is hindered by significant inconsistencies in how studies were analysed with additional limitations in the studies with reference to sample size, population characteristics, potential confounders. Finally, the quality of study designs and reporting of study details in journal publications needs to improve so that critical and systematic reviews can be performed to the highest level.
The impact of extracorporeal membrane oxygenation on mortality in patients with cardiogenic shock post acute myocardial infarction: a systematic review and meta-analysis
Authors: Paddock S , Meng J , Johnson N , Chattopadhyay R , Tsampasian V , Vassiliou V
Published: June 2024

Aim

To systematically review studies reporting the impact of VA-ECMO on mortality in patients with acute myocardial infarction complicated by cardiogenic shock.

Methods

Comprehensive search of medical databases (Cochrane Register, PubMed) was conducted. Studies that reported mortality outcomes in patients treated with VA-ECMO for infarct-related cardiogenic shock were included.

Results

The database search yielded 1194 results, of which 11 studies were included in the systematic review. Four of these studies, with a total of 586 patients, were randomised-controlled trials and were included in the meta-analysis. This demonstrated that there was no significant difference in 30-day all-cause mortality with the use of VA-ECMO compared to standard medical therapy (OR 0.91; 95% confidence interval (CI) 0.65-1.27). Meta-analysis of two studies showed that VA-ECMO was associated with a significant reduction in 12-month all-cause mortality (OR 0.31, CI 0.11-0.86). Qualitative synthesis of the observational studies showed that age, serum creatinine, serum lactate and successful revascularisation are independent predictors of mortality.

Conclusions

VA-ECMO does not improve 30-day all-cause mortality in patients with cardiogenic shock following acute myocardial infarction, however there may be significant reduction in all-cause mortality at 12 months. Further studies are needed to delineate the potential benefit of VA-ECMO in long-term outcomes.
Young hearts, old challenges: analyzing stemi under 50
Authors: Raposo M , Abrantes A , Gregorio C , Cazeiro D , Ferreira D , Cravo J , Vilela M , Cardoso P , Pinto F
Published: June 2024

Introduction

Acute ST segment elevation myocardial infarction (STEMI) remains a leading cause of premature mortality and morbidity, even in younger patients (pts), with an important loss of quality adjusted life years. Recent studies have tried to identify specific characteristics of young pts with STEMI to help stratify risk factors and optimize prevention measures.

Purpose

To characterize and evaluate outcomes in a population of young pts with STEMI.

Methods

Retrospective, single-center study of consecutive pts, with age below 50 years, who were admitted with STEMI and underwent percutaneous coronary intervention (PCI), between 2017 and 2021. Demographics, clinical characteristics, and clinical outcomes, including major cardiovascular events (MACE) and mortality, were analyzed. Multivariable cox proportional hazard model was performed to identify predictors of long-term prognosis.

Results

We included 257 pts, 82,5% were men, with a mean age of 44.4 ± 4.9 years. 73% of pts were smokers, a 7 fold increase when compared with Portuguese populational data regarding smoking habits. 63% of pts had dyslipidemia, with a mean cLDL of 120 ± 41mg/dL. 39,6% of pts were overweight, with a BMI ≥ 25. Regarding other risk factors, 35% of pts had arterial hypertension and 15% were diabetic. Most pts had STEMI presentation in class 1 of the Killip-kimball classification, with only 4 presenting with Killip 4. The majority of pts had one vessel disease and were submitted to angioplasty with coated stent implantation, with the anterior descendent coronary artery (CA) and right CA identified as culprit lesions in 58% and 28% of pts, respectively. During a mean follow-up (FUP) of 2.9 ± 1.4 years, 16 pts died, 12 of which within the first 30 days. 27 pts developed heart failure, 18 suffered reinfarction and 7 were admitted with stroke. In our analysis, ejection fraction (EF) at presentation (mean 48.9 ±11%) was the only variable associated with MACE and mortality during FUP (p<0.001).

Conclusion

Despite having an apparently more benign initial presentation, STEMI in young pts is associated with high risk mortality and MACE. Close follow-up and risk factor management have a major role, particularly in this population.
Combined effects of gamma-glutamyltransferase and high-sensitivity C-reactive protein on cardiovascular events in patients with diabetes and chronic coronary syndrome
Authors: Li T , Yuan J
Published: June 2024

Background

Gamma-glutamyltransferase (GGT) is widely used for the diagnosis of liver and obstructive biliary diseases and as an indicator of alcohol consumption. Recently, the role of GGT in cardiovascular fields has attracted attention due to the growing awareness of the interaction between the heart and other organs such as the liver and kidney. Epidemiological studies suggest an association between GGT levels and all-cause mortality in patients with coronary artery disease. It has also been observed that an elevated GGT level is associated with cardiovascular risks such as systemic inflammation and metabolic syndrome.

Purpose

The study aimed to investigate the combined effects of GGT and high-sensitivity C-reactive protein (hs-CRP) on cardiovascular events in patients with diabetes and chronic coronary syndrome (CCS).

Methods

This secondary analysis of a multicentre prospective cohort included 4467 diabetic CCS patients. A GGT level of <55 U/L for males or <33 U/L for females is considered to be low. A low hs-CRP level is defined as <2 mg/L. The primary endpoint was all-cause death. The secondary endpoints include cardiac death, non-fatal myocardial infarction, non-fatal stroke, and revascularisation. Associations of GGT and hs-CRP with cardiovascular events were estimated using Cox regression.

Results

Over a median follow-up period of 2.1 years, 82 all-cause deaths occurred. Patients with elevated levels of GGT and hs-CRP experienced the highest risk of all-cause death (adjusted hazard ratio=3.70, 95% confidence interval: 1.86–7.35, p<0.001). Patients with elevated levels of GGT and low levels of hs-CRP had a 2.56-fold risk of all-cause death than those with low levels of both markers. Similar trends were observed for cardiac death. In addition, elevated levels of both GGT and hs-CRP significantly increased the risks of non-fatal myocardial infarction and any revascularisation.

Conclusion

In diabetic CCS patients, GGT and hs-CRP synergistically increased the risk of cardiovascular events. Combining GGT and hs-CRP may help identify high-risk patients. Table 1.Cox analysis  Figure 1. Kaplan-Meier curves
Life essential 8 associated with a lower risk of stroke: ideal cardiovascular health in the EPIC-NL prospective cohort study
Authors: Spronk M , Van Der Schouw Y T , Te Hoonte F , Boer J M A , Verschuren W M M , Bots M L , Vernooij R W M , Uijl A
Published: June 2024

Introduction

The American Heart Association (AHA) introduced the concept of Life’s Essential 8 (LE8) to measure and monitor cardiovascular health (CVH) to prevent cardiovascular diseases.

Purpose

This study aims to identify the association between LE8 and the risk of incident total stroke, ischemic stroke, and haemorrhagic stroke.

Methods

We included 37,358 participants from the EPIC-NL (European Prospective Investigation Into Cancer and Nutrition- Netherlands) population-based cohort. The LE8 score was calculated according to the AHA’s definition using the LE8 metrics; diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood pressure, and blood glucose. The overall LE8 score (range 0-100) was categorised into low (0-49), moderate (50-79), and high (80-100) CVH. A Cox proportional hazard model adjusted for age, sex, educational levels, alcohol consumption and history of atrial fibrillation, was used to assess the association between LE8 and the risk of stroke.

Results

The mean age of participants was 49 years ± 12 years and 75% of participants were female. The mean LE8 score of the participants was 72 ± 11. During the median follow-up of 15.3 years (interquartile range: 14.1-16.5 years), 1323 (3.5%) total stroke, 873 (2.3%) ischemic stroke, and 247 (0.7%) haemorrhagic stroke cases occurred. Moderate and high CVH scores were associated with a lower risk of total stroke compared with low CVH scores: hazard ratio (HR) 0.52 [95% confidence interval (95%CI) 0.41-0.65] for moderate and HR 0.33 [95%CI 0.25-0.43] for high CVH). For ischemic stroke we observed similar associations (HR 0.46 [95%CI 0.35-0.61] for moderate and HR 0.31 [95%CI 0.23-0.44] for high CVH) as well as for haemorrhagic stroke (HR 0.68 [95%CI 0.37-1.25] for moderate and HR 0.38 [95%CI 0.19-0.75] for high CVH).

Conclusions

Our findings suggest an inverse graded relationship between LE8 and stroke. A higher baseline LE8 score was associated with an impressive lower risk of total stroke, ischemic stroke, and haemorrhagic stroke among Dutch adults. Improving the LE8 score could therefore potentially be a valuable tool to prevent the risk of stroke.
Effect of statins on thoracic aortic disease: results from a meta-analysis and experimental data
Authors: Poggio P , Rega S , Valerio V , Moschetta D , Massaiu I , Rusconi V , Bertolini F , Perrucci G L , Myasoedova V A
Published: June 2024

Background

Thoracic aortic aneurysms (TAAs) that progress to acute aortic dissections are often fatal. Numerous risk factors, such as smoking, uncontrolled hypertension, and dyslipidemia, lead to increased wall stress and adverse outcomes. Nowadays, there is no pharmacological treatment that can reduce or even halt TAA progression.

Purpose

To evaluate the effect of statins on TAA growth rate and outcomes in TAA patients using a meta-analysis approach and testing the anti-fibrotic effect of satins in an in vitro model.

Methods

A detailed search related to the effects of statins on TAA was conducted according to PRISMA guidelines. The qualitative and quantitative analyses of statin effects on TAA growth rate were performed on 4 studies including 1850 patients, and for statin impact on outcomes were performed on 3 studies (2867 TAA patients). In vitro, the anti-fibrotic effect of 6.6 μM Atorvastatin were tested on vascular smooth muscle cells (VMSC) isolated from tunica media of ascending thoracic aorta of patients with aneurysm.

Results

We observed significant positive effect of statins on TAA growth rate. In particular, patients under statin treatment showed a reduced growth rate difference in means of -0.36 (95%CI: -0.64, -0.08; p=0.013) compared with controls, patients that did not take statins. Regarding the outcomes, such as death, dissection, or rupture of the aorta, and the need for operative repair, statins exhibited a protective effect reducing the number of events in patients with TAA with a logarithmic odds ratio of -0.56 (95%CI: -1.06, -0.05; p=0.030) compared to controls. Our in vitro results highlighted that, in transforming growth factor beta 1 (TGF-β1) pro-fibrotic condition, VSMC expressed a significant lower amount of collagen type I alpha 1 chain (COL1A1) when treated with Atorvastatin (untreated: 2.66±0.23 fold increase; treated: 1.63±0.09 fold increase; p=0.014).

Conclusions

Statins show a protective effect on TAA growth rate and adverse outcomes in patients with TAA, and an anti-fibrotic property on VSMC. Due to their pleiotropic effects, statins should be considered as a valuable pharmacological strategy to prevent the progression of TAA.
Smart assistance for coronary artery disease patients with low ejection fraction and dilated cardiomyopathy treated with percutaneous coronary intervention: preliminary results from SCAD pilot study
Authors: Elia E , Melito A , La Malfa G , Demarchi A , Maggio S , Maconi A , Penpa S , Betti M , Roveta A , Pistis G , Secco G G
Published: June 2024

Background

Coronary artery disease (CAD) and ischemic heart failure (HF) still is one of the leading causes of death worldwide and adherence to medical and physical treatment is crucial to improve patients’ prognosis and reduce hospitalization (1).

Purpose

To investigate the potential benefit of information and communications technology (ICT) frameworks in daily activities to assist patients with ischemic dilated cardiomyopathy with low ejection fraction (LVEF) treated with percutaneous coronary intervention (PCI) to understand and comply all pharmacological and preventive measures and monitoring the health status (2, 3).

Methods

patients admitted for ischemic dilated cardiomyopathy associated with LVEF (<40%) were enrolled and underwent block randomization between smart assistance follow up plus standard of care or standard of care alone. Smart assistance group was equipped with smartphone, smartwatch, pulseoximeter and sphygmomanometer and, with the respective caregivers, underwent specific training and education on the use of the devices in addition to routine follow-up visits. On the other hand, the control group control group underwent outpatient visits at 30,90 and 120 days as standard of care in our routinely practice.

The primary endpoint was the occurrence of HF hospitalization, secondary endpoints were physical activity, compliance to pharmacological prescriptions, perceived quality of life and all-cause mortality.

Results

A total of 218 patients were enrolled in the present study: 83 patients were enrolled in the smart assistance group and 135 in the control group. The median age was 61.4 years and the majority of patients were male (83.4%) with a median LVEF of 31%. The follow-up was 164±14 days in the smart assistance group and 171±9 days in the control group. No statistically significant difference at the baseline were found between the two groups. The primary endpoint occurred in the 9 patients in the smart assistance group and in 38 patients in the control group (10.8% vs 25.9%, p<0.01). Compliance to pharmacological treatment occurred in 94% of the smart assistance population and EQ-5D VAS score was higher in the smart assistance group during the follow-up compared to previous studies, 84 (interquartile range [IQR] 76-89) at one month and 83 (IQR 73-87) at 6 months. Physical activity increased during follow-up. No difference was found regarding all-cause mortality. No adverse events related to the smart assistance system was reported during the follow-up.

Conclusions

ICT frameworks may help in the post-discharge management and follow-up of patients with ischemic dilated cardiomyopathy with low LVEF treated with PCI by reducing HF hospitalization, improving compliance with pharmaceutical and physical treatment and increasing quality of life.
Examining the relationship between mobile health app weight recording habits and weight loss achievement in individuals with obesity and lifestyle-related disease
Authors: Hagiwara Y , Sakoda T , Ishida S , Kanai M , Sakui D , Miki T
Published: June 2024

Background

The use of mobile health to promote healthy behaviors is increasing rapidly. Establishing a habit of recording body weight is effective for weight loss, especially in individuals with obesity. However, the relationship between the rate of recording body weight on mobile apps and its effectiveness in weight loss through health guidance programs led by healthcare professionals remains unclear.

Objective

This study aimed to investigate the differences in weight recording habits on a mobile app and the achievement of weight loss in individuals with obesity and lifestyle-related diseases.

Methods

Participants being treated for lifestyle-related diseases and enrolled in a corporate-provided mobile app-supported lifestyle improvement program were included if their BMI was at least 25 kg/m^2. The program, spanning six months, offered 12 telephone consultations and chat-based communications to support better exercise and dietary habits. Participants entered their weight into the app, and the weight change rate was calculated as the average during the first two weeks and the last two weeks of the program. Weight loss achievement was defined as a reduction of 3% or more. The weight input rate was categorized into four groups based on the quartiles of recording rates. Logistic regression analysis, adjusted for age, gender, BMI, and physical activity level, and with weight loss achievement as the dependent variable, was used to explore the association between weight recording rates and weight loss achievement.

Results

The study included 1,884 participants, with an overall weight loss rate of 40.2%. The recording rates for each quartile were as follows: Q1: 0-50%, Q2: 50-87%, Q3: 88-97%, Q4: 98-100%. The weight loss achievement rates in each group were Q1: 24.5%, Q2: 36.5%, Q3: 45.8%, and Q4: 52.9%. An increase in weight input rate corresponded to an increase in weight loss achievement rate. Logistic regression analysis showed a statistically significant association between weight input rate and weight loss achievement (Q1: Reference, Q2: Odds Ratio 1.64, 95% CI: 1.220-2.192; Q3: Odds Ratio 2.50, 95% CI: 1.871-3.327; Q4: Odds Ratio 3.27, 95% CI: 2.455-4.390).

Conclusion

In a mobile health-supported lifestyle improvement program, a significant correlation was observed between weight recording rates and weight loss achievement. Groups with recording rates above 80% showed high weight loss achievement rates, suggesting that the frequency of weight recording may indicate success in weight management efforts.
NIRS analysis of periodic breathing in heart failure: unraveling ventilation-perfusion dynamics
Authors: Salvioni E , Chiesa M , Mapelli M , De Martino F , Campodoico J , Mattavelli I , Vignati C , Nava A , Campana N , Agostoni P
Published: June 2024

Background

Periodic breathing (PB) during exercise refers to a gradual. noticeable. and cyclic fluctuation in minute ventilation oxygen uptake (V̇O2) and carbon dioxide elimination (V̇CO2). This pattern may endure throughout the entire exercise session or be apparent only in the initial phases. Its presence is linked to an unfavorable prognosis in patients with heart failure (HF). particularly when concurrent with periodic breathing during sleep.

It is unknown whether PB influences O2 availability in the muscles. Near infra-red spectroscopy (NIRS) allows to monitor changes in total. oxygenated and deoxygenated haemoglobin concentration and it has been used in heart failure (HF). to assess muscle oxygenation status.

Methods

We enrolled HF patients who had been found with PB during HF hospitalization or ambulatory cardiopulmonary exercise test (CPET). NIRS was performed within 1-2 days after clinical observation PB. We measured at rest. continuously and simultaneously. ventilation. ventilatory gas exchange. heart rate. O2 saturation. total and oxygenated/deoxygenated hemoglobin content over the quadriceps by NIRS. Respiratory data were collected by spirometer, while hemoglobin muscle data by NIRS and then data were integrated.

Results

We enrolled 20 patients (70±10 years. 95% males. LVEF 27±8%). Baseline data and results obtained at maximal CPET are shown in table 1. Five patients did not show PB during the NIRS measurement period. In all cases where oscillatory behaviour of respiratory gases could be observed (n=15). an oscillation of oxygenated (HbO2) and deoxygenated hemoglobin (HHbO2) in the muscle was also found. We observed two different behaviours of NIRS traces. In most cases HbO2 had an oscillation exactly counterphase to the oscillation of HHbO2 (Figure 1. left). In contrast. one case showed a concordant oscillation of the two traces (figure 1. right). In this case total Hb was almost constant). By analysing the concordance between the ventilation and respiratory gas oscillation in all cases. an exact correspondence of the number of respiratory oscillations to those detected at the muscle could be found.

Conclusions

Our study revealed two distinct patterns of NIRS. Those with an oscillation in oxygenated (HbO2) and deoxygenated hemoglobin (HHbO2) with a counterphase relationship. suggest a potential oscillation in ventilation/perfusion mismatch. In contrast. the concordant oscillations in both traces. accompanied by evident pulsatility in total hemoglobin. may be indicative of a possible cardiac output-related periodicity.

Further research is warranted to elucidate the specific mechanisms driving these distinct patterns and their clinical implications in the context of heart failure. Understanding the underlying causes of periodic breathing may contribute valuable insights for tailored interventions and improved prognostic assessment in HF patients. Figure 1
Assessing malnutrition to prevent mortality in patients with advanced heart failure: Hades study
Authors: Munoz M , Calero E , Lopez M , Duran J , Navas E , Alonso S , Argemi N , Casademunt M , Furio P , Casajuana E , Domingo M , Vinyoles E , Verdu-Rotellar J M , Del Val J L
Published: June 2024

Background/Introduction

Altough malnutrition has been associated with higher mortality in heart failure (HF), information about its impact on community-dwelling older patients with advanced HF remains scarce.

Purpose

This study is aimed at determining the prevalence and impact of malnutrition in the mortality of patients with advanced HF.

Methods

A prospective multicenter study included a cohort of community-dwelling older patients with HF in New York Heart Association IV (NYHA) functional status, or those in NYHA III who had needed hospitalisation at least twice in the previous six months.

A total of 22 primary healthcare centres, two university hospitals, one acute-care hospital, and one geriatric rehabilitation unit, participated in the study.

To evaluate nutritional status, the MNA-SF seven-item questionnaire was administered. When the scores were lower than eleven points, an additional questionnaire classified patients into two categories: risk of malnutrition or established malnutrition

Results

A total of 271 patients with HF were included. Women constituted 59.8%, and mean age was 84.2 years (SD 8.3). Patients older than 65 years represented 98.1% of the sample. Median follow-up was 14.9 months (percentile 25-75; 4.9-26.9). Malnutrition risk was observed in 127 and confirmed malnutrition in 33 patients. During follow-up, 134 of the included participants died.

Comorbidity was not observed to be determinant in either malnutrition risk or mortality.

The multivariate model adjusted by sex, age, and Body Mass Index showed that established malnutrition was an independent risk factor for mortality (Odds Ratio 2.91, 95% Confidence Interval 1.14; 8.22)

Conclusion

In a cohort of community-dwelling older patients with advanced HF, malnutrition has been associated with higher rates of mortality. Malnutrition risk should be systematically addressed by primary care healthcare professionals to improve survival rates in these patients
Evaluation of the ability to participate in cardiac telerehabilitation in patients with acute decompensated heart failure: Tele-ADHF substudy
Authors: Van Leunen M , De Lathauwer I , Kemps H
Published: June 2024

Background

Cardiac rehabilitation (CR) is generally recommended in patients with chronic heart failure (CHF), particularly for frail patients admitted to the hospital. However, the referral and attendance rates remain poor worldwide, <20% in Europe and <5% in the USA, respectively [1]. This interim analysis of the Tele-ADHF trial gives insight in the patient selection for a cardiac telerehabilitation (CTR) intervention during hospital admission and the dropout before reaching ‘stabilisation’.

Purpose

The purpose of this interim analysis was to evaluate the dropout rate in CHF patients after hospital admission before starting CTR intervention. Secondary, differences in demographic and clinical characteristics were evaluated between patients that reached 'stabilisation' or not.

Methods

Patients hospitalised for acute decompensated heart failure (ADHF) and meeting study in- and exclusion criteria were asked for study participation. All study participants started with Remote Patient Management (RPM) after hospital discharge. When reaching stable heart failure, defined as optimal medical therapy (OMT) and unchanged heart failure symptoms for at least two weeks, patients were randomised for starting CTR (intervention group) or continuing with RPM alone (control group) [2].

Results

49% of the eligible hospitalised CHF patients were included in the study. 49 patients with a median age of 76 years started the ‘stabilisation period’ with RPM. 15 patients dropped out before reaching stabilisation and randomisation (33.1%); 7 died, 2 got admitted for geriatric rehabilitation, 4 stopped for personal reasons, and 2 were lost for follow-up. Patients that never reached randomisation had more adverse events (64.3% vs. 20.6%; p = 0.004) and a lower quality of life (37.6 vs. 49.4; p = 0.008).

Conclusion

CTR has the potential to reach 2/3 of eligible CHF patients willing to start rehabilitation after hospital discharge. The dropout rate of 1/3 was associated with lower quality of life, poor health outcomes (death and readmission) and personal perspectives. Figure 1. Flowchart
Assessment of heart rate and oxygen consumption during and following a six-minute walk test in patients awaiting liver transplant
Authors: Skow R , Mcmurtry T , Foulkes S , Cruz C , Limon-Miro A , Tomczak C , Tandon P , Haykowsky M
Published: June 2024

Background

People with liver cirrhosis (LC) who are awaiting liver transplant have reduced physical function and quality of life [1,2]. However, the physiologic factors contributing to decreased physical function remain unclear.

Purpose

To test the hypothesis that people with LC will have worse exercise efficiency during a standardized six-minute walk test (6MWT) defined as a shorter walk distance at a higher energy cost (e.g., higher oxygen consumption; VO2). We further hypothesized that patients with LC will have prolonged post-exercise heart rate and VO2 kinetics compared to adults of similar age without LC.

Methods

Nine participants with LC who are being assessed for transplantation (60±7 years, 2 female, 31.3±6.9 kg/m2) and seven age- and sex-matched healthy adults (HA; 60±9 years, 1 female, 27.6±3.9 kg/m2) were recruited for this study. Participants with LC were enrolled as part of a larger pre-habilitation exercise and nutrition intervention and were classified as pre-frail according to the liver frailty index (LFI: 3.8±0.4). The LC group had Child-Pugh scores between 9-12 (Class B and C; n=3 and n=6, respectively) and MELD-Na score of 16.8±4.9. We measured heart rate and VO2 (VO2 Master portable analyzer) prior to (five-minutes seated rest), during the last two-minutes of the 6MWT (i.e., at steady-state exercise), and immediately post-exercise (five- minutes of seated recovery; Figure 1). Blood pressure was also measured at rest and two-minutes after the 6MWT. Post-exercise heart rate and VO2 recovery kinetics were determined using monoexponential modelling (OriginLab, 2023b). Specifically, we determined the time delay to the start of the exponential decline in heart rate or VO2 following exercise termination, and the time to reach 63% of the recovery (τ) during the five-minutes of seated rest. From this, the mean response time (MRT) was computed as MRT= time delay + τ.

Results

Resting heart rate, blood pressure, and VO2 were not different between groups (Table 1). During the last two-minutes of the 6MWT, heart rate was not different between groups. However, owing to a greater total distance walked (HA: 629±50m vs LC: 397±133m; p<0.001), VO2 was higher in the HA group (Table 1). The heart rate MRT was not different between groups (HA: 66±34s vs LC: 46±17s; p=0.164) but VO2 MRT was 25% slower in LC (85±22s) compared to HA (64±14s; p=0.045).

Conclusion

These preliminary data suggest that patients with LC who are awaiting liver transplant have skeletal muscle metabolic alterations and/or reduction in oxygen extraction as evidenced by the lower exercise VO2 and slower post-exercise VO2 recovery. Interventions to improve fitness and physical function such as pre-habilitation programs may improve short- and long-term recovery following liver transplant.
Hyper-trabeculation in olympic athletes: advanced LV function analysis by CMR
Authors: Monosilio S , Spinelli A , Prosperi S , Lemme E , Di Gioia G , Mango R , Tonti G , Pedrizzetti G , Gualdi G , Squeo M R , Pelliccia A , Maestrini V
Published: June 2024

Background

Left ventricular (LV) hyper-trabeculation is frequently observed among high-level athletes and often raises concerns for differential diagnosis with cardiomyopathies.

Aim

To evaluate standard and advanced LV function by CMR in a cohort of elite athletes with LV hyper-trabeculation.

Methods

Thirty Olympic athletes with LV hyper-trabeculation and thirty without LV hyper-trabeculation matched for sex (59% male) and sport disciplines (power 24%, mixed 28% and endurance 48%) were enrolled. They all underwent cardiovascular preparticipation screening that was unremarkable. CMR without contrast administration was performed. Hyper-trabeculation was defined based on Petersen criteria for left ventricular non-compaction (LVNC), but all the athletes presented preserved compacted layer. Differences in standard and advanced LV function parameters between the two groups were evaluated using a dedicated, offline feature-tracking software to analyze the standard three long-axis cine loops. LV global longitudinal and circumferential strain (GLS and GCS) and LV hemodynamic forces (HDFs), representing the forces exchanged between the blood and the myocardium and being novel and validated markers of LV function were evaluated. The ratio between the HDFs two main directions (longitudinal and transversal), meaning the distribution of forces into the LV, was computed in the entire cardiac cycle, systole and diastole.

Results

There were no significant differences between the two groups regarding the amount of training in terms of years and hours of training per week (p=0.065 and p=0.262, respectively). Hyper-trabeculated athletes showed slightly higher LV volumes and lower ejection fraction than non-hyper-trabeculated ones, even if the difference was not statistically significant (EDVi, ESVi and EF: p= 0.397, 0.118 and 0.101, respectively). There were also no significant differences in LV-GLS, GCS and HDFs distribution in the entire cardiac cycle, systole and diastole (Table and Figure).

Conclusions

Olympic athletes with LV hyper-trabeculation but preserved compacted layer did not significantly differ from non-hypertrabeculated ones in terms of dimension and advanced parameters of LV function. CMR advanced study of LV function could help differentiate physiological and pathological remodelling in athletes. Table.  Figure.
Exploring low QRS voltages and QRS fragmentation in pediatric and adolescent athletes: prevalence and determinants factors
Authors: Graziano F , Genta E O , Manfrin L , Zorzi A , Corrado D , Brusamolin L , Giada F
Published: June 2024

Background

Low QRS Voltages (LQRSV) in limb leads and QRS fragmentation (FQRS) are possible signs of myocardial fibrosis and cardiomyopathy, but they are not mentioned in the 2017 International Criteria for the interpretation of athlete’s ECG.

Purpose

We aimed to investigate the determinants of LQRSV and FQRS in a cohort of young apparently healthy athletes undergoing preparticipation screening (PPS).

Methods

We analysed a consecutive series of ECG recorded at the time of PPS of young athletes aged 7-18 years. The maximal peak-to-peak QRS voltage was considered and LQRSV was defined when all limb leads have a voltage <0.5 mV. Fragmented QRS morphologies were coded and detected in each individual lead and then grouped into five patterns. Lead aVR was not considered.

Results

We included 2140 children-athletes (mean age 12.5±2.6 years, 48% males) with no overt cardiac diseases. Mean QRS voltage in limb leads was 1.4±0.4 mV, similar between males and females and between younger and older athletes (Figure 1). The correlation between maximal QRS voltages and BMI or exercise intensity was weak. Only 5 (0.2%) children-athletes showed LQRSV. At least one fragmented QRS complex was identified in 831 (39%) of children-athletes, particularly in leads V1 (24%), V2 (12%) and aVL (16%) (Figure 2). If children-athletes with a rSr’ pattern in V1-V2 were excluded, only 10 (0.5%) showed FQRS in ≥2 contiguous leads. These 10 children-athletes were older than those without FQRS, but did not differ in terms of sex, BMI or exercise-intensity.

Conclusions

LQRSV in limb leads and FQRSV in ≥2 contiguous leads excluding V1-V2 are rare in children-athletes undergoing PPS of both sexes and are not training-related: for this reason, they may require additional testing to rule out an underlying disease. Figure 1  Figure 2
Early insulin resistance in low-risk subjects with normal glycemia is associated with subclinical atherosclerosis
Authors: Iglesies-Grau J , Garcia-Alvarez A , Oliva B , Mendieta G , Garcia-Lunar I , Fuster J J , Devesa A , Perez-Herreras C , Fernandez-Ortiz A , Brugada R , Ibanez B , Fernandez-Jimenez R , Fuster V
Published: June 2024

Background

Higher glycated hemoglobin (HbA1c) levels are directly associated with subclinical atherosclerosis burden. However, the association between earlier insulin resistance markers and the development of subclinical atherosclerosis is poorly understood.

Purpose

To assess the association between the Homeostatic Model Assessment of Insulin Resistance Index (HOMA-IR) and subclinical atherosclerosis, on top of cardiovascular risk factors in individuals with normal HbA1c.

Methods

A cohort of 3,741 middle-aged individuals from the PESA study, with basal HbA1c <6.0% and without known CV disease, underwent extensive imaging (multi-territorial vascular ultrasound and coronary artery calcium score, CACS) to assess for the presence, burden, and extent of subclinical atherosclerosis.

Results

Individuals with higher HOMA-IR values had a higher prevalence of both traditional and non-traditional CV risk factors. Higher HOMA-IR values showed a positive association with the multi-territorial extent of subclinical atherosclerosis and CACS (p<0.001), Figure 1, and an increased global plaque volume by 3DVUS (p<0.001), Figure 2. The association was observed in both individuals with HbA1c levels below and above the median value of 5.4% (p < 0.001). This trend held for three individual territories (carotid, femoral, and coronary artery). Overall, after adjusting for key CV risk factors and HbA1c levels, HOMA-IR values ≥3 were associated with both the multi-territorial extent of subclinical atherosclerosis and CACS>0: odds ratio of 1.41 (95CI: 1.01 to 1.95, p=0.041), and 1.74 (95CI: 1.20 to 2.54, p=0.004) respectively, as compared to HOMA-IR <2 (reference). In a stratified analysis, this association remained significant in low-to-moderate SCORE2 risk individuals (75.6% of the cohort) but not in high-risk adults.

Conclusions

The use of HOMA-IR identified low-risk individuals with a higher burden of subclinical atherosclerosis on top of traditional CV risk factors and HbA1c. HOMA-IR is a simple measure in clinical practice that could facilitate earlier implementation of CV primary prevention strategies. HOMA-IR and subclinical atherosclerosis.  HOMA-IR and 3D vascular ultrasound.
Association between urinary concentrations of heavy metals and trace elements and renal function in Swiss adults: a cross-sectional study
Authors: Xie S , Vaucher J , Marques-Vidal P
Published: June 2024

Background/introduction

Chronic kidney disease (CKD) is an important public health problem. Heavy metals and trace elements can affect kidney function; however, there are few studies on the association between heavy metals and trace elements and kidney function in the general population.

Purpose

To assess the associations between urinary concentrations of 23 elements (Li, Be, Al, V, Cr, Mn, Co, Ni, Cu, Zn, As, Se, Mo, Ag, Cd, Sn, Sb, Hg, Tl, Pb, Bi, Fe, and Iodine) and kidney function, evaluated by estimated glomerular filtration rate (eGFR).

Methods

Cross-sectional survey of 6204 adults (51.7% women, 52.4±10.7 years). Associations were assessed via Spearman correlation and pairwise comparisons. Concentration of the 23 elements was standardized to the urinary creatinine levels.

Results

Bivariate analysis showed that urinary Mn, Co, Ni, Zn, Cd, and Sn levels were negatively associated, and urinary V, As, Sb, Hg, Pb, and Iodine were positively associated with eGFR (see figure). There were 3224 (52%), 2809 (45.3%) and 171 (2.7%) participants with normal renal function, impaired renal function (IRF, defined as a eGFR between 60 and 90 ml/min/1.73 m²), and CKD (eGFR <60 ml/min/1.73 m²), respectively. After multivariable analysis, compared with participants with normal kidney function, participants with IRF and CKD had lower urinary V, Mn, Cu, Se, Mo, Ag, Cd, Hg, Tl, Pb and Bi levels (all P for trend <0.001).

Conclusion

Urinary heavy metals/trace elements are associated with kidney dysfunction. Further blood heavy metal/trace element analysis and prospective studies are needed to evaluate the potential risks of heavy metal/trace element exposure on kidney function. Matrix of bivariate correlations.  Table comparing renal categories.