bluuebunny/crossref_metadata_2025 huggingface dataset:
CT coronary angiography in Selected Group of patients with Chest pain of new onset predicts and prevents hospital admissions & Outpatient Clinic referrals
Authors: Cameron M , Wang I , Ashikodi E , Dhir N , Raja Y , Baig M
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

NICE (National Institute of Clinical Excellence) guidelines currently recommend the use of CT coronary Angiogram (CTCA) as the initial test to investigate coronary artery disease in patients with new onset of chest pain.

Our aim was to evaluate the relationship between the CT coronary angiogram findings on index presentation, and hospital admissions and re-referral to outpatient clinics in following 2 years.

Method

Data was accrued via a retrospective analysis of electronic medical records at Sunderland Royal Hospital pertaining to patients who presented to the Rapid Access Chest Pain Clinic (RACPC) and underwent CTCA in 2017.Data included:

Presentation – Typical & atypical angina

Risk factors profile

Investigations including ECG, ECHO, CTCA, perfusion scan and invasive coronary angiography

Severity of coronary artery lesion on CTCA

Hospital admissions or re-referral to outpatient clinics in 2 year follow up

Results

In the 235 patients studied, mean age was 56 years with 130 (55.5%) men and 195 (82.9%) presented with atypical angina as shown in table.

Out of 195 patients with atypical chest pain only 17 (8.7%) were diabetics and most of them 178 (91%) had Coronary Calcium score of 1-400. Most patients (184) underwent CT coronary angiogram with 39 (21%) having normal coronary arteries, 126 (68%) with mild to moderate coronary artery disease and 19 (11%) with severe coronary artery disease. Subsequent assessments with invasive coronary angiography, myocardial perfusion scan and Treadmill exercise did not reveal significant disease warranting coronary revascularization.

Patients with normal or mild -moderate CAD on CTCA 24 (15%) represented with acute chest pain (only one needed PCI) and 6 (3.5%) were referred to outpatient clinics over 2 years follow up. In patients with severe CAD on CTCA, 6 (32%) presented with acute chest pain and 4 (21%) needed PCI. Almost all patients were treated with statins and antiplatelets following CTCA results.

Conclusion

CT coronary angiography is sensitive and specific in assessment of hemodynamically significant coronary artery disease in non-diabetic patients presenting with angina in outpatient setting.

CTCA in patients with normal or mild to moderate CAD also gives confidence to the clinician and prevents further un-necessary investigation and hospital admissions/outpatient referrals.
Primary and Secondary Prevention of Cardiovascular Diseases educational programme on the Instagram
Authors: Alexandra D , Ryabinina MN , Aksenova GA , Benimetskaya KS , Vasilyeva IA , Isaeva AV , Lobzhanidze FA , Novikova DS , Pivenstein AL , Savonina OA
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Purpose. To study the possibility of conducting the ‘Primary and Secondary Prevention of Cardiovascular Diseases’ educational programme aimed at promoting health literacy among cardiology blog followers on Instagram.

Material and methods. In the present study the methodology for conducting the educational programme on Instagram included the following: choosing the agents of influence and format of audience engagement; determining the most relevant topics and time frames; identifying the frequency and characteristics depending on the selected format of audience engagement; developing evaluation metrics; conducting the programme; evaluation of study results; defining the scaling strategy. The educational programme was conducted daily from 19 to 30March 2020 through professional medical accounts on Instagram. The programme format included posts of up to 4,000 characters on primary (healthy diet, smoking cessation, physical activity, obesity, vegetarian diet) and secondary prevention (drug treatment) of cardiovascular diseases. The study results were evaluated by descriptive statistics for standard social network metrics.

Results. The total number of cardiology blog followers is 367,727. The audience of professional doctors" blogs is mostly female (89 to 95%), the age group of 25 to 34 years accounts for 40 to 47% of the followers. Ten posts of the educational programme were viewed by a total of 104,794 users, gathering a total of 9,692 audience engagements (comments, shares, likes and saves). Such topics as consumption of vegetables, salt and sugar, physical activity and obesity accounted for the highest audience engagement (1,146; 1,100; 2,195; 1,052 and 1,534 users, respectively).

Conclusions. The Instagram social network can be used for educational programmes aimed at promoting health literacy among Russian people. It is necessary to further improve the methodology for conducting research in social networks in order to select the most effective technologies that contribute to the preservation of public health.
The effect of age and gender on heart rate variability in healthy individuals
Authors: Alyahya A , Fuller A , Okwose N , Charman S , Macgowan G , G Jakovljevic D
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Objective

Cardiovascular autonomic function, represented by heart rate variability (HRV) is a simple, non-invasive measure used to determine alteration of sympathetic and parasympathetic control. The aim of the present study was firstly to evaluate the effect of age and gender on HRV measures, and secondly to determine the relationship between measures of HRV and functional capacity in healthy individuals

Methods

This was a retrospective, single centre, cross-sectional, observational study. Data were collected between January 2018 and July 2019. Sixty-eight healthy participants (age range: 19-78 years) were stratified according to age into the younger age group (<40 years of age, N = 43, males, N = 26; females, N = 17) or the older age group (>55 years of age, N = 25, males, N = 14; females, N = 11). Frequency domain HRV measures (i.e. absolute and normalised low frequency power (LF), high frequency power HF and their ration i.e. LF/HF ratio) were derived from RR interval and recorded at rest (supine position) for 30 minutes. Simultaneous non-invasive gas-exchange and central haemodynamic measurements (bioimpedance) were collected at rest and during maximal graded cardiopulmonary exercise stress test using semi-recumbent cycle ergometer.

Results

The mean age of the younger group was 26 ± 6 years and older 64 ± 6 years. Cardiorespiratory fitness (i.e. peak oxygen consumption) was significantly reduced in older compared to younger age group (1.60 ± 0.57 vs. 2.38 ± 0.74 L/min, p < 0.01). The mean absolute values of HF power declined with age in males by 32% (younger, 1156 ± 806 ms2 vs. older, 835 ± 488 ms2, p = 0.18), but not in females 3% difference (younger, 1182 ± 958 ms2 vs older, 1150 ± 843 ms2, p= 0.92). There was no significant difference in HF power between males and females in the younger age group (young male, 1156 ± 806 ms2  vs. young female, 1182 ± 958ms2, p = 0.92), but older males demonstrated 32% lower HF power than older females (835 ± 488 ms2 vs. 1150 ± 843 ms2, p= 0.25). Further analyses revealed no significant relationship between measures of heart rate variability and functional capacity i.e. the HF power was not significantly related to peak oxygen consumption in males (r= - 0.15, p= 0.36) or females (r= 0.05, p = 0.80).

Conclusions

High frequency power of the heart rate variability declines with age more in men but not women. Gender difference in high frequency power is apparent in older but not younger age, with older women showing nearly one third higher HF than older men. Measures of heart rate variability do not predict cardiorespiratory fitness
Skeletal muscle status, autonomic balance and short-term results of cardiac surgery
Authors: Oleinik P , Sumin AN , Bezdenezhnykh AV
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Research Institute for Complex Issues of Cardiovascular Diseases

The aim - investigate the association of the lower extremities skeletal muscle state, status autonomic nervous system (ANS) and short-term results of the cardiac operations. 

Design

Study included 64 patients, who underwent planned cardiac surgery. All subjects before surgery performed a routine laboratory and instrumental examinations, six-minute walk test (6MWT), and static-dynamic tests on the training device. ANS was carried out, using ORTOexpert software. Were formed 2 groups – with the combined endpoint CEP (n = 9) and without CEP (n = 55). CEP included: perioperative development stroke, myocardial infarction, persistent arrhythmias and heart block, multiple organ dysfunction syndrome, death. 

Results 

Not found difference between the groups in gender, age, in main clinical data and laboratory tests indicators, and in endurance of the skeletal muscles or the 6MWT. In the CEP group, strength of skeletal muscles of the upper and lower extremities was lower, initially more pronounced sympathetic activation and larger values of the power of the frequency spectrum (TF). 

Stress index (IS) was lower in the CEP group, but after transitioning orthostatic position it surpassed the number without CEP. One-factor logistic regression analysis established factors associated with the development of CEP - poor muscle status, peripheral atherosclerosis; high EuroSCORE, cardiopulmonary bypass duration (CBD) and ANS disbalance. Multivariate regression analysis to establish the relationship of poor skeletal muscle status, pronounced sympathicotonia and a high incidence of postoperative complications.

Logistic regression analisys Odds ratio [ -95%; +95%CL] p One-factor logistic regression Stenosis ICA ≥ 30% 9,545 [1,030; 88,467] ,043 Shoulder Girdle Muscle Strength (Kg) 0,893 [0,786; 1,001] ,048 Knee extensors strength (kg) 1,012 [0,997; 1,029] ,098 Amo (basic) 0,958 [0,920; 0,998] ,037 IS (basic) 0,996 [0,990; 1,000] ,096 EuroSCORE (points) 1,643 [1,003; 2,694] ,043 CBD (min) 1,010 [1,001; 1,022] ,068 Multiple-factor logistic regression p=,001 LF/HF 1,175 [0,972; 1,420] ,088 Amo (basic) 0,950 [0,905; 0,997] ,034 Shoulder Girdle Muscle Strength (Kg) 0,863 [0,750; 0,993] ,036 LF/HF-ratio Low frecuency/High frecuency Amo-mode amplitude
Outcomes in nonagenarians with acute coronary syndrome. Is medical treatment important?
Authors: Echarte-Morales JULIO , Tundidor Sanz ELENA , Martinez Gomez E , Cepas-Guillen PEDRO , Borrego Rodriguez JAVIER , Viana Tejedor ANA , Caldentey Adrover G , Vidal PABLO , Rodriguez Santamarta MIGUEL , Flores Umanzor E , Fernandez Ortiz A , Quiroga XAVIER , Sabate MANEL , Fernandez-Vazquez FELIPE
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

 Nonagenarians have a high rate of comorbidities and are underrepresented in studies of ischemic heart disease. It is unknown whether treatment at discharge is useful in preventing adverse events at follow up. 

Purpose 

The aim of this study is to evaluate the secondary prevention with medical treatment in nonagenarians with acute myocardial infarction.

Methods

A multicenter, observational and retrospective study was carried out in nonagenarians admitted by acute coronary syndrome (ACS) between January 2005 and December 2018. Baseline characteristics, interventional procedures, treatment at discharge and outcomes at 1 year were evaluated. Patients with type 2 acute myocardial infarction were excluded. 

Results 

680 patients (92,6 ± 2,4 years old) were included. Hypertension was present in 79.4% of the entire population. Percutaneous coronary intervention (PCI) was performed in 32.1% of patients, and this group had a higher GRACE score compared to the conservative treatment group (177 versus 172; p = 0.001). Patients with ST-segment elevation myocardial infarction (STEMI) were more likely to receive an invasive strategy than the non-ST segment elevation myocardial infarction (NSTEMI) (61.5% versus 41.5%; p= 0.001). 263 patients died at 1 year follow up with in-hospital mortality of 17%. In STEMI group, patients with statins and dual antiplatelet therapy at discharge had lower mortality during follow up compared to those who did not received (26.7 % versus 41.5%; p = 0.001 and 31% versus 22%; p = 0.02, respectively) (Image 1). 

Conclusions

Nonagenarian patients with ACS have a high prevalence of hypertension and ICP procedures are not performed frequently. They also have a high mortality rate, although statins and dual antiplatelet therapy could be an effective secondary prevention.

Abstract Figure.
A comprehensive secondary prevention benchmark (2PBM) score identifying differences in secondary prevention care in patients after acute coronary syndrome
Authors: Liu Y , Haegele M , Frey S , Strebel I , Jordan F , Lange R , Burkard T , Clerc OF , Pfister O
Published: May 2021

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Unrestricted grands from AstraZeneca, Boehringer Ingelheim and Sanofi

Background

Reaching secondary prevention targets improves long-term prognosis in patients after acute coronary syndrome (ACS). Although prevention targets are defined by guidelines, their achievement rates are insufficiently documented. Suitable benchmarking tools are lacking.

Purpose

 We aimed to determine the degree of secondary prevention care by creating a secondary prevention benchmark score (2PBM) and using it in patients undergoing ambulatory cardiac rehabilitation (CR) after an acute coronary syndrome. 

Methods

In this observational cohort study, 472 consecutive ACS patients who completed the local ambulatory CR programme between 2017-2019 were included. Benchmarks for secondary prevention medication, clinical and lifestyle targets were predefined and combined in the complete 2PBM with maximum 10 points. The association of patient characteristics and achievement rates of individual components and the complete 2PBM were assessed using multivariable logistic regression analysis. 

Results

Patients were on average 62 ± 11 years old and predominantly male (n = 406; 86%). Type of ACS was ST-elevation myocardial infarction (STEMI) in 241 patients (51%) and non-ST-elevation myocardial infarction in 216 patients (46%). Achievement rates for individual components of the 2PBM were 71% for medication, 35% for clinical and 61% for lifestyle benchmarks. Achievement of medication benchmark was associated with younger age [odds ratio (OR): 0.979, 95% confidence interval (CI) 0.959-0.996, p = 0.021] and history of STEMI [OR: 2.05, 95% CI 1.35-3.12, p = 0.001]. Achievement of clinical benchmark was associated with medication benchmark [OR: 1.66, 95% CI 1.03-2.71, p = 0.042]. The complete 2PBM was achieved by 74 patients (16%), while 362 patients (77%) reached ≥8 points. Achievement of complete 2PBM was independently associated with a history of STEMI [OR: 1.79, 95 CI 1.06-3.08 p = 0.032]. 

Conclusion

Benchmarking with 2PBM identifies gaps and achievements in secondary prevention care. A history of STEMI was associated with the highest 2PBM score, suggesting best secondary prevention care in patients after STEMI. 2PBM may be used for internal quality control, comparison of cohorts and future correlation studies between CR targets and outcomes.

Abstract Figure.
Circulating levels of proprotein convertase subtilisin/kexin type 9 (PCSK9) are associated with monocyte subsets in patients with stable coronary artery disease
Authors: Krychtiuk KA , Lenz M , Hohensinner P , Distelmaier K , Schrutka L , Kastl SP , Huber K , Hengstenberg C , Wojta J , Speidl WS
Published: May 2021

Funding Acknowledgements

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

Background and aims

Proprotein convertase subtilisin/kexin type-9 (PCSK9) is an enzyme promoting the degradation of low-density lipoprotein receptors (LDL-R) in hepatocytes. Inhibition of PCSK9 has emerged as a novel target for lipid-lowering therapy. Monocytes are crucially involved in the pathogenesis of atherosclerosis and can be divided into three subsets. The aim of this study was to examine whether circulating levels of PCSK9 are associated with monocyte subsets.

Methods

We included 69 patients with stable coronary artery disease. PCSK9 levels were measured and monocyte subsets were assessed by flow cytometry and divided into classical monocytes (CD14++CD16-; CM), intermediate monocytes (CD14++CD16+; IM) and non-classical monocytes (CD14 + CD16++; NCM).

Results

Mean age was 64 years and 80% of patients were male. Patients on statin treatment (n = 55) showed higher PCSK9-levels (245.4 (206.0-305.5) ng/mL) as opposed to those without statin treatment (186.1 (162.3-275.4) ng/mL; p = 0.05). In patients on statin treatment, CM correlated with circulating PCSK9 levels (R = 0.29; p = 0.04), while NCM showed an inverse correlation with PCSK9 levels (R=-0.33; p = 0.02). Patients with PCSK9 levels above the median showed a significantly higher proportion of CM as compared to patients with PCSK-9 below the median (83.5 IQR 79.2-86.7 vs. 80.4, IQR 76.5-85.2%; p = 0.05). Conversely, PCSK9 levels >median were associated with a significantly lower proportion of NCM as compared to those with PCSK9 <median (10.2, IQR 7.3-14.6 vs. 14.3, IQR 10.9-18.7%; p = 0.02). In contrast, IM showed no association with PCSK-9 levels.

Conclusions

We hereby provide a novel link between PCSK9 regulation, innate immunity and atherosclerotic disease in statin-treated patients.
Tailored clinical management after blinded statin challenge improved long-term lipid control in coronary patients with self-perceived muscle side-effects
Authors: Sverre E , Peersen K , Kristiansen O , Fagerland MW , Perk J , Husebye E , Vethe NT , Dammen T , Munkhaugen J
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Helse Sør-Øst, Vestre Viken Trust

Background

Statin discontinuation due to self-perceived muscle side-effects is a major challenge in clinical practice. Strategies are needed to improve lipid control in these patients.

Purpose

We studied if information about the results of a blinded statin challenge experiment, followed by tailored lipid lowering treatment, had long-term effects on lipid control in coronary patients with self-perceived muscle side-effects.

Methods

A post-trial intervention study of patients classified with statin dependent (N = 20) and independent (N = 50) muscle complaints in the MUscle Side-Effects of atorvastatin (MUSE), a randomized, double-blinded, crossover trial. All participants were informed of the MUSE trial results in an individual consultation and provided tailored lipid-lowering treatment according to protocol with 1-2 follow-up calls. Lipids were controlled at the end of follow-up.

Results

Mean age was 64 (SD 9.5) years and 33% (N = 23) were females. During an average follow-up of 13 months (SD 3.3), mean LDL-cholesterol was reduced by 0.3 (SD 0.6) mmol/L (p = 0.005) in patients with statins and by 1.7 (SD 1.0) mmol/L (p = 0.005) in patients without statins at inclusion in the MUSE trial (Table). We found no changes in the overall use of high-intensity statins, but ezetimibe was used by 11 additional patients and 4 patients were prescribed a PCSK9-inhibitor. Participants in the subgroup without statins at inclusion used; atorvastatin (N = 2), rosuvastatin (N = 3) or a PCSK9-inhibitor (N = 2) at follow-up. 90% found their own trial results useful in making decisions about future statin use.

Conclusions

Information about the results of a statin challenge experiment combined with tailored and systematical prescription of lipid-lowering agents had favourable long-term effects on lipid control in coronary patients with self-perceived muscle side-effects.

Characteristics of the study population Using statins at inclusion (n = 62) Not using statins at inclusion (n = 8) Classified with statin-dependent side-effects, n (%) 15 (24) 5 (63) LDL-cholesterol at inclusion, mean (SD) 2.2 (0.8) 4.2 (1.1) LDL-cholesterol at follow-up, mean (SD) 1.9 (0.7) 2.5 (0.8) High intensity statin (ie. ≥40 mg atorvastatin or ≥20 mg rosuvastatin) at inclusion, n (%) 40 (55.6) 0 (0) High intensity statin at follow-up, n (%) 38 (61) 2 (25) Ezetimibe at inclusion, n (%) 13 (21) 3 (38) Ezetimibe at follow-up, n (%) 26 (42) 1 (13) PCSK-9 inhibitor at follow-up, n (%) 2 (3) 2 (25) Usefulness of own trial result in making decisions about future statin use on a 0 to 10 Likert scale, mean (SD) 8.1 (2.0) 9.6 (0.6)
A novel direct method to determine adherence to simvastatin therapy in patients with coronary heart disease
Authors: Vethe N , Husebye E , Andersen AM , Bergan S , Kristiansen O , Fagerland MW , Munkhaugen J
Published: May 2021

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): National Association of Health

OnBehalf

NORCOR

Background

Poor adherence to statin therapy remains a public health concern associated with adverse clinical outcome. Reliable classification and detection of statin adherence is needed in clinical practice and for clinical studies with overall aim to improve the lipid management. Simvastatin is a frequently used statin in cardiovascular disease prevention.

Purpose

To develop a feasible test based on spot blood samples to monitor the adherence to simvastatin therapy in coronary heart disease (CHD) patients.

Methods

Eighteen CHD patients on an evening dose of simvastatin 20 mg (n = 7), 40 mg (n = 5) and 80 mg (n = 6) were studied at steady-state pharmacokinetics. Ten patients were instructed to avoid simvastatin dosing and return for blood sampling the subsequent three days. Dose-normalized plasma concentrations of simvastatin lactone, simvastatin acid and the sum of the two were evaluated as discriminators between adherent dosing and dose avoidance. Bioanalytical quantifications were performed with liquid chromatography tandem mass spectrometry.

Results

The dose-normalized plasma concentrations at steady-state demonstrated 23-fold and 39-fold interindividual variabilities for simvastatin lactone and simvastatin acid. A simvastatin acid cut-off at 1.0·10^-2 nmol/L/mg identified 100% of those omitting 2 doses and 60% of those omitting a single dose (Figure 1). Simvastatin acid showed superior ability to discriminate dose avoidance from adherence, and also the best agreement between samples handled at ambient and cool temperature (median deviation 3.5%, interquartile range -2.5 to 13%). A cut-off for morning dose schedule, with similar ability to discriminate, was estimated at 2.0·10^-3 nmol/L/mg.

Conclusion

A novel method discriminating between good and poor adherence to simvastatin therapy in CHD patients has been developed. The sample handling is feasible for routine practice, and the assessment of adherence can be performed by direct measurements in spot blood samples, according to specific cut-off values.

Abstract Figure 1 Drug levels vs dose avoidance
Association of type 2 diabetes mellitus and mortality after coronary artery bypass graft surgery- a meta analysis
Authors: Abdul Razzack A , Pothuru S , Adeel Hassan S , Mandava S , Theja Reddy K , Missael Rocha Castellanos D , Rocha Castellanos D , Lilian Contreras Gallegos G , Sanchez Alfaro A , Arshad J , Sattar Y
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background- Recent studies have demonstrated the favorable cardiovascular outcomes of coronary artery bypass graft surgery (CABG) among patients with diabetes mellitus (DM). However, little is known regarding the impact of T2DM in patients undergoing CABG. We aimed to compare the long-term mortality following CABG in patients with and without T2DM.

Methods-Electronic databases ( PubMed, Embase, Scopus, Cochrane) were searched from inception to December 15th, 2020. Unadjusted odds ratios (OR) were calculated from dichotomous data using Mantel Haenszel (M-H) random-effects with statistical significance to be considered if the confidence interval excludes 1 and p < 0.05.The primary outcome was all-cause mortality.

Results-Sixteen studies with a total of 183,200 participants (DM = 51,474, Non-DM = 131,726) were included in our analysis. Average follow up was 3 years. Mean age was 56.7 and 54.8 in the DM and Non-DM groups respectively. A statistically significantly higher rate of mortality was observed in patients with T2DM (OR 1.54; 95%CI 1.40-1.69; p < 0.00001, I2 = 36)as opposed to patients without T2DM.

Conclusion- Although CABG is the better revascularization strategy as opposed to PCI, Type 2 DM is an independent predictor for long-term mortality after CABG surgery.

Abstract Figure.
Impact of perceived stress into mortality among the elderly population
Authors: Imaeva A , Shalnova S , Kapustina A , Balanova Y , Shkolnikov V
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction. According to the results of the recent studies, high levels of perceived stress were the potent risk factors for all-cause and cardiovascular mortality among the middle-aged population. However, there were few studies on the impact of this factor to mortality among the older males and females.

Purpose. To investigate the association between perceived stress and all-cause and CVD mortality among the population of 75 years and older.

Methods. This study was a part of the prospective cohort survey "Stress, aging and health." Data of 455 adults 75 years and older (287 males and 168 females) was used. We evaluated perceived stress Cohen"s Stress Scale. All items were scored on a 5-point scale, high scores indicated high levels of stress. Perceived Stress Scale sum scores were categorized into quintiles; we considered scores in the highest quintile (>19) as abnormal. The mean follow-up was 12 years, 292 deaths occurred, including 200 from cardiovascular diseases (CVD). Association between perceived stress and all-cause and CVD mortality was evaluated by Cox regression model after adjustment for age.

Results. High levels of stress were significantly associated with all-cause and CVD mortality among elderly males (HR = 1,48 95% CI: 1,09-1,99; p = 0,01; HR = 1,65; 95% CI: 1,15-2,36; p = 0,007) after adjusting for age. At the same time, among females aged 75 years and older no significant associations of perceived stress scale high scores with all-cause and CVD mortality were found (HR = 1,28; 95% CI: 0,84-1,96; p = 0,25; HR = 1,19; 95% CI: 0,73-1,95; p = 0,48).

Conclusions. Perceived stress contributed significantly to higher mortality rates among males aged 75 years and older. While among females of the same age, no significant associations between high stress levels and all-cause and CVD mortality were found.
The effects of preventive counseling followed by remote support via phone on the motivation to change lifestyle in patients with high cardiovascular risk
Authors: Pogosova N , Yusubova AI , Yufereva YM , Sokolova OY , Karpova AV , Ausheva AK , Arutyunov AA
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Personal motivation for lifestyle change plays a fundamental role in modifying unhealthy habits. It can be improved, for example, through education. 

Objectives

To assess the effects of preventive counseling with focus on diet modification followed by remote support via telephone on the motivation to change lifestyle in patients (pts) with high cardiovascular  risk in a long-term follow-up.

Methods

This is a prospective randomized controlled study of pts aged 40 to 65 years with high/very high CV risk (≥5% according to the Systematic Coronary Risk Evaluation scale [SCORE]) and any 2 criteria of metabolic syndrome.  Pts were randomized into 2 groups in 1:1 ratio. The intervention group received comprehensive preventive counseling with focus on diet modification followed by remote preventive counseling by phone every two weeks for the first 3 months after enrollment (a total of 6 sessions). The control group received usual care in Health centers which also included basic preventive counseling. A specially designed questionnaire was used to evaluate the motivation to change lifestyle at  baseline and 12 months.

Results

A total of 100 pts (women - 80%, aged 59.85 ± 4.47 years) were randomized. At baseline 81% pts had high and 19% - very high CV risk. The groups were well balanced according to demographic and clinical features. At 1 year of follow-up the intervention group experienced significant improvement in motivation for lifestyle changes vs control. The proportion of pts achieving advanced stages of change process was 38% vs. 12% in the control group where 82% of pts only continued to think of lifestyle modification.

Conclusion

Preventive counseling followed by remote support via phone provided a significant improvement in motivation to change lifestyle.

Intervention group Control group P for change from baseline Baseline After 12 months Baseline After 12 months Not ready yet, % 0 0 0 0 <0.05 Often think of lifestyle changes, % 62 46 86 82 Ready to do changes if provided specific advices, % 32 16 12 6 Are in process of successful changes, % 6 38 2 12
Cardiac rehabilitation uptake in ESC member countries: heterogeneity and obstacles
Authors: Alves Da Silva P , Ruivo JA , Abreu A , Perk J
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cardiac Rehabilitation (CR) is a multidisciplinary intervention with proved results in patients with cardiovascular (CV) disease. CR penetration status and implementation strategies differ among ESC various members, with different uptake performance according to the results from the latest Overview of CR in ESC member countries (OCRE) report.

Purpose

To analyse possible implementation factors influencing differential CR phase II uptake after myocardial infarction across OCRE countries. 

Methods

An online survey was sent to all National CV Prevention Coordinators of 51 ESC member countries (champion physicians with deep understanding of their national CR state and easy access to all CR centres for information), to cover important CR demographic, structural and quality control topics. Chi-Square test of independence was performed to find possible statistical associations among surveyed topics with reported average post-MI uptake rate per country.

Results

Forty-two ESC-affiliated countries answered the survey (82% participation rate): 57% were from the South (n = 24); 62% high income countries, 24% upper middle, 14% lower middle, as defined by the ESC Atlas; 65% (n = 28) followed ESC related guidelines. CR uptake was reported at 0-25% (n = 17), 25-50% (n = 14), 50-75% (n = 7), 75-100% (n = 4).

There was a significant correlation between geographic localization and CR patient enrolment, with Northern countries having a higher rate of uptake [X2 (3, n = 42) p = 0,012]. Country wealth did not correlate with CR uptake, but patient low socio-economic status per se, reported as an obstacle by 50% of all countries, showed a positive correlation trend with lower CR enrolment [X2 (3, N = 42), p = 0,07]. A positive association trend between CR predominantly funded by public means and uptake rate was also noted [X2 (3, N = 42), p = 0,08]. Other factors, such as in or outpatient CR delivery predominance or coordination of the program by a cardiologist did not influence the uptake rate. Forty-one percent of the countries reported lack of preventive culture as an obstacle at healthcare level and 16% of them stated cultural issues at patient-level, although no distinct correlation with CR uptake was shown.

Conclusions

Our analysis shows regional differences between Northern and Southern countries in terms of CR uptake following myocardial infarction. The positive exploratory correlation trends may suggest that social/cultural/financial aspects may play a role in the uptake asymmetries. Specifically powered studies and interaction analysis should be sought in the future concerning those variables in particular.
Hemodynamic response to high and low load resistance exercise in patients with coronary artery disease: a crossover, randomised, clinical trial
Authors: Kambic T , Hadzic V , Lainscak M
Published: May 2021

Funding Acknowledgements

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

Background

Low loads resistance exercise (LL-RE) is advised as an adjunct therapy to aerobic exercise in cardiac rehabilitation (CR), while the implementation of high loads (HL) RE in the early phase of CR is limited by the scarce body of evidence on the safety associated with hemodynamic response during the exercise.

Purpose

The aim of this study was to evaluate hemodynamic response during HL-RE and LL-RE in patients with coronary artery disease (CAD) prior to enrollment in CR.

Methods

A total of 43 patients were enrolled into the study, age, mean (SD), 61 (10) years, height 172.3 (7.8) cm, weight 88.09 (16.66) kg and left ventricular ejection fraction 53 (10) %. After the initial ambulatory screening by cardiologist and cardiopulmonary exercise test, patients were familiarised with proper lifting and breathing technique, and performed one repetition maximum (1-RM) test on leg press machine during the first visit to CR. During the second and third visit to CR, hemodynamic response (measured as heart rate [HR], systolic blood pressure [SBP], diastolic blood pressure [DBP] and blood oxygen saturation) to LL-RE (3 sets, 16 repetitions per set at 40 % of 1-RM) and HL-RE (3 sets, 8 repetitions per set at 80 % of 1-RM) was measured in a crossover randomised manner. A lifting cadence of 1 s of concentric contraction and 1 s of eccentric contraction was used with 90 s of rest between sets, and 48-72 hours of rest between both RE sessions. Rating of perceived exertion (RPE, 0-10 Borgs` scale) was assessed at baseline and after each set of LL-RE and HL-RE.

Results

Both types of RE were shown to be safe, without any reported cardiovascular events. Forty-one patients completed LL and HL-RE, and two were excluded from the final analysis (one due to failure in measurement and one was unable to complete the last set of HL-RE). Compared to baseline, HR and SBP increased during LL-RE [+21 bpm, p < 0.001; +17 mm Hg, p < 0.001] and HL-RE [+18 bpm, p < 0.001; +16 mm Hg, p < 0.001]. Increase in HR compared to baseline was greater after the last set of LL-RE compared to HL-RE (32 % vs. 28 %, p = 0.015), without significant changes in SBP and DBP between RE. RPE increased during LL-RE and HL-RE (both p < 0.001), with higher rating after the 1st set of HL-RE compared to LL-RE (Median (interquartile range), 6 (5-7) vs. 6 (5-6), p = 0.009).

Conclusions

LL-RE and HL-RE were shown to be safe and well tolerable among patients with CAD. HL-RE induced similar hemodynamic response compared to LL-RE. Future trials should aim to compare the safety and efficacy of LL and HL resistance training in out-patient CR.
The efficacy of cardiac rehabilitation on exercise performance in men and women
Authors: Kambic T , Lainscak M
Published: May 2021

Funding Acknowledgements

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

Background

Over the last years exercise training has gained IA class recommendation as a core component of cardiac rehabilitation (CR) in patients with coronary artery disease (CAD). Despite the strong evidence of higher mortality and rehospitalisation rates in women compared with men with CAD, women are less frequently enrolled in CR programs and show lower exercise adherence. However, when enrolled women showed similar improvement as men, but this remains to be further elucidated.

Purpose

The aim of this study was to examine the gender differences in improvement of exercise performance in patients with CAD following CR programme.

Methods

A total of 91 patients with CAD (74 men and 17 women, mean (SD), aged 59 (11) years and 60 (10) years, p > 0.05; median (interquartile range), height 177 (173, 181) cm and 159 (158, 167) cm, p < 0.001; weight 92.1 (82.4, 98.6) kg and 72.3 (69.1, 79.6) kg, p = 0.001, respectively) participated in out-patient CR. Each patient completed 36 exercise sessions comprised of general warm up with calisthenics, followed by 5 aerobic intervals of cycling on stationary bikes (5 minutes of loaded cycling at the intensity of 50 %-70% of peak power separated by 2 minutes intervals of unloading cycling) and finished with stretching and breathing exercises. Training load and target training heart rate were increased every two weeks. The exercise test was performed at baseline and after CR.

Results

At baseline, there was a significant difference between men and women in peak power (P max) (men 122 (25) W vs. women 74 (19) W, p < 0.001), maximum oxygen consumption (VO2 max; men 19.45 (3.60) ml/kg/min vs. women 16.00 (3.35) ml/kg/min, p < 0.001) and exercise test time (men 658 (150) s vs. women 363 (115) s, p < 0.001). During the training both genders increased training intensity (men: +34 (12) W and women: +25 (9) W, both p < 0.001) and target heart rate (men: +10 (5, 19) bpm and women: +10 (5, 20) bpm, both p < 0.001), whereas training intensity was increased more in men than women (+9 W, p = 0.003). Exercise training led to improvement in P max (men: +15 (20) W, p < 0.001, women: +14 (12) W, p < 0.001), VO2 max (men: +1.87 (2.52) ml/kg/min, p < 0.001, women: +2.47 (2.05) ml/kg/min, p < 0.001) and exercise test time (men: +99 (134) s, p < 0.001, women +95 (90) s, p < 0.001). In addition, after adjusting for baseline values there were no sex differences in post training P max, VO2 max and exercise test time.

Conclusions

CR improved the exercise performance similarly in men and women, thus, more women should be encouraged to enrol into CR programmes. Still, larger and adequately powered randomised studies are warranted to further elucidate this issue.
Exercise training early after acute ST-elevation myocardial infarction and its effect on ventricular remodeling
Authors: Sigl A , Esefeld K , Latsch F , Halle M
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Deterioration of left ventricular function after acute myocardial infarction is common, particular in ST-elevation myocardial infarction (STEMI). This often leads to heart failure with reduced ejection fraction (HFrEF). Exercise training has shown to be beneficial in stable chronic heart failure patients. However, effects of exercise training have been rarely investigated during very early phases of STEMI. 

Purpose

The Exercise in Acute Myocardial Infarction (Ex-AMI) pilot study wanted to investigate whether exercise training has beneficial effects on ventricular remodeling under the following conditions:

a) started early after myocardial infarction 

b) exclusively after STEMI

c) performed with higher intensity. 

The hypothesis of this study was that exercise training early after acute myocardial infarction performed for 24 weeks is superior to usual care, regarding the improvement of echocardiographic parameters. It was also assumed that higher-intensity interval training is more effective than moderate continuous training. 

Methods

 

Therefore, we randomized 19 patients with STEMI (58.0 ± 7.1 years, 5% female) and left ventricular ejection fraction (LVEF) <55% to:

1. Moderate continuous training (MCT; 50-60% VO2peak; n = 6)

2. Higher intensity interval training (HIIT; MCT interspersed by intervals of 80-85% VO2peak; n = 6) 

3. Usual care (UC; n = 7) 

Exercise groups (EG: MCT and HIIT) started seven days after STEMI (run-in period for two weeks, followed by a tailored supervised exercise program for 22 weeks). Three-dimensional echocardiography and cardiopulmonary exercise testing were performed at the beginning and at the end of the training period. Patients were also continuously monitored for adverse events.

Results

At baseline, LVEF (46.3 ± 6,5%) as well as exercise capacity (VO2peak: 17.8 ± 4.4·kg-1·min-1) were impaired. In both exercise groups (EG: MCT and HIIT) LVEF improved significantly more than in the control group (mean change +7.3 ± 3.5% in EG vs. 2.3 ± 2.3% in UC; p = 0.007). Furthermore HIIT was not superior to MCT (mean change 7.6 ± 3.6% in HIIT vs. 6.7 ± 4.1% in MCT; p = 0.78) in terms of LVEF. There were no training associated adverse events. 

Conclusion

Exercise training early after acute STEMI seems to have anti-remodeling effects. There is a need for more randomized controlled trials to confirm these findings, in order to find the optimal timing and dose of exercise after STEMI.

Abstract Figure. Changes in LVEF (in %) after 24 weeks
The importance of first and second ventilatory thresholds to define aerobic exercise intensity in cardiac patients and in healthy subjects: what is essential can be visible to the eyes
Authors: Anselmi F , Cavigli L , Pagliaro A , Valente S , Valentini F , Cameli M , Focardi M , Mochi N , Mondillo S , Dendale P , Hansen D , Bonifazi M , Halle M , D"ascenzi F
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background. Although structured exercise training is strongly recommended in cardiac patients, uncertainties exist about the methods for determining exercise intensity (EI) and their correspondence with effective EI obtained by ventilatory thresholds. We aimed to determine the first (VT1) and second ventilatory threshold (VT2) in cardiac patients, sedentary subjects and athletes comparing VT1 and VT2 with EI defined by recommendations.

Methods. We prospectively enrolled 350 subjects (mean age: 50.7 ± 12.9 years; 167 cardiac patients, 150 healthy sedentary subjects, 33 competitive endurance athletes). Each subject underwent ECG, echocardiography, and cardiopulmonary exercise testing. The percentages of peak VO2, peak heart rate (HR), and HR reserve were obtained at VT1 and VT2, and compared with EI definition proposed by the recommendations.

Results. VO2 at VT1 corresponded to high rather than moderate EI in 67.1% and in 79.6% of cardiac patients, applying the definition of moderate exercise by the previous recommendations and the 2020 guidelines, respectively. Most of cardiac patients had VO2 values at VT2 corresponding to very-high rather than high EI (59.9% and 50.3%, by previous recommendations and 2020 guidelines, respectively). A better correspondence between ventilatory-thresholds and recommended EI domains was observed in healthy subjects and in athletes (90% and 93.9%, respectively).

Conclusions. EI definition based on percentages of peak HR and peak VO2 may misclassify the effective EI and the discrepancy between the individually determined and the recommended EI is particularly relevant in cardiac patients. A ventilatory threshold-based rather than a range-based approach is advisable in order to define an appropriate level of EI.

Abstract Figure.
Impact of exercise based cardiac rehabilitation program in patients with transcatheter aortic valve replacement
Authors: Estrada Martinez LE , Lara Vargas JA , Pineda Juarez JA , Morales Portano JD , Gomez Alvarez JB , Merino Rajme JA , Campo Aguirre R , Leyva Valadez E
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

 Due to the increase in global prevalence of degenerative valve disease, aortic stenosis (AS) has played a preponderant role in the cardiovascular scenario, especially in patients undergoing transcatheter aortic valve replacement (TAVR). An alternative management for this patients are the cardiac rehabilitation programs (CRP); however, their effect has not been completely understood, both in exercise capacity and quality of life, but neither in the improvement of cardiopulmonary performance and other cardiovascular outcomes.  Purpose: To evaluate the effect of the CRP on exercise tolerance and cardiopulmonary performance in patients with AS undergoing TAVR.  Methods: A cohort study was conducted including 26 patients with AS undergoing TAVR and divided into an intervention group who performed a 4-week supervised training program in the Cardiac Rehabilitation Service and a control group to whom instructions and recommendations to performed unsupervised exercise at home were given. Demographic and clinical data (VO2Max, METS12, oxygen pulse, heart rate, double product, left ventricular ejection fraction, body mass index) were collected at baseline and after a 4-week follow-up. Results: 15 patients were included in the intervention group and 11 patients in the control group. There were no baseline significant differences between groups. After the intervention, significant differences were observed in the METS 12 final gain variable between the control and intervention group (4.55 vs 3.1 p = 0.01). Intergroup analysis showed significant differences (percentage changes) in the intervention group with an increase of METS12 (67.4%, p = 0.001), oxygen pulse (18.21%, p = 0.01), final METS (39.47% p = 0.001) and a decrease in VO2 recovery time (-12.5%, p = 0.05), in the ergometric performance index by heart rate (-38.17%, p = 0.001) and by double product (-38.1%, p = 0.001).

Conclusions

 A 4-week cardiac rehabilitation program is effective to improve exercise tolerance and cardiopulmonary response in patients with AS undergoing TAVR; improvement was statistically significant in METS12, oxygen pulse, VO2 recovery time, METS-load and ergometric performance index for heart rate and double product. METS12 final gain was statistically significant in intervention group in comparison with the control group.

Abstract Figure. Control vs Intervention Group (METS12)