bluuebunny/crossref_metadata_2025 huggingface dataset:
Characteristics and prognosis of patients with elevated triglycerides in acute myocardial infarction: observational data from a large database over a 17 years period
Authors: Zeller M , Chague F , Maza M , Bichat F , Cottin Y , Farnier M
Published: May 2023

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Amarin Corp.

Background and aim

From a large database of a regional registry, we aimed to address the prevalence, characteristics and prognosis of patients with elevated triglycerides (TG) in patients hospitalized for an acute myocardial infarction (MI).

Methods

From the multicenter database (RICO survey), all consecutive patients hospitalized for an acute MI (2001-2017) and alive at discharge were included. Patients with TG > 500 mg/dL, lost to follow-up (FU), or under chronic fibrate treatment were excluded. Patients with high TG (> 200 mg/dL) on admission were compared to those with TG ≤ 200 mg/dL. Endpoints were recurrent ischemic events (i.e. recurrent MI, angina, unstable angina, stroke or urgent revascularization (PCI or CABG)) at 1-year FU.

Results

Among the 10667 patients included, 1886 (17.7%) had elevated TG. When compared with patients with TG £ 200 mg/dL, patients with high TG were younger (59 vs 69 y, p<0.001), had a higher BMI (28 vs 26 kg/m², p<0.001), were more frequently men (77 vs 68%, p<0.001), diabetic (27 vs 21%, p<0.001), and smokers (42 vs 28%, p<0.001). The rate of statin therapy at discharge was similar for the 2 groups (79 vs 77%, p=0.285), as well as SYNTAX score and rate of multivessel disease (p=0.368 and p=0.791). In high TG group, LDL cholesterol was higher (130 vs 120 mg/dL, p<0.001) and HDL-cholesterol was lower (37 vs 46 mg/dL). At 1-Y FU, recurrent ischemic events were more frequent in elevated TG patients (11.2 vs 9.1%, p=0.004). In multivariate logistic regression analysis, high TG (OR (95%CI): 1.356(1.095-1.679)) remains an independent estimate for recurrent ischemic event, even after adjustment for confounding (GRACE score, diabetes, obesity).

Conclusions

In our large population-based cohort, elevated TG are common in acute MI, and associated with residual risk of recurrent ischemic events, beyond traditional prognostic markers. Our data may help to identify candidates for targeted therapies to reduce recurrent ischemic risk after MI.
Cannabis use and risk of atherosclerosis cardiovascular disease: a two-sample mendelian randomization study
Authors: de La Harpe R , Schoeler T , Thorball C W , Thomas A , Kutalik Z , Vaucher J
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Whether cannabis use causally associates with atherosclerotic cardiovascular disease (ASCVD) remains unknown. A genetic approach, using Mendelian randomization principles, can help make inferences on the association between a risk factor and a disease outcome when a clinical trial is impracticable for ethical reasons.

Aims

To estimate the effect of genetically determined cannabis use on risk of ASCVD, including coronary artery disease (CAD) and acute ischemic stroke (AIS).

Methods

Using two-sample Mendelian Randomization (MR), 65 independent (R2<0.2) genetic markers associating with "ever use of cannabis" in 184’765 European individuals were employed to estimate the causal association between cannabis use and risk of ASCVD. The genetic instruments were first used to test the causal association between cannabis use and CAD in 60’801 cases and 123’504 controls. Second, we explored the causal association between cannabis use and AIS in 34’217 cases and 406’111 controls. Genetic data for both outcomes predominantly comprised individuals from Caucasian origin. To triangulate genetic findings, we conducted a meta-analysis of observational studies reporting a link between cannabis use and ASCVD, CAD or AIS.

Results

Based on the genetic analysis, there was no evidence for a causal effect of cannabis use on the risk of CAD (OR=0.97, 95%CI 0.92-1.02, p-value=0.19) or AIS (OR=1.03, 95%CI 0.98-1.09, p-value=0.41). Sensitivity analyses, including MR-Egger, weighted median MR, Steiger filtering and multivariate MR analysis, yielded similar results, and no heterogeneity and directional pleiotropy were observed. Based on the meta-analysis of 6 observational studies for each outcome, ever use of cannabis was not associated with CAD (pooled OR=1.23, 95% CI 0.78-1.69), nor AIS (pooled OR=1.22, 95%CI 0.95-1.50).

Conclusion

Using a genetic approach recapitulating a clinical trial, we found no evidence in support of a causal effect between cannabis use and CAD or AIS.
Readability of the current preparticipation cardiovascular screening questionnaires: Are they suitable for athletes?
Authors: Riding N
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Pre-participation screening (PPS) is now implemented by the majority of the leading sporting organisations around the globe, where the presence of the personal symptoms and family history questionnaire has to date been constant among all. The leading cardiology and sporting bodies of the AHA, ESC, IOC and FIFA all however independently publish, and advocate altered variations of the form, which are not validated, and based on expert opinion alone.

Purpose

The National Institute of Health (NIH) recommend questionnaires be written at a reading age of between 11-14 years. To date the readability and suitability of commonly used PPS questionnaires has not been investigated; thus, it was our aim to assess the readability of several PPS questionnaires from the leading sporting and cardiology organisations.

Methods

Readability analysis was performed on the PPS questionnaires from the leading sporting and cardiology organisations 1) AHA; 2) The PPE monograph; 3) ESC; 4) FIFA; 5) IOC. To assess the readability of the questionnaires, several formulae were applied, using multiple regression equations to predict the reading ability needed to understand the given text. The readability formula used were the Flesch Kincaid, Flesch Reading Ease, New Dale-Chall, SMOG scale, FORCAST, Coleman-Liau, and the Gunning Fog scale.

Results

Readability analysis demonstrated that the PPS questionnaires had an average reading age of between 14 and 18 years, resulting in all falling outside the NIH recommended reading age. The best performing questionnaire in terms of readability was the IOC questionnaire (average 13.7 years). The questionnaire with the highest reading age was the AHA 14-step (18.4 years), where 34.3% of the total words within the questionnaire were considered difficult according to the New Dale-Chall list. Questions relating to symptoms were considered easier to comprehend than family history questions. This was also exemplified by percentage of "unfamiliar" words, with symptoms questions having an average of 19.4%, while family history questions having an average of 27.3%. Within the sub analysis of individual questions, chest pain, syncope and palpitations were questions documented by all organisations, however the wording of these showed notable variation, with an average 7.5-year difference in reading age between questionnaires.

Conclusion

The readability of the current PPS questionnaires exceed the NIH recommended reading age of 11-14 years. Readability is an integral part of health literacy, and should a question be too difficult for an athlete to comprehend, this misunderstanding may lead to them rejecting the questionnaire or providing an inaccurate response. The PPS questionnaire remains a mainstay within the screening process, yet more research needs to be conducted to establish athlete comprehension and tailor future questionnaires towards this, with the goal of improving specificity and sensitivity.
Coronary angiographic profile in non ST elevation acute coronary syndrome: risk stratification and management strategy
Authors: Dakhil Z A , Farhan H A S A N
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

It has been reported that risk scores like GRACE and TIMI scores in NSTE-ACS are associated with more complex coronary anatomy and predict worse outcomes. No data from Iraq regarding how these scores reflect severity of coronary obstruction.

Purpose

We aimed to investigate how obstructive coronary lesions are related to GRACE or TIMI risk class in NSTE-ACS.

Methods

Patients with NSTE-ACS were prospectively recruited and stratified according to TIMI and GRACE risk scores into high, intermediate and low classes. Their coronary angiography findings were recorded, and results classified accordingly into: Normal coronaries, non-critical coronary lesion<70% and critical coronary lesion (obstruction≥70% of coronary artery).

Results

n=150, among whom 65.33% were referred for coronary catheterization. For patients catheterized within 2 hours: 20% have normal coronary angiography (all in lower risk category), 80 % have obstructive coronary lesions. Moreover, those who were catheterized within>24 hours were 74 patients, among whom; 16.21 % had normal coronary angiography and 81.08% had obstructive (Critical) coronary lesions. However, there was no statistical significance for types of coronary lesions considering timing to intervention or risk category. In 29.59% of those who were referred for catheterization, they had PCI at same session and 29.59% had been referred for CABG. Patients with higher GRACE scores were more frequent to be referred for CABG. Conversely, on classifying patients according to TIMI score, those with intermediate TIMI scores were more to be referred for CABG.

Conclusions

Higher TIMI and GRACE scores were associated with more significant angiographic coronary lesions and with more referral for CABG than lower risk patients. This finding supports the importance of referring higher risk patients for catheterization according to guideline recommendation especially in resource-limited settings in Iraq where proper risk stratification is crucial to choose those who will benefit the most from invasive strategy.
Daytime napping and the risk of atrial fibrillation in the SUN cohort
Authors: Diaz-Gutierrez J , Baron-Esquivias G , Martinez-Gonzalez M A , Bazal P , Goni L , Barrio-Lopez M T , Bes-Rastrollo M , Amigo-Otero E , Ruiz-Canela M
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Regional Development Fund (FEDER) and Spanish Ministry of Health.

Introduction

Previous research has identified a potential relationship between sleep patterns and atrial fibrillation (AF). Short daytime napping is a widespread healthy habit particularly in Mediterranean countries. However, as far as we know, daytime napping and the risk of developing AF has not been analysed before.

Purpose

Our objective was to assess the association between daytime napping and the incidence of AF in a Mediterranean cohort.

Methods

The SUN project is a dynamic, prospective cohort of Spanish university graduates. A total of 20,348 participants, free of AF at baseline, were followed-up for a median time of 13.8 years, with a retention proportion of 91%. Daytime napping was assessed at baseline and participants were categorised according to their average daily napping time. Incident cases of AF were confirmed by a cardiologist according to a prespecified protocol. Multivariable Cox regression models were used to estimate hazard ratios (HR) of AF according to daytime napping time.

Results

During follow-up, we identified 131 incident cases of AF. In comparison to participants with short daytime napping (<30 minutes/day), those who slept ≥30 minutes/day exhibited a significant 90% higher relative risk of incident AF (adjusted HR= 1.90; 95% CI: 1.26, 2.86), whereas no significant risk was observed for participants who did not have nap (adjusted HR = 1.26; 95% CI: 0.82, 1.93). After excluding participants that reported not having nap, those with shorter daytime napping had a lower risk of developing AF, with the greatest risk reduction between 15-30 minutes/day (adjusted HR = 0.44; 95% CI: 0.27, 0.72), in comparison to sleeping >30 minutes/day.

Conclusions

Daytime napping was significantly associated with the risk of developing AF. Sleeping a longer nap (≥30 minutes/day) was associated with an increased risk, while a shorter nap between 15-30 minutes/day was associated with a lower risk of incident AF. These findings suggest a potential novel healthy lifestyle habit in the primary prevention of AF.
The impact of the COVID-19 pandemic on the quality of centre-based cardiac rehabilitation
Authors: Jug B , Trsan J , Novakovic M , Tasic J , Krevel B , Fras Z , Lainscak M , Farkas Lainscak J
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Slovenian Research Agency Ministry of Health, Slovenia.

Background

The coronavirus-19 (COVID-19) pandemic has severely disrupted the provision of cardiac rehabilitation (CR), with responses ranging from outright closure of CR centres to adapting CR provision to the diversion of resources and changing public health guidance. Using interrupted time-series analysis, we sough to estimate the impact of the COVID-19 pandemic the quality centre-based CR.

Methods

Quality indicators for 1,268 patients undergoing centre-based CR after a myocardial infarction were extracted from the national CR registry, and summarized with a composite quality score (i.e., adjudicating one point for each: antithormbotic therapy, high-potency statin therapy, low-density lipoprotein cholesterol [LDL-C] <1.4 mmol/L, systolic blood pressure <130 mmHg, body mass index <25 kg/m2, non-smoking status, >20% improvement in exercise capacity from baseline). Composite quality scores were aggregated on monthly time units; an interrupted time series of 52 time points was constructed, with breakpoint defined on 1 March 2020. Using Prais-Winsten (autoregressiove order 1) segmented regression, change in level and time trend of the composite quality score were estimated, with 95% confidence intervals [95%CI].

Results

After the pandemic outbreak, waiting times for CR increased (from 56 [IQR 36-82] to 75 [IQR 58-102] days, p<0.001), while duration of CR (from 100 [SD 58] to 90 [SD 67] days) and number of sessions (from 33 [SD 7] to 28 [SD 9]) decreased (p<0.001 for both). The outbreak of COVID-19 was associated with a non-significant change in level (+0.370 [95%CI -0.207; 0.946] points, p=0.204) and a significant change in trend (-0.0438 [95%CI -0.0841; -0.0437] points/per month, p=0.034) of the composite quality score. Patterns for estimates did not change significantly after adjustment for number of sessions and/or duration of CR. See Figure 1.

Conclusons

The COVID-19 pandemic has affected the quality of centre-based CR, with a trainsient (non-significant) increase followed by a persistent (significant) trend of decreasing quality of CR provision. Our findings suggest the need for intensifying the quality of secondary prevetive care during CR in the forthcoming post-pandemic recovery.
Enlarged dimensions of cardiac chambers and the root of the aorta as a significant cardiovascular impact of pandemic COVID-19: a population-based study
Authors: Chlabicz M , Dubatowka M , Jamiolkowski J , Szum-Jakubowska A , Solomacha S , Zieleniewska N , Sowa P , Lawicki S , Szpakowicz A , Ptaszynska-Kopczynska K , Moniuszko-Malinowska A M , Kaminski K A
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): National Centre of Science.

Background

The long-term complications in the cardiovascular (CV) system that the acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may cause are not fully understood. The aim of the study was to assess the impact of a coronavirus disease of 2019 (COVID-19) pandemic on echocardiographic (ECHO) and electrocardiographic (ECG) parameters.

Methods

This was single-center prospective cohort study. The study population consisted of 2 groups: the group before the COVID-19 pandemic (713 probands tested from 18. March 2018 to 17. March 2020) compared to the group during the COVID-19 pandemic (425 probands tested from 14. July 2020 to 02. March 2022). The comprehensive assessment was performed including laboratory parameters, ECHO and ECG.

Results

The studied populations did not differ by sex, age, body mass index and systolic blood pressure (BPs), while diastolic BP (BPd) was significantly lower in the group during the COVID-19 pandemic (p<0.001). In the group during COVID-19 the dimensions of all cardiac chambers, i.e., left atrial dimension (p<0.001), left atrial volume index (LAVI) (p<0.001), right atrial volume (p<0.001), left ventricular dimension (p=0.013), right ventricular dimension (p=0.046) and aortic root dimension (p=0.001) were larger compared to the pre-pandemic population. The ECG showed longer P-wave (p=0.022), PQ segment (<0.001) and QRS complex durations (p=0.042) in the pandemic population compared to the pre-pandemic population. In contrast, there was no significant statistical difference between the analyzed groups in terms of left ventricular hypertrophy (LVH) assessed by ECHO or ECG criteria. In addition, N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations was significantly higher in the population during COVID-19 (p=0.011).

Conclusion

SARS-CoV-2 has had an impact on the cardiovascular system by increasing the size of all heart chambers and the root of the aorta which may have deleterious effects in the future. Careful monitoring of long-term effects is needed.
Sleep quality and sleep disorders in patients with acute coronary syndrome
Authors: Sanchez Sanchez C , Mora Robles J , Larrubia Valle J I , Moncada Ventura A M , Urbano Carrillo C A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Sleep disorders have been considered risk factors for cardiovascular diseases, and poor sleep quality has become a common complaint in patients with coronary artery disease. Despite being a very common problem in these patients, it is not yet routinary studied and reflected in the clinical practice guidelines.

Purpose

To study the prevalence and type of sleep disorders in patients with acute coronary syndrome (ACS).

Methods

This study was a quantitative, descriptive, cross-sectional investigation. We included patients admitted for ACS (unstable angina, STEMI, NSTEMI, MINOCA,...) during the period from June to October 2022. The patients were interviewed, collecting the following information: Demographic variables (age, sex, marital status), classic cardiovascular risk factors (hypertension, diabetes mellitus, dyslipidemia), presence or absence of a diagnosis of Obstructive Sleep Apnoea (OSA), as well as treatment or not with CPAP, toxic habits (tobacco, alcohol, other drugs), need for sleep medication and sleep quality using the Pittsburgh Sleep Quality Index (PSQI), which is a validated self-rated questionnaire that assesses sleep quality and sleeps disturbance over the past month.

Results

We included 46 patients in our study. The mean age was 68,85 years (SD 11,88), 69,56% were male and 60,87% were married. The main reason for admission was NSTEMI. The distribution of risk factors was: High blood pressure 78,26%, Diabetes Mellitus 36,96%, dyslipidemia 63,04%, smoking 21,74%, drinking alcohol habitually 19,57%, and other drugs abuse 4,35%. The prevalence of OSA was 17,39%. Overall, the mean PSQI score of all participants was 8,98 (SD 4,73). The most affected sleep component was ‘Sleep disturbance’ (mean score 1,76/3), followed by ‘Sleep latency’ (1,5/3) and ‘Sleep duration’ (1,48/3). 34,78 % referred use of sleep medication and 41,30% had daytime dysfunction. Table 1 shows the results in PSQI related to the reason for hospitalization.

Conclusions

Sleep disorders and poor sleep quality are remarkably prevalent in our cohort of ACS patients, which could be considered as a possible added cardiovascular risk factor or risk modifier. We consider the proactive investigation of sleep disorders useful in clinical practice as we can develop strategies to improve sleep and reduce residual cardiovascular risk and quality of life.
Risk factor clustering in men and women with CHD in the Southern Cone of Latin America
Authors: Marza Florensa A , Gutierrez L , Gulayin P , Vaartjes I , Grobbee D E , Klipstein-Grobusch K , Irazola V
Published: May 2023

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): This work was supported by the National Heart, Lung, and Blood Institute (NHLBI) grant number HHSN268200900029C.

Background

Presence of multiple risk factors (RF) increases the risk for cardiovascular morbidity and mortality, and this is especially important in patients with coronary heart disease (CHD).

Purpose

The current study investigates sex differences in the presence of multiple cardiovascular RF in subjects with established CHD in the southern Cone of Latin America.

Methods

We analyzed cross-sectional data from the 634 participants aged 35-74 with CHD from the community-based CESCAS Study. We calculated the prevalence for counts of cardiometabolic (hypertension, dyslipidemia, obesity, diabetes) and lifestyle (current smoking, unhealthy diet, low physical activity, excessive alcohol consumption) RF. Differences in RF number between men and women were tested with age-adjusted Poisson regression. We identified the most common RF combinations among participants with ≥ 4 RF. We performed a subgroup analysis by educational level.

Results

The prevalence of cardiometabolic RF ranged from 76.3% (hypertension) to 26.8% (diabetes), and the prevalence of lifestyle RF from 81.9% (unhealthy diet) to 4.3% (excessive alcohol consumption). Obesity, central obesity, diabetes and low physical activity were more common in women, while excessive alcohol consumption and unhealthy diet were more common in men. Close to 85% of women and 81.5% of men presented with ≥ 4 RF. Women presented with a higher number of overall (relative risk (RR) 1.05, 95% CI 1.02-1.08) and cardiometabolic RF (1.17, 1.09-1.25). These sex differences were found in participants with primary education (RR women overall RF 1.08, 1.00-1.15, cardiometabolic RF 1.23, 1.09-1.39), but were diluted in those with higher educational attainment. The most common RF combination was hypertension/dyslipidemia/obesity/unhealthy diet.

Conclusion

Women in the CESCAS study showed a higher burden of multiple cardiovascular RF. Sex differences persisted in participants with low educational attainment, and women with low educational level had the highest RF burden.
Medication use by insurance coverage in subjects with coronary heart disease in the Southern Cone of Latin America
Authors: Marza Florensa A , Gutierrez L , Gulayin P , Klipstein-Grobusch K , Grobbee D E , Vaartjes I , Irazola V
Published: May 2023

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): This work was supported by the National Heart, Lung, and Blood Institute (NHLBI) grant number HHSN268200900029C.

Background

Clinical guidelines recommend cardioprotective medication use in coronary heart disease (CHD) patients. Underuse of these drugs is common among patients of low resources, which may be explained by insufficient access in the public sector.

Aim

We aim to assess medication use and barriers to care by insurance coverage in subjects with CHD in the Southern Cone of Latin America.

Methods

We analysed cross-sectional data from 593 participants with CHD residing in Argentina, Chile and Uruguay, within the CESCAS community-based cohort study. Participants were categorized as covered by public insurance only or having additional coverage (social security or private insurance).

We calculated the prevalence of recommended medications use, mean number of medications, use of ≥ 1 and ≥ 2 drugs, and reported barriers to needed care in insured and uninsured participants. Differences between coverage groups were assessed with univariable and multivariable analysis (logistic and Poisson regression) adjusted by age, sex, previous revascularization, educational level and barriers.

Results

Medication use ranged from 39.8% (lipid-lowering) to 84.1% (antihypertensives). Mean number of medications was 1.8 (SE 0.1), 95.4% used ≥ 1 drugs, and 59.8% used ≥ 2 drugs. There were no significant differences by coverage in medication use, except for higher ACE-inhibitor and nitrate use among participants in the public sector (35.8% vs. 53.2%, p=0.001; and 1.5% vs. 5.2%, p=0.047 respectively). In the multivariable analysis, having public coverage only was not significantly associated with medication use, but it was with reporting barriers to care (OR 2.06, 95% CI 1.21-3.52).

Conclusion

Insurance coverage was not associated with the use of most medications in CHD patients in the Southern Cone of Latin America, possibly due to public health programs providing them free of charge. Uninsured participants more often face barriers to access medical care, and future studies should address these healthcare inequalities.
Dysrhythmic profile of inotropic therapy in patients with acute coronary syndrome
Authors: Rocha De Almeida A , Carias De Sousa M , Congo K , Trinca M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Patients with acute coronary syndrome (ACS) may develop ventricular dysfunction and need to use drugs with a positive inotropic effect, during the acute phase. Despite the hemodynamic benefit of the use of these drugs, positive inotropic drugs may have several side effects, including ventricular tachycardia (VT)and atrial fibrillation (AF).

AF can complicate the management of patients with ACS, since these patients need intense antiplatelet therapy, and in the case of AF, it may have to be associated with anticoagulant therapy, thereby increasing the bleeding risk. The clinical significance of AF during an acute event remains to be ascertained.

Purpose

This study aims to assess the frequency of occurrence of dysrhythmic complications with the use of positive inotropic drugs in patients hospitalized for ACS.

Methods

We performed a 6-year retrospective, observational, multicenter study. We included patients with ACS who used positive or not inotropic drugs during hospitalization, dividing the sample into two groups respectively (Group 1 and Group 2). Between the two groups we compared the occurrence of ventricular tachycardia and atrial fibrillation. In addition, we performed an analysis for the use of levosimendan.

Results

We analyzed a sample of 5860 patients. Of these, 70.3% were male. In Group 1 we included 377 patients and in Group 2 5329 patients. The occurrence of VT in Group 1 was higher than in Group 2 (15.5% vs 1.6%; p<0.001; OR: 11.472; 95% CI [8.212;16.027]). The rate of occurrence of AF in Group 1 was higher than in Group 2 (19.3% vs 5.1%; p<0.001; OR:4.413; 95% CI [3.388;5.749]). Regarding the use of levosimendan, 50 patients were analyzed. VT was more frequent with the use of this drug than without it (18.0% vs 2.5%; p<0.001; OR: 8.576 95% CI [4.092;17.976]). Atrial fibrillation was more frequent with levosimendan use than with no use (34.0% vs 6.0%; p>0.001; OR: 8.137; 95% CI [4.487;14.754]).

Conclusion

Arrhythmic complications were much more frequent in the group that used positive inotropic drugs, namely VT and AF. Levosimendan stands out, related to the increase in the occurrence of AF and the remaining inotropes with an increased risk of VT. These arrhythmic complications pose a challenge in the management of these patients, as in patients with ACS, the use of Levosimendan is associated with more episodes of AF, and might complicate the antithrombotic therapy strategy choice.
Cardiopreventive effect of Klotho protein on oxidative stress, inflammation and apoptosis during cardiac ischemia/reperfusion injury
Authors: Olejnik A , Kaminska M , Radajewska A , Krzywonos-Zawadzka A , Bil-Lula I
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Science Centre, Poland.

Background

The injury of the myocardium during ischemia/reperfusion (IRI) involves metabolic, morphological and contractile disorders [1]. Klotho is a membrane or soluble anti-aging protein. Recent studies have proven the correlation of Klotho deficiency and the occurrence and development of cardiovascular diseases [2].

Purpose

This study aimed to evaluate the effect of Klotho protein supply on oxidative stress, inflammation and apoptosis in hearts subjected to IRI.

Methods

Isolated Wistar rat hearts perfused with the Langendorff method were subjected to ischemia, followed by reperfusion, in the presence or absence of Klotho protein. Hemodynamic parameters, and the levels of nitrate/nitrite (NOX)-, glutathione peroxidase (GPx), superoxide dismutase (SOD), nuclear factor kappa-light-chain-enhancer of activated B cells (NF-Κb), nuclear factor of activated T-cells, cytoplasmic 1 (NFATc1), interleukin-6 (IL-6), matrix metalloproteinase 2 (MMP-2), cytochrome c (cyt c) and caspase-9 were evaluated.

Results

Infusion supply of Klotho during IRI resulted in a recovery of contractile function (p=0.031) and heart rate (p=0.02). Klotho protein contributed to increase in the production of GPx (p=0.045) and SOD (p=0.006). The levels of (NOX)- (p=0.022), NF-Κb (p=0.006), NFATc1 (p=0.027), IL-6 (p=0.002), MMP-2 (p=0.008), cyt c (p=0.0002) and caspase-9 (p=0.009) were decreased in the IRI+Klotho group, as compared to the IRI group.

Conclusions

Klotho protein preserved heart mechanical function, enhanced antioxidant capacity, and reduced inflammation and apoptosis in the injured heart. Thus, Klotho can be recognized as a novel cardiopreventive/cardioprotective agent in ischemic damage.
Cardiac rehabilitation in older populations - never too late to rehabilitate
Authors: Gregorio C , Aguiar-Ricardo I , Alves Da Silva P , Cunha N , Martins A M , Abrantes A , Rodrigues M C , Afonso G , Araujo G , Miguel Correia S , Pinto F J , Abreu A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Age is one of the most determinant cardiovascular risk factors and the prevalence of cardiovascular disease is higher after 70 years old. Referral to cardiac rehabilitation programs for elder individuals is often overlooked since such patients are deemed as frail, high risk and may show lack of competence when attending these programs.

Purpose

To assess differences in clinical characteristics and outcomes between pts >70 years old with younger ones.

Methods

Prospective cohort study which included consecutive pts who were participating in a centre-based CR program lasting 8-12 weeks from 2019 to 2021. We analysed prevalence of risk factors, lab echocardiographic and CPET data in women who were enrolled in the program. Statistical analysis was performed with Chi-square and Wilcoxon tests.

Results

From a pool of 349 patients, only 74 (21%) were 70 or more years old. In this group most of pts were male (90,5%), mean age of 75,2 +- 4,34 year-old. 90% pts had arterial hypertension (n=67), 76% had dyslipidemia, 34% were diabetic and 57,5% were smokers or past smokers. Most patients were in NYHA II (64,2%) and the remainder in NYHA I (29,9%) and III (6%). Mean ejection fraction was 52 +- 14%. NTproBNP in first evaluation 1335 pg/mL, LDL-c 80,4mg/dL and HDL 46,8%. Both groups (<70 and >70years) were relatively homogeneous, except for differences in sex (male sex mor prevalent (p=0.019) and hypertension (p=0.006). Interestingly there were no significant differences in both groups regarding hospital admissions, rate of reinfarction and cardiovascular death. In both groups we noted a significant improvement in echo and CPET, reaching statistical significance in ejection fraction variation (p=0.01), duration of CPET (p=0.048) workload peak; however, in contrast to younger patients, VO2 peak improvement was non significative.

Conclusions

Although there is a higher prevalence in cardiovascular disease among older people, CR referral is far lower. As we can see, such interventions are safe and effective also in older pts and thus we should identify factors going against their inclusion in CR programs and prioritize risk stratification.
Cardiac Rehabilitation in Covid Era: was it equally effective?
Authors: Abrantes A , Aguiar-Ricardo I , Alves Da Silva P , Martins A M , Gregorio C , Sousa P , Fiuza S , Caldeira E , Belo A , Rodrigues M C , Pinto F J , Abreu A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cardiac rehabilitation is currently described as a mainstay when it comes to treatment of cardiac patients (pts), mainly ischemic heart disease. Despite this, referral and implementation suffered a decrease amidst covid outbreak.

Purpose

To describe, in a cardiac rehabilitation center, the real life data regarding programme effects during covid pandemic and after the release of most sanitary measures.

Methods

Prospective cohort study which included consecutive pts who were participating in a center-based CR program lasting 8-12 weeks from 2019 to 2021. The CR program included initial evaluation by cardiologist and rehabilitation specialist with collection of clinical characteristics, three times weekly supervised exercise sessions, appointment with rehabilitation nurse, nutritionist and psychologist and educational sessions. Lab tests, echocardiogram and CPET were done before and after completion of the program.

Results

We analyzed 349 patients, mean age 60 ± 11,14 years, 83% male, most of them referred because of ischemic heart disease (83,6%), followed by valvular heart disease (7,0%). Mean ejection fraction was 48,4 ± 12,8 and most patients were in NYHA class II (65,1%). After program completion we noticed a clear benefit regarding functional class (NYHA before and after CRP: NYHA I 25,7% vs 63,7%; NYHA II 65,1% vs 34,5%; NYHA III 9,2% vs 1,9%; p<0.05), although differences in weight and body mass index were non significant. Laboratorial data also showed a favourable and significant improvement: NTproBNP 1068±752 pg/mL vs 498±764 (p<0.001); LDL-c 84±35,4 vs 70,6±30,2 (p=0.001); HDL-c 44,7±12,1mg/dL vs 46,8±10,4mg/dL (p=0.001); Triglycerides 126,9±66,6mg/dL vs 116,9±51,8mg/dL (p=0.34); HbA1c 6,07 vs 6,06 % (p=0.89). The significant differences in cholesterol were seen even after adjusting for statin dosage.

Conclusions

Despite constraints in CR programs during the pandemic, the long term data shows that maintaining such programs has an important effect when it comes to risk factor control and clinical improvement.
Klotho and FGF23 proteins levels and occurrence of myocardial infarction in patients with acute coronary syndrome
Authors: Olejnik A , Plonka J , Gierlotka M , Bil-Lula I
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Wroclaw Medical University, Poland.

Background

Klotho is a transmembrane and secretory protein, and acts as a co-receptor for fibroblast growth factor 23 (FGF23). Recent studies have underlined the importance of Klotho in renal disorders, where Klotho deficiency served as an early biomarker and therapeutic target [1]. Disrupted levels of Klotho and FGF23 were associated with cardiovascular disease [2].

Purpose

This study aimed to analyze the level and role of Klotho and FGF23 proteins in patients during an episode of myocardial infarction (MI).

Methods

This study consisted of 159 patients admitted by the Department of Cardiology between 2013 and 2021. The study group comprised 129 patients diagnosed with acute coronary syndrome (ACS), who were referred for further invasive diagnosis (MI group). Blood samples were collected immediately after invasive diagnostic (t0) and between 24-48 h post-procedure (t1). The criteria for the control subjects (n=30) were no declaration of past MI and no ACS based on the examination conducted on admission (no MI group).

Results

The level of Klotho protein in the MI group was increased at t0 (median=622.3 pg/ml; p=0.029), and then normalized at t1 (median=510.3 pg/ml; p=0.893), as compared to no MI patients (median=502.3 pg/ml). The level of FGF23 protein in the MI group was higher at t0 (median=384.6 pg/ml; p=0.03), and continued to increase at t1 (median=825.8 pg/ml; p<0.0001), as compared to no MI patients (median=158.3 pg/ml). ROC analysis showed moderate accuracy for Klotho at t0 (AUC=0.633; p=0.043) and FGF23 at t0 (AUC=0.651; p=0.03), and high accuracy for FGF23 at t1 (AUC=0.866; p<0.0001).

Conclusions

The level of Klotho and FGF23 proteins are higher in patients with MI compared to the healthy population. Thus, Klotho and FGF23 can be recognized as potential biomarkers for MI in patients with ACS. The high diagnostic power of FGF23 level 24-48 h post-MI creates a great diagnostic and clinical usefulness of this parameter.
Exercise prescription to patients with cardiovascular disease is in greater agreement with ESC/EAPC recommendations after using the EXPERT Training tool
Authors: Hansen D , Marinus N , Cornelissen V , Ramakers W , Coninx K
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by the Flemish Research Fund (FWO, FWO-ICA: G0F4220N).

Background

Exercise prescriptions by clinicians to patients with cardiovascular disease (CVD) often disagree with recommendations, thus requiring improvement.

Aim

To assess whether exercise prescriptions by clinicians to patients with CVD are better in agreement with ESC/EAPC recommendations when the EXPERT Training tool is used for digital training.

Design: Prospective non-randomized intervention study.

Methods

Twenty-three Belgian physiotherapists first prescribed exercise intensity, frequency, session duration, program duration and exercise type (endurance or strength training) for the same three patient cases, from which the agreement with ESC/EAPC recommendations (based on a maximal score of 60/per case: agreement score) was assessed. Next, they completed a one-month digital training by using the EXPERT Training tool and completed 31±13 (out of 45 available) training cases. Thereafter, the same three patient cases as at entry of study were filled out again, with re-assessment of level of agreement with ESC/EAPC recommendations.

Results

After using the EXPERT Training tool the clinicians’ prescribed significantly greater exercise frequencies, program durations and total exercise volumes in all three patient cases (p<0.05). In case 1, 2 and 3, the agreement score increased from 29±9 (out of 60) to 41±9, from 28±9 to 41±10, and from 34±7 to 45±8, respectively (p<0.001). Hence, the total agreement score increased from 91±17 (out of 180) to 127±19 (p<0.001, +44±32%). A lower starting agreement score and younger age correlated significantly with a greater improvement in total agreement score (p<0.05).

Conclusions

Exercise prescriptions to patients with CVD, generated by clinicians, are significantly better in agreement with ESC/EAPC recommendations when the EXPERT Training tool is used.
Timed up and go test associated and may predict peak vo2
Authors: Danilo Silva Dos Santos D S S , Ciro Oliveira Queiroz C O Q , Celso Nascimento De Almeida C N A , Eduardo Sahade Darze E S D , Gustavo Freitas Feitosa G F F , Fernanda Matos E Oliveira F M O , Davi De Jesus Lopes D J L , Luiz Eduardo Ritt L E R
Published: May 2023

Funding Acknowledgements

Type of funding sources: None. Main funding source(s): No funding.

Background

the Timed Up And Go test (TUG) is a form of mobility and functional capacity evaluation, but is still not well studied in cardiac patients.

Objective

test TUG association and prediction capacity for peak VO2.

Methods

cross sectional study. Patients with cardiophaties, admitted to a cardiac rehabilitation facility, who were submitted to TUG and a cardiopulmonary exercise test (CPET). Pearson correlation, multiple linear regression, ROC curves and Bland-Altman analysis were applied. From the total 2/3 were designated to the creation and 1/3 to the validation population. A p value < 0.05 was admitted as significant.

Results

201 patients, mean age of 67±13 years, 30% were female, 70% had ischaemic cardiopathy. Heart failure was present in 30%, 53% were NYHA I, 37% NYHA II, the mean left ventricle ejection fraction was 56±16%. Mean peak VO2 was 17±6 ml.kg-1.min-1 and mean TUG was 7±2.5 seconds (s). The correlation between TUG and peak VO2 was: r= -0.53 (IC95%= -0.62 -0.42; p<0.001) with a R² of 0.28. The AUC to predict a peak VO2 ≥20 ml.kg-1.min-1 based on TUG was 0.80 (IC95% 0.74-0.86; p<0.001) and the best cut point ≤5.47s (sensitivity 83% and specificity 63%). Based in 134 patients (2/3 of the total), the following equation was described to peak VO2 prediction based in TUG results: peak VO2= 33.553+ (-0.149*age) + (-0.738*TUG) + (-2.870*sex); male=0, female=1. In the validation population (1/3 of the total), the peak VO2 estimated by TUG was 18.8±3.2 ml.kg-1.min-1 and the CPET measured was 18.1±5.9 ml.kg-1.min-1 (p > 0.05).

Conclusion

TUG and peak VO 2 were moderately but significantly associated. A equation to predict peak VO2 based on TUG was described and validated with good performance. Achieving 5.47s or less in TUG was related levels of peak VO2 that are related to better prognosis.
Enhancement of left ventricular compliance in twin pregnancy
Authors: Pellegrino A , Toncelli L , Pasquini L , Mecacci F , Pedrizzetti G , Modesti P A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The knowledge of maternal left ventricular adaptation in twin pregnancies is incomplete.

Purpose

The objective of this study was to longitudinally investigate maternal changes of left ventricular (LV) function and compliance in twin pregnancies.

Methods

Thirty-five women (age 35.3±4.8 years) with uncomplicated twin pregnancy were enrolled to undergo transthoracic echocardiography at 10-15 (T1) and 30-38 (T3) week’s gestation. Left atrial (LA) and LV dimensions, LV volumes and mass, diastolic parameters (at pulsed wave Doppler and tissue Doppler), global longitudinal strain (GLS) at speckle-tracking imaging, and non-invasive pressure-volume curves (PV loops) were measured and calculated.

Results

Maternal LA and LV dimensions, LV volumes and mass had an increasing trend from T1 to T3 (p<0.001 for all). E/A remained stable, while E/e’ ratio slightly increased during gestation. GLS showed no changes between the two visits. At PV loops analysis (Figure 1), LV end-systolic elastance (Ees) and arterial elastance (Ea) both decreased, with no changes in ventricular-arterial coupling (VAC). LV end-diastolic volumes increased from T1 to T3 with no changes in LV end-diastolic filling pressure; the rightward shift of the end-diastolic pressure-volume relationship (EDPVR) suggested enhanced LV cavity compliance (Figure 2). An increase in stroke work was observed.

Conclusions

During twin pregnancy GLS and VAC were not modified showing functional adaptation to enhanced haemodynamic load. Importantly, stroke work increase was sustained by enhancement in LV end-diastolic volume with unaltered filling pressure.
Differences in trends in blood pressure and lipid assessment in patients with and without depression with atherosclerotic cardiovascular disease
Authors: Summers R , Ellins E A , Halcox J P J
Published: May 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): British Heart Foundation.

Background

Patients who have atherosclerotic cardiovascular disease (aCVD) and depression are at increased risk of future CVD events compared to those without depression. The reasons for this are not fully understood. Appropriate management of aCVD risk factors (RF) including blood pressure (BP) and Lipids are essential for secondary prevention.

Aim

To explore BP and lipid assessment over time in patients with aCVD with and without depression, in the Welsh population.

Methods

A retrospective observational cohort study of patients with aCVD was conducted using individual level linked electronic health record data between 2009 & 2019 using the all-Wales SAIL databank. Clinical codes were used to identify aCVD and depression diagnoses, and BP and lipid assessments from GP data. Numbers having assessment of BP and/or lipids during each calendar year were documented.

Results

In 2009, the cohort consisted of 183,275 (F=44.2%, mean age= 69.6 (SD=12.3)). 58.5% of patients had both BP and lipid assessments in that year, with 15.1% having BP only, 2.8% lipid only and 23.6% with neither. Over the subsequent 10y, the proportion with neither BP or lipid checks (23.6% 2009 vs 31.7% 2019, Fig 1.A) and the proportion with only one or neither RF checked increased (Fig 1.A). When comparing those with a history of depression to those without, the worsening trend over time was similar, but patients without depression were more likely to have neither RF checked (13.6% in those with depression vs 26.4% in those without in 2009 and 22.3% vs 35.7% respectively in 2019 Fig 1.B).

Conclusion

These data show a concerning trend for BP and lipids to be checked less rigorously for secondary prevention of aCVD. Although historically aCVD patients with a history of depression are more likely to have a worse outcome, RF assessment is more comprehensive in these patients in Wales. Whether differences in RF control may contribute to variation in outcomes between those with and without depression remains to be determined.
Long-term clinical impact of patients with multi-vessel involved non-obstructive coronary artery disease
Authors: Jung J , Lee S N , Her S H , Yoo K D , Moon K W , Moon D G , Jang W Y
Published: May 2023

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Yuhan Corporation, Seoul, Korea.

Background

Although non-obstructive coronary artery disease (CAD) was a relatively common finding in patients undergoing coronary angiography (CAG), it had previously been characterized as "insignificant CAD" and underestimated in importance. However, recent studies have increasingly showed that non-obstructive CAD is also associated with poor clinical outcomes. But the long-term clinical impact of multi-vessel involved non-obstructive CAD are not yet well-known.

Purpose

The aim of the present study was to determine the long-term clinical impact on patients with multi-vessel involved non-obstructive CAD.

Methods

A total of 2,083 patients without obstructive CAD and revascularization history were enrolled between January 2010 and December 2015. They were classified into 4 groups according to the number of vessels involved non-obstructive CAD (25%≤ luminal stenosis < 70%): 0, 1, 2, 3 diseased vessel (DV). We followed patients for 5 years. The primary outcome was major cardiovascular and cerebrovascular events (MACCEs) defined as a composite of cardiac death, myocardial infarction (MI) and stroke. The secondary outcomes were each component of the primary outcome and all-cause death.

Results

2,083 patients were classified into four groups according to the number of non-obstructive DVs (0 DV: 251 [60%],1 DV: 506 [24%], 2 DV: 250 [12%], 3 DV: 76 [4.0%]). The occurrence of MACCEs numerically increased as the number of non-obstructive DV increased, especially in 3 DV (MACCEs, 0 DV: 78 [6.2%], 1 DV: 33 [6.5%], 2 DV: 17 [6.8%], 3 DV: 14 [18.4%], p<0.001). After adjustment, patients with non-obstructive 3 DV still showed significantly poorer clinical outcomes than 0 DV in terms of MACCEs, MI and stroke. (MACCEs: hazard ratio [HR] 2.09, 95% confidence interval [CI] 1.15-3.79, p=0.016; MI: HR 15.17, 95% CI 2.37-97.25, p=0.004, Stroke: HR 2.04, 95% CI 1.01-4.16), P=0.049) Conclusions. Multi-vessel involved non-obstructive CAD, especially in 3 DV, was associated with poor long-term (5 years) clinical outcomes. Theses finding suggested that more intensive treatment may be required in this subset of patients.