bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of physical activity in out-of-hospital cardiac arrest survivors: a sub-study of the targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (TTM2) trial
Authors: Heimburg K , Lilja G , Blennow Nordstrom E , Gregersen Ostergaard L , Grejs A M , Keeble T R , Mion M , Rylander C , Segerstrom M , Thomsen I K , Ullen S , Unden J , Wise M P , Cronberg T , Tornberg A B
Published: May 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Riksförbundet HjärtLung Hans-Gabriel and Alice Trolle-Wachtmeister Foundation for Medical Research.

Background

Low physical activity is a risk factor for new cardiac events in out-of-hospital cardiac arrest (OHCA) survivors. Physical activity could be assessed by both self-reports and objective accelerometer data.

Aim

To investigate the coherence between self-reported and objectively assessed physical activity among OHCA survivors.

Method

Cross-sectional study including OHCA survivors in Sweden, Denmark and the United Kingdom. Two questions about moderate- and vigorous-intensity physical activity during the last week were used as self-reports. Additionally, moderate- and vigorous-intensity physical activity were objectively assessed with an accelerometer (ActiGraph wGT3X BT) worn at the waist for seven consecutive days.

Results

49 of 106 included OHCA survivors had answered the two questions and had seven valid days of accelerometer assessment and were included in the analyses. According to self-reports, the median of moderate-intensity physically active days was 5 [3:7] and vigorous-intensity physically active days was 1 [0:3] during the week wearing the accelerometer. Assessed by accelerometery, the median of moderate-intensity physically active days was 3 [1:5] and vigorous-intensity physically active days was 0 [0:0] . Correlations between self-reported and objectively assessed moderate- and vigorous-intensity physical activity were sufficient (rs=.336, p=0.018) and (rs=.375, p=0.008) and agreements were fair (k=0.269, p=0.001) and slight (k=0.148, p=0.015).

Conclusion

Self-reported and objectively assessed moderate- and vigorous-intensity physical activity correlated but the agreements were only slight to fair indicating that researchers need to exert caution when interpreting results from physical activity questionnaires.
Risk of atherosclerotic cardiovascular disease in patients with premature ASCVD: A study from approximately 1 million young adults
Authors: Rana J , Liu J , Moffet H , Nasir K , Mamas M , Blankstein R , Karter A , Sidney S
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Risk of atherosclerotic cardiovascular disease (ASCVD) attributable to premature ASCVD remains poorly understood.

Purpose

To evaluate the risk of ASCVD among those with premature ASCVD versus those without in a large contemporary population.

Methods

This observational cohort study included young adults (ages 30-55 years) with and without prior ASCVD (as of January 1, 2006) who were members of an integrated healthcare delivery system in Northern California. Adjusted multivariate models were specified to estimate risk ratios (RRs) for incident ASCVD events by ASCVD status at baseline. Incident ASCVD events were defined as a composite of nonfatal myocardial infarction, ischemic stroke, or coronary heart disease death through December 31, 2020.

Results

A total of 929,214 individuals met the selection criteria of no prior ASCVD and 5,703 with prior ASCVD. Mean age was 43.9 (±7.3) years and 50.0 (±5.2) years, respectively. Fifty-two and thirty percent were women in each cohort, and the median follow-up was 11.8 and 8.3 years, respectively. Crude ASCVD rate was 2.1 and 24.5 events per 1,000 person-years, respectively. Age-adjusted Kaplan-Meier curves for ASCVD in individuals with and without prior ASCVD in Figure. In models adjusted for demographics (sex, age, race) and traditional risk factors (diabetes, hypertension, LDL-cholesterol, HDL-cholesterol, total cholesterol, smoking), individuals with prior ASCVD had RR of 4.6 (95% CI 4.3-5.0) for CHD, RR of 3.0 (95% CI 2.7-3.4) for stroke and RR of 4.1 (95% CI 3.8-4.3) for ASCVD.

Conclusions

Risk of ASCVD among those with prior ASCVD was several-fold greater compared to those without prior ASCVD. Continued efforts for secondary prevention are needed in this vulnerable high-risk population.
DAHNA-An integrated innovative mobile application for the screening and management of the atherosclerotic cardiovascular disease risk
Authors: Tatu-Chitoiu G , Damian S , Weiss E , Mocanu I , Patrascu M , Dragoi P , Tatu-Chitoiu D
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Backgrond: DAHNA (Diet According to the Healthy Heart Nutritional Approach) is an integrated innovative free mobile app that allows:1.Screening of the atherosclerotic cardiovascular diseases (ASCVD) risk. 2.Personalized healthy diet based on the cardiometabolic screening. 3.Personalized advice and referral to doctors for those with a high/very high risk score. 4. Long-term following of the major risk factors.

Objective

Presentation of DAHNA functionalities, operation mode and first results through public implementation.

Methods

DAHNA can be downloaded on any mobile phone regardless of its operating system. Functionalities:ASCVD risk score assessment by an „all-in-one-for-all" risk calculator joining the 2021 European Society of Cardiology (ESC) SCORE2/SCORE2-OP scores and the American Heart Association (AHA) Framingham score. When the user mentions his/her country either SCORE2/SCORE2-OP or Framingham opens automatically.For Europe calculation is based on the four SCORE2/SCORE2-OP tables of the four risk regions. DAHNA is not limited to healthy people, but allows the user to mention if he/she already has diabetes, chronic kidney disease or ASCVD. From this moment on, he/she is notified that is at high/very high risk. 2.Based on the ASCVD risk DAHNA offers: 2a. Personalized healthy menus (Mediterranean diet) including the macro and micronutrients in the recommended daily dose.The ingredient list is automatically created with the required quantities.The user can choose between the personal purchase of the ingredients or ordering the list from suppliers 2b.short movies for initiation into physical activity 2c.up-to-date educational medical information. 2d.The need for a quick consultation for those with high/very high risk. 2e.Periodically follow-up of the outcome of the ASCVD risk. All data are collected in a central data base.

Results

Between August 10th, 2022 (when this version was launched) and November 1st, 2022, 15780 users downloaded DAHNA (265 downloads/day, mean age: 48+/-10 years, 58% females; 16% smokers, 18% hypertension. A 100% correspondence between the results of DAHNA calculator and ESC tables was confirmed.

Conclusion

1.DAHNA is the first app to combine the ASCVD risk scores with the assignment of personalized healthy diet, healthy lifestyle advice and periodic risk self-assessment. 2.DAHNA is an universal ASCVD risk mobile calculator 3.DAHNA offers a real-time knowledge and following of the dynamics of the major risk factors and ASCVD risk in large populations. These data should be important for the adjustment of the health policies.
The WALK HOP program: a French innovative multicentric home-based cardiac rehabilitation initiative
Authors: Tomas M C F , Six M M , Pavy B , Guy J M , Nguyen N V
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Fonds pour l'innovation du système de santé (FISS) - France.

Background

Cardiac rehabilitation (CR) has demonstrated scientific benefits in terms of morbidity and mortality. In France, 2019 national data indicates that only 22,3% of coronary patients benefit from CR. The development of alternative programs to center-based cardiac rehabilitation (CBCR) must be considered as a public health priority and requires a reorganization of ambulatory care pathways.

Purpose

The objective of the "Walk Hop" program is to demonstrate that home-based cardiac tele-rehabilitation (HBCT) is a complementary and safe approach to CBCR, able to increase the proportion of patients benefiting from a rehabilitation program.

Methods

This feasibility study started begin of 2022. 3,200 coronary patients will be recruited in 8 participating cardiac rehabilitation centers (CRC). Total duration of the experiment is 42 months. The program is financially supported by the French authorities.

The HBCT solution developed for the study is proposed to patients by the CRC cardiologist. A multidisciplinary platform consisting of a secure portal and an application allows bidirectional communication. Patients are equiped with a cycle ergometer and a validated heart rate monitor. The application presents aerobic and muscle strenghtening activities and therapeutic education and collects data from the sessions carried out, adherence to the program, symptoms and quality of life.

Results

By october 2022, 157 active patients have been included in the program with a large majority of men (86%). Mean age is 53,9 ± 9,0. Hypercholesterolemia is noted in 36,9% of the included patients, smoking in 31%, arterial hypertension in 30,6% and diabetes in 11,1%. Obesity/overweight affects 60% of the population. Mean time from angioplasty to initiation of the rehabilitation is 81 ± 90 days. Mean number of home rehabilitation sessions is 21 and a total of 3342 home sessions have been realized. No cardiovascular event or rehospitalization have been registered since the beginnng. Mean adherence to the prescribed sessions is 80 ± 20% and the mean power gain at the end of the program is 14,6 ± 9,9 %.

94% of the patients expressed satisfaction or high satisfaction at the end of the program.

Conclusion(s)

The Walk Hop program is evaluating the feasibility and acceptability of HBCT with remote monitoring and digital assistance by smartphone. The preliminary data are encouraging in view of the final expected impact: greater cost-effective access to rehabilitation programs by removing obstacles like distance or resumption of work. It is also expected that HBCT will provide an improvement in the long-term maintenance benefits.
Comparison of radial artery occlusion occurrence (RAO) between compression band device and manually applied gauze compression after transradial coronary procedure, a PROBE study
Authors: Ramos H J R , Marcelo J
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Hemostasis of the radial artery after transradial coronary procedure can be achieved either manually by means of a gauze or mechanically through a device compression band, and radial artery occlusion (RAO) is one of its common complications.

Purpose

The study sought to compare the occurrence of RAO between the two hemostasis methods being used after a transradial coronary procedure to determine an effective and safe method that can be recommended for use.

Methodology

This was a Prospective, Randomized Open-label Blinded Endpoint (PROBE) study. A total of 137 patients undergoing a transradial coronary procedure were randomized equally using block randomization sampling technique. Radial artery patency was evaluated by color duplex ultrasonography within 24-72 hours after the procedure. The primary endpoint was early RAO. Secondary endpoints included complications such as access-site bleeding, pain, and hematoma.

Results

Three (2.19%) early RAOs occurred, 1 (1.47%) in the band compression device group and 2 (2.9%) in the manual gauze compression group (p= 1.000). There were no significant differences between the 2 groups regarding access-site bleeding [type 1 bleeding, 3 (4.48%) vs 2 (2.90%); p= 0.678]; pain with median pain score of 0 (0-6) vs 0 (0-7); p= 0.742; and hematoma [Grade I: 3 (4.41%)vs 2 (2.9%); Grade II: 0 vs 2 (2.9%); Grade III: none, and Grade IV: 0 vs 2 (2.9%); p= 0.363].

Conclusion

Compression Band Device and Manually Applied Gauze Compression have similar rates of early RAO, access-site bleeding, pain, and hematoma.
Are there gender differences in diagnostic and therapeutic sports cardiology care? Data from one sports cardiology centre
Authors: Jiravsky O , Pesova P , Krausova D , Pleva M , Spacek R , Sknouril L , Jiravska Godula B
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cardiovascular care of highly active individuals and competitive athletes has become an important topic in the field of sports medicine. The evolving understanding of exercise-induced cardiovascular remodeling in athletes has led to a more thorough characterization of physiological adaptation versus pathological dysfunction, but this distinction is often challenging because of diagnostic commonalities. The current data reflect sport-specific analyses of predominantly male athletes that may not be readily applicable to the female athletic heart. Another aspect of this care may be the different approach to indication, interpretation, and referral between men and women.

Objective

To determine whether there is a difference between men and women in access to sports cardiac care. Whether there is a difference between the indicated investigations, therapeutic care and recommendations made.

Methods

Retrospective analysis of the registry of all athletes of the Sports Cardiology Centre (SCC). Statistical comparison of the cohort of women and men in all parameters studied.

Cohort: Between 1/2020-6/2022, a total of 115 cases of athletes, 100 men and 15 women (13%), aged 26 (+/-11 years), were examined and definitively closed in the SCC. Demographics in Table No. 1.

Results

There were no statistically significant differences in indications, symptoms, examination methodologies, percentage of diagnosis or eligibility for sport from a cardiological perspective. The only statistically significant difference seen was in the higher percentage of women taking regular pharmacological medication (hormonal contraception was not included in this category) - namely 40% of women taking regular medication vs. 60% of women without medication vs. 85% of men without regular medication vs. 15% with regular medication (p=0.019). The differences in parameters across categories are summarized in Table No. 2.

Conclusion

Except for the total number of men and women screened, we do not see a significant difference in indication, screening, diagnosis and eligibility proposal between genders.
The role of the arrhythmologist in a sports cardiology centre: the devil is in the detail
Authors: Jiravsky O , Pesova P , Spacek R , Krausova D , Pleva M , Miklik R , Sknouril L , Jiravska Godula B
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

The role of the arrhythmologist in a sports cardiology centre (SCC) is to provide comprehensive care to athletes with cardiac arrhythmias.

Objective

To determine the proportion of athletes with arrhythmias examined at a SCC. To define the differences in care between an athlete with and without arrhythmia.

Methods

Retrospective analysis of the registry of all athletes of one SCC. Identification of patients=athletes with arrhythmias, description of key differences in access to arrhythmology subunits.

Cohort: Between 1/2020-6/2022, a total of 115 cases of athletes, 100 males and 15 females (13%), aged 26 (+/-11 years), were examined and definitively closed at SCC. Twenty-two athletes (19%) received care for cardiac rhythm disorders. Duration of sports activity was at the borderline of statistical significance in demographic parameters (see Table No. 1), with 15 (+/-11) vs 12 (+/-8) years for athletes with non-arrhythmic diagnoses (p=0.085).

Results

In the statistical comparison of the groups without and with arrhythmias (Table No. 2), we see a statistically significantly higher proportion of athletes presenting because of symptoms and with pathological findings of the pre-participation screening, with a higher proportion of family history of sudden cardiac death, with a higher proportion of coronary CT use and an extraordinary statistical significance of cardiac MRI use. Conversely, there is no statistically significant difference in diagnosis and impact on sports eligibility.

The sports cardiologist must be particularly cautious in the diagnosis and treatment of ventricular extrasystoles, which have a different "diagnostic-eligibility" pathway for athletes. Similarly, they must listen to the medical history more than non-athletes and be willing and able to use various sports monitor records.

In invasive methods of diagnosing and treating arrhythmias, it is necessary to understand when arrhythmias occur in real life and try to mimic the diagnostic conditions of this situation (e.g., when inducing clinical arrhythmias that an athlete has in real life during the peak moments of a match or race). Last but not least, the sports cardiologist must communicate the potential changes that may occur by ablative treatment of the arrhythmia (e.g., a decrease in maximal heart rate after AVNRT ablation on the so-called slow pathway, or, e.g. a possible increase in resting heart rate after pulmonary vein isolation with radiofrequency or laser energy).

Conclusion

Athletes with arrhythmias are different in many aspects, and the role of the arrhythmologist in the sports cardiology team is to be prepared to respect these differences in an effort to provide the best possible care for the athlete.
Outcomes of a cardiac screening program: are those referred worse off?
Authors: Abela M , England K , Grech V
Published: May 2023

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): 1. Cardiovascular PHD Scholarship awarded by Research, Innovation and Development Trust Malta (supported by Beating Hearts Malta). 2. Tertiary Education Scholarship Scheme.

Introduction

Awareness of sudden cardiac death in young individuals is gaining momentum. The evidence supporting screening in non-athletic individuals is also growing, but outcome data in this subgroup is lacking.

Objective

This study assessed the short-term outcomes of a large cohort of screened Maltese adolescent individuals. Outcome analysis was also extended to a large group of age matched individuals who were not offered systematic screening.

Methodology

Fifth form students (born 2002) were systematically invited to undergo cardiac screening in the 2017/2018 scholastic year. Most were cleared at screening (Group 1). The rest were referred at enrolment or had an abnormal ECG with a known diagnosis (Group 2). Events since enrolment were obtained from hospital databases.

Outcome analysis for adolescents born in 2001 who were alive and residing in Malta in 2017 was also conducted (Group 3). Data was collected through public registries. These individuals were not offered systematic cardiac screening.

An event was defined as death, hospitalisation (cardiac symptoms with abnormal findings, arrhythmias or heart failure) or cardiac intervention. Kaplan Meier and log rank analysis (IBM SPSS Statistics vs23) were used to determine the event free proportion in both groups. Events deemed to be of an acquired nature (inflammatory disorders or trauma) were disregarded.

Results

The cohort consisted of 6580 adolescents. Groups 1 and 2 included 2672 adolescents (mean age 15.0±0.33 years, 50.4% female). 109 (4.1%) were referred for further evaluation.

After a median follow-up of 52±2 months, 9 (0.3%) subjects experienced an event. No deaths were recorded. Events included hospitalisation (Group 1: n=2, Group 2: n=5) and interventions (Group 1: Pacemaker n=1, Group 2: EPS & ILR n=6). One subject (Group 2) had 3 events. Group 2 were more likely to experience an event (p<0.001). 99.9% in Group 1 and 94.8% in Group 2 remained event free.

Group 3 consisted of 3913 subjects. This group was also followed up for 52±1 months. Three subjects (0.1%) had an event (n=1 hospitalisation with a new diagnosis of cardiomyopathy, n=2 EPS & ILR) at a similar rate as group 1 (p=0.097) and lower compared to group 2 (p<0.001). 99.9% remained event free.

Conclusion

Participants in group 2 were more likely to experience an event. Cardiac screening does not offer any outcome benefit in the short term. Studies with longer follow-up periods are required to determine the efficacy of a cardiac screening program.
Secondary prevention of Coronary Heart Disease (CHD) in the Moroccan population. Survey of Risk Factor (SURF) CHD II Morocco
Authors: Tazi Mezalek A , Squalli Houssaini Z , Soufiani A , Mouine N , Marza Florensa A , Alami M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Global Cardiovascular (CV) mortality is highly increasing, mainly in low and middle-income countries because of lifestyle change and the rise of cardiovascular risk factors. Controlling these risk factors is very important to reduce cardiovascular disease morbidity and mortality. Risk factor control is particularly important in patients with established cardiovascular disease since these patients are at very high cardiovascular risk.

SURF is an international and simple clinical audit that aims to record and manage cardiovascular risk factors in patients with established coronary heart disease (CHD).

The goal of this analysis is to investigate risk factor recording and management in secondary prevention of CHD in the Moroccan population, a country considered as a very high CV risk according to the European Society of Cardiology.

Methods

Data of Moroccan patients with documented coronary heart disease (including stable angina pectoris, acute coronary syndrome, PCI and CAGB) were collected via an online survey during routine clinic visits. Patients’ demography, risk factors, physical and laboratory measurements, and medications were recorded.

Results

A total of 324 patients were recruited in 3 different centers in Morocco. There was a male predominance (81.5%) and mean age was 66.5 (SD 10.6) years.

Recording of risk factors was high for smoking (96.7%), physical activity (97.3%) and blood pressure (87.8%). However, for some risk factor measurements like LDL cholesterol (recording 29.9%), information was often missing. Risk factor recording in Morocco was higher than the North Africa and Eastern Mediterranean (NAEM) regional and global estimates for smoking and physical activity; similar for blood pressure; and lower for LDL levels.

Considering the attainment of risk factor goals defined by clinical guidelines, 79.6% of patients never smoked or quit smoking, and 25.0% were practicing physical activity at least 30 min 3-5 times a week. Regarding risk factor measurements, 38.2% had blood pressure <140/90mmHg and 27.3% had LDL <1.8mmol/L. Cardiac rehabilitation programs were attended by 3.5 % of participants. The level of target attainment in Morocco was like regional and global levels for smoking; like regional but lower than global results for physical activity; and lower than regional and global estimates for blood pressure and LDL.

Conclusion

The patients enrolled in our registry have multiple modifiable risk factors, with a poor control. The results underline the need for interventions to improve secondary prevention of CHD in Morocco.
For lifestyle recommendations, better be rich and well educated
Authors: Patriota P , Marques-Vidal P
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Management of cardiovascular risk factors (diabetes, hypertension, and high cholesterol levels) should start by implementing a healthy lifestyle. Whereas lifestyle recommendations are provided irrespective of the patient’s socio-economic status has not been recently assessed in the Brazilian population.

Aims

To assess the preventive measures against cardiovascular risk factors according to educational level and income in the Brazilian population.

Methods

We used survey data of the 2019 Brazilian National Health Survey (PNS). The PNS is a nationwide household-based survey carried out by the Brazilian Ministry of Health. The PNS included face-to-face interviews and collected information on lifestyle management of diabetes, hypertension and high cholesterol levels by a healthy diet, an adequate weight, and quitting smoking. Information on the participant’s educational level and income (in multiples of the basic salary per capita) was also collected.

Results

Of the 81,197 participants included, 7,293 (9.0%), 23,065 (28.4%) and 13,304 (16.4%) reported being diagnosed with diabetes, hypertension, and high cholesterol levels, respectively. Dietary recommendations were the most frequently provided (94.8%, 94.6% and 88.6% for diabetes, hypertension, and high cholesterol levels, respectively), while recommendations to stop smoking were the least frequently provided (72.6%, 62.0% and 68.2% for diabetes, hypertension and high cholesterol levels, respectively). After multivariate adjustment, participants with a higher educational level or a higher income had a higher likelihood of being given lifestyle recommendations for hypertension or high cholesterol, while no significant trends were found for most recommendations for diabetes; see table, significant (p<0.05) trends are in grey background.

Conclusion

Better educated, wealthier Brazilians benefit more from lifestyle recommendations regarding cardiovascular risk factor management. This could impact the incidence of CVD according to socioeconomic groups.
Retrospective cohort study at two centers, systolic blood pressure response during exercise testing
Authors: Pesova P , Jiravska-Godula B , Jiravsky O , Sovova M , Moravcova K , Ozana J , Sovova E
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Palacky University Olomouc Faculty of Medicine Czechia.

Introduction

Measurement of blood pressure (BP) is a standard part of the exercise testing protocol in the general population and in athletes, however, we do not have a sufficient definition of normal and abnormal blood pressure response to exercise and we don´t know the prognostic impact of exercise systolic blood pressure.

Purpose

To present systolic blood pressure values during exercise in athletes examined by an exercise test.

Methods

Retrospective analysis of blood pressure response to exercise in a selected cohort of athletes who performed a bicycle ergometer exercise test at two centers. We excluded individuals with prevalent cardiovascular disease. An individual ramp protocol to maximum was used and blood pressure was measured by auscultation method. Resting BP and the highest systolic blood pressure during exercise (SPBmax), maximum heart rate (TF), and maximum workload were recorded for each individual. The SBP/Watt-slope and the SBP/Watt-ratio at peak exercise were calculated. The SBP/Watt-slope was calculated as the ratio of the difference in the rest SPB and peak SPB measurement over the increment of workload. The SBP/Watt-ratio at peak exercise was calculated as the ratio of peak SBD over the peak workload. Sex-specific mean values, standard deviations, and 5th, 25th, 75th and 95th percentiles were determined.

Results

Between the years 2015 and 2021, 14 702 individuals – 3821 females (27,2 %) and 10 251 males (72,8 %) – underwent the exercise test, with an average age of 19 years (±14). The average Body Mass Index (BMI) was 21,1. The average maximum heart rate achieved was 183/min (±16) and the average peak workload achieved was 3,9 W/kg regardless of gender. The following values were calculated for the whole cohort: peak SBP/Watt-ratio and SBP/Watt-slope. More detailed results are in Table 1. Sex-specific values can be seen in Table 2.

Conclusion

The values of BP response during exercise testing in our cohort are comparable to recently published data. These data can change the interpretation of SPB response to exercise in the future. There is also a strong need for further research-the multivariate analysis of factors associated with a higher blood pressure response to exercise and determination of sex and age-specific values.
Measurement of small, dense lipoproteins. Usefulness of the Tg/HDL index compared to direct LDL measurement
Authors: Morales Alcazar C , Morales Alcazar C , Martinez Rodriguez A , Martinez Rodriguez A , Fernandez Olmo R , Torres Llergo J , Torres Llergo J , Segura Aumente J , Segura Aumente J , Puentes Chiachio M , Puentes Chiachio M , Fernandez Anguita M , Fernandez Anguita M , Garcia Ruano A , Garcia Ruano A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None. Main funding source(s): Ninguna

Introduction

The Triglyceride/HDL (Tg/HDL) ratio when > 2 is translated into the presence of small, dense lipoproteins (sdLDL), which are more atherogenic and help us measure global lipid risk regardless of LDL levels. There is the possibility of measuring sdLDL directly, but it is not performed in routine clinical practice. The objective of our study was to analyze the correlation of the TG/HDL index with the direct measurement of sdLDL and cardiovascular risk (CVR).

Materials and methods

Patients who were treated in cardiology from July 1 – July to September 30, 2022 were analyzed consecutively and the determination of the lipid profile with direct measurement of sdLDL was requested. This measurement is considered risk when sdLDL> 50 mg/dl.

Results

n 75. Mean age 60 ± 15 years. 37.3% were women. 49.3% were hypertensive, 48% dyslipidemic, 22.7% diabetic, 32% smokers, 58.7% very high CVR and 54.7% with lipid-lowering treatment. Mean LDL levels were 84.3±37 mg/dl, non-HDL 110±39 mg/dl, triglycerides 139±75 mg/dl, remnant cholesterol 27.8 ±15 mg/dl, LDL-sd 34±20 mg/dl and Tg/HDL 3.5±±2. Patients with Tg/HDL>2 had mean sdLDL levels 36± 23 mg/dl vs 29.7 ± 14 mg/dl (p0.06) and those with Tg/HDL>3 39.8± 26 mg/dl vs 28.9± 12 mg/dl ±(p<0.02). All patients with LDL> 50 mg/dL levels had Tg/HDL>2, however 60% of patients with Tg/HDL>2 had LDL<50 mg/dL levels (p0.01), but only 37% Tg/HDL>3 (p<0.001). (Table 1. Relationship between lipid profile, Tg/HDl and LDL-SD) 20% of very high/high RCV patients had LDL>50 mg/dl, 9.1% moderate RCV and 12.5% low RCV.

Conclusions

The Tg/HDL index may be more useful in identifying patients with LDL> 50 mg/dl primarily when it is > 3.
Effect of hybrid cardiac rehabilitation using a smart device: a randomized controlled trial
Authors: Lee J W , Yoo J Y , Cho H Y , Kim C , Sung J , Han J Y , Jee S
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Korea National Institute of Health.

Background

Although cardiac rehabilitation (CR) has been proven to be effective in secondary prevention for patients with cardiovascular diseases, the actual participation in CR is still unsatisfactory. Because home-based CR provides better access to patients and is as effective as center-based CR, it is considered a promising alternative that can overcome various barriers impeding CR implementation. However, home-based CR has not garnered enough attention due to a lack of proper communication, concerns about unexpected adverse events caused by non-monitored exercises, and the absence of supporting insurance services.

Purpose

We utilized a smart ring with a photoplethysmography to monitor heart rate. Recorded data were stored on a website where the researchers could remotely access and check the uploaded measurements. This study aims to identify the clinical effects of hybrid CR by weekly telephone counseling based on the patients' actual physical activities obtained from the device.

Methods

Cardiovascular disease patients were educated on concrete methods of home-based CR, including the type, intensity, and time of exercise as well as precautions. They were also instructed to wear the device during exercise. The patients were randomly enrolled into two groups: intervention and observation groups. The patients of the intervention group were given weekly telephone counseling and encouraged to maintain optimal physical activities. In the observational group, only exercise data were recorded without additional interventions. Before and after three months of training, the results of the symptom-limited cardiopulmonary exercise test between the two groups were compared.

Results

A total of sixty-four patients were enrolled (thirty-two in each group). The subjects were 59.8 ± 9.0 years old and fifty-three (82.8%) were male. There were no significant differences in diagnosis and results of baseline symptom-limited cardiopulmonary exercise test between the two groups (Table 1). After three months of training, peak oxygen consumption was significantly improved in both groups. However, the improvement was greater in the intervention group compared to the observation group (Table 2).

Conclusion

Home-based CR using a smart device was effective in improving oxygen consumption. For greater effectiveness, proper monitoring and timely counseling by medical experts are likely to be necessary.
Physical fitness in patients with diabetic dyslipidemia: Diabetes or dyslipidemia to blame?
Authors: Yigit S , Akinci B , Ulker Eksi B , Korkmaz Dayican D , Calikoglu B F , Yeldan Karagoz I , Satman I
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Diabetic dyslipidemia is common in individuals with type 2 diabetes mellitus (T2DM), as a result of the atherogenic lipid profile seen due to deficiency in insulin hormone. Metabolic disorders such as poor glycemic control, endothelial dysfunction and increased free fatty acids may affect health-related physical fitness parameters in diabetic dyslipidemia.

Purpose

The aim of our study is to examine health-related physical fitness parameters in T2DM patients with and without dyslipidemia.

Methods

65 T2DM patients (mean age=51.9±6.5/years, F:48, M:17) diagnosed with diabetic dyslipidemia (low-density lipoprotein (LDL-C) ≥ 100 mg/dL) and 36 T2DM patients (mean age=52.8±6.4/years, F:25, M:11) without dyslipidemia were included in the study. All patients with diabetic dyslipidemia were on statin treatment. Glycosylated haemoglobin (HbA1c), fasting blood glucose (FBG), high-density (HDL-C) and low-density lipoprotein (LDL-C), triglyceride, and total cholesterol were noted. Body composition (TANITA), right and left quadriceps muscle strength (J-Tech Commander Muscle Tester), grip strength for dominant hand (Jamar dynamometer), functional capacity (6 Minute Walk Test) and physical activity level (pedometer, Omron HJ 321E Walking Style) were assessed.

Results

HbA1c, FBG, body composition, muscle strength, functional capacity and physical activity levels of the groups were all similar in T2DM patients with or without dyslipidemia (p>0.05) (Table 1). LDL-C and triglyceride were significantly higher in T2DM patients with dyslipidemia (p<0.0001). There was a significant negative correlation between LDL-C and right (r=-0.349, p=0.004) and left quadriceps (r=-0.354, p=0.004) muscle strength in T2DM patients with dyslipidemia.

Conclusions

In this study, it was observed that dyslipidemia did not have a distinctive effect on health-related physical fitness parameters in individuals with T2DM. It was also observed that LDL-C was associated with lower extremity muscle strength in diabetic dyslipidemia.
Predictors of cardiovascular disease in a familial hypercholesterolemia unit
Authors: Cubillas Quero A , Eliche Mozas P , Cruz Romero L , Diaz Caler A B , Duran Torralba M C , Cortez Quiroga G A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Screening and cascade screening for familial hypercholesterolemia (FH) is advised in patients with early coronary heart disease (ECHD) or high-risk dyslipidemia LDL-c >190 mg/dL without secondary cause. The diagnostic rates of FH by genetic testing are 5-9% in patients with ECHD and 2-5% in patients with high-risk dyslipidemia.

Methods

Observational retrospective study of a cohort of 615 patients over 18 years of age, included in an HF unit (177 index cases and 438 first-grade relatives). The population was divided into 201 (32.7%) patients with cardiovascular disease (CVD) (Group A), and 414 patients without CVD (Group B). Clinical characteristics, variables of the inclusion blood test in the HF unit and the lipid-lowering treatment implemented were compared.

Results

Group A patients were older, wiht a higher proportion of male, higher rates of hypertension and diabetes, higher body mass index (BMI), higher percentage of obese, and no difference in historical maximum LDL-c levels compared to Group B.

Group A patients, as a result of CVD, receivedmore potent lipid-lowering treatment, had lower levels of LDL-c but without differences in meeting their LDL-c objective (45.7% vs 39%, p=0.19), presented a higher rate of small and dense LDL-c either measured by LDL-c/ApoB ratio <1.3 or Triglycerides/HDL-c >2, and lower HDL-c values with a higher percentage of values minor than 40 mg/dL in men and less than 45 mg/dL in women (HDL-c <40-45). Group A had higher lipoprotein (a) values and higher lipoprotein (a) >180 mg/dL (equivalent to FH), a higher proportion of chronic kidney desease and increased uric acid (table 1).

Conclusions

In a population of patients with suspected FH, the presence of CV risk factors (male sex, older age, high blood pressure, diabetes, obesity, chronic kidney desease), and atherogenic blood test (HDL<40-45, increased lipoprotein (a), increased uric acid, small and dense LDL-c) were associated with CVD. The detection of these in this patient population of patients should lead us to act early and aggressively to prevent the development of CV events.
Right ventricle adaptation to high intensity training assessed by cardiac magnetic resonance in olympic athletes
Authors: Monosilio S , Prosperi S , Ciuffreda A , Lemme E , Di Gioia G , Mango R , Tonti G , Pedrizzetti G , Gualdi G , Pelliccia A , Squeo M R , Maestrini V
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Several determinants affect cardiac remodelling in athletes, including sport discipline, body size and sex. Recently, interest in myocardial deformation (MD) imaging as reliable functional index is growing. Available MD data are usually derived by echocardiography and mostly related to the evaluation of the left ventricle. Data on right ventricle (RV) deformation assessed by CMR are lacking and, currently, specific reference values in athletes have not been explored.

Purpose

To assess RV deformation in a cohort of Olympic athletes and to evaluate possible inter-individual differences related to type of sport and sex.

Methods

A cohort of Olympic athletes with unremarkable cardiovascular pre-participation screening tests was enrolled. A group of sedentary individuals was also enrolled for comparison. All subjects underwent CMR without contrast. Cine-images were post-processed to assess RV volume, ejection fraction (EF) and MD by computing global longitudinal strain (GLS) by feature-tracking software. Athletes were divided in subgroups based on sex, ESC sport classification and RV enlargement (RVEDV/LVEDV>1 or ≤1).

Results

265 Olympic athletes (15% skill, 19% power, 25% mixed, 41% endurance; 58% male) and 21 sedentary controls were enrolled. Endurance athletes showed the greatest RV remodeling in terms of volumes (Table). No differences in RV-EF were found comparing athletes of different sport categories, but between athletes and sedentary controls. Median value of RV-GLS of the whole athletic cohort was -23 (-21, -25). There were no significant differences among the different sport disciplines other than endurance vs. sedentary controls for RV-GLS. Female athletes showed higher values of RV-GLS when compared with males. When examined with regard to presence of RV enlargement, no differences were observed (Figure).

Conclusion

Endurance athletes showed the greatest right ventricle remodelling in terms of RV volumes and function. Specifically, they showed the highest values of RV volumes and the lowest values of RV-GLS of the entire athlete’s population, but still within the normal range. Female athletes had higher RV-GLS values when compared with males. No difference was observed between athletes with dilated RV compared to non-dilated RV.
Native T1 and T2 mapping by CMR in a cohort of olympic athletes: does sport discipline make difference?
Authors: Monosilio S , Prosperi S , Birtolo I L , Lemme E , Di Gioia G , Mango R , Gualdi G , Pelliccia A , Squeo M R , Maestrini V
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiac Magnetic Resonance (CMR) represents the gold standard for morpho-functional assessment and for myocardial tissue characterization. Although Mapping technique provided added value to tissue characterization, data on Mapping in athletes are still scarce and differences between sport disciplines have not been evaluated.

Purpose

To compare T1 and T2 Mapping values between Olympic Athletes engaged in different types of sport and a control group of sedentary subjects.

Methods

A group of Olympic athletes with unremarkable cardiovascular pre-participation screening prior the Olympic games underwent CMR without contrast administration. A group of sedentary subjects was enrolled as a control group. Cine, native T1 and T2 Mapping were analyzed. Athletes were divided in different sports categories according to the ESC classification.

Results

265 Olympic athletes (15% skill, 19% power, 25% mixed, 41% endurance - 58% male) and 21 controls were enrolled. Comparing athletes of different sport categories and sedentary controls, endurance presented the lowest value of T1 Mapping. T2 Mapping was slightly higher in endurance athletes but were within normal limits (referred to local normal range) (Table). Compared with males, female athletes had higher values of T1 native myocardial Mapping [956 (934-981) vs 941 (926-963); p=0,004], while there were no significant differences regarding T2 Mapping values (p=0,874) (Figure).

Conclusion

T1 was lower and T2 Mapping slightly higher athletes engaged in endurance compared to other sport disciplines and sedentary controls. Female athletes showed higher T1 native myocardial Mapping compared with males, while T2 Mapping did not show differences.
Atrial fibrillation - environmental and socio-economic determinants at regional level. Case of Poland
Authors: Roszkowska S
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

The study aimed to assess the influence of environmental and socioeconomic factors on the prevalence of hospitalization for atrial fibrillation (AF).

The rate of AF hospitalizations in Poland is one of the highest in Europe. The risk of hospitalization in patients with AF is related not only to lifestyle, but also to environmental, economic, social factors and the organization of the health care system.

Using National Institute of Public Health, Central Statistical Office and Voivodeship Inspectorates for Environmental Protection in Poland data and panel data techniques (including spatial ones) the impact of environmental and socioeconomic factors on AF in Poland has been estimated. The age- and sex-standardized data on the prevalence of hospitalization due to AF in Poland in 2012-2019 on poviats level were explained using set of air quality indicators (namely PM2.5), environmental factors, organization of the health care system and regional determinants of the socioeconomic situation.

An increase in the number of physicians by 1/1000 of the population and healthcare expenditure by PLN 100 per capita resulted in a decrease of 2% (-0.002 [-0.003;-0.001]; P=0.002) and 5%(-0.005 [-0.008;-0.002]; P<0.001) in the number of hospitalisations due to AF in the group under 64 years. A 1 pp increase in the proportion of green areas resulted in a 4% decrease in hospitalisations. In contrast, an increase in GDP per capita by 1 th PLN and a decrease in the proportion of people working in agriculture by 1 pp were associated with a 1%( -0.010; [-0.013;-0.007]; P<0.001) and 0.2% decrease in hospitalisations, respectively.

There is geographical variation in the prevalence of AF and socioeconomic factors are an important determinant of this condition. In the working-age group, improvements in the economic situation are likely to have positive health effects, in contrast to those in the post-working age group, where increases in health sector expenditure have the greatest effect.
Extreme cardiac remodelling observed in elite endurance athletes: analysis of myocardial deformation and estimated hemodynamic forces
Authors: Monosilio S , Prosperi S , Ciuffreda A , Lemme E , Di Gioia G , Mango R , Pedrizzetti G , Tonti G , Gualdi G , Pelliccia A , Squeo M R , Maestrini V
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Athletes of endurance disciplines present the highest level of cardiac remodelling often generating concerns for differential diagnosis with cardiomyopathies. In addition to standard morpho-functional evaluation, left ventricle (LV) myocardial deformation (MD) and estimated intra-ventricular hemodynamic forces (HDFs) are emerging diagnostic tools, particularly in heart failure patients. In the athletic population MD data are scarce while HDFs are lacking.

Purpose

To describe MD and HDFs evaluated by CMR feature-tracking in a cohort of endurance Olympic athletes and to evaluate the possible relationship with LV geometry.

Methods

A group of endurance Olympic athletes evaluated prior the Olympic games and with unremarkable cardiac pre-participation screening tests was enrolled. All athletes underwent CMR without contrast administration. Cine images were post-processed to evaluate end-diastolic and end-systolic LV volumes, ejection fraction (LVEF), global longitudinal and circumferential strain (GLS and GCS) and estimated HDFs by a dedicated feature-tracking software. HDFs were measured in apex-base (AB) and latero-septal (LS) directions, over the entire cardiac cycle, in systole and diastole. LS/AB ratio was also derived to determine forces distribution. Athletes were divided in subgroups according to the 3D sphericity index (< 40% or 40%). A group of sedentary subjects was enrolled as a control group.

Results

109 endurance Olympic athletes (62% male; mean age 26 ± 5 years) and 21 sedentary subjects were enrolled. Athletes with increased sphericity index (≥40%) were 61 (56%) and presented with greater EDV, ESV and lower LVEF compared to those without increased sphericity and controls (Table). No significant differences were found between athletes and controls regarding LV-GLS and GCS. HDFs distribution was not different between groups and even athletes with a more spherical LV shape showed an HDFs diastolic ratio comparable to those of athletes with lower sphericity index and control.

Conclusion

Although more than half of endurance athletes presented with altered geometry (increased sphericity index), strain parameters and hemodynamic forces were not different from sedentary controls and those athletes without increased sphericity. The use of advanced parameters to evaluate cardiac function could be used as a tool to confirm the benign nature of cardiac adaptation due to intense exercise training.