bluuebunny/crossref_metadata_2025 huggingface dataset:
Addition of inspiratory muscle training to a combined exercise rehabilitation program improves systemic microcirculation of chronic heart failure patients
Authors: Katsoula C , Karatzanos E , Vasileiou I , Briasoulis A , Papadopoulou E , Kontogeorgos C , Kalampakos N , Papazachou O , Routsi C , Nanas S , Vasileiadis I
Published: June 2024

Introduction

Chronic heart failure (CHF) has been characterized with microcirculation and endothelial abnormalities, as well as impaired function of the respiratory system. Exercise training programs have been an important component of CHF rehabilitation. Inspiratory muscle training (IMT), a supplementary form of exercise, induces beneficial effects on the functional status of patients; however, there have not been much data on its effects on the systemic microcirculation.

Purpose

The aim of the study was to evaluate the effect of the addition of an IMT regime to a combined exercise rehabilitation program on the microcirculation of non-exercising muscles (systemic effect) in CHF patients.

Method

Twenty-five (22♂/3♀) stable CHF patients, on optimal medication, [age: 60.3±8.9 years, ejection fraction (EF): 32.3±7.7%, maximal inspiratory muscle pressure (MIP): 81.9±23.8 cmH2O, predicted MIP (%): 89.1±25.6, VO2peak:17.9±3.9 ml/kg/min, NYHA≥ΙΙ] were randomly assigned to the intervention group (IG, n=12) or the control group (CG, n=13) and trained 3×/week for 12 weeks. Both groups participated in a combined regime (aerobic exercise and muscle training). In addition, IG performed IMT (5 sets × 10 repetitions, 35-60% MIP) and CG sham-IMT (5 sets × 10 repetitions, 10% MIP). Systemic microcirculation was assessed with near-infrared spectroscopy (NIRS) and the 3-min vascular occlusion technique at the thenar muscle. Cardiorespiratory exercise testing and muscle strength assessment were also performed, before and after the program. Microcirculation variables evaluated included oxygen consumption rate and reperfusion rate. Values are expressed as mean and standard deviation.

Results

Reperfusion rate improved in the IG compared to the CG (from 3.5±1.6 to 4.5±1.4 %/min vs 3.2±1.6 to 3.2±1.8 %/min, p<0.05), while oxygen consumption rate did not change (IG: from 12.9±3.6 to 14.1±2.9 %/min, CG: 12.4±4.8 to 12.9±5.5 %/min, p>0.05). There was a significant between-group difference for MIP (IG: from 74±29 to 98±21 cmH2O, CG: from 90±16 to 91±16 cmH2O, p<0.05). Not any between-group differences (p>0.05) were found for VO2peak (IG: from 18.2±3.7 to 19.2±4.3 ml/kg/min, CG: from 17.6±4.1 to 18.5±4.7 ml/kg/min), maximum workload (IG: from 120±52 to 132±49 watt, CG: from 119±43 to 129±45 watt), maximum leg extension load (IG: from 42±14 to 48±14 kg, CG: from 42±16 to 47±18 kg), or any other cardiorespiratory and strength variables evaluated.

Conclusions

An IMT regime, in addition to a combined exercise training rehabilitation program, improved the systemic microcirculation in CHF patients; in particular, the reperfusion rate index, which reflects the endothelial function.
Assessing blood pressure control and antihypertensive therapy in patients with hypertension: a comparison with one-year medical records data in Bulgaria (SNAPSHOT study)
Authors: Postadzhiyan A , Garkov K I R I L
Published: June 2024

Background

Hypertension poses a significant public health challenge in Bulgaria, requiring comprehensive strategies for prevention and management.

Purpose

The aim was to assess the evolution of blood pressure (BP) control and antihypertensive therapy compared to one year earlier in patients with hypertension.

Methods

SNAPSHOT was a cross-sectional, observational, multicentre, epidemiological study conducted in Bulgaria. It involved 129 investigators and included 3366 patients with hypertension. Patients’ data were collected from both a single visit and medical records dating back one year.

Results

A total of 3363 patients were analysed, with a mean (standard deviation [SD]) age of 67.2 (10.8) years. Most patients were female (60.9%), educated at secondary school level (63.4%), overweight or obese (77.9%), and non-smokers (76.5%). The mean (SD) systolic and diastolic BP were 143.1 (18.4) mmHg and 84.3 (11.8) mmHg, respectively, during the study visit, compared with values of 135.9 (14.9) mmHg and 82.3 (8.2) mmHg obtained from medical records on average 11.1 (5.5) months earlier. Systolic/diastolic BP was assessed as <140/90 mmHg in 39.1% of patients at the study visit, compared to 55.1% one year earlier. At the study visit, BP was considered as controlled according to stricter age and diseases specific targets in the guidelines in 22.8% of patients, compared to 16.0% one year earlier (Figure 1). For most patients (73.8%), BP control status, as per guidelines, remained consistent between the study visit and one year earlier. Most patients (67.5%) did not achieve controlled blood pressure at either time (Figure 2).

At the study visit, almost all patients (99.5%) were treating their hypertension, took their treatment once or twice daily (94.7%). The most used medications were beta blockers (61.2%), diuretics (57.5%), and/or angiotensin-converting enzyme inhibitors (48.6%) and medications were mostly combined as bitherapy (32.2% patients) or as combination of 3 drugs (36.4% patients). No change in therapy was recorded for most patients (68.1%) between the medical records and the study visit one year later. However, a mean systolic BP of 150.6 mmHg triggered a treatment dose increase in 13.8% of patients, while the number of antihypertensive drug class was increased in 15.3% of patients in response to mean systolic BP of 148.0 mmHg. There was a switch from free combinations to a single pill combination in 7.1% of patients.

Conclusion

This study revealed a concerning prevalence of uncontrolled hypertension, with similar rates observed in one year observation. This emphasised the need for more effective management strategies to improve BP control in patients with hypertension. Figure 1  Figure 2
Pyridoxal-5'-phosphate as a cost-effective treatment option for hypertension
Authors: Lellig M , Munoz-Castaneda J M , Hermann J , Noels H , Rodriguez M , Tepel M , Jankowski J , Jankowski V
Published: June 2024

Background/Introduction

Hypertension is a worldwide health problem and treatment options in low-income countries are still limited. This results in high mortality. Therefore, the availability of drugs that are affordable and accessible to patients in low-income countries is still an urgent need. Angiotensin II, one of the essential vasoconstrictive peptides in the human organism, is post-translationally modified to pyruvamide-angiotensin II by pyridoxal-5’-phosphate. Pyridoxal-5’-phosphate is a less expensive vitamin B6 derivative and therefore could be a novel, cost-effective drug for the treatment of hypertension.

Purpose

We analysed the impact of post-translational modification of angiotensin II to pyruvamide-angiotensin II by pyridoxal-5’-phosphate on blood pressure.

Methods

The post-translational modification of angiotensin II to pyruvamide-angiotensin II by pyridoxal-5’-phosphate was investigated in vitro by mass spectrometry. Calcium ion influx into vascular smooth muscle cells treated with angiotensin II or pyruvamide-angiotensin II, respectively, was also investigated in vitro. In ex vivo experiments, the vasoconstrictive effect of angiotensin II and pyruvamide-angiotensin II, respectively, was analysed by using the bioassay of the isolated perfused rat kidneys. Furthermore, angiotensin II and pyruvamide-angiotensin II were investigated in in vivo experiments. Both Wistar Kyoto rats and spontaneously hypertensive rats were treated with pyridoxal-5’-phosphate by using mini-osmotic pumps and the blood pressure was measured time-dependently.

Results

Calcium ion influx in vascular smooth muscle cells after stimulation with pyruvamide-angiotensin II was lower compared to angiotensin II. Perfusion pressure of isolated perfused rat kidney increased less by pyruvamide-angiotensin II than by angiotensin II. Furthermore, the systolic and diastolic blood pressure of SHR treated with PLP decreased to physiological levels after three days of treatment (syst./diast.: 171 ± 1 / 139 ± 5 mmHg vs. 129 ± 1 / 98 ± 2 mmHg; p<0.0001). The blood pressure of WKY rats treated with Ang II increased to hypertensive values after three days of treatment, while the blood pressure of WKY rats treated with Ang II and PLP is within the physiological range (syst./diast.: 167 ± 1 / 133 ± 3 mmHg vs. 129 ± 1 / 99 ± 2 mmHg; p<0.0001).

Conclusions

Pyridoxal-5’-phosphate significantly decreased rat blood pressure and might be a cost-effective drug for hypertension treatment. Respectively, an increased pyridoxal-5’-phosphate intake recommendation in the form of vitamin B6 intake might have a decreasing effect on blood pressure in the hypertensive population.
Assessing the reliability of coronary artery calcium score in symptomatic patients: challenging the 'power of zero'
Authors: Basaran O , Beyoglu B , Bastug H , Demirci E , Akdeniz H , Dereli H , Uyanik B S
Published: June 2024

Background

The concept of a zero coronary artery calcium (CAC) score has been associated with a favorable prognosis and a high negative predictive value for excluding obstructive coronary artery disease (CAD), commonly known as the "power of zero." However, this approach has certain limitations, such as its inability to detect non-calcified plaques. In this study, we aimed to investigate the prevalence of both obstructive and non-obstructive plaques in patients with a CAC score of zero.

Methods

We conducted a retrospective evaluation of symptomatic patients who had undergone coronary artery calcium scoring and coronary computed tomography angiography (CCTA) between January 2020 and December 2021 at our institution.

Results

Out of the 884 patients enrolled in the study, 516 were found to have a CAC score of zero. Among these patients, the mean age was 51.9±11.0 years, and 51.6% were male. Surprisingly, 81 patients (15.7%) with a CAC score of zero exhibited some degree of plaques, while 435 patients (84.3%) had no detectable plaques. Among those with plaques, 25 (4.8%) had mild plaques, 47 (9.1%) had moderate plaques, and 9 (1.7%) had obstructive plaques as revealed by CCTA. Further details on the severity and extent of plaques can be found in the figure.

Conclusion

Our study unveiled a significant number of symptomatic patients with a CAC score of zero who actually had atherosclerotic plaques. This finding challenges the notion of the infallible "power of zero" in symptomatic patients. While CAC scanning remains valuable for risk stratification, it should be acknowledged that relying solely on a CAC score of zero may overlook cases with underlying atherosclerotic plaques. As a result, clinical decision-making should involve a comprehensive assessment, and further investigation might be necessary to ensure an accurate diagnosis and appropriate management in symptomatic patients.
Assessing the impact of long-term high-dose statin treatment on perivascular inflammation and plaque distribution - a comprehensive coronary CTA follow-up study
Authors: Matyas B , Benedek I , Rat N , Blindu E , Parajko Z S , Mihaila T , Benedek T
Published: June 2024

Background

Coronary computed tomography (CCT) has validated the use of perivascular fat attenuation index (PVAT-FAI) as a credible indicator of coronary inflammation and plays a crucial role in coronary artery disease (CAD), particularly concerning plaque vulnerability and progression. Various investigations have delved into the potential benefits of statins in mitigating the hazard of plaque rupture and ensuing cardiovascular episodes. The impact of statin therapy on PVAT-FAI, however, remains yet to be distinctly illustrated.

Purpose

We aimed to evaluate the long-term effects of high-dose statins on PVAT-FAI changes at the site of coronary lesions and to examine changes in plaque distribution and lipid profile modifications during follow-up visits.

Methods

Our prospective observational study included patients with typical chest pain, a low-to-intermediate likelihood of CAD, and documented atheromatous plaque through CCT. Following ESC guidelines, they received high-dose statin therapy and underwent serial CCT using a 128-slice scanner over 1 to 3 years. We utilized advanced features of the CaRi-Heart® and syngo.via Frontier® systems to assess coronary plaques and measure changes in PVAT attenuation.

Results

52 patients (mean age 60.43 ± 9.21, 65.38% males). Changes in plaque morphology were investigated, revealing significant alterations. Notably, in mixed plaques, calcified portions increased (from 53.92 ± 31.29 mm³ to 87.42 ± 43.48 mm³, p < 0.0001), while non-calcified plaque volume (NCPV) decreased (from 180.5 ± 66.81 mm³ to 155.4 ± 59.51 mm³, p = 0.0209). PVAT attenuation generally decreased after one year and remained low, indicating reduced inflammation in the following arteries: LAD (15.93 ± 9.22 vs. 12.03 ± 6.27, p = 0.0142), LCX (14.78 ± 7.35 vs. 12.15 ± 7.51, p = 0.0513), and RCA (19.60 ± 8.99 vs. 16.73 ± 9.17, p = 0.1249). The CaRi-Heart® risk also decreased significantly (from 33.20 ± 22.07 to 20.65 ± 16.14, p = 0.0041). Linear regression analysis demonstrated a correlation between increased PVAT attenuation and higher volumes of NCPV (p < 0.0001, r = 0.3032) and lipid-rich plaque volume (p < 0.0001, r = 0.3281).

Conclusion

Our study provides evidence that high-dose statin therapy significantly reduces CAD risk factors, inflammation, and plaque vulnerability, as evidenced by the notable decrease in PVAT attenuation, a critical indicator of plaque progression. The effect of statins on FAI - Score
Cadiorespiratory fitness gains in phase 3 cardiac rehabilitation participants - impact of weekly exercise training frequency
Authors: Borges M , Lemos Pires M , De Sa G , Novakovic M , Cazeiro D , Cunha N , Pinto F J , Pinto R , Magalhaes J , Abreu A
Published: June 2024

Background

High cardiorespiratory fitness (CRF) is associated with lower all-cause mortality risk in cardiovascular disease (CVD) patients. Cardiopulmonary exercise testing (CPET) is the gold standard method to assess CRF in CVD patients and it is used to individualize exercise training prescription. Long-term phase III cardiac rehabilitation (CR) programs can feature a variety of exercise modalities and schedules. Understanding how weekly exercise training frequency and attendance rates to exercise CR sessions might affect gains in CRF after 12 months might enhance a better insight on how to provide tailored guidance to patients.

Purpose

To compare peak oxygen uptake (VO2peak) in CVD patients attending phase III CR exercise sessions either 3 times/week or 2 times/week over 12 months.

Methods

CVD patients attending for 12 months a phase III CR program were included. VO2peak was assessed through a CPET (cycle ergometer, ramp protocol) at baseline (M0) and after 12 months (M1). After initial screening, patients chose to attend 60 minutes exercise CR sessions either 3 or 2 times/week. Attendance rates were calculated dividing the number of sessions attended by the number of sessions planned. Paired and independent sample t-tests were used (or non-parametric alternatives when applicable).

Results

One hundred and twelve patients completed 12-months of a phase III exercise-based CR program. Nighty-one patients attended 3 times/week [62±10 years-old, 86.8% male, 87.9% had coronary artery disease (CAD)] and twenty-one attended 2 times/week (66±8 years-old, 71.4% male, 85.7% CAD). Patients attending 3 times/week had improvements in VO2peak between M0 and M1 (M0: 21.22 ± 6.35 ml/kg/min vs. M1: 23.12 ± 7.21 ml/kg/min; p-value < 0.001). Furthermore, comparing the percentage of gains between M0 and M1, patients that attended 3 times/week had more gains in VO2peak (9.65 ± 18.05% vs. 0.59 ± 10.71%; p-value = 0.043) compared to the 2 times/week group. Attendance rates did not differ between groups (68.48 ± 16.64% vs. 72.42 ± 14.05%; p-value=0.159).

Conclusion

Patients attending a higher number of CR exercise sessions (3 times/week) had a greater improvement in CRF after 12 months on a phase III CR program. Higher attendance rates in patients that choose CR sessions 2 times/week might be crucial to achieve CRF gains. Further analyses are needed to comprehensively understand the impact of weekly exercise training frequency and attendance rates in other health outcomes in long-term CR programs.
Added value of therapy with sucrosomial iron (SI) on top on ferricarboxymaltose (FCM) for the treatment of iron deficiency anemia (IDA) after cardiac surgery (CS): preliminary data
Authors: Venturini E , Giallauria F
Published: June 2024

Background

The FCM is the gold standard for IDA therapy in heart failure. Moreover short-term treatment of IDA after CS using FMC or SI showed a significant similar improvement of key hematological parameters (HP) and in functional capacity (1). The aim of the present study was to evaluate whether the use of both therapies had an additional positive effect on the same parameters.

Methods

26 consecutive IDA patients, (normal ventricular function, mean age 71,5 ± 8y), after the admission in Cardiac Rehabilitation were all treated with FCM (group A) and a part (group B , n 13) also with SI. The study design included a single dose of 1000 mg of FCM at T1 (at 8-10 days from CS) and after a dose of 60 mg of SI per day from T1 to T2 (the day of discharge 10 days after ) until T3 , 15 days after. Measures of efficacy included changes from baseline in HP, natriuretic peptides (NP), and the 6-minute-walking-test (6MWT). The choice of SI dose was based on a study (2) that demonstrated its effectiveness in reducing transfusion requirements in patients undergoing elective CS.

Results

The data are shown in the Table. The statistical analysis was conducted with the Mann Whitney test (non-parametric). At baseline there were no differences in Vit B12, folate and reticulocytes. Hb and other HP increased significantly, with no differences between the two groups. The increase in Transferrin Saturation (Tsat) was greater (but not significant) in group B with lower baseline level. The ferritin (F) level was much higher in group A; the delta is also significant. Therefore in group treated with FCM and SI the F remains stable, while in the other it doubles (+94%). No significant differences were observed in others parameters. Only the NP level was lower at T3 in group B; but the data does not appear to be clinically relevant, considering the different baseline values.

Conclusions

The high levels of F are a consequence of the inflammatory state following CS. On the other hand, it is known that FCM can induce a further increase in F may be due to a low-grade pro-inflammatory effect correlated to the high level of iron deposition in macrophages. The SI can mitigate this effect, with significant effectiveness already in a preliminary case study. Also relevant is the positive impact on TSAT with the possibility of reaching the guidelines-level more quickly. The increase in the number of cases will allow us to achieve more certain results.
Impact of cardiac rehabilitation on cardiovascular risk factors - getting in control
Authors: Cravo J , Ana Beatriz Garcia A G , Ana Margarida Martins A M , Marta Vilela M V , Diogo Ferreira D F , Daniel Cazeiro D D C , Ana Abrantes A A , Pedro Silva P S , Maria Clarissa Rodrigues M R , Alda Jordao A J , Mariana Cordeiro Ferreira M F , Nelson Cunha N C , Ines Ricardo I R , Fausto Pinto F P , Ana Abreu A B
Published: June 2024

Introduction

Cardiac rehabilitation (CR) plays a key role in secondary prevention of patients (pts) with cardiovascular (CV) disease. The control of CV risk factors is a cornerstone of a comprehensive CR program.

Purpose

To analyze the impact of CR on CV risk factor optimization.

Methods

Single-center prospective cohort study including consecutive pts enrolled in a phase 2 CR program, from 2015 to 2023. Body weight, body mass index (BMI), waist circumference (WC), blood pressure (BP), smoking habits, and cholesterol and hemoglobin A1c (HbA1c) levels were evaluated before and after completion of the program. Results were assessed through paired samples t-test or Wilcoxon test.

Results

A total of 446 pts were included (80% male), with a mean age of 60.5±11.5years. 72.1% of pts had arterial hypertension, 72.2% had dyslipidemia, 26.6% were diabetic and 62.9% were active or past smokers. Mean body weight, BMI and WC were 80.2±14.5 kg, 27.6±4.3 kg/m2 and 102.0±11.2 cm, respectively.

There was a statistically significant reduction in systolic BP (-3.2± 17.5mmHg, p<0.001), diastolic BP (-2.6±13.0mmHg, p<0.001) and WC (-1.2±4.6cm, p<0.001), as well as a significant percentage of pts who quit smoking (53%).

Regarding cholesterol levels, there was an improvement in total cholesterol (median level 151 vs. 139, Z=-5.450, p<0.001), high-density lipoprotein (median level 42 vs. 46, Z=-4.870, p<0.001), low-density lipoprotein (LDL) (median level 81 vs. 66, Z=-6.316, p<0.001), and triglycerides (median level 115 vs. 101, Z=-2.878, p=0.004). In the subgroup of ischemic pts, only 17.8% were initially below the LDL recommended target (<55mg/dL). After CR, a higher percentage of pts achieved adequate lipid control (33%).

Differences regarding HbA1c levels, weight and BMI were only significant in subgroup analysis of diabetic and obese pts (Z=-2.128, p=0.033; -1.0±4.4kg, p=0.027; Z=-2.155, p=0.031, respectively).

Conclusion

Results from this cohort of patients highlight the increasing importance of patient referral to a structured CR program, in order to optimize control of CV risk factors.
Cardiopulmonary exercise testing in athletes and non-athletes with hypertrophic cardiomyopathy
Authors: Karlsson F , Scicluna J , Gauci M , Desira J , Felice T , Abela M
Published: June 2024

Introduction

Cardiopulmonary exercise testing (CPET) in hypertrophic cardiomyopathy (HCM) is useful for risk stratification and symptom evaluation. Current guidelines recommend serial CPET testing in this subgroup. Data comparing CPET testing in athletes versus non-athletic individuals with HCM is inexistent.

Objective

The main objective of this study was to compare CPET variables in athletes and non-athletes with HCM.

Methodology

HCM patients consecutively referred for CPET were included. HCM diagnosis included those with a) unexplained LV maximal wall thickness (LVMWT) of ≥ 15mm or b) LVMWT 12-15 mm with supporting features (FH of HCM, abnormal ECG, abnormal MV morphology, scar, genotype positive). Those with concomitant cardiovascular disease were excluded. Individuals who engaged in ≥4hrs of moderate-high intensity physical activity weekly (within the previous year) were placed in the athletic group.

Results

39 HCM patients were included (mean age at diagnosis 48 ± 15 years, 92.3% male, 69.2% non-athletes, 87.2% Caucasian, mean BMI 28.4 kg/m2 ± 4.3, median follow up 36 months). A fourth (6/26, 23.1%) had a FH of HCM, 9/25 (36.0%) had a FH of SCD. Some (43.6%) were on a beta blocker. Most were asymptomatic (66.7%). A few (10.2%) had evidence of LVOT obstruction. Most (76.9%) had ECG features typical of HCM. A fourth (17.9%) had a device implanted (n=6 ICD, n=1 ILR). 44.0% (11/25) were genotype positive. Nearly a third (28.2%) had a maximal LV wall thickness of >20mm. Septal HCM was the most common phenotype (61.5%), followed by apical (20.5%), apical/septal (12.8%) and other (5.1%). The mean HCM 5-year SCD risk score was 2.3% ± 1.5%.

Non-athletic patients were more symptomatic (44.4% vs 9.1%, p=0.034). The RV was also larger in the athletic group (p=0.048). All other baseline characteristics where similar in both groups. LV size, RV/LV function, replacement fibrosis, left atrial size and maximal LV wall thickness on ECHO and CMR were also similar.

CPET was a maximal test in the majority (92.3%). Half (53.8%) had a reduced aerobic exercise capacity (%VO2MAX). VO2MAX was significantly lower in individuals on beta blockers (19.1±5.2 vs 25.1±6.4 mls/kg/min, p=0.003). A third (30.8%) had a reduced O2/Pulse, some (15.4%) and/or abnormal O2/pulse response. Most had a reduced PETCO2 at peak (71.8%). VO2/WR was reduced in 64%. A third (38.5%) had ventricular arrhythmias, 10.3% had an inappropriate blood pressure response, 23.1% had an abnormal heart rate recovery.

Athletes with HCM performed better compared to non-athletes. Athletes had higher aerobic exercise capacity and more favourable CPET parameters (Table 1). Athletes were also less likely to have ≥2 abnormal CPET variables that would suggest a cardiac limitation (41.7% vs 81.5%, p=0.01).

Conclusion

Athletes with HCM performed better during CPET compared to non-athletes. This suggests that athletic remodelling may enable athletic individuals with HCM to cope better during exercise.
Prevalence and predictors of elevated cardiac troponins among athletes after participation in a sports event: a systematic review and meta-analysis
Authors: Berge K , Stekelenburg J O , Janssen S L J E , Aengevaeren V L , Eijsvogels T M H
Published: June 2024

Background

Myocardial injury is defined by cardiac troponin (cTn) concentrations above the upper reference limit (URL) and is diagnostic for acute myocardial infarctions if combined with ischemic symptoms, ECG changes, or imaging. However, exercise can increase cTn concentrations above the URL and introduce diagnostic ambiguity for physicians if individuals seek medical attention post-exercise.

Purpose

To determine the prevalence of elevated cTn concentrations (>URL) after participation in sports events and to identify mediators of elevated cTn concentrations.

Methods

A systematic literature search in Pubmed, SPORTDiscus, and Embase was performed on 1 February 2023. Identified articles were screened for in- and exclusion criteria, and eligible articles were entered into a random-effects meta-analysis of cTn prevalence >URL. We calculated study weighting and overall effect size using the restricted maximum likelihood method. Differences in cTn elevations between pre-specified subgroups were tested using the chi-square test, and associations between the prevalence of cTn >URL and continuous mediators were assessed using logistic regression and restricted cubic spline models.

Results

In total, 3,990 articles were identified and screened, and 122 articles were included in the final analyses. The analytical cohort consisted of 7,616 athletes of whom 76.4% were male with an average age of 44 years. The overall post-exercise prevalence of cTn >URL was 35% (95%CI 30–41). The prevalence of cTn >URL was higher when using high-sensitivity assays (55% [44–67]) vs conventional assays (26% [21–32], p<0.001) and for Troponin T (41% [32–50]) vs Troponin I (29% [22–36], p=0.040). Individuals aged ≥40 years were more likely to have elevated cTn >URL (39% [31–47]) compared to peers <40 years (24% [16–33, p=0.018]), while there were no differences between females (38% [19–58]) vs males (31% [23–39], p=0.51). Vigorous-intensity endurance sports had the highest prevalence of cTn >URL, including cycling (36% [21–52]), running (39% [32–46]), and triathlon (48% [24–73]), while we found a lower prevalence of cTn >URL for contact sports (4% [0–13]) and prolonged moderate-intensity walking (7% [4-10]) events (p<0.001). There was a non-linear relationship between exercise duration and the prevalence of cTn >URL (p for non-linearity<0.001), with the highest prevalence for event durations between 3-4 hours (58% [44-72]).

Conclusions

One in three athletes had cTn concentrations >URL following the completion of a sports event. The prevalence was higher when blood samples were analysed with Troponin T assays or high-sensitivity assays and among older athletes or those participating in vigorous-intensity endurance sports with an exercise duration between 3-4 hours.
Pre-hospital phase characteristics of sport-related myocardial infarction: insights from a large multicentre regional survey
Authors: Chague F , Kouame I , Bichat F , Maza M , Saint Jalmes M , Braghini N , Lhuillier I , Vincent-Martin M , Porot G , Molins G , Mock L , Ravisy J , Zeller M , Cottin Y
Published: June 2024

Background

Coronary artery disease (CAD) including acute myocardial infarction (AMI) is the major cause of sport-related (SR) sudden cardiac arrest (CA). However, context and determinants of outcomes in SR-CA remain poorly explored.

Purpose

To identify opportunities for target prevention of such dramatic events, we aimed to analyse prevalence, characteristics and prehospital management of out of hospital cardiac arrest (OHCA) in SR-AMI.

Methods

From a large prospective multicentre regional survey (IMACS), all consecutive patients hospitalised for an SR-AMI, from April 1st 2018 to February 22nd 2023 were analysed, SR-AMI was defined as AMI occurrence during sport or at recovery (<1 hour after sport).

Results

Among the 140 patients with SR-AMI included, 13 (9.3%) were female, median age was 61-y (IQR 54-66), 16(11.4%) had prior CAD and 14 (10%) experienced an OHCA. The main sports were cycling (33.6%), fitness (12.1%), hiking (11.4%) and running (10.7%). Most SR-AMI occurred during exercise (60.7%) and were ST segment elevation myocardial infarction (STEMI) (67.4%). When compared with patients without CAD, CAD patients had the same age, similar rate of prodromal symptoms and bystander at MI symptom onset (Table). The rate of patients who performed an appropriate call to emergency medical services (EMS) was low and similar with or without history of CAD. Median time to EMS call was shorter in patients with prior CAD. OHCA were 4 times more common in patients with CAD (31.3% and 8.7%, respectively (p=0.011)). However, the time delay for EMS call was similar for the 2 groups in patients without OHCA (p = 0.630). Among OHCA in the absence of EMS (n=9), bystanders always performed cardiopulmonary resuscitation, while they used AED in only 2 events.

Conclusions

Our findings from a large regional survey identify specificities in the pre-hospital phase of SR-AMI. We showed a gap in opportunities for prevention and management of these dramatic events.
Post-exercise ketone supplementation improves endurance performance, but not cardiac function during an 8-week training intervention
Authors: Bekhuis Y , Robberechts R , Rosseel T , Taha K , Hespel P , Poffe C , Claessen G
Published: June 2024

Background/Introduction

Post-exercise ketone supplementation (PEKS) is commonly used in endurance athletes to alleviate overtraining symptoms and to stimulate recovery. The introduction of PEKS can blunt the development of symptoms associated with overtraining, suggesting a potential improvement in exercise recovery and exercise-induced cardiac adaptations. Although acute nutritional ketosis temporarily improves cardiac function at rest in healthy individuals and heart failure patients, the effects of PEKS on cardiac function during exercise and its relation to endurance performance remain to be tested.

Purpose

The aim of this study is to investigate the effects of PEKS on (a) endurance performance, (b) cardiac adaptations, and (c) safety, during a well-balanced 8-week training intervention to prevent overtraining.

Methods

Recreationally active young men (n=28) were enrolled in a double-blind, pair-matched, placebo-controlled, supervised 8-week endurance training program (Figure 1). The intervention group (n=14) received 25 grams of oral ketone ester (KE) immediately after each training session and 30 min before sleeping time, while the controls (n=14) ingested an isocaloric control drink (CON). Before (PRE) and after (POST) the training intervention, maximal oxygen uptake, endurance performance, and cardiac function during exercise were evaluated using a cardiopulmonary exercise test (CPET), a 30-minute time trial (TT30min), and a CPET combined with echocardiography (CPETecho), respectively. Left ventricular global longitudinal strain during exercise was used as a measure of contractile reserve.

Results

Mean power output during TT30min at POST (299±28W vs. 291±27W, p=0.0004) (Figure 2A), as well as during upright CPET (473±41W vs. 457±43W, p=0.029) was significantly higher between KE and CON. Peak oxygen consumption (KE: +208±320 mL vs. CON: +327±398 mL, p>0.05) and peak exercise cardiac output (KE: +0.82±3.28 L/min vs. CON: +1.67±1.97 L/min, p>0.05) during CPETecho increased after the training intervention, but no significant difference was observed between KE and CON (Figure 2B-C). Global longitudinal strain during exercise was similar in PEKS compared to controls.

Conclusions

This study is the first to demonstrate that PEK improves endurance performance in recreationally active men but does not impact cardiac function during exercise. This indicates that the positive effect of PEKS on exercise performance is not mediated by cardiac adaptations. Further research is required to elucidate the mechanisms through which PEKS improves endurance performance.
PowerAI-CVD: Chinese-specific artificial intelligence-powered predictive model for cardiovascular disease
Authors: Li L , Chou O H I , Lu L , Lee Q , Kaur N , Wong W T , Chang C , Liu H , Wai A K C , Cheung B M Y , Liu T , Tse G , Zhou J
Published: June 2024

Background

The main risk stratification tools for identifying high-risk individuals of cardiovascular disease (CVD) are based on Western populations. Few models are developed specifically for Asian populations and are not enhanced by artificial intelligence (AI). The aim of this study is to develop the first AI-powered quantitative predictive tool for CVD (PowerAI-CVD) incorporate physiological blood pressure measurements, existing diseases and medications, and laboratory tests from Chinese patients.

Methods

The study analysed patients who attended family medicine clinics between 1st January 2000 and 31st December 2003. The primary outcome was major adverse cardiovascular events (MACE) defined as a composite of myocardial infarction, heart failure, transient ischaemic attack (TIA)/stroke or cardiovascular mortality, with follow-up until 31st December 2019. The performance of AI-driven models (CatBoost, XGBoost, Gradient Boosting, Multilayer Perceptron, Random Forest, Naïve Bayes, Decision Tree, k-Nearest Neighbor, AdaBoost, SVM-Sigmod) for predicting MACE was compared. Predicted probability (ranging between 0 and 1) of the best model (CatBoost) was used as the baseline in-silico marker to predict future MACE events during follow-up.

Results

A total of 154,569 patients were included. Over a median follow-up of 16.1 (11.6-17.8) years, 31,061 (20.44%) suffered from MACE (annualised risk: 1.28%). The machine learning in-silico marker captured MACE risk from established risk variables (sex, age, mean systolic and diastolic blood pressure, existing cardiovascular diseases, medications (anticoagulants, antiplatelets, antihypertensive drugs, and statins) and laboratory tests (NLR, creatinine, ALP, AST, ALT, HbA1c, fasting glucose, triglyceride, LDL and HDL)). MACE incidences increased quantitatively with ascending quartiles of the in-silico marker. The CatBoost model showed the best performance with an area under the receiver operating characteristic curve of 0.869. The CatBoost model based in-silico marker shows significant prediction strength for future MACE events, across subgroups (age, sex, prior MACE, etc) and different follow-up durations.

Conclusions

The AI-powered risk prediction tool can accurately forecast incident CVD events, allowing personalised risk prediction at the individual level. A dashboard for predictive analytics was developed, allowing real-time dynamic updates of risk estimates from new data. It can be easily incorporated into routine clinical use to aid clinicians and healthcare administrators to identify high-risk patients.
Joint consideration of LDL-C and polygenic risk for incident coronary heart disease in a multi-ethnic cohort of 48,881 individuals
Authors: Iribarren C , Lu M , Elosua R , Rana J S
Published: June 2024

Background

Elevated concentrations of LDL-cholesterol (LDL-C) are a major independent modifiable risk factor for coronary heart disease (CHD). However, the degree to which background polygenic risk can modulate the effect of high LDL-C remains unclear.

Methods

We utilized data from a subset of the Genetic Epidemiology Resource in Adult Health and Aging (GERA) multi-ethnic cohort (n=48,881; mean ± SD age = 58.1 ± 10.3 years; 63% female; 18% non-European ancestry) who were non-diabetic and not taking cholesterol lowering medication at baseline in 2003-2007. We stratified the cohort into three groups of CHD genetic risk (low=quintile 1; intermediate=quintiles 2, 3 and 4; and high=quintile 5) using a 12-SNP Polygenic Risk Score (PRS) for CHD (CARDIO inCode-Score, GENinCode Plc). Incident CHD consisted of primary in-patient codes for angina pectoris, myocardial infarction, revascularization procedures or CHD death through 12/31/2022 (n=1,725); mean follow-up was 14.3 years. Age-adjusted CHD rates per 10,000 person-years were estimated using Poisson regression (accounting for death and health plan disenrollment) according to polygenic risk and LDL-C level. Hazard ratios and 95% confidence intervals for 1 standard deviation (SD) increment of LDL-C in each PRS group were obtain using Cox regression adjusting for 10 principal components of ancestry plus traditional risk factors. We tested for formal interaction LDL-C*PRS as continuous variables in the fully adjusted model. As a complimentary approach we tested interaction between high PRS (quintile 5 vs. lower) and LDL ≥190 (vs lower). Finally, we calculated number needed treat (NNT) to prevent 1 CHD event in each PRS group.

Results

After multivariate adjustment, each 1 SD increment of LDL-C was associated with 1.07 (95% CI, 0.95-1.21; p=0.24), 1.22 (95% CI, 1.15-1.29; p=0<0.0001) and 1.14 (95% CI, 1.03-1.26; p=0.009) increased hazard of CHD among low, intermediate, and high PRS groups, respectively. There was no interaction between linear effects of LDL-C and PRS (p=0.34). On the other hand, we found evidence of interaction (p=0.002) between high PRS and LDL ≥ 190. The NNT was lowest in the high PRS group and highest in the low PRS group (see Figure below).

Conclusions

Our results are consistent with a multiplicative model of high polygenic risk and high LDL on CHD risk. While all patients with elevated LDL-C ought to be treated, our data suggest that an earlier and more aggressive lipid lowering therapy may be directed towards those with high polygenic risk. Figure.
Clinical determinants of the macrovascular reactivity response as assessed by flow mediated slowing in people at risk for cardiovascular disease
Authors: Decorte E , Cauwenberghs N , Claes J , De Wilde C , Michielsen M , Bekhuis Y , Hansen D , Van Craenenbroeck E , Goetschalckx K , Claessen G , De Smedt D , Kutznetsova T , Cornelissen V
Published: June 2024

Background

Non-invasive methods that assess endothelial function may improve the evaluation of cardiovascular risk in primary care. Previous research showed that flow-mediated slowing (FMS) of the brachial-radial pulse wave velocity reflects cardiovascular risk, but larger studies on the FMS response in at-risk populations are required to further unravel its clinical and added value for cardiovascular risk stratification.

Purpose

We investigated the clinical determinants of the full FMS response in people at risk for cardiovascular disease.

Methods

We collected baseline FMS data from a subsample of 157 participants enrolled in the PRIORITY trial (Personalized remotely guided preventive exercise therapy for a healthy heart). Participants had at least one of following risk factors at baseline: systolic blood pressure (BP) / diastolic BP between 130/80 – 159/99 mmHg and/or on antihypertensive treatment, prediabetes with either fasting plasma glucose 100-125mg/dL or HbA1c 5.7%-6.4%, diabetes mellitus, obesity (BMI >30 kg/m2), or evidence of subclinical diastolic dysfunction.

We continuously recorded the brachial-radial PWV using a Vicorder device in supine position at rest and after 5-minutes of supra-systolic occlusion of the upper arm (Figure 1). Stepwise linear regression analyses were performed to assess clinical determinants of the FMS response. We illustrated the effect of important determinants on the FMS response by plotting the estimated marginal means of the final models for each FMS post-occlusion interval by the mean and one standard deviation changes of each determinant.

Results

The study sample was on average 60.2 +/- 11.23 years old and included 74 women (47.1%). Until 180 seconds post-occlusion, a lower FMS response was significantly associated with higher diastolic BP and higher triglycerides levels (P<0.05 for all 0-180s intervals). Higher age only correlated with less decline in brachial-radial PWV in the 60 to 90 seconds post-occlusion interval (P=0.050). Participants with elevated triglycerides or elevated DBP or both exhibited significantly less decline in brachial-radial PWV as compared to those with average or below average levels (Figure 2, panels A to C).

Conclusion

In individuals at increased risk for cardiovascular disease, worse macrovascular reactivity was associated with hypertriglyceridemia and high diastolic BP. Our findings suggest that the use of FMS may have clinical value for cardiovascular risk evaluation and highlight the importance of an optimal control of triglycerides and diastolic BP for adequate cardiovascular risk management. More studies are needed for assessing the additive value of such testing for cardiovascular disease prediction and management beyond current strategies.
The impact of risk factor modification on asymptomatic atherosclerosis in patients with metabolic syndrome
Authors: Tasic I , Tasic I S , Petrovic D , Kostic S , Djordjevic D , Stoickov V , Vukojcic N
Published: June 2024

Introduction

Metabolic syndrome (MetS) is one of the main risk factors for atherosclerosis. Current research indicates the impact of its components to the progression of atherosclerosis and higher frequency of major cardiovascular (CV) events and mortality.

The Aim

Determining the components of MetS that correlate most with asymptomatic atherosclerosis (AA) and the effect its modification has on the progression of atherosclerosis.

Material and Мethods

The paper compares the results of 113 monitored patients with arterial hypertension in the period 2022-2023, divided into groups with and without MetS. In both groups the presence of subclinical carotid artery damage was assessed by measuring the thickness of tunica intima and media (IMT), the presence of plaques and stenosis, with analysis of the occurrence of major CV events from 2009 until the last control.

Results

After the last follow-up examination, the number of major CV events (40.70% vs. 11.86%) and cancer (22.00% vs. 6.77%) were significantly more frequent in the group of patients with MetS. Total mortality was higher but not statistically significant in the group with MetS. Lipid status and blood pressure were improved in both groups. After a 13-year follow-up, IMT increased (0.97 to 1.30 in patients with MetS and 0.85 to 0.99 in patients without MetS), along with the degree of stenosis in both groups (from 29.9% to 40.35% in the group with MetS and 37.80% to 42.40% without MetS). The group with MetS reached the target values in a smaller percentage for all components of MetS, especially triglycerides (45.7% in the group with MetS compared to 86% in the group without MetS).

Conclusion

Early identification of individuals with AA can prevent cardiac events in patients with MetS, but more intensive therapy and lifestyle changes are necessary to reach target values of its components and prevent progression to major CV events.
Reaming at resistant hypertension: old weapons brought back
Authors: Gregorio Antunes Coelho R , Esteves A , Sa C , Calcada A , Louzada R , Silva Ferreira J , Quintal J , Bernardes P , Goncalves S , Santos R , Seixo F
Published: June 2024

Background

High blood pressure (BP) is the most prevalent cardiovascular risk factor and remains the leading modifiable cause of death. In many patients, pharmacological therapy is insufficient to adequately control blood pressure. Multiple clinical trials have demonstrated the safety and efficacy of renal sympathetic denervation in reducing BP.

Purpose

The aim of this study is to present our center’s initial experience with a radiofrequency renal denervation technique, describing the characteristics of the first patients submitted to this procedure, as well as to evaluate its safety and effectiveness in our population.

Methods

An observational study with all patients who were treated with renal denervation, between January and September 2023, was performed. For this procedure we selected patients with resistant Hypertension, defined as elevated BP values despite treatment with at least 3 different classes of anti-hypertensive medications (including one diuretic). Patients with secondary hypertension and with eGFR <40 mL/min/1.73m2 were excluded. Baseline patient characteristics were evaluated as well as ABPM/AMPA values prior to the procedures and at least 3 months after. The Wilcoxon test was used to compare median blood pressure values before and after the procedure. A p-value <0.05 was considered statistically significant.

Results

Nine patients underwent renal denervation, 7 (78%) male with a median age of 66 [50;70] years.

Three (33%) patients had grade 1 arterial hypertension, four (44%) had grade 2 and two (22%) had grade 3. Six patients (67%) had diabetes mellitus, seven (78%) had dyslipidemia, four (44%) were smokers and six (67%) had obstructive sleep apnea syndrome.

All patients were taking renin-angiotensin-aldosterone system inhibitors, dihydropyridine calcium channel blockers and diuretics. Six patients (67%) were taking spironolactone and all but one were taking beta-blockers. Five patients (56%) were taking rilmenidine and one (11%) methyldopa. Patients were taking a mean of 5 (± 1) pharmacological classes. After renal denervation, previously ongoing pharmacological therapy was maintained.

There was no statistically significant difference in renal function before (GFR 90 [61;125] ml/min/m2) and after (GFR 96 [70;130] ml/min/m2) renal denervation (p = 0.770). There were no complications.

Comparing BP values prior and after the procedure, renal denervation was associated with a significant reduction in systolic (reduction of 18 [15;23] mmHg; p = 0.008), diastolic (9 [5;10] mmHg; p = 0.011) and mean BP (13 [9;15] mmHg, p = 0.008).

Conclusions

Renal denervation proved to be a safe and effective procedure in reducing blood pressure in this first group of patients with resistant hypertension who was submitted to procedure in our center. Further patients need to be included and a longer follow-up is needed to assess the benefit of this technique.