bluuebunny/crossref_metadata_2025 huggingface dataset:
The demographic, psychosocial and clinical characteristics associated with cardiac risk factor control: an analysis of secondary prevention in adults with established coronary heart disease
Authors: Brennan S , Avalos G , Mc Evoy J W
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background and Purpose

Achieving risk factor (RF) control in patients with established coronary heart disease (CHD) reduces the risk of CHD events.(1) Cross-sectional studies have shown that the implementation of current prevention guidelines is poor, with most patients failing to meet recommended targets.(2,3) This study aims to identify demographic, psychosocial and clinical characteristics associated with the non-achievement of RF targets in a population with CHD.

Methods

In this post-hoc cross-sectional analysis, multivariable logistic regression identified characteristics significantly associated with poor RF control in participants of the iASPIRE study which recently assessed secondary CHD prevention in Ireland.

Results

An unhealthy diet (Odds Ratio [OR] 1.6, 95% CI 1.1-2.4, p=0.015), male sex (OR 1.8, 95% CI 1.2-2.8, p=0.007) and type of acute coronary syndrome event (OR 0.6, 95% CI 0.4-0.9, p=0.012) were associated with failure to achieve blood pressure recommendations. Female sex (OR 2.3, 95% CI 1.4-3.8, p=0.002), lack of high-intensity statin (OR 2.4, 95% CI 1.5-3.8, p<0.001) and recurrent hospitalisation for CHD (OR 1.9, 95% CI 1.3-2.8, p=0.001) were associated with poor LDL-C control. Decreasing age (OR 0.9, 95% CI 0.9-1.0, p=0.018), marriage (OR 4.3, 95% CI 1.5-12.1, p=0.007) and insulin use (OR 9.7, 95% CI 1.9-50.4, p=0.007) were associated with a HbA1c of ≥53mmol/mol. The absence of a longstanding illness or disability and decreasing resting heart rate were associated with composite RF control.

Conclusion

Several demographic, psychosocial and clinical characteristics are associated with achieving guideline-recommended RF targets. These findings will support the development of targeted solutions that will improve guideline implementation and the practice of CHD prevention in a high-risk population.
Bempedoic acid and PCSK9 inhibitor eligibility in a contemporary population with atherosclerotic cardiovascular disease
Authors: Brennan S , Mc Evoy J W
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background and Purpose

The reduction of low-density lipoprotein cholesterol (LDL-C) in patients with established coronary heart disease (CHD) reduces the risk of atherosclerotic cardiovascular disease (ASCVD) events.(1) Many CHD patients fail to achieve guideline-recommended LDL-C targets without prohibitively expensive proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9 inhibitors).(2, 3, 4) This study aims to assess the impact that bempedoic acid may have on PCSK9 inhibitor eligibility in a population with CHD and ascertain whether its universal adoption would lead to overall cost-savings and a cost-effective reduction in ASCVD events.

Methods and Results

This retrospective analysis included 635 participants from the iASPIRE study, which recently assessed secondary prevention in an Irish cohort of CHD patients. We applied the 2019 ESC/EAS dyslipidaemia guideline LDL-C target of <1.4mmol/L and simulated the average treatment effect of improved lipid-lowering therapy with statins, ezetimibe and bempedoic acid. 86.3% of iASPIRE participants did not have LDL-C control and qualified for treatment intensification. Optimisation of statin therapy would allow 24.4% of patients to achieve their LDL-C goal, while the addition of ezetimibe would improve this to 55.7% leaving 44.3% eligible for a PCSK9 inhibitor. Utilising bempedoic acid would further reduce the proportion eligible to 18.7%. Based on current market prices and the universal application of ESC/EAS recommendations,(1, 5) the adoption of bempedoic acid would reduce the annual treatment costs associated with PCSK9 inhibitor use by almost 50% and result in cost savings per prevented CVD event.

Conclusions

The vast majority of CHD patients currently fail to achieve the recommended LDL-C target in everyday clinical practice. Ezetimibe and optimised statin therapy would enable most patients to meet their LDL-C goal. Employing bempedoic acid in patients with poor LDL-C control would significantly reduce the requirement for PCSK9 inhibitors and lead to cost savings per prevented CVD event.
Effect of cardiac rehabilitation on intensity of physical activity according to type of surgery and Eurscore II after open heart surgery
Authors: Bolatbekov B , Baibolova M , Trusheva K , Kuramys S , Bolatbekova Z , Baimagambetov A , Kudaiberdieva GZ
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Patients after open heart surgery require cardiac rehabilitation (CR), as reconstructive surgery reduces the quality of life. A perioperative EuroSCORE II score is used for assessment of risk of worse outcomes after surgery. Few is known whether CR is feasible in patients undergoing open heart surgery with moderate and high risk Euroscore II and whether the intensity of physical activity (PA) varies according to the type of heart surgery.

Objective

To evaluate effect of CR on perceived intensity of PA and target heart rate in patients who underwent open heart surgery and different EurSCORE II scale.

Methods

The retrospective cohort study included 104 patients who underwent open heart surgery and stage 2 CR: group 1- 64 patients with coronary artery bypass surgery (CABG), group 2 - 40 patients with valvular heart disease (VHD) surgery. We evaluated following parameters: subjective assessment of PA intensity on the Borg scale and objective assessment on the achievement of the training heart rate before and after CR. The perioperative risk of worse outcomes was assessed using EuroSCORE II scale.

Results

According to the EuroSCORE II scale: 1st group patients were at: -low risk -21%, moderate risk -68%, high risk -11% and 2nd group - low risk 29%, moderate risk 54%, and high risk 17%. None of patients had adverse effects of CR. In the first group, the subjective assessment on the Borg scale before CR was slightly higher than in the second group: -2.43 ± 0.09 points vs. 2.22 ± 0.11 points before CR. At the end of the CR, there was a significant increase (p<0.05) in perception of intensity of PA in both groups - the 1st group –4.37 ± 0.06 points and in 2nd group - 4.35 ± 0.07 points. Target heart rate before CR did not differ between groups: group 1 - 75 ± 5.7 beats per minute and group 2 - 89 ± 7.7 beats per minute (p=0.552): after CR there was a significant decrease in heart rate: group 1 - 55 ± 2.2 bpm, group 2 - 61 ± 3.2 bpm (p =.0012).

Conclusion

1. CR increases significantly intensity of physical activity in pts after open heart surgery 2. Though the VHD surgery pts might have lower intensity of PA before CR, the intensity of PA after CR did not differ between CABG and VHD surgeries, increasing in both groups. 3. Patients with moderate and high EurSCORE II risk comprised 80 and 69% of patients in our cohort, none of them experienced adverse effect of CR and had improvement of PA and achieved target heart rate.
Assessing the prevalence of hypertension in patients with chronic coronary artery disease in Cyprus
Authors: Christou V , Karataraki F , Diakonikolaou S , Eid O , Eid R , Styliou T , Abdelrahman R , Moutiris J
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Coronary Heart Disease (CHD) is the most common type of heart disease and a major cause of mortality worldwide, since according to CDC and WHO, it accounts for 18.2 million cases and 17.9 million deaths annually, respectively. Hypertension can precipitate the condition significantly, thus controlling it plays an important role in the secondary prevention of the disease.

Aim

The aim of this study is to highlight the significance of hypertension as a risk factor in patients with CAD, as well as, to compare its prevalence to those of the EUROASPIRE IV and the statistics published from the ESC Atlas of Cardiology in 2019.

Methods

A retrospective, observational study was created, from the Registry of Cyprus Heart Survey, where 375 individuals (88% Males, 66 years old on average) were examined in Nicosia General Hospital Cardiology Clinics with CAD, between the years 2011 and 2014. Their past medical history in regards to hypertension was noted and the data was analyzed by using Microsoft Excel software.

Results

The total prevalence of hypertension, based on the past medical history of the patients was 59% (females 61% and males 68%). Out of these, 44% still had abnormally elevated blood pressure on their visit to the Cardiology Clinic (females 36% and males 45%). Additionally, the EUROASPIRE IV study showed a prevalence of hypertension of 42.7% and ESC Atlas 24.8%, with median rates 22.3% for females and 27.0% for males. The total mean systolic blood pressure amongst all patients in our study was 136 mmHg, with no significant differences between males and females (136 mmHg and 137 mmHg respectively), while in ESC Atlas, the median SBP levels were noted to be 123.0mmHg in females and 130.0 in males.

Conclusion

Comparing the results from this group of consecutive patients from the Cyprus Heart Survey to the results of EUROASPIRE IV and ESC, it is made clear that all three studies point to the same conclusion. Firstly, it is important to acknowledge the difference between the two genders, with males recording a higher prevalence of hypertension. Moreover, despite the improvement observed in the management of hypertension that has been noted in our study, the secondary prevention guidelines are still not appropriately met. Managing appropriately hypertension, is of utmost importance in lowering the risk of recurrence of CAD in the context of secondary prevention measures.
The impact of nonoptimal lipids on the progression of coronary artery calcification in asymptomatic young adults: results from the KOICA registry
Authors: Lee H , Park HE , Chun EJ , Chang HJ , Sung J , Jung HO , Choi SY
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Recently, as cumulative exposure of lipids for a lifetime has become important to prevent and predict atherosclerotic cardiovascular disease (ASCVD), it is recommended to obtain the optimal lipid levels from a young age. However, questions remain regarding the vascular changes in young adulthood by nonoptimal lipid levels.

Purpose

We aimed to investigate the progression of coronary artery calcification (CAC) according to lipid profiles in Korean young adults.

Methods

From the KOrea Initiative on Coronary Artery calcification registry, we collected 2,940 statin-naïve adults under 45-year-old, undergoing serial coronary artery calcium scans for the purpose of routine health check-ups between 2002 and 2017. CAC progression was assessed according to the optimality of lipid levels and each lipid variable.

Results

In this cohort (mean age, 41.3 years; man 82.4%), only 477 subjects (16.2%) had the optimal lipid profile, defined as triglycerides <150 mg/dl, LDL cholesterol <100 mg/dl, and HDL cholesterol ≥45 mg/dl. During follow-up (median 39.7 months), CAC progression was observed in 438 participants (14.8%) and more frequent in nonoptimal lipid group (16.5% vs 5.9%; p<0.001). Nonoptimal lipid levels during young adulthood increased the risk of CAC progression after adjusting for other cardiovascular risk factors (adjusted HR, 2.36; p=0.001), with a stepwise risk increase according to lipid levels. In particular, in the subjects with an initial calcium score of zero (adjusted HR, 2.13; p=0.014), those in their 20s or 30s (adjusted HR 2.70; p=0.029), and those without any other risk factors (adjusted HR 2.51; p=0.025), deemed as very low-risk groups, nonoptimal lipid levels more than doubled the risk of CAC progression, respectively. Among lipid variables, high triglycerides appeared to provide the greatest impact on CAC progression of young adults.

Conclusions

The proportion of young adults with optimal lipid levels was lower than expected. Nonoptimal lipid level was significantly associated with the risk of CAC progression in young adults, even with low-risk. Triglycerides had the strongest association with the risk of CAC progression. Screening and intervention for nonoptimal lipid levels, particularly triglycerides, from an early age might be of clinical value.
Representativeness of women and racial/ethnic minorities in randomized clinical trials on bempedoic acid
Authors: Cicero A , Gori D , Fogacci F
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Women and racial minorities have continued for a long time to be underrepresented in randomized clinical trials testing lipid-lowering therapies (i.e. statins, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, ezetimibe, bile acid sequestrants, fibrates, niacin, and omega-3 polyunsaturated fatty acids).

Purpose

We sought to investigate presence of disparities in trials testing the new emergent lipid-lowering drug bempedoic acid (BA).

Methods

Several databases were searched with the use of a purposedly developed search strategy. To minimize the chances of missing data, the identified clinical trials were subsequently searched on http://www.clinicaltrials.gov. Original studies were included in the analysis if they met the following inclusion criteria: (i) being a clinical trial with either multicentre or single-centre design and (ii) having an appropriate controlled design for BA.

Results

Considering together, the overall participation rate and the mean participation rate across the clinical studies, men, whites and non-Hispanic/Latinos were sufficiently represented compared with their proportion in the disease population. Non-whites and Asians were underrepresented. Women, blacks and Hispanic/Latinos were from adequately to over-represented across clinical trials, though in the pooled population their portion was lower than their share of the disease population.

Conclusions

Further efforts are needed to enhance the representativeness of clinical trials according to race and sex and ensure complete information about efficacy and safety of treatment with BA.
Short-term trajectories of exercise-induced plasma lipid changes in overweight females, with a focus on HDL cholesterol
Authors: Hubacek J , Suchanek P , Lanska V
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health, Czech Republic

Background

Increased levels of plasma lipoproteins are among the modifiable risk factors of cardiovascular disease. Dietary changes and increased physical activity are the most powerful non-pharmacological interventions for the optimisation of plasma lipid levels.

Objectives

The aim of our study was to investigate the effect of an intensive short-term lifestyle intervention on plasma lipid trajectories in overweight non-diabetic females.

Materials and Methods

Two hundred and two healthy overweight (BMI > 27.5 kg/m2) females underwent an intensive short-term (10-week) intervention (at least four units of 1-hour exercise activity weekly at optimal energetic intake) aimed at lowering body weight. Plasma lipid (TC, LDL-C, HDL-C, TG) levels were examined at baseline and every two weeks over the course of the 10-week intervention.

Results

There was a significant decrease in BMI (Δ -4.7%, P<0.001) and body weight (Δ -4.9%, P<0.001) after the intervention. Positive changes (decreases) in TC (Δ -8%, P<0.001), TG (Δ -9%, P<0.001) and LDL-C (Δ -11%, P<0.001) were observed immediately after two weeks, but levels did not decrease further. In contrast, HDL-C did not increase as expected: after two weeks of intervention, we observed a significant decrease of about 6% (P<0.001) followed by a slow return to baseline values. But even after ten weeks of intervention, HDL-C values had not reached the values detected at baseline.

Conclusion

In overweight females, HDL-C decreased after short-term intensive lifestyle intervention. To confirm the protective effect of increased physical activity, plasma lipids need to be examined over a longer time period.
Impact of COVID-19 infection on a physically active population: evaluation functional using the Cardiopulmonar Exercise Test (CPET)
Authors: Berenguel Senen A , Borrego Rodriguez J , Godoy Lopez JR , Gadella Fernandez A , De Cabo Porras C , Serrano Blanco A , Gallango Brejano M , Gigante Miravalles E , Morante Perea MC , Cepas-Guillen PL , Lazaro Salvador M , Villasante Felix ME , Fernandez-Vazquez F , Rodriguez Padial L
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

An increase it is being seen in patients who are referred for consultation due to dyspnea persistent after having overcome COVID19. The cause for this sequel is still not entirely clear, but our group has observed -in another study- that the consumption of oxygen (VO2) determined by cardiopulmonar exercise test (CPET) in these patients is low with respect to its predicted (p50). The objective of the present work was to demonstrate this hypothesis against to a control group with similar characteristics, who have not suffered from COVID19.

Methods

We conducted a prospective study with military personnel who are part of a corps of army elite. All subjects have performed the same training daily during the last 2 years. They were divided into 3 groups: the first (G1) made up of those who had not suffered from the COVID19 disease; a second group (G2) that had suffered from it, but did not report impairment of functional class (CF); and a third group (G3) who maintained dyspnea persistent 3 months after suffering from the disease. Analytical with NT-proBNP, echocardiogram, basal spirometry, and CPET were performed. None required hospital admission.

Results

36 subjects were included, distributed as follows: G1 (n = 14), G2 (n = 15), G3 (n = 7). The 3 groups had a similar age and BMI. None of the subjects presented alterations in baseline spirometry, neither structural heart disease in the echo, and nor relevant analytical alterations, being NT-proBNP less than 125 pg/ml in all of them. In relation to the response variables cardiovascular, statistical differences (p = 0.03) were observed in peak oxygen consumption predicted among the three groups (% predicted peak VO2), being significantly lower in the G3 subjects. In addition, a trend was observed -in absolute values- of peak VO2 to be lower in G3 -not significant probably due to the small sample size-. They were not objectified significant differences in PulseO2, nor in OUES. No patient presented alterations in the ventilatory efficiency parameters, or in final BR.

Conclusions

In our sample, patients who remained with persistent dyspnea after COVID-19, have a lower functional capacity compared to healthy subjects of the same characteristics, and with respect to subjects who after COVID19 do not present any symptoms. This subjective deterioration of the FC can be objectively quantified using CPET, thus reaffirming its value in this context.
Would be the minute ventilation variability an alternative to the dichotomous diagnosis of exercise oscillatory ventilation?
Authors: Karsten M , Ribeiro GS , Deresz LF , Salvioni E , Silveira LS , Hansen D , Agostoni P
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): CAPES and FAPERGS.

Background

Exercise oscillatory ventilation (EOV) is an abnormal ventilatory phenomenon observed in chronic heart failure (HF) patients usually defined as EOV-positive or EOV-negative based on a dichotomous diagnosis. Minute ventilation variability (vVE) can quantify the presence of these oscillations and assist the prognosis of patients.

Purpose

To analyse the sensitivity and specificity of vVE to predict 2-year all-causes of death in HF patients.

Methods

Data from 233 cardiopulmonary exercise tests from HF patients performed between 2011 and 2014 at an Italian heart centre were analysed. The vVE was defined by the standard deviation (SD) of VE normalized by the number of respiratory cycles (SD/n) during the exercise tests. The cut-off to predict 2-year mortality was determined by the receiver-operating characteristic (ROC) curve.

Results

Thirty-five deaths were registered at 2-years. The ROC curve indicated ≤ 54.9 as the better cut-off for vVE (32 deaths were registered in follow-up; Figure 1). The relative risk was 3.9 (1.3 to 12.4) with a hazard ratio of 2.7 (1.3 to 5.6) for 2-year mortality.

Conclusion

The vVE appears to be a sensitive alternative to quantify EOV and stratify high-risk cases from 2-year all-cause mortality.
Long-term effects of high-intensity interval training, moderate-to-vigorous intensity continuous training and Nordic walking on physical and mental health in patients with coronary artery disease
Authors: Terada T , Cotie L , Tulloch H , Mistura M , Vidal-Almela S , O'neill C , Reid R , Pipe A , Reed J
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health Research (CIHR) Postdoctoral Fellowship

Background/Introduction

Twelve weeks of high-intensity interval training (HIIT), moderate-to-vigorous intensity continuous training (MICT) and Nordic walking (NW) have been shown to improve functional capacity, quality of life (QoL) and depression in patients with coronary artery disease (CAD). However, their long-term effects are unknown.

Purpose

The primary purpose was to compare the long-term effects and sustainability of 12 weeks of HIIT, MICT and NW on functional capacity. The secondary purpose was to assess the long-term effects and sustainability of 12 weeks of HIIT, MICT and NW on QoL and depression severity.

Methods

Patients with CAD were randomized to a 12-week HIIT, MICT or NW program. Functional capacity, QoL and depression severity were measured at baseline, at the end of 12 weeks of intervention, and following 14 weeks of observation phase (week 26). Functional capacity was measured with a 6-minute walk test (6MWT); QoL was assessed by the HeartQoL and Short-Form-36; and depression severity by the Beck Depression Inventory-II (BDI-II). The long-term effects (changes between baseline and week 26) and sustainability (changes between week 12 and week 26) were assessed by linear mixed models for repeated measures.

Results

Of 130 participants randomized, 86 (HIIT: n=29, MICT: n=27, NW: n=30) completed week 26 assessments. There were significant improvements in 6MWT distance (F=149.657, p<0.001), QoL and depression severity (both p<0.05) from baseline to week 26; the increase in 6MWT distance was greater for NW when compared to MICT (F=7.021, p=0.010) and HIIT (F=5.279, p=0.025, Figure). Between week 12 and week 26, 6MWT distance (F=10.863, p=0.001) and physical QoL (physical component summary [PCS]; F=4.084, p=0.047) increased significantly, whereas mental QoL significantly decreased (mental component summary [MCS]; F=4.052, p=0.047).

Conclusion

HIIT, MICT and NW have positive long-term impacts on functional capacity, QoL and depression severity. However, NW was shown to confer additional benefits in increasing long-term functional capacity. The positive effects of the 12-week exercise programs were sustained at week 26 except for mental QoL.
The relation between Phase Angle as muscle function by BIA and physical function and nutrition states in cardiac patients
Authors: Kawazu T , Kurose S , Kimura Y
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

[Purpose] Phase angle (PhA) by BIA was studied as muscle function in various diseases. However the effects of nutrition states to phase angle is unclear especially in cardiac patients. This study examined the relationship between PhA, physical function and nutritional index in patients with heart disease.

Methods

PhA was measured using InBody770 for 33 heart disease patients (age: 71.6 ± 13.4 years, EF: 58.6 + 11.0%) who underwent cardiac rehabilitation during hospitalization. Short Physical Performance Battery (SPPB) was performed for physical function evaluation, and ALB, eGFR, and NT-ProBNP were evaluated for blood tests. calorie intake and GNRI were calculated as nutritional assessments.

Results

PhA was 4.1 ± 0.9 °. PhA has a positive correlation with SMI (r = 0.62), chair rise time (r = 0.62), dietary calorie intake (r = 0.49), GNRI (r = 0.50), NT-ProBNP (r = -0.631), ECW A negative correlation was found with / TBW (r = -0.91). As a result of multiple regression analysis with PhA as the dependent variable, ECW / TBW (β = -0.73), SMI (β = 0.33), and chair rise time (β = 0.10) were extracted as significant independent factors (β = -0.13). r² = 0.96).

[Conclusion] PhA in patients with heart disease was correlated with physical function and nutritional index, and a significant independent factor was physical function. In particular, lower limb muscle strength was extracted independently of extracellular water ratio and muscle mass. These results suggest that PhA may be a comprehensive index of physical function in cardiac patients.
Patients with Minor Non-Disabling Stroke (MiNDS): results of a structured cardiovascular rehabilitation program
Authors: Palermi S , Brugin E , Compagno S , Pescatore V , Tegon G , Sarto M , Marin R , Masato M , Panico A , Biffi A , Giada F
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Ischemic cerebral and cardiac events are the leading causes of mortality and morbidity in Minor non-Disabling Stroke (MiNDS) patients. Control of cardiovascular risk factors, including physical activity levels, is a key strategy in secondary prevention of MiNDS. However, there is a gap between recommendations and real achieved physical activity levels in these patients. Clinical benefits obtained with cardiovascular rehabilitation in cardiac ischemic patients could be obtained with similar programs also in patients with MiNDS, given the common pathophysiological substrate of these two diseases.

Purpose

To evaluate safety, effectiveness and feasibility of a cardiovascular rehabilitation program based on structured physical exercise (SPE) in patients with MiNDS.

Methods

39 MiNDS patients (26 males, mean age 66 years) underwent an accurate medical screening process, body composition evaluation, cardiopulmonary exercise test (CPET) and muscular strength assessment, before and after a 12-sessions in-hospital SPE program, and after 6- and 12-months follow-up during which they could continue their training schedule on their own.

Results

After in-hospital rehabilitation program, a significant improvement in CPET parameters, body composition and muscular strength was observed. These modifications persisted in the 32 patients who continued 6- and 12- months follow-up training, while regressed in the 7 patients who stopped training.

Conclusions

Results of the present study show that a SPE-based cardiovascular rehabilitation program provides clinical benefit in patients with MiNDS.
Role of Integrated yoga like posture, breathing exercise, music, sattvic diet and bhagwad geeta for quit smoking and cardiovascular prevention as compare to still active smokers
Authors: Sen N , Tanwar SONAL , Jain ASHOK , Kumar DEEPAK , Sen NARESH
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Coronary heart disease (CHD) is increasing in young individuals and female also in India due to smoking .The possible effect of smoking on endothelial function has long been revealed and also cause oxidative distress, negatively affects platelet function, fibrinolysis, inflammation and vasomotor function.

Purpose

Smoking cessation program by integrated yoga to quit smoking for better cardiovascular prevention .

Methods

17655 pre-hypertensive and prediabetic enrolled during 2009- 2011 at different medical centers, male versus female 4: 1 (age 18-50 years), 10660 non-smokers and 6995 smokers at same smoking index. We categorized group A for Integrated yoga like posture, breathing exercise (Pranayama), music, sattvic diet and bhagwad geeta for quit smoking and Group B who were denied for spiritual vedic program. Session were perform with three cycles for 3 months and taken follow up after 5 & 10 years.

Results

Data suggest that quit smoking samples were found in integrated yoga group A, 88 % versus 15 % in normal group B. We compared data and found significant BP, HR, HRV reduction around 2.5 fold higher reduction in integrated yoga group quit smokers as compare to still smokers in normal group B with P value ( 0.002, 0.004, 0.003), 1.5 fold reduction of BMI in group A (p<0.005). Significant two fold decrease of incidence of diabetes type 2 and left ventricular diastolic dysfunction, improvement of treadmill METs value, 6 min walk and pulmonary vital capacity in integrated yoga group after 10 years of follow up. 38% risk reduction of acute myocardial injury and stroke found in integrated yoga quit smoking group A.

Conclusion

Smoking cessation is mandatory to reduce cardiovascular events. Integrated yoga is a master life style intervention for quit smoking without medical side effects in future.
Shorter cardiac rehabilitation programs: taking time is taking effectiveness?
Authors: Alves Da Silva P , Brito J , Aguiar-Ricardo I , Cunha N , Abrantes A , Fonseca J , Pinto R , Caldeira E , Sousa P , Pinto FJ , Abreu A , Miguel S
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Due to the covid-19 outbreak, cardiac rehabilitation programs (CRP) underwent most needed adaptions to stay operative. To face all the requests and guarantee sanitary measures, we reduced the duration of the program from about 12 weeks to about 8 weeks, so we could have smaller groups but still respond to all patients who had been referred. However, it is still unclear whether less hours of contact and exercise sessions can achieve the same results as traditional CRP.

Objective

To analyse the effectiveness of shorter duration CRP on risk factor control and exercise tolerance after concluding the program.

Methods

Observational single center study including two groups of patients who underwent CRP: one group who had been in 12 weeks-CRP before the pandemic sprout and another group enrolled in an 8-week program after April 2021. Albeit differences in their duration, both CRP had the same structure: observation by cardiologist, physiatrist, specialist nurse, exercise (aerobic and strength exercises) and educational sessions, as well as nutrition and psychologist consultation.

Results

A total of 114 pts were analysed (mean age 62,4±11,6 years, 85.1% men, 86% with ischemic heart disease). Main comorbidities were hypertension (68,4%), dyslipidaemia (70%) and diabetes (30,7%). 78 pts completed a longer programme with 12 weeks duration while 36 underwent a shorter CRP with 8 weeks. There were no statistically significant differences between both groups regarding population demographics, aetiology, LVEF and co-morbidities.

After CRP, there was significant improvement in risk factor control (mainly lipidic profile and weight) and echocardiographic parameters in both groups. We noted an important reduction in LDL levels (85±42.6mg/dL before CRP and 67.68±28.45mg/dL after), approaching the guideline recommended levels (<55mg/dL): 29.8% before vs 42.6% after (p=0.079), with no difference between the two groups (p=0,65). Significant improvement of LVEF was also observed (53% to 57%, p <0.001) without difference between the two groups (p=0.112).

Exercise tolerance improved similarly in both groups, assessed by the time of exercise stress test: we registered a global increase of 65 ± 1.38s after CRP, with no difference between the two groups (p = 0.157).

Conclusion

Shorter duration CRP showed similar results concerning risk factor control, echocardiographic LVEF and exercise tolerance improvement, suggesting that they can be an effective alternative when needed.
Centres of sports cardiology in Czechia - first experiences
Authors: Tuka V , Jenisova A , Jiravska-Godula B , Jiravsky O
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

Sports cardiology is a subspeciality of cardiology. It differs from general cardiology practice; the presence of an athlete’s heart can be challenging to differentiate from incipient cardiac pathologies, and athletes often present with atypical symptoms and expectations. In Czechia, three Centres of Sports Cardiology (CSC) for athletes older than 15 years and one for children were founded 2020 and endorsed by the Czech Society of Cardiology and the Czech Society of Sports medicine.

Purpose

The present study aims to share our experience from the first two years of functioning two tertiary sport cardiology centres (Centre 1 and Centre 2)

Methods

Only athletes registered for the examination from 1st January 2020 till 7th November 2021 were included.

Results

We included 149 athletes (79 from Centre 1 and 71 from Centre 2). The mean age was 29 ± 13 years. The majority of sports were mixed (n= 83) than endurance (n=58) and very few power (n=3) and skill sports (n=1). The main reason for examination was abnormal preparticipation screening results (n=46), symptoms (n=45) and abnormal findings on complementary examination (n=31). Only two athletes were indicated from cascade screening and one athlete after sudden cardiac arrest.

In CSC we performed electrocardiograms (n=101), echocardiography (n=77), HolterECG (n=39), 24-hour ambulatory blood pressure monitoring (n=3), cardiac magnetic resonance (n=13) one CT-coronary angiography, cardiopulmonary exercise stress test (n=41), invasive coronary angiography (n=3), other examination (n=15). We were able to ascertain a diagnosis in 113 athletes; a suspected diagnosis was in 14 athletes, and in 20, we were unable to set any diagnosis. The main conclusions were that 79 (53%) of athletes were eligible to sport participation, in 34 (23%) of athletes, the eligibility had a condition, and only 10 (6.7 %) athletes were ineligible to sport participation. (However, the main conclusions were that 79 (53%) of athletes were eligible to sport participation, in 34 (23%) of athletes, the eligibility had a condition, and only 10 (6.7 %) athletes were ineligible to sport participation. ) The ineligibility was due to cardiomyopathy (n=5), long QT syndrome (n=2), valvular heart disease (n=1), Marfan syndrome (n=1), preexcitation syndrome (n=1). Only six athletes were lost to follow-up, and in 13 (8.7 %), the examination process was not yet closed.

Conclusion(s)

The establishment of sports cardiology centres in Czechia respects the global trend in cardiovascular care for athletes. The first 22 months of their work confirm the importance of their existence with the centralization of subspecialty cardiology care. Confirmation of the trend is the establishment of full eligibility in 76% of examined athletes. Similarly, the non-recommendation of further sports activity in less than 7% of examined athletes again confirms the correctness of the existence of sports cardiology centres.
Prevalence of Physiological Electrocardiographic Findings in a Brazilian Cohort of Young Football Players: B-Pro Foot ECG Pilot Study
Authors: Stein R , Ferrari F , Helal L , Emed LGM , Dilda GD , Aleixo HC , Bassan F , Martins VM , Da Silveira AD
Published: May 2022

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Hospital de Clínicas de Porto Alegre Research and Event Incentive Fund (FIPE-HCPA)

Introduction

The 12-lead electrocardiogram (ECG-12) is a useful tool in the assessment of athletes, and it may present findings compatible with physiological adaptations to regular exercise. ECG-12 findings in Brazilian soccer players are unknown.

Purpose

To describe the prevalence of physiological ECG-12 findings in young Brazilian soccer players based on the "2017 International Criteria for Electrocardiographic Interpretation in Athletes".

Methods

Continuous variables were displayed as mean and standard deviation or median and interquartile range, while prevalence’s with 95% confidence intervals, and stratified by race. Intra-group differences were estimated by linear models or binomial and multinomial logistic regressions. Type I error was set to set a at 0.05. An additional margin of 0.025 was considered at the discretion of the statistician conditioned to the quality of the model. All analysis were running in Stata version 16.0.0.

Results

2,581 athletes from 27 clubs (mainly first division), aged 15-35 years (median: 18 years) were evaluated. 1,268 (49.1%) were Caucasians, 796 (30.8%) Mixed-race (MR) and 517 (20.1%) Afro-Brazilians (AB). In this sample from across the country, we identified the following findings and its respective prevalence: sinus bradycardia (50%), ectopic atrial rhythm (1.4%), junctional rhythm (0.3%), incomplete right bundle branch block (23.7%), first-degree atrioventricular (AV) block (3.0%), Mobitz type I AV block (0.1%), and increase QRS voltage for left or right ventricular hypertrophy (35.2% and 17.3%, respectively). The mean PR interval was 153.9±28.7 ms, corrected QT interval 399.2±28.0 ms, and QRS duration 96.0±14.0 ms. ST elevation followed by T-wave inversion in leads V1–V4 was identified in 11/517 (2.1%) of AB athletes. Early repolarization was present in 828 athletes (32.1%), being more prevalent in AB when compared to MR and Caucasians (P = 0.003). Likewise, AB had a greater PR interval in comparison to MR and Caucasians (P <0.001 and P = 0.007, respectively). On the other hand, Caucasians had a significant longer QRS duration compared to AB. For all remaining variables there was no difference among races.

Conclusions

To the best of our knowledge, this is the first large study to describe the prevalence of physiological electrocardiographic finding in young Brazilian soccer players, according to "2017 International Criteria for Electrocardiographic Interpretation in Athletes". Future studies comparing the frequency of these findings with the prevalence observed in other cohorts are welcome.
Cardiac screening in police and armed forces: a pilot project
Authors: Yamagata K , Yamagata LM , Abela M
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Most international bodies now recommend cardiac screening for all individuals undertaking high intensity physical activity. The sensitivity and specificity of the ECG in cardiac screening is undisputed.

Study Objective

Two major national institutions (Police Force and the Armed Forces) have now recognized the importance of having a cardiac screening program. As of 2020, the department of Cardiology has been offering remote ECG interpretation for all new recruits. The aim of the study was to retrospectively review this service, specifically looking at the diagnostic yield.

Methodology

All reported ECGs were retrospectively evaluated. ECG changes were labelled as training related, borderline or pathological ECG patterns as depicted in the 2017 International Recommendations for ECG interpretation in athletes. Demographic, symptom and ECG data were tabulated. The clinical outcomes of those referred were also recorded. Categorical data was presented as percentages. Statistical analysis was performed using SPSS v23.

Results

318 recruits were screened, mean age 31.42 ± 13.2 years. The majority (n=196, 61.6%) were younger than 35 years. It was a predominant male population (n=262, 82.4%), all being Caucasian. Armed forces and police force recruits were equally represented (n=154, 48.4% vs n=164, 51.6%). No one reported symptoms (0.0%). The commonest training related changes included early repolarisation (22.3%), left ventricular hypertrophy (15.4%), sinus bradycardia (14.2%) and partial right bundle branch block (7.5%). Some had pathological ECG patterns (Anterior T Wave Inversion n=6 [1.9%], ST segment depression n=6 [1.9%], pathological Q waves n=5 [1.6%], ventricular ectopics n=3 [0.9%], pre-excitation n=2 [0.6%], inferior T Wave inversion n=1 [0.3%], Short QT n=1 [0.3%]).

Most were cleared at the initial assessment (n=292, 91.5%). 26 (8.2%) were referred for further evaluation. 14 (4.4%) needed a repeat ECG. Most (n=6, 23.1%) were cleared after secondary evaluation. Another 4 (15.4%) needed surveillance. 6 (23.1%) had a clinical diagnosis, equating to 1 in 53 individuals screened (1.9% of initial cohort). Two patients were already under the care of a cardiologist (n=1 sinus venosus defect with PAPVD, n=1 ischaemic cardiomyopathy). 4 were newly diagnosed cardiac patients (n=1 HCM, n=2 WPW, n=1 Aortopathy). Age did not have any significant impact on the diagnostic yield (<35 [50%] vs ≥35 [50%] years, p=0.244).

Conclusion

8.2% were referred for further evaluation (1 in 12). 1.9% (1 in 53) had a clinical diagnosis. This highlights the importance of an ECG based screening algorithm in close liaison with experts in cardiac screening. A clinical diagnosis in law enforcement and army personnel may have important lifelong career implications.
The prevalence of risk factors and pattern of obstructive coronary artery disease in young indians (< 45 years) undergoing percutaneous coronary intervention: a gender-based multi-center study
Authors: Jariwala PVJ , Jadhav KARTIK , Patil RR , Chawla KK
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

In a retrospective study, we aimed to explore the prevalence of risk factors and trends of obstructive coronary artery disease (CAD) in Indian females under 45 years old compared to males of the same age group who underwent percutaneous coronary intervention (PCI).

Purpose

With changing lifestyles, the onset of traditional risk factors at the early stages of life is the major culprit for developing CAD at an early age. For several years, the significance of CAD in young women was underestimated. There are some sex-related variations in CAD, and symptoms of CAD in women, regardless of age, have low specificity even in the absence of risk factors.

Materials and Methods

This was a retrospective, observational, multi-centre study of young Indian females and males (< 45 years) who underwent PCI as per the guidelines at three high-volume centres of India. The study evaluated the prevalence of risk factors, clinical and angiographic patterns of obstructive CAD in young Indian women compared to men.

Results

In a cohort of 3656 patients who underwent PCIs, 113 young females comprised 3.1% of those with obstructive CAD, while 254 young males constituted 6.9%. Traditional risk factors such as hypertension, diabetes, and family history of premature CAD were the most common in both genders, whereas dyslipidaemia, obesity, smoking, and alcoholism were more common in young males. The acute coronary syndrome was the most common clinical presentation. The single-vessel disease was common with the involvement of the left anterior descending artery as a most common angiographic feature. The prevalence of cardiogenic shock was 4.4% in females and 4.1% in males while the in-hospital mortality rate was 1.77% in young females and 2% in young males.

Conclusion

CAD in young Indians is on the rise, and frequent screening for obstructive CAD should be done, especially in those with symptoms and risk factors.
The incidence of cardiac arrhythmias during exercise stress testing among patients with obesity undergoing sleeve gastrectomy
Authors: Vecchiato M , Quinto G , Mazzucato B , Gasperetti A , Neunhaeuserer D , Ermolao A , Battista F
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Obesity is associated with higher rate of cardiovascular morbidity and mortality, anatomical and functional cardiac alteration.(1) In particular, several studies found an association between increased body weight and arrhythmic events.(2) Sleeve Gastrectomy (SG) is recognized as significant treatment option for obesity, with beneficial effect in both weight loss and comorbidities.(3) Moreover, this treatment results in positively decrease in some basal parameters currently associated with increased risk of arrhythmic events, even if little is known about real incidence of cardiac arrhythmias, especially during exercise, before and after bariatric surgery.(4)

Purpose

To investigate the prevalence of arrhythmic events during maximal exercise testing in patients with moderate-severe obesity and to evaluate how SG affects the number of arrhythmic events.

Methods

All patients with moderate or severe obesity who were considered suitable candidates for SG after multidisciplinary evaluations were consecutively included in this study. Each patient underwent an incremental, maximal, ECG-monitored cardiopulmonary exercise testing (CPET) before and 6-months after SG. Presence and complexity of atrial premature beats (APBs) and ventricular premature beats (VPBs) has been evaluated at rest, during exercise and during recovery phase.

Results

318 patients with morbidly obesity (BMI 44.20±6.79 kg/m2, age 48.9±10.7 years) were included in the study. After SG, patients presented lower heart rate at rest (80.75±12.60 versus 64.84±9.89 bpm, p<0.001) and an increased exercise time (831.30±195.32 versus 941.13±222.16 s, p<0.001). The analysis of the arrhythmic events during the complete test showed a slight significant difference between pre-SG and post-SG, only regarding number of patients presenting APBs (p=0.038). However, the incidence of arrhythmic events was significantly increased during the recovery phase in post-SG evaluation, both by number of patients with at least one arrhythmic episode and by number of arrhythmic events per minute (Table I). Patients affected by severe obesity had a higher risk occurrence of arrhythmias during CPET, notably atrial premature beats (p=0.038), when compared to patients with moderate obesity. No differences were found among post-SG patients. Men presented more frequently VPBs compared to women, both in pre-SG (p=0.048) and post-SG evaluation (p<0.001). No gender differences were observed in APBs (Figure 1).

Conclusion

Patients affected by severe obesity show an increased prevalence of atrial premature beats, even if no episode of exercise-induce atrial fibrillation has been described. In the early post-surgical phase, the risk of exercise-induced arrhythmias may be higher during the recovery phase, although SG does not seem to increase the occurrence of life-threating arrhythmias.