bluuebunny/crossref_metadata_2025 huggingface dataset:
Sex-biased proteomic regulation in obesity
Authors: Halland H , Vitorino R , Gerdts E , Meyer K , Kararigas G
Published: October 2024

Background

Obesity is a major risk factor for heart failure with preserved ejection fraction, particularly in women. Obesity-associated inflammation is thought to contribute to this relationship. However, the role of biological sex in the regulation of circulating inflammatory proteins in obesity is not well understood.

Purpose

We aimed to explore sex differences in the plasma inflammatory protein profile in obese subjects.

Methods

Clinical data and samples were collected from 450 women and men with a body mass index (BMI) >27 kg/m² without known cardiovascular disease participating in the FAT associated CardiOvasculaR dysfunction study. Obesity was defined as BMI≥30 kg/m². Olink’s Target 96 inflammation panel, which profiles 92 proteins using proximity extension assay technology, was analysed in biobank samples. A comprehensive correlation analysis was performed to describe relationships between protein biomarkers and clinical variables. Gene enrichment analysis was performed to shed light on biological pathways associated with differentially expressed proteins (DEPs). To determine the functional significance of the DEPs, we used the repositories Gene Ontology and Kyoto Encyclopedia of Genes and Genomes. Pearson correlation coefficients were calculated to assess linear associations between the DEPs and relevant clinical variables.

Results

Women and men did not differ by age (49±9 vs 48±9 years), BMI (32.3±4.6 vs 31.6±3.7 kg/m²) or in prevalences of diabetes (both 11%) or obesity (65% vs 62%) (all p>0.05). However, hypertension was more common in men than women (74% vs 52%, p<0.001). In men (n=188), obesity was associated with downregulation of monocyte chemotactic protein 3, tumor necrosis factor (ligand) superfamily member 12, interleukin 10 and protein S100-A12 and with upregulation of neurotrophin-3 (all p<0.05), thereby suggesting a mechanism for the observed impaired inflammatory response and insulin resistance. In women (n=262), obesity was associated with the downregulation of interleukin 7, interleukin 12 subunit beta, interleukin 6, and C-X-C motif chemokine 11, suggesting a state of persistent low-grade inflammation. In addition, the upregulated sulfotransferase 1A1 and SIR2-like protein 2 proteins indicate a physiologic adaptation to oxidative stress and the metabolic excess endemic to obesity.

Conclusion

We found that the abundance of several circulating inflammatory proteins was altered in presence of obesity, and that the plasma proteomic profile differed by sex. Interestingly, there was no overlap in the DEPs between women and men in the presence of obesity. These findings support the hypothesis that the pathophysiological mechanisms driving obesity-associated inflammation and immune dysregulation differ by sex. In turn, this may aid in the pursuit of discovering sex-specific biomarkers to identify obese individuals at particular risk of heart failure.
HFpEF and glycemic variability: GHIDD Trial
Authors: Fazio G
Published: October 2024

Background

Recently the guidelines of European Association of Preventive Cardiology reported that the prevalence of diabetes mellitus in patients with diastolic heart failure (HFpEF) is around 31%. Glunovo® is a transdermal device capable of detecting and storing the concentration of glucose in the abdominal interstitial fluid 480 times a day for up to 14 consecutive days.

Purpose

In our study we evaluated the non diabetic patients with HFpEF with Glunovo to evaluate the glycaemic variability in this population

Methods

100 patients with HFpEF admitted to cardiology units of 4 Italian centres on the major islands were enrolled consecutively. Glunovo® was applied to each enrolled patient for 7 days. At the end of the glycaemic monitoring were calculated for each patient the glycaemic variability and the incidence of hyperglycaemia and hypoglycaemia. Glycaemic variability refers to a blood glucose value of ≥ 200 mg / dL or ≤ 59 mg / dL detected more than 3 times in a day for at least 4 days. The inclusion criterion was the presence of diastolic heart failure while the only exclusion criterion was the presence of diabetes diagnosis. Overall, 43 males and 57 females were enrolled with a mean age of 69.3 years (39-87 years). All patients underwent a timely glucose measurement at admission which excluded the presence of hyperglycaemia. No potentially hyperglycaemic drugs were added to the treatment during the hospital stay. Continuous glucose monitoring was performed as an integral part of the hospitalization diagnostic routine.

Results

In 94 of the 100 patients enrolled it was possible to conclude the analysis, detecting the glycaemic variability, the point glycaemia values and the estimated glycated haemoglobin value. A glycaemia ≥200 mg/dL was found in 53 patients (56%) while a high glycaemic variability was found in 51 patients (54%). A blood glucose value <59 mg / dl was found in 48 patients (51%). Only 5 times the estimated glycated Hb values were> 7%. 32 of the patients who had at least 3 punctual glucose values ≥200 mg/dL were prescribed an oral glucose load curve, which in 100% of cases confirmed the diagnosis of diabetes.No statistically significant differences were found based on age group or sex. In the control group, consisting of 10 patients without DHF undergoing continuous glucose monitoring at one of the participating cardiology units, an unknown hyperglycaemia was found in only 1 patient (10%) and a glycaemic variability in only 1 patient (10%).

Conclusions

Our experience suggests an incidence of hyperglycaemia and glycaemic variability more then 65% in patients affected by HFpEF. If our data were reproducible on a large scale, a so high prevalence of diabetes in patients with HFpEF cold explain the efficacy of SGLT-2 inhibitor and GLP-1 Agonist in this class of patients.
Comparison of cardiovascular outcomes in patients with diabetes treated with tirzepatide versus semaglutide: a multi-institutional analysis
Authors: Cervantes M , Miles B , Mehta A
Published: October 2024

Introduction

Glucagon-like-peptide-1 (GLP-1) receptor agonists have been demonstrated to have cardiovascular benefits in patients with diabetes. Two of the most prescribed medications in this class are tirzepatide and semaglutide. Tirzepatide is a dual glucose-dependent insulinotropic polypeptide and GLP-1 receptor agonist, while semaglutide is a selective GLP-1 receptor agonist. Tirzepatide and semaglutide have previously been directly compared to assess efficacy in glycemic control as the primary endpoint. However, there is limited data directly comparing cardiovascular outcomes between the two medications in patients with diabetes. This retrospective cohort study compares the incidence of major adverse cardiovascular events (MACE) in patients with diabetes treated with tirzepatide or semaglutide.

Purpose

The purpose of this study is to identify differences in cardiovascular outcomes between patients with diabetes treated with tirzepatide as compared to semaglutide.

Materials and Methods

The TriNetX research network was used for this study. Two patient cohorts were generated using International Classification of Disease 10 (ICD-10) codes and medication codes in the TriNetX system. Both cohorts of patients had a history of diabetes (E08-E13) and no prior history of cerebral vascular accident (I63) or myocardial infarction (I21). One cohort received semaglutide and the other tirzepatide. Each cohort was prohibited from receiving the other agent. The cohorts were balanced for age, race, gender, and ethnicity by propensity score matching and the greedy nearest neighbor algorithm resulting in 36,212 patients in each arm. They were then evaluated for the 3-year outcomes of major adverse cardiovascular events (myocardial infarction, cerebral vascular accident, and death).

Results

Tirzepatide was associated with statistically significantly fewer MACE outcomes compared to semaglutide for each of the individual endpoints as well as the overall composite endpoint over the 3 year follow up period.

Table 1. MACE events for semaglutide and tirzepatide.

Table 2. Relative risks for semaglutide MACE endpoints compared to tirzepatide.

Conclusions

In this retrospective cohort study, tirzepatide was associated with a lower incidence of major adverse cardiovascular events compared to semaglutide in patients with diabetes. These findings suggest that tirzepatide offers superior cardiovascular protection for primary prevention compared to semaglutide and warrant further investigation in future studies and clinical trials.Table 1Table 2
Hypoperfused myocardium and systolic function in patients with AMI undergoing complete revascularization
Authors: Si J , Zheng C , Lu J , Li J
Published: October 2024

Background and Aim

Coronary revascularization is the standard treatment for acute myocardial infarction (AMI), while the restoration of epicardial flow is non-parallel to myocardial reperfusion. This study sought to investigate the dynamic of myocardial perfusion and its association with left ventricular (LV) systolic function in AMI patients undergoing complete revascularization.

Methods

AMI patients who underwent complete revascularization were prospectively enrolled, and hybrid positron emission tomography/magnetic resonance (PET/MR) was performed at 2 months and 1 year. Hypoperfused myocardium was defined as myocardium with reduced perfusion and normal metabolism.

Results

Forty-five patients (59.80 ± 10.68 years, 80.0% male) were enrolled, and hypoperfused myocardium (median: 12% of LV) was detected in 21 (46.7%) patients 2 months post-AMI. Patients with hypoperfused myocardium (Group A) had significantly higher hypersensitive C-reactive protein (hs-CRP) (p = 0.016) and lower T2 value (p = 0.010) than those without (Group B). In the follow-up PET/MR at 1 year, significant LV ejection fraction improvement was observed in Group A (56.39 ± 9.76% vs. 54.58 ± 10.39%, p = 0.016) but not in Group B (51.63 ± 13.09% vs. 50.79 ± 16.95%, p = 0.615). Six (31.6%) patients in Group A showed recovery of perfusion, of which there were more females (p = 0.025), fewer diabetics (p = 0.044), or overweight (p = 0.035), with better global longitudinal strain (GLS) (p = 0.005).

Conclusions

Myocardial hypoperfusion is not rare and evolves over time in AMI patients undergoing complete revascularization, of which the reversal is probably associated with improved LV systolic function.Structured Graphical AbstractRepresentative PET/MR image of 2 separat
Glucose lowering drugs with proven cardiovascular benefit following acute coronary syndrome in type 2 diabetes: treatment gaps and outcomes
Authors: Naoum I , Saliba W , Barnett-Griness O , Aker A , Zafrir B
Published: October 2024

Background and Aims

Real-world data on the implementation and prognostic impact of glucose-lowering drugs with proven cardiovascular benefits in patients with type 2 diabetes (T2D) following acute coronary syndromes (ACS) is limited. We investigated the utilization and treatment patterns of sodium-glucose contrasporter-2 inhibitors (SGLT2I) and glucagon-like peptide-1 receptor-agonists (GLP1RA) in T2D patients experiencing ACS, and analyzed their association with mortality and major adverse cardiovascular events (MACE) including recurrent ACS, acute revascularization, heart failure or ischemic stroke.

Methods

Retrospective analysis of 9,756 patients with T2D from a nationwide healthcare organization hospitalized with ACS between 01/2019 and 01/2022. Drug prescriptions were estimated pre-hospitalization, 90-days and 1-year following hospitalization. The association between SGLT2I and/or GLP1RA treatment with MACE and mortality was investigated using time-dependent Cox regression analysis with multivariable adjustment.

Results

Prescription rates (prehospitalization, 90-days and 1-year posthospitalization) of GLP1RA were 13%, 13.2%, and 18%, and of SGLT2I were 23.9%, 33.6% and 42.7%, respectively. At 1-year, 13.9% prescribed both therapeutic groups. The use of SGLT2I and/or GLP1RA was higher in younger age-groups, and increased from 2019 to 2021 (38.1% to 59.2%). The adjusted hazard ratio for the association of pre- or post-hospitalization SGLT2I and/or GLP1RA treatment with mortality and MACE was 0.724 (0.654-0.801) and 0.974 (0.909-1.043), respectively.

Conclusions

In real-world practice of patients with T2D experiencing ACS, implementation of SGLT2I and particularly GLP1RA was suboptimal, both early and 1-year following hospitalization, emphasizing the need to improve medical care. Treatment with SGLT2I and/or GLP1RA was associated with favorable impact on mortality but not MACE.Graphical Abstract
Could piano music therapy alleviate high sinus rhythm in subjects with controlled hypertension?
Authors: Tase A , Tase A , Dumitrache M , Calina F C , Stanciulescu L , Stoiculescu A
Published: October 2024

Background/Introduction

With a millenary tradition, music is rediscovered nowadays, as adjuvant therapy. The number of beats per minute (bpm) is the common factor of cardiology – representing heart rate (HR), and music – reprezentative for tempo.

Purpose

Our goal was the HR modulation in patients (pts) with moderate tachycardia using three piano kits: K1 – Adagio by Albinoni, K2 – Piano Concerto nr. 21 by Mozart, second part; and K3 – Liebestraum by Liszt.

Methods

During 1st January – 31st December 2023, we identified by ambulatory screening 288 pts adequate for our goal. As exclusion criterion, we considered any type of rhythm or conduction dysturbances. All selected pts were controlled with antihypertensive agents not altering HR, usually thiazide/thiazide-like diuretics and/or ACEis/ARBs. The study group consisted in 144 hypertensive pts controlled at least six months, without any other cardiac diseases. The control group consisted in 144 pts with normal cardiologic examination. Both groups were demographically balanced. The HR at admission was between 84 and 120 bpm, the pts being stratified in three bpm subcategories. All pts have done three visits consisting in: physical examination, ECG, lab markers, TTE for V1 at initiation and EoS at six months, and respectively, physical exam and ECG for V2 at 3 months.

Results (in bpm): Inside the group with HR 84-96 treated with K1, the Controlled HTN group (CHG) and the Normal Cardiac group (NCG) alleviated HR from 85,8 +/- 12,6 to 82,6 +/- 12,2; and from 85,7 +/- 12,6 to 80,8 +/- 11,9, respectively. For pts inside the interval 97-108 treated with K1, the CHG group and the NCG alleviated HR from 94,3 +/- 14,1 to 90,9 +/- 13,7 and, respectively, from 94,4 +/- 14,1 to 89,7 +/- 13,6. In pts from HR spectrum 97-108 treated with K2, the CHG and the NCG alleviated HR from 98,4 +/- 14,6 to 95,7 +/- 14,1; and from 98,5 +/- 14,6 to 94,1 +/- 13,8; respectively. Inside the group with HR spectrum 109-120 treated with K1, the CHG and the NCG alleviated HR from 97,1 +/- 14,3 to 94,8 +/- 13,9; and, respectively, from 97,0 +/- 14,3 to 93,9 +/- 13,7. For pts inside the interval 109-120 treated with K2, the CHG and the NCG alleviated HR from 101,7 +/- 14,6 to 99,3 +/- 14,2; and from 101,8 +/- 14,6 to 97,3 +/- 14,1; respectively. In pts from HR spectrum 109-120 treated with K3, the CHG and the NCG alleviated HR from 106,1 +/- 14,7 to 103,8 +/- 14,6; and from 106,5 +/- 14,4 to 103,6 +/- 14,4; respectively.

Conclusions

The effect of piano music on HR seems favorable in controlled hypertensive pts without major comorbidities, probably by interfering the sympathetic vegetative nervous system. In this regard, it could be used as adjuvant in optimizing this cardiac parameter. However, a multicentered randomized clinical study will be needed.
Smoking cessation medicines and e-cigarettes in smokers with obesity
Authors: Kouroutzoglou A , Ioakeimidis N , Terentes-Printzios D , Tsabras T , Katsi V , Lazaros G , Kalfountzos D , Tsioufis K , Vlachopoulos C
Published: October 2024

Purpose

The interaction between obesity and smoking is complex. Aim of this study is to compare the abstinence rates of smoking cessation pharmacotherapies vs electronic cigarettes in obese smokers.

Methods

57 obese smokers (aged 41±8 years, BMI: 33.8 ±2.4 Kg/m2) visiting our unit from January 2016 to November 2022 were randomized into three smoking cessation therapy groups: 1. NRT (nicotine patch), 2. NRT + bupropion (NRT+bupr) and 3. Electronic cigarette (EC).

Results

There were not significant differences in severity of nicotine dependence and cigarette consumption (pack-years) between the three treatment groups. Furthermore, the three groups had similar age and prevalence of traditional risk factors. At the end of treatment period (3 months), 5/19 (26 %) and 9/19 (47%) of subjects under therapy with NRT alone and NRT + bupropion combination respectively, were abstinent from smoking while 10/19 (53%) of individuals using EC did not smoke combustible cigarettes. Left plot shows the continuous abstinence rates at 6 months. Continuous abstinence rates were similar in the NRT and NRT+bupropion group at 6 months compared to 3 months (end of treatment), while 8/19 (42%) of individuals using EC did not smoke. Interestingly , at 6 months among users of EC 6 continued vaping nicotine alone, 7 continued to smoke tobacco cigarettes while vaping and 4 continued smoking cigarettes alone. Nevertheless only 2 out of 19 participants in that group stayed abstinent from both combustible cigarette smoking and vaping. Blood pressure remained unchanged in all groups while weight decreased in the group treated with the combination of bupropion and NRT compared to NRT alone and EC groups (right plot, P<0.01).

Conclusions

Our preliminary data indicate that continuous abstinence rates at 6 months were higher in obese smokers receiving NRT+bupropion combination therapy compared to those of individuals who used NRT alone. There is also a low abstinence rate of both cigarette smoking and vaping among individuals using EC as an aid for smoking cessation. The NRT+bupropion combination therapy was associated with a favorable effect on weight change in obese smokers.EC vs pharmacotherapy in obese smokers
Exercise oscillatory ventilation as a predictor of mortality in patients with amyloid cardiomyopathy
Authors: Willixhofer R , Ermolaev N , Kronberger C , Weyer L , Rettl R , Duca F , Binder C , Kammerlander A , Kastner J , Bergler-Klein J , Neder A , Badr-Eslam R
Published: October 2024

Background

Exercise oscillatory ventilation (EOV) signals multiple abnormalities in hemodynamics and ventilatory control which may predict poor outcome in patients with cardiac diseases.

Purpose

To assess whether EOV (+) patients with amyloid cardiomyopathy show higher mortality rates compared to their counterparts without EOV.

Methods

We analyzed cardiopulmonary exercise testing results for EOV defined by continuous (>60% of exercise duration) oscillations in minute ventilation (VE), cycling with a frequency of one minute and an amplitude above 15% of resting VE, in patients with amyloid cardiomyopathy.

Results

156 patients with amyloid cardiomyopathy, aged 78 (±7) years, 87% male with a NYHA functional class of II (49.4%) and median B-type natriuretic peptide levels of 2548 (1374-4703) ng/L. Comorbidities include hypertension (73.1%), polyneuropathy (45.5%), coronary heart disease (41.0%), diabetes mellitus (17.3%) and chronic obstructive pulmonary disease (10.9%). Patients had a mean peak oxygen consumption of 14.8 (±4.42) ml/kg·min and a VE to carbon dioxide production (VCO2) slope ≥ 40 in 67.9% of cases. EOV was seen in 38 (24.4%), clearly absent in 92 (59.0%) and not clearly differentiable in 26 (16.7%) patients. 33 (21.2%) had a HF-related hospitalization and 31 (19.9%) died. EOV shows a hazard ratio of 2.35 (CI 1.088 – 5.075, p-value <0.05) for all-cause mortality. In fact, the log-rank test showed a difference in survival time between patients with and without EOV (p=0.03) with a median survival time of 46 months.

Conclusion

EOV may improve the prognostic yield of incremental CPET in patients with amyloid cardiomyopathy.Kaplan-Meier Curve for EOV
Chronotropic incompetence predictors in a Cardiac Rehabilitation Program following myocardial infarction
Authors: Marcos Garces V , Merenciano-Gonzalez H , Martinez Mas M L , Climent Alberola J I , Minano Martinez I , Perez N , Lopez-Bueno L , Esteban Argente M C , Valls Reig M , Arizon Benito A , Bertolin-Boronat C , De Dios E , Paya Rubio A , Sanchis J , Bodi V
Published: October 2024

Background

Chronotropic incompetence (CI) has been described in many patients after myocardial infarction (MI) and can negatively affect physical capacity, especially if negative chronotropic therapy (NCT) is prescribed. Prediction of CI after MI could be useful for tailored medical therapy and exercise training prescription.

Purpose

We aim to predict CI on initial exercise ECG testing (ExECG) in MI patients submitted to a Cardiac Rehabilitation Program (CRP).

Methods

Patients with ST-segment elevation MI (STEMI) or occlusion MI (OMI) submitted to our CRP were prospectively included. After an initial follow-up phase of clinical stabilization and medical therapy optimization, ExECG (conventional or cardiopulmonary) was performed. Peak VO2 and chronotropic reserve index [(maximum heart rate – resting heart rate) / ([220-age] – resting heart rate)] were measured. Chronotropic incompetence was defined as <80% chronotropic reserve index (≤62% in patients treated with NCT). Pharmacological therapy with NCT was registered in absolute and equivalent doses per bisoprolol 2.5mg units (B2.5EU). The effect of NCT on CI was studied by ANOVA test, and predictors of CI by binary logistic regression analysis. The model was tested by area under the curve (AUC) analysis in receiver operating characteristic curves. A p<0.05 was considered statistically significant.

Results

The cohort comprised 143 patients, mostly middle-aged (mean 60.3±15.8 years) males (85.3%) with anterior or inferior MI (44.8% and 44.8%, respectively). Mean left ventricular ejection fraction (LVEF) was 52.4±10.6% and 36.4% depicted LVEF<50%. NCT was prescribed in most patients (n=125, 87.4%), and median equivalent dose was 1 [0.5-1] B2.5EU. CI was noted on more than half of the population on initial ExECG (n=75, 52.4%). Higher NCT doses per B2.5EU associated with worse mean chronotropic reserve indexes: 72.8±24.4% in patients without NCT; 71.7±18.7% in patients with 0.5 B2.5EU; 62.8±18.2% in patients with 1 B2.5EU; and 58.7±16.9% in patients with ≥2 B2.5EU (ANOVA p=0.04). On binary logistic regression analysis, only two variables were independent predictors of CI: diabetes mellitus (HR 3.02 [1.26-7.23], p=0.01) and LVEF (0.97 [0.94-0.99] per increased %, p=0.04). However, the predictive power of the model was poor (AUC 0.62 [0.53-0.71], p=0.01).

Conclusions

Chronotropic incompetence after a MI is associated with lower LVEF, diabetes mellitus, and higher doses of NCT. Although significant interindividual variability exists in chronotropic response in the post-infarction period, these factors could be taken into consideration for tailored prescription (or deprescription), especially in patients who may not derive any prognostic benefit from NCT.Chronotropic incompetence in CRP
Cardiac rehabilitation attendance and outcomes 3 years after acute coronary syndrome (ACS): Linked national data of the SNAPSHOT ACS audit
Authors: Hyun K , Hollings M , Briffa T , Brieger D , Chew D , French J , Astley C , Gallagher R , Ellis C , Carr B , Nallaiah K , Lintern K , Neubeck L , Candelaria D , Redfern J
Published: October 2024

Background

In international guidelines, cardiac rehabilitation is recommended to reduce readmissions, mortality and improve disease management. However, evidence from a long-term follow-up in a representative cohort is scarce.

Purpose

To compare 3-year outcomes among acute coronary syndrome (ACS) survivors who attended cardiac rehabilitation programs and those who did not.

Methods

This was a follow-up of the SNAPSHOT ACS cohort in 1,920 Australians. Clinical data of those presenting with suspected ACS, hospitalised, discharged alive and followed for 18 months were linked to jurisdictional/national regulatory hospitalisation, mortality and pharmacotherapy records. Outcomes were all-cause and cardiovascular mortality, myocardial infarction (MI) and cardiovascular readmissions. Cox regression was used to analyse all-cause mortality, and Fine and Gray competing risk model for cardiovascular mortality, MI and cardiovascular readmissions, where non-cardiovascular mortality or all-cause mortality were competing events. The models were adjusted for age, sex, discharge diagnosis and coronary revascularisation.

Results

The cohort was aged 66±13.5 years; 60% were male, 31% had a discharge diagnosis of MI, and 490 (26%) attended cardiac rehabilitation. Cardiac rehabilitation attendees more frequently received coronary revascularisation and had a discharge diagnosis of MI during index admission. Attendees were more likely to be men (70% vs 57%, p<0.001) with a family history of coronary disease (43% vs 36%, p=0.008). The prescription of ≥3 guideline-indicated medications was higher in cardiac rehabilitation attendees. Compared to those who did not attend cardiac rehabilitation, the hazard of all-cause mortality was lower for the attendees (4.3% vs 8.6%, HR: 0.55, 95% CI: 0.34-0.91), but the hazard of MI and cardiovascular readmissions significantly greater in the attendees (17% vs 8.5%, HR: 1.99, 95% CI: 1.41-2.82; 42% vs 33%, HR: 1.34, 95% CI: 1.10-1.63; respectively) (Figure). There was insufficient cardiovascular mortality between groups to fit a statistical model (n=7 (1.4%) vs n=24 (1.7%), p=0.705).

Conclusions

Survivors of ACS attending cardiac rehabilitation were associated with reduced all-cause mortality and increased readmissions related to MI and cardiovascular disease at 3 years follow-up. These findings support secondary prevention strategies to mitigate mortality risk after ACS.
Feasibiliy, safety and patient perceptions of an exercise-based cardiac telerehabilitation programme
Authors: Back M , Leosdottir M , Ekstrom M , Hambraeus K , Ravn-Fischer A , Borg S , Brosved M , Flink M , Hedin K , Lans C , Olovsson J , Urell C , Oberg B , James S
Published: October 2024

Background

Despite proven benefits of exercise-based cardiac rehabilitation (EBCR), few patients with myocardial infarction (MI) complete these programs and there is a need to develop more flexible and evidence-based options.

Purpose

The aim of this study was to evaluate feasibility, safety, and patient perceptions of remotely delivered EBCR.

Methods

This study was conducted at 23 cardiac rehabilitation centres during the Covid-19 pandemic (March 2020-September 2022), when access to centre-based EBCR was restricted. A total of 231 patients with MI <80 years were included 2-4 weeks after discharge to participate in a remote EBCR programme 2 times/week for 3-4 months. Exercise was delivered through a real-time group-based video meeting, connecting the physiotherapist to patients exercising at home. Safety monitoring in terms of adverse events (AE) and serious adverse events (SAE) were recorded. Outcomes were assessed before and after remote EBCR completion and comprised tests of physical fitness and questionnaires: self-reported physical activity and exercise (Haskell questionnaire), physical capacity (VAS), kinesiophobia (TSK-Heart), health-related quality of life (EQ5D-VAS), self-efficacy for exercise, and patient acceptance of the program.

Results

Patients performed in median 19 (Q1 9 - Q3 23) remote EBCR sessions. A total of 16 AEs were registered during exercise (e.g chest pain, syncope, dizziness, musculoskeletal symptoms) which were all resolved. Two SAEs that required hospitalization were reported (chest pain, in-stent restenosis), both unrelated to exercise. At end of remote EBCR, significant improvements in physical fitness, self-reported exercise and physical capacity, kinesiophobia, and health-related quality of life were observed (Table 1). Delta values were similar to previous centre-based EBCR studies. Patients agreed that remote EBCR improved health care access (83%), was easy to use (94%), and 95% found exercise performance and interaction acceptable.

Conclusions

This study supports that remote EBCR is feasible and safe with a high patient acceptance post-MI. The clinical effectiveness needs to be confirmed in a randomized controlled design.
Atrial fibrillation, prevention and rehabilitation in a primary healthcare setting. A feasibility study
Authors: Elnegaard C , Brandes A , Borregaard B , Tveskov C , Zwisler A D , Risom S
Published: October 2024

Background

Atrial fibrillation (AF) often influences daily life with symptoms like palpitations, dyspnoea, fatigue, fear and anxiety. Research show that patients with AF benefit from prevention and rehabilitation interventions. However, evidence is scarce and mainly hospital-based, and it is unknown whether the transition to the primary healthcare sector gives the same positive results. In 2019, a Danish primary care Health Center and the cardiology department at the local hospital completed a multidimensional prevention and rehabilitation intervention for patients with AF.

Purpose

To investigate the feasibility of delivering a multidimensional prevention and rehabilitation intervention for patients with AF in a primary care Health Center.

Methods

This study was a mixed-methods, non-randomized, intervention, feasibility study. A convergent mixed-methods design was used, and results were illustrated in side-by-side joint displays. Patients were included at a Hospital AF clinic referring to the Health Center. The prevention and rehabilitation intervention consisted of risk factor management, patient education, physical activity and yoga. Two patient-reported outcomes measures (PROMs) were used, the HeartQoL measuring health-related quality of life (HRQoL) and the Hospital Anxiety and Depression Scale (HADS) measuring symptoms of anxiety and depression. Data were collected at baseline (T0), at end of intervention (T1), and at two-months follow-up (T2) and analysed descriptively. Focus group interviews were analysed thematically and covered experiences of participating, needs and preferences, outcomes and feasibility of collecting PROMs. The reporting was guided by the Consolidated Standards of Reporting Trials (CONSORT) extension to pilot and feasibility trials.

Results

43 patients (53% women; median age 66 (range 52-81) years) completed the intervention. Table 1 shows that HRQoL increased, and symptoms of anxiety and depression decreased. These results maintained at follow-up. Figure 1 shows the qualitative themes. Patients experienced being understood and supported by health professionals and peers. They thought it difficult to know what their needs were. However, some patients had specific preferences for interventions. For changes in outcomes, the patients identified that gaining tools and knowledge about the disease from the interventions helped. It was feasible to collect PROMs during the intervention and finally, the patients had an attention to what comes next, when finishing the intervention in the primary care setting.

Conclusion

It was feasible to deliver a multidimensional prevention and rehabilitation intervention for patients with AF at a primary care Health Center. HRQoL increased and symptoms of anxiety and depression decreased. The patients experienced being supported and gaining tools and knowledge to handle AF. Future large randomized controlled trials must confirm these results.
Clinical and angiographic features of patients experiencing exercise-induced out-of-hospital cardiac arrest
Authors: Kuroki N , Takayama T , Kohsaka S , Nagao K , Nakata J , Kuwabara M , Ashida T , Masaki R , Murata N , Hirose K , Yagi T , Yamamoto T , Takayama M
Published: October 2024

Background

Out-of-hospital cardiac arrest (OHCA) is a devastating condition that exhibits significant clinical heterogeneity. Previous studies have reported coronary artery disease (CAD) as the most common cause of OHCA. Possible causes of exercise-induced OHCA in patients with CAD include ST-elevation myocardial infarctions (STEMI), exercise-induced myocardial ischaemia and other triggers. We investigated whether there are differences in the clinical and angiographic features between 'exercise-induced (EX)' and 'non-exercise-induced (non-EX)' OHCA secondary to CAD.

Methods

In total, resuscitated 2300 patients (from 72 institutions) with OHCA due to CAD were registered within our regional CCU network database between 2010 and 2021. The population of the coverage area is 16.8 million during the day and 14.1 million at night. Patients with a trigger were grouped based on their triggering event: at rest, sleeping, eating, drinking, watching television, bathing, excretion, mild physical activity, driving, exercise and other activity. We classified the patients into 2 groups based on their triggering event as exercise: exercise (EX) group(n=169) and Non-Ex group(n=2131). The primary clinical outcome of interest was favorable 30-day neuroprognosis.

Results

Baseline characteristics was shown in the Table (below). Acute coronary syndrome (ACS) was the most common type of clinical presentation in each group. In ACS, the EX group had less ST elevation and/or left bundle branch block in electrocardiogram (57% vs. 68%; P=0.01), and initial good flow (TIMI grade 3) of culprit lesion in coronary artery was more frequently seen in the EX group than in the Non-EX group (23% vs. 12%; P< 0.01). A Kaplan-Meier survival curve analysis showed that EX group had favorable clinical outcome compared with Non-EX group (71% vs 58%, p<0.001:log-rank test). Multivariate analysis demonstrated that exercise-related trigger for OHCA was an independent predictor of favorable outcome (OR:0.59, 95%CI:0.38-0.90; P=0.015).

Conclusion

EX-OHCA had favorable clinical outcome compared with non-EX-OHCA. Reason may be that these patient present with culprit lesion that has good blood flow, possibly leading to fewer STEMI events.Baseline charactaristicComparison in Patients with ACS
Sizing of the aortic valve using virtual reality - next step towards personalized medicine?
Authors: Kanschik D , Haschemi J , Heidari H , Klein K , Afzal S , Maier O , Piayda K , Oezaslan G , Antoch G , Lichtenberg A , Fleissner F , Scherner M , Kelm M , Zeus T , Jung C
Published: October 2024

Background

High-quality imaging is integral throughout the transcatheter aortic valve implantation (TAVI) process, from patient selection and preprocedural planning to real-time guidance during the procedure and postprocedural follow-up. Multislice computed tomography (MSCT) is currently the gold standard. The next step in this area is the three-dimensional (3D) visualization of cardiac and extra-cardiac structures using virtual reality (VR).

Purpose

This study aimed to investigate the feasibility, accuracy, and reproducibility of VR for the visualization of the aortic valve, the surrounding structures, and its role in the planning of TAVI procedures.

Methods

Based on the preprocedural MSCT data of 60 patients who underwent TAVI at our heart center, measurements using 3mensio software were compared with 3D visualizations and measurements using VR software. Additionally, eight physicians evaluated the application of VR using a structured questionnaire to define its benefits and limitations.

Results

VR measurements correlated well with the 3mensio software measurements, and there were no significant differences between the two methods. The VR measurements were mentioned first: Annulus perimeter 77.4 ± 7.8 vs. 77.0 ± 8.1 (p=0.182), r = 0.929; Annulus diameter 24.6 ± 3.2 vs. 24.4 ± 2.6 (p=0.483), r = 0.868; LVOT diameter 23.5 ± 3.1 vs. 23.7 ± 2.8 (p=0.442), r = 0.785; SoV left 32.9 ± 4.1 vs. 32.7 ± 3.7 (p=0.331), r = 0.920; SoV right 30.8 ± 4.3 vs. 30.7 ± 3.7 (p=0.653), r = 0.909; noncoronary SoV 32.9 ± 3.6 vs. 32.6 ± 3.7 (p=0.209), r = 0.913; STJ 30.0 ± 3.6 vs. 29.7 ± 3.2 (p=0.175), rs = 0.882; Ascending aorta 34.5 ± 3.4 vs. 34.5 ± 3.1 (p=0.469), r = 0.921, RCA height 15.1 ± 3.2 vs. 15.4 ± 3.2 (p=0.179), rs = 0.910, LCA height 12.4 ± 2.7 vs. 12.3 ± 3.0 (p=0.252), rs = 0.924. Furthermore, users reported that VR simplified anatomical understanding (1.3 ± 0.5 vs. 1.9 ± 0.4, p = 0.046), and improved 3D comprehension (1.1 ± 0.4 vs. 2.3 ± 0.5, p = 0.023).

Conclusion

The use of VR in the planning of TAVI procedures enables precise and reproducible measurements. In addition, VR can help assess the often complex anatomy, which can increase the safety and efficiency of procedures. Further clinical studies are needed to evaluate the potential benefits of VR application in planning and performing other structural interventions.
Potential impact of cold water immersion on arrhythmogenesis: a pilot exploratory study surrounding the Geneva christmas cup
Authors: Craviari C , Merkt B , Baggish A L , Namdar M , Meyer P
Published: October 2024

Background

Cold-water immersion (CWI) is gaining popularity and is regulated by sports federations with guidelines for various cold temperature ranges. Small studies suggest cardiovascular and stress reduction benefits from regular CWI, yet acute effects and cardiac risks remain underexplored.

Purpose

This study aimed to assess the impact of CWI on arrhythmogenesis among participants of the 2023 Geneva Christmas Cup, the world's largest cold-water swimming event.

Methods

Volunteers aged 45 and older were recruited through the organizing committee. Each underwent baseline cardiovascular risk assessment 10 days prior to the event, including medical interviews, physical exams, blood tests, and 12-lead ECGs. A waterproof ECG recorder (BodyGuardian Mini®) was attached to participants, monitoring them for 10 days up to the end of the race. An activity diary recorded training sessions, CWI exposure, and any symptoms. Data from BodyGuardian Mini® were analyzed for CWI-induced arrhythmias and conduction disturbances. The local ethics committee approved the study.

Results

Twenty volunteers (11 women, mean age 56 ± 6.4 years) participated. Their mean SCORE2/SCORE2-OP was 4 ± 1.8%, with 60% at low to moderate and 40% at high cardiovascular risk. Average weekly training was 5.5 ± 2.9 hours. Lake temperature was 7.0 degrees. One participant could not race but all completed CWI training and wore ECG recorders for an average of 226 ± 32 hours. Sixteen participants (80%) exhibited non-sustained atrial tachycardia (average 12.4 ± 8.8 events), and four (20%) had non-sustained ventricular tachycardia events (average 1.2 ± 0.5), with no significant pauses or >1st degree AV block observed. No arrhythmic events were directly linked to CWI.

Conclusion

This exploratory study of active, middle-aged participants with moderate cardiovascular risk found no association between CWI and arrhythmias. Further, larger-scale studies are necessary to conclusively determine CWI's safety.
Absence of coronary artery disease in high-risk sickle cell anemia patients: a new illustration supporting the protective effect of Bilirubin against atherosclerosis?
Authors: Stevenard M , Derbel H , Iles S , De Luna G , Tacher V , Amorouayeche Z , Ibrahim C , Boyer L , Alassaad L , Guillet H , Savale L , Derumeaux G , Bartolucci P , Dhumieres T
Published: October 2024

Background

Sickle cell anemia (SCA) is associated with both cardiac and systemic vascular disorders, which are the leading cause of morbi-mortality. Although these patients cumulate multiple cardiovascular (CV) risk factors, along with chronic inflammation and endothelial activation, some pre-clinical studies underlined a paradoxical protection against atherosclerosis.

Purpose

The aim of this study was to evaluate the prevalence of coronary artery disease in a high-risk SCA population.

Methods

From January 2019 to December 2023, consecutive adult patients with SCA were prospectively included in the DREPACOEUR registry to specifically analyze cardiac structure and function. They all had a comprehensive CV evaluation at steady-state in day-hospital including clinical exam, cardiac imaging, rhythm monitoring along with biology analysis. Only patients that underwent coronary imaging (CT coronary angiogram) were included in this study.

Results

Ninety patients were included. Mean age was 44±12, 50% were male with a high prevalence of systemic hypertension (57%), obstructive sleep apnea (21%) and 10% smokers. Only one patient had history of diabetes while no dyslipidemia (or lipid lowering therapy) was reported. Heart function was mainly preserved with a mean left ventricular ejection fraction (LVEF) of 58±5%. Expectedly, patients showed low hemoglobin level 8,7±1.4g/dL with high hemolysis markers. Glomerular filtration rate was 109 [62; 122] mL/min/m² with 21% having chronic kidney disease. Plasmatic LDLc level was low (0.7±0.3g/L, with 20% <0.5g/l) while triglycerides (TG) were highly variable (1.1±0.7mg/dL). Strikingly, no patient showed signs of significant coronary artery disease, with 87% presenting a calcium score of 0, 77% had a CAD-RADS of 0 while no patient was higher than 2. Correlation and linear regression analysis were performed to find independent parameters associated with LDLc and TG. Total bilirubin was the only variable that correlated with both LDLc and TG (R= -0.37, p<0.001 and R= -0.33, p=0.001 respectively).

Conclusion

Despite systemic vasculopathy and chronic inflammation, ageing SCA patients showed no significant coronary artery disease. These data are in line with pre-clinical studies suggesting a lipid-lowering role of bilirubin and its protective effect against atherosclerosis.
Cardiac morphology and function in patients with primary biliary cholangitis (PBC) without cirrhosis
Authors: Bidiuk J , Szmigielski C , Lewandowski J , Sinski M
Published: October 2024

Background

Primary biliary cholangitis (PBC) is a chronic, autoimmune liver disease causing destruction of the small intralobular bile ducts in the liver. PBC patients can also develop extrahepatic manifestations. Though patients with PBC have often elevated levels of serum lipids, data concerning cardiac involvement is inconsistent and cardiovascular changes may be underdiagnosed.

Purpose

The purpose of the study was to assess cardiac morphology and function in patients with PBC without cirrhosis and comparison with control subjects.

Methods

We studied 52 females with PBC, and included in the analysis 22 females without cirrhosis, who were compared to 44 healthy female controls matched for age (53.4 ± 9.2 and 51 ± 8.3 yrs., respectively, p =0.312). Transthoracic echocardiography (TTE) was performed with the analysis of the left ventricular (LV) global longitudinal strain (GLS) and myocardial work. Additionally, impedance cardiography was conducted, with the analysis of the autonomic function using BRS (baroreceptor sensitivity), HRV (heart rate variability) and BPV (blood pressure variability).

Results

Systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) differed between PBC and control group (128 ± 17 mmHg vs. 116 ± 11 mmHg, p=0.007 and 78± 12 mmHg vs. 75 ± 8 mmHg, p=0.024, and 73.5 ± 12 bpm vs. 71 ± 8 bpm , p=0.024, respectively). PBC group had larger diameter of the cardiac chambers when adjusted for body surface area (BSA), including left atrium (LA/BSA) and right ventricle (RV/BSA), as well as left ventricular mass (LWMI) and relative wall thickness (RWT), with no difference in the left ventricular end diastolic diameter (LVEDD/BSA). LV ejection fraction (EF) measured by bi-plane Simpson method was higher in PBC group. LV diastolic function parameters (E/A, E/e’) differed in patients with PBC when compared with controls, however, without signs of diastolic dysfunction. LV GLS indices (GLSAVG, GLSLAX, GLS4C, GLS2C) were significantly higher in PBC group, as well as global myocardial work indexes: global myocardial work (GWI) and global constructive work (GCW). Non-invasive autonomic assessment showed lower BPV in patients with PBC without cirrhosis, but no differences in baroreceptor sensitivity and HRV. Impedance cardiography did not show differences between both groups.

Conclusion

Our study shows that PBC patients without cirrhosis are characterized by remodeling and functional changes of the heart, when compared to age-matched controls. These changes could imply hyperkinetic circulation even before the development of cirrhosis in PBC patients.
Vascular thrombosis and relapse-associated factors in Behcet's syndrome: a comprehensive analysis of 136 patients
Authors: Chadli S , Khibri H , Maamar M , Moatassim N , Ammouri W , Harmouche H , Adnaoui M , Tazi Mezalek Z
Published: October 2024

Background

Vascular thrombosis in Behçet syndrome (BS) is frequent and associated with high morbidity and mortality rates.

Purpose

To investigate BS patients presenting with a thrombotic event (TE) and identify the factors associated with relapse.

Methods

We retrospectively conducted a single-center, descriptive, and analytic study, from 2000 to 2022, enrolling all BS patients presenting TE, including venous thrombosis (VT) and/or arterial thrombosis (AT).

Results

TE was observed in 136/531 patients (25%), mostly men (83%), aged 29 ± 9 years (11-50) at BS onset. TE was the initial presentation of BS (32%) or occurred after a median of 4 years [0;25]. It included VT (92.5%), AT (18%), and both (13%). VT mostly consisted of DVT in the lower extremities (60%), vena cava (30%), and cerebral (15%) veins. It involved one (55%), two (27%), and multiple (16%) veins (Figure 1). AT mainly affected the pulmonary (42%), femoral (21%), coronary (17%), cerebral (8%) arteries, and aorta (8%). Arterial aneurysms were common (18%), especially in the pulmonary arteries (11%). Intracardiac thrombosis was also visualized (10%). Noncardiovascular manifestations mainly included aphthous ulcers (96%), pseudofolliculitis (36%), ocular lesions (41%), and arthralgias (22%). Hemostasis parameters were within normal ranges. Patients were treated with colchicine (98%), corticoids (98%), and immunosuppressants (80%). Anticoagulation and anti-platelet aggregation were administered in 90% and 15% of the cases, respectively. Six patients underwent vascular surgery. Post-thrombotic syndrome was noted in 14% of the patients. Relapse was common (25%), mainly occurring in men (81%), of younger age (24 ± 6) at first TE. Relapse consisted of one (55%), two (32%), or multiple episodes (13%). It occurred in the same vascular system initially affected (69%), a different one (12%), and both at the same time (19%). Multivariable analysis revealed TE at onset (OR= 2.99, 95% CI[1.14 ; 7.82], p=0.02), arterial thrombosis (OR= 2.91, 95% CI[1.10 ; 8.40], p=0.04), and arterial aneurysms (OR= 2.58, 95% CI [1.09 ; 8.45], p=0.02) as factors significantly associated with TE relapse (Figure 2).

Conclusion

Our study highlights several particularities of TE in BS, with TE at onset, arterial thrombosis, and arterial aneurysms emerging as significant relapse factors.