bluuebunny/crossref_metadata_2025 huggingface dataset:
Mixed messages? Information about cardiovascular health and alcohol use: a cross-sectional study of patients in cardiology care
Authors: Wallhed Finn S , Welfordsson P , Bjorck C , Grzymala-Lubanski B , Hambraeus K , Lidin M , Haugen Lofman I , Braunschweig F , Danielsson A K
Published: June 2024

Background

Hazardous alcohol use is a leading risk factor for disability and death, yet observational studies have also reported reduced cardiovascular disease mortality among regular, low-level drinkers. Such findings are refuted by more recent research, yet have received significant media coverage. There has been little research on how adults with cardiovascular disease access information and how they perceive risks of alcohol consumption. Studies to date are restricted to the United States, limiting generalizability to other contexts.

Purpose

To explore: 1) how patients with cardiovascular diseases access health information about moderate drinking and cardiovascular health; 2) the perceived messages these sources convey, and 3) associations with own level of alcohol use.

Method

We conducted a cross-sectional survey of patients in cardiology services at three hospitals in three different regions in Sweden. The study outcome was hazardous alcohol use, assessed using the Alcohol Use Disorders Identification Test-C questionnaire and defined as ≥3 in women and ≥4 in men. The exposure was accessing information sources suggesting that moderate alcohol consumption can be good for the heart, as opposed to accessing information that alcohol is bad for the heart. Health information sources were described using descriptive statistics. Gender, age and education were adjusted for in multiple logistic regression analyses.

Results

From 1230 eligible patients, 83% responded to relevant survey questions. Of these, 48.6% had heard that drinking moderately can affect the heart (mean age 70.5 years, 65% males). A total of 330 (62.3%) patients who had heard that drinking moderately can affect the heart described being exposed to reports that moderate alcohol use can be good for the heart, and 108 (21.7%) met criteria for hazardous alcohol use. Health information sources included newspapers (32.9%), television (29.2%), healthcare staff (13.4%), friends/family (11.8%), social media (8.9%) and websites (3.7%). Participants indicated that most reports (77.9%) conveyed mixed messages about the cardiovascular effects of moderate drinking. Exposure to reports of healthy heart effects was associated with increased odds of hazardous alcohol use (odds ratio=1.67, 95% confidence interval=1.02–2.74).

Conclusions

This study suggests that many patients in cardiology care access health information about alcohol from media sources, which convey mixed messages about the cardiovascular effects of alcohol. Exposure to reports suggesting that moderate drinking has protective cardiovascular effects was associated with increased odds of hazardous alcohol use. Findings highlight a need for clear and consistent messages about the health effects of alcohol. Table Health information sources
The chronic heart failure evolutions: different fates and routes
Authors: Chiesa M , Salvioni E , Emdin M , Piepoli M , Sinagra G , Mapelli M , Senni M , Bonomi A , Metra M , Limongelli G , Parati G , Agostoni P
Published: June 2024

Background

Individual prognostic assessment and disease evolution pathways in chronic heart failure (HF) are unmet needs. The application of unsupervised learning methodologies could help at: a) identification of HF patient phenotypes; b) identification of the evolution states and progression in each phenotype and c) assessment of risk of adverse event.

Methods

We retrospectively analyzed the MECKI registry including 7948 HF patients. After preliminary preprocessing, we selected 4876 patients with a minimum 2-year follow-up. We implemented a Topological Data Analysis (TDA), based on 43 variables derived from clinical, biochemical, cardiac ultrasound and exercise evaluations, to identify several patients’ clusters. Thereafter, we used the trajectory analysis to describe the evolution of HF states, which is able to identify bifurcation points, characterized by different follow-up paths, as well as stopping points, i.e. specific end-stages conditions of the disease. Finally, we conducted a survival analysis to generate 5-year time-to-event curves using as study endpoint the composite of cardiovascular death, LVAD or urgent heart transplant. Findings were validated on internal (n=527) and external (n=777) populations.

Figure 1 shows the main methodological steps (upper and middle panel).

Results

Nineteen patient clusters were identified by TDA. Table 1 shows the main collected variables according to events occurrence at 2 and 5 years follow up. Trajectory analysis revealed a path characterized by 3 bifurcation points with 2 different follow-up path each and 4 stopping points (Figure 1, lower panel). Clusters survival rate varied from 44% to 100% at 2 years and from 20% to 100% at 5 years, respectively. Finally, we compared the event frequency at a 5-year follow-up for each study cohort cluster with those in the validation cohorts (R = 0.94 and R = 0.84, p < 0.001, for internal and external cohort, respectively).

Conclusions

Each HF phenotype has a specific disease progression and prognosis. The bifurcation points need attention since are followed by different disease routes with 4 different disease end-stages which are characterized by different prognosis. These findings allow to individualize HF patient evolutions and to tailor assessment.
Impact of iron deficit in exercise capacity in heart failure patients: the role of VE/VCO2 slope and VO2peak
Authors: Campodonico J , Salvioni E , Mapelli M , Vignati C , Pezzuto B , Acquistapace A , Lorenzon B , Agostoni P
Published: June 2024

Aims

Iron Deficit (ID) is frequently observed in HF patients even in the absence of anemia. In Heart Failure (HF) patients ID is associated to a reduced exercise performance regardless of anemia, related to abnormality in O2 delivery and utilization (evaluated by VO2 peak) and/or to inefficiency in ventilation during exercise (evaluated by VE/VCO2 slope), respectively. Of note, both peak VO2 and VE/VCO2 are independent predictors of HF severity being in ID HF patients reduced and increased, respectively. The aim of this study is evaluating whether it is possible to indicate as the leading cause of exercise limitation in HF patients with ID, but not anemia oxygen delivery abnormalities or reflex induced hyperventilation or whether both are concomitant.

Methods and Results

We analysed data of 1043 patients hospitalized for HF. 413 patients have ID (transferrin saturation, TSAT <20%) and 630 have TSAT≥20%. Patients with TSAT<20% showed a significantly lower VO2 anerobic threshold (AT) and VO2 peak and a higher VE/VCO2 slope, also when parameters were adjusted for hemoglobin (Hb), left ventricular ejection fraction (LVEF), age, gender and serum creatinine. In particular, in patients with TSAT< 20% VO2AT= 688 ± 290 ml/min, VO2 peak= 967 ± 377 ml/min, VO2 peak/Kg= 15 ± 3 ml/min, and VE/VCO2= 38 ± 9 while in patients with TSAT≥20% VO2AT= 881 ± 357 ml/min; VO2 peak= 1269 ± 529 ml/min, VO2peak/Kg= 16 ± 6 ml/min, and VE/VCO2= 33 ± 8 (Table 1).

Finally, adjusting also for VO2 peak difference between TSAT< and ≥ 20% for VE/VCO2 persists as after adjusting for VE/VCO2 VO2 peak differences did (Fig 1a and 1b).

Conclusion

In HF patients ID is associated with exercise performance impairment independently from anaemia, age, left ventricle ejection fraction and serum creatinine. Both peakVO2 and VE/VCO2 relationship slope are pivotal and independent causes of exercise limitation in these patients. Fig 1  Table 1
Dapagliflozin effect on cardiopulmonary function in HFrEF patients
Authors: Mapelli M , Mattavelli I , Vignati C , Salvioni E , Mantegazza V , Garlasche A , Pezzuto B , Gugliandolo P , Capovilla T M , Marongiu A , Maranzano G , Agostoni P
Published: June 2024

Background

Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are currently a standard therapy for patients with heart failure with reduced ejection fraction (HFrEF). This study aims to assess the effects of Dapagliflozin on exercise capacity, cardiac biomarkers, fluid retention, renal and pulmonary function.

Methods

We prospectively enrolled a cohort of stable HFrEF outpatients (left ventricular ejection fraction, LVEF<40%, New York Heart Association, NYHA, class II or III) eligible for SGLT2i therapy and performed serial cardiopulmonary exercise tests (CPET), pulmonary function tests (standard spirometry and diffusing capacity of the lungs for carbon monoxide, DLCO), laboratory and echocardiographic assessments before the beginning of treatment with Dapagliflozin and after 6 months, in order to evaluate its effects on exercise capacity, ventricular remodelling, cardiac biomarkers, fluid retention, renal and pulmonary function.

Results

49 patients (86% males, age 64±12 years) on optimal medical therapy (84% on sacubitril/valsartan; 98% on β-blockers, 84% on MRAs) were evaluated. The main variables are reported in table 1. We observed an increase in LVEF (32.8±7.1 vs. 35.5±8.3%; p<0.001) and a reduction in left ventricular end-diastolic (EDV) and end-systolic (ESV) volumes (EDV: 209±83 vs. 199± 77 mL, p=0.004; ESV: 143±73 vs. 133± 68 mL, p<0.001). There were no significant changes in peak oxygen uptake, while ventilatory efficiency during exercise (VE/VCO2 slope) showed a significant improvement (fig.1). Hemoglobin (Hb) and hematocrit levels improved, while renal function sodium and potassium levels remained stable, as did blood urea nitrogen, while BNP, NT-proBNP, glycated Hb, ST2, and hs-TNI did not reach statistical significance in this sub-population. NYHA functional class improved, together with a significant decrease of MECKI (Metabolic Exercise test data combined with Cardiac and Kidney Indexes) score, from 3.9% to 2.7% with a positive impact on two-year prognosis.

Conclusion

Medium-term treatment with Dapagliflozin demonstrated beneficial effects on LV remodelling, exercise ventilatory efficiency and functional status. In particular, an improvement in VE/VCO2 slope and MECKI score paralleled with an enhancement in echocardiographic parameters and NYHA functional class was observed. However, our study did not detect medium-term effects of Dapagliflozin on spirometry values, DLCO, fluid retention and NT-proBNP. These results suggest that some favourable effects could unfold over a longer period of time. Further studies with longer follow up are desirable to assess Dapagliflozin effects even in such a well-treated HF population.
Effects of a behavioral psychological intervention in addition to an exercise rehabilitation program in chronic heart failure patients
Authors: Pizga A , Kordoutis P , Delis D , Linardatou V , Ntalianis A , Brouskeli V , Rovina N , Nanas S , Routsi C , Karatzanos E
Published: June 2024

Introduction

Patients with chronic heart failure (CHF) have an increased risk of presenting symptoms of stress and depression compared to the general population. For this reason, mental health components have been integrated into exercise rehabilitation programs. The effectiveness of behavioral interventions has not been evaluated in this clinical population.

Purpose

The aim of this study was to investigate the impact of a behavioral phycological intervention on stress, depression, and life satisfaction in CHF patients.

Method

Thirty-six consecutive stable CHF patients on optimal medication (age: 56±10 years, EF<50%) were randomly allocated to the intervention group (IG, n=18) or the control group (CG, n=18). All the patients participated in a combined exercise rehabilitation program (aerobic exercise and strength training) of 36 sessions (3×/week, 12 weeks). The IG team was additionally given information and emotional support (12 sessions) through psychoeducation, stress management techniques and positive reinforcement of self-care behaviors. Depression, stress and life satisfaction rate were assessed with self-report scales, and aerobic capacity with cardiopulmonary exercise test before and after the intervention. Values are expressed as mean and standard deviation.

Results

In the whole cohort, VO2peak was improved after the program (from 19.4±3.9 to 22.0±6.5 ml/kg/min, p=0.04). Depression rate was reduced in the IG (from 3.4±4.0 to 1.6±2.4, p<0.01) but not the CG (from 3.6±3.4 to 4.0±3.7, p=0.32). Stress rate was reduced (p<0.01) in both IG (from 14.3±8.6 to 9.1±7.4) and CG (from 13.2±9.8 to 8.6±5.9). Finally, life satisfaction was increased in the IG (from 23.8±5.2 to 30.8±3.5, p<0.01), while decreased in the CG (from 26.0±6.9 to 20.2±6.5, p<0.01]. Significant between-group differences were observed in the depression rate and life satisfaction (p<0.01).

Conclusion

Behavioral and emotional support, with psychoeducation, stress management techniques and positive reinforcement, in addition to an exercise rehabilitation program, can have a positive impact in reducing depression symptoms and boosting the mental status of CHF patients. Further research is necessary to explore the effects of different behavioral and psychological techniques.
The relationship between blood pressure and mortality in the general population - it is not as simple as one might think - results from 20 years follow-up in the Study of Health in Pomerania
Authors: Franksmann M , Gross S , Ittermann T , Friedrich N , Markus M , Markus M , Doerr M , Bahls M
Published: June 2024

Introduction

Hypertension is the leading risk-factor for cardiovascular disease (CVD). Whether treatment of hypertension below 140/90 mmHg or 120/80 mmHg is appropriate for optimal CVD risk reduction is unclear.

Purpose

We used data from the population-based Study of Health in Pomerania (SHIP) to assess the relationship between baseline blood pressure and all-cause as well as cause-specific mortality in individuals with and without antihypertensive medication.

Methods

Participants were stratified by use of anti-hypertensive medication (w/ medication and w/o medication), and blood-pressure at baseline: (1) <120/80 mmHg, (2) <140/90 mmHg, and (3) hypertension ≥140/90mmHg. We used adjusted multivariable Cox regression models with a median follow up time up of 13.5 years (IQR: 9.4-20.8). Participants in group (1) w/o antihypertensive medication served as the reference group.

Results

The following participants were included: w/o medication: (1) n=1,602; (2) n=1,766; (3) n=1,216; w/ medication: (1) n=278; (2) n=741; (3) n=951. Participants w/o and w/ antihypertensive medication had a mean age of 43 (SD 14) years and 60 (SD 12) years, respectively. A total of 52.4% (w/o medication) and 48.7% (w/ medication) were women. Overall 876 individuals died during follow-up. Individuals with medication at baseline always had a higher risk for all-cause mortality irrespective of measured blood pressure compared to the reference group: (1) HR 2.29 (95%-CI: 1.49-3.53); (2) HR 1.72 (95%-CI:1.19 -2.47); (3) HR 1.79 (95%-CI:1.26-2.55). Blood pressure in individuals without medication was not related to all-cause mortality. In subjects w/o medication, higher blood pressure levels were not significantly associated with CVD mortality. With intake of medication at the baseline examination, blood pressure <120/80 mmHg was not related to CVD mortality. On the other hand, blood pressure <140/90 mmHg (HR 2.74, 95%-CI: 1.02-7.39) and hypertension (HR 3.36, 95%-CI: 1.26-8.99) was significantly associated with higher CVD mortality in treated individuals. Participants w/o medication had no higher risk of non-CVD mortality compared to the reference group. In contrast, taking medication and a baseline blood pressure <120/80 mmHg was significantly related to a higher non-CVD mortality risk (HR 2.43, 95%-CI: 1.45-4.07), while <140/90 mmHg or hypertension w/ mediaction was not significantly related to higher risk of non-CVD mortality.

Conclusion

Normotensive blood pressure <120/80 mmHg in treated individuals was associated with lower risk of CVD-mortality. However, simultaneously this was also related with higher risk of non-CVD mortality. Thus, intensive antihypertensive treatment seems to shift the mortality risk from CVD to non-CVD without decreasing the risk for all-cause mortality.
Real-world data regarding blood pressure control rates in hypertensive obese patients: a prospective, observational multicentric study performed in Romania
Authors: Vintila A M , Dolofan B M , Trambitas N , Vittos O
Published: June 2024

Background

Achieving optimal blood pressure (BP) control is the most important aspect in the management of hypertension. There are complex mechanisms relating obesity to hypertension, fact that makes the hypertension treatment more challenging among those individuals, both for patients and physicians alike.

Objective

To assess the BP control rates in hypertensive obese patients treated with single pill combination (SPC) antihypertensive medications in real-world conditions.

Design and method: Real-world, prospective, observational, multicenter study, performed in Romania (May-Aug 2023), collecting data from 192 sites (107 GPs and 85 Cardiology sites). The study included hypertensive obese patients, for which the investigator based on his/her best medical judgement and in line with the practice guidelines prescribed one SPC antihypertensive medication. The patient observational period was 12 weeks [including 3 visits- V0 (baseline), V1 (4 weeks), V2 (12 weeks)].

Results

1299 hypertensive, obese patients (56.22±11years; 53.89% females), Body Mass Index (BMI) 34.35±4.21 kg/m2; within "very high" CV risk category (68.82%) (calculated as per SCORE2 and SCORE2-OP), CV family history (56.81%), comorbidities (52.12%). Among patients with comorbidities the most frequently identified were diabetes mellitus type 2 (37.37%), valvular heart disease (20.97%), angina (19.35%) and heart failure (16.24%). At 1-month visit, 723 patients (55.65%) failed to reach BP targeted values of ESC/ESH 2018 guidelines and 768 patients (59.12%) failed to reach BP targeted values of ESH 2023 guidelines. Interestingly, changes in SPC dose or prescription at 1-month visit were made only for patients considered in investigator’s opinion as "uncontrolled" - 292 patients (22.48%). The rest, 1007 patients (77.52%) were considered as "controlled" and no changes in the treatment were implemented. At the end of the observational period (3-month), the optimal BP control was reached in 36.33% patients (as per ESC/ESH 2018 guidelines), and in 33.03% patients (as per ESH 2023 guidelines), respectively. It is important to mention that at 3-month visit, the SBP values were for 86.29% of patients below 140 mmHg (regardless of age or associated comorbidities) (Fig.1).

A small percentage of the "uncontrolled" patients at study end (7.5%) (ESC/ESH 2018), respectively (8.85%) (ESH 2023), were optimally controlled at V1 and no changes in the treatment were performed, nevertheless, the duration of optimal control was not maintained throughout the study.

Conclusions

This real-world evidence study identified an important therapeutic inertia of investigators regarding SPC therapy intensification by dose up-titration and showed that after a 3-month treatment period the optimal BP control was obtained on average in one out of three hypertensive obese patients.
Management of patent foramen ovale; findings from a nationwide survey
Authors: Apostolos A , Drakopoulou M , Trantalis G , Ktenopoulos N , Katsaros O , Aggeli C , Ntaios G , Tsivgoulis G , Tsioufis C , Toutouzas K
Published: June 2024

Background

Several clinical trials have provided evidence supporting the transcatheter closure of patent foramen ovale (PFO) in selected patients following a cryptogenic stroke. However, it remains unknown to what extent these guidelines have been implemented in everyday clinical practice and the familiarity of physicians from different specialties with PFO closure.

Purpose

The aim of our nationwide survey is to explore the implementation of transcatheter PFO occlusion in Greek clinical practice.

Methods

Attending level cardiologists, internal medicine physicians and neurologists involved in the management of PFO-related strokes working in Greece were invited to complete an online questionnaire. The questionnaire consisted of 19 questions and was designed to obtain comprehensive data on provider demographics, PFO characteristics, and specific clinical scenarios.

Results

A total of 51 physicians (56.9% cardiologists, 25.5% neurologists and 17.6% internal medicine physicians) completed the survey, resulting in a response rate of 53%. Cardiologists, internal medicine physicians and neurologists agree on several issues regarding PFO closure, such as PFO closure as first line treatment, management of patients with DVT or prior decompression sickness, and post-closure antithrombotic treatment, but different approaches were reported regarding closure in patients with thrombophilia treated with oral anticoagulation (p=0.012) and implantable loop recorder placement for atrial fibrillation exclusion (p=0.029 and p=0.020).

Conclusions

Our findings show that cardiologists, internal medicine physicians and neurologists agree in numerous issues, but share different views in the management of patients with thrombophilia and rhythm monitoring duration. These results highlight the significance of collaboration among physicians from different medical specialties for achieving optimal results.
An innovative cardiac rehabilitation based on the power-force-velocity profile to further improve cardiorespiratory capacities in coronary artery disease patients
Authors: Hupin D , Fanget M , Roche F
Published: June 2024

Background

Individually optimising the training programme of cardiac rehabilitation (CR) remains a major concern among young coronary artery disease (CAD) patients. Among effective tools, the power-force-velocity profile (PFVP) is usually assessed to improve performance in athletes through individualised training. Therefore, assessing PFVP may allow better personalization of CR. The aim of this study was to compare the effects of a new CR customized based on patient’s PFVP versus a traditional CR in CAD patients on cardiorespiratory, biological and muscular systems.

Methods

A total of 86 patients participated in this study. The 3-week intervention consisted of physical training sessions (4/week) and therapeutic education workshops (1/week). Experimental group patients followed a specific cycling training programme based on their deficient PFVP quality. Control patients attended a conventional, common CR programme. Cardiopulmonary exercise test (VO2 at the first ventilatory threshold, VT1, and the peak), blood tests (low- and high-density lipoproteins cholesterol, LDL-C and HDL-C), handgrip and quadriceps force were performed at baseline and after CR.

Results

The mean age was 60.8 ± 9.6 y, 15% were women. A significantly greater benefit in VO2 peak(experimental: +21.5 ± 19.2% vs. control: +10.5 ± 15.8%, p<0.001), VO2 at VT1 (experimental: +35.5 ± 33.6% vs. control: +8.4 ± 31.2%, p<0.001), and LDL-C (p=0.001) were observed in the experimental group. Both groups significantly increased HDL-C and muscle parameters.

Conclusion

The novel CR, based on initial PFVP, showed greater benefits on cardiorespiratory capacities and lipid profile than a conventional, non-individualised CR. Therefore, PFVP could be used in CR to adapt specifically the content of training sessions.
Enhanced cardiac rehabilitation with ultra-Processed food reduction and time-restricted eating resolves metabolic syndrome and prediabetes in coronary heart patients: the DIABEPIC-1 study
Authors: Iglesies-Grau J , Dionne V , Latour É , Gayda M , Besnier F , Gagnon D , Debray A , Gagnon C , Tessier A J , Simard F , Nigam N , L Allier P L , Juneau M , Bouabdallaoui N , Bherer L
Published: June 2024

Background

Cardiac rehabilitation programs provide a valuable opportunity to promote the adoption of healthy lifestyle behaviors in patients with atherosclerotic cardiovascular diseases (ASCVD) and metabolic comorbidities, including metabolic syndrome (MetS) and prediabetes. However, strategies to reverse these conditions remain to be explored.

Objectives

The DIABEPIC-1 study aimed to assess the feasibility of an enhanced six-month cardiac rehabilitation program for patients with ASCVD while investigating prediabetes and MetS remission.

Methods

The study’s program combined exercise training with an intensive nutritional intervention involving counseling on reducing ultra-processed foods (UPFs), adopting a Mediterranean diet, and implementing time-restricted eating (TRE). Segmental body-composition measurements, complete blood analysis, maximal exercise testing, a 3-day nutritional diary recorded with the Keenoa artificial intelligence App, and lifestyle questionnaires were completed at baseline, three months, and six months. Complete remission of prediabetes was defined as a HbA1c level below the diagnostic threshold (<5.7%) for ≥3 months without pharmacological therapy. Partial remission was defined when HbA1c was <5.7% at six months. Complete remission of MetS was reached when <3 NCEP/ATP-III Criteria were met at three months and maintained at six months. Partial remission occurred when <3 NCEP/ATP-III Criteria were met at six months.

Results

The study enrolled 36 participants with a six-month completion rate of 88.9% and compliance with all protocol interventions of 92.5%. Waist circumference decreased significantly by -9.2 cm (95%CI: -7.4 to -10.9; p <0.001), and participants lost an average of -8.0 kg (95%CI: -6.3 to -9.7; p<0.001), primarily from fat mass and visceral fat. Participants showed improved glycemic and lipid profiles, insulin resistance markers, and liver health (Table 1). They also improved cardiorespiratory fitness, reduced UPF consumption, and increased adherence to the Mediterranean diet and TRE, leading to lower caloric intake and enhanced nutrient profiles. Notably, 50% of participants achieved prediabetes remission, with higher initial HbA1c levels associated with a 100% remission rate. Additionally, 70% of participants with MetS at the study's outset achieved remission (Figure 1).

Conclusion

Our findings indicate the feasibility of enhancing a cardiac rehabilitation program with a stepwise intensive nutritional intervention, resulting in clinically significant outcomes. This includes the remission of key causal risk factors in a substantial number of ASCVD patients. Baseline Charactersitics and Changes.  MetS and Prediabetes Remission.
Exercise-based cardiac rehabilitation for patients with coronary heart disease - the CaReMATCH individual patient meta-analysis
Authors: Stens N A , Buckley B J R , Dibben G O , Buffart L M , Kleinnibbelink G , Van Royen N , Taylor R , Thijssen D H J
Published: June 2024

Introduction

Exercise-based cardiac rehabilitation (ExCR) is an integral part of coronary heart disease (CHD) management.

Purpose

The Cardiac Rehabilitation Meta-Analysis of Trials in patients with CHD using individual patient data (CaReMATCH) initiative has dual aims of: (1) providing contemporary estimates on the effectiveness of ExCR for CHD; (2) examining potential differential effects of ExCR across CHD patient subgroups.

Methods

Individual patient data from randomized controlled trials comparing ExCR to no ExCR (controls) published since 2010 and with at least 6 months of follow-up were sought. The outcomes of health-related quality of life (HRQoL) (EQ-5D, 15D and SF-6D utility scores [UI]), all-cause and cardiovascular disease (CVD)-related mortality and hospitalization were pooled using one- and two-stage individual patient meta-analysis.

Results

Out of 30 eligible trials (10,677 patients), 8 trials were analysed (4,975 patients, 92.9% post-myocardial infarction). Compared to controls, participation in ExCR resulted in a reduced risk of all cause (hazard ratio [HR] 0.68, 95% confidence interval [CI]: 0.53 to 0.87) and CVD-related hospitalisation (HR 0.62, 95% CI: 0.46 to 0.83), and improved HRQoL (mean difference in UI: 0.043, 95% CI: 0.021 to 0.064). No differences were seen in all-cause and CVD mortality (HR 1.13, 95% CI: 0.80 to 1.60; 1.41, 95% CI: 0.32 to 6.15 respectively). There was no evidence of a differential effect of ExCR across subgroups apart for HRQoL at follow-up, as larger ExCR benefits were obtained in those with a low education level (UI of low vs high education level: 0.062, 95% CI: 0.026 to 0.10; -0.0129, 95% CI: -0.035 to 0.0093 respectively) and a low baseline HRQoL (per 0.10 increment in baseline UI: -0.0073, 95% CI: -0.014 to -0.00093).

Conclusion

Reinforcing findings of trial level meta-analyses, our IPD meta-analysis found contemporary ExCR participation to improve HRQoL and reduce risk of hospitalization. Importantly, we reveal little differential treatment effects across patient subgroups, supporting the prescription of ExCR to all patients with CHD to achieve clinical benefit. Figure 1
Predictors of physical activity levels one year after the start of cardiac rehabilitation
Authors: Heutinck J M , Brouwers R W M , Vromen T , Kemps H M C
Published: June 2024

Introduction

Physical activity levels often decline after cardiac rehabilitation (CR) completion and a significant number of patients remain physically inactive. While CR participation is associated with a 32% risk reduction in all-cause mortality, this effect is expected to increase if patients maintain an active lifestyle. Predicting physical activity levels after CR helps to identify patients at risk of relapsing into an inactive lifestyle.

Purpose

To identify patient characteristics that predict their objectively assessed physical activity level (PAL) one year after the start of a CR programme.

Methods

We used data from the SmartCare-CAD clinical trial, in which 300 patients with coronary artery disease entering phase 2 outpatient CR were randomised between May 2016 and July 2018 to centre-based CR with supervised training or telerehabilitation with relapse prevention. Follow-up was 12 months. PAL was calculated using accelerometer and heart rate sensor data. For the current analysis, patients in the intervention and control group were pooled, as no significant between-group difference in PAL was observed in the response over time. We performed univariate regression analysis to identify possible predictors (p<0.20) for PAL at 12 months, followed by a multiple regression analysis.

Results

Patients with both baseline and 12-month PAL data available (n=206) were included in the analysis (89% male, mean age 61.0 ± 9.7 years). Univariate analysis revealed 4 predictors of PAL at 12 months: higher baseline PAL, higher baseline percentage of expected exercise capacity and greater increase in exercise capacity at 3 months were associated with higher 12-month PAL levels, whereas higher educational level was associated with a lower 12-month PAL level. The overall regression model including these 4 predictors was statistically significant (adjusted R² = 0.202, F(4, 195) = 13.61, p = < 0.001), with all variables being independent predictors (Table 1). Other baseline characteristics (i.e. age, sex, BMI, health literacy, comorbidity index, working status and treatment allocation) were not related to 12-month PAL levels.

Conclusion

Predicting physical activity levels one year after the start of cardiac rehabilitation is partly possible, with 20% of the variability being explained by our regression model. Predictive characteristics for a low PAL at 12 months were low PAL at baseline, low baseline exercise capacity and little improvement of exercise capacity during CR, with PAL at baseline being of most influence. Surprisingly, high educational level was also associated with a lower PAL at 12 months. These findings help identify patients that may benefit from personalised CR programmes and extended guidance.
Effects of thyroid ft3 levels on exercise induced remodelling in elite athletes practicing different sporting disciplines
Authors: Di Gioia G , Maestrini V , Monosilio S , Lemme E , Squeo M R , Buzzelli L , Serdoz A , Zampaglione D , Fiore R , Pelliccia A
Published: June 2024

Introduction

Free triiodothyronine (fT3) profoundly affects the cardiovascular system. Studies in the general population demonstrated that variations in thyroid hormone levels, even within the euthyroid range, can influence cardiac parameters.

Purpose

Aim was to investigate how thyroid hormone, within the limits of normality, affects exercise-induced cardiac remodelling in a large cohort of Olympic athletes.

Methods

We evaluated 1342 Olympic athletes (mean age 25.6±5.1) practising different sporting disciplines (power, skills, endurance and mixed). Athletes underwent blood (thyroid stimulating hormone, fT3 and fT4), echocardiographic and exercise-stress tests. Athletes assuming thyroid hormones, with thyroiditis or TSH out of the normal ranges were excluded.

Results

In all disciplines rest heart rate (HR) was positively correlated to fT3 (power: p=0.0002; R2=0.04,; skills: p=0.0009; R2=0.05; endurance: p=0.007; R2=0.03 and mixed: p=0.04; R2=0.01). Same for peak HR at exercise-stress test in power, skills and endurance (respectively p < 0.0001; R2=0.04; p=0.01; R2=0.04, and p=0.005; R2=0.02). Moreover, a positive correlation was observed with interventricular septum (power: p<0.0001; R2=0.11; skills: p=0.02; R2=0.03; endurance: p=0.002; R2=0.03; mixed: p<0.0001; R2=0.04). Furthermore, fT3 directly correlated with left ventricle end-diastolic volume in skills (p=0.04; R2=0.03), endurance (p=0.04, R2=0.01) and mixed (p=0.04; R2=0.01).

Conversely, thyroid hormones were influenced by type of sporting discipline practiced: endurance athletes presented the lowest TSH (p <0.0001), fT3 (p = 0.007) and fT4 (p < 0.0001).

Conclusions

Our study demonstrated a close, bidirectional relationship between exercise and thyroid function. Chronic aerobic exercise influence thyroid hormones by lowering TSH, fT3 and fT4 as an adaptive mechanism. However, on the other side small variation of fT3 circulating levels, even within the normal range, affect heart morpho-functional parameters (rest and peak heart rate, interventricular septum, left ventricle end-diastolic volume indexed) in all sporting disciplines and influence the athlete’s heart response to exercise induced adaptive mechanisms. Therefore, thyroid function assessment should be taken into account when an evaluation on athlete’s heart is performed. Influence of ft3 on heart rate.  Influence of ft3 on IV septum.
The use of myocardial work index for the evaluation of elite endurance athletes with lower ejection fraction
Authors: Ortolina D , Di Gioia G , Maestrini V , Monosilio S , Squeo M R , Lemme E , Serdoz A , Zampaglione D , Fiore R , Pelliccia A
Published: June 2024

Background

Athlete's heart is characterized by cardiac chambers adaptations to physical activity with the subsequent possibly presence of some diagnostic overlaps with dilated cardiomyopathy. In general population, heart failure with preserved ejection fraction (EF) already exhibit altered myocardial work indexes (MWI) and those with reduced global work efficiency (GWE) display lower exercise capacity. However, in the setting of differential diagnosis, thanks to the afterload-independency MWI could be capable to identify those athletes with early subclinical damages.

Purpose

Aim of our study was to study MWI in endurance athletes with lower values of LV ejection fraction in order to evaluate the presence of early subclinical damage.

Methods

We studied 96 endurance Olympic athletes, mean age 27.4±7 years, 63 (67.7%) male, mean BMI 22.5±4.6. Athletes practiced different disciplines including: 9 athletics (>800 mt, marathon, long-distance track&field), 14 canoeing, 37 rowing, 13 cycling, 11 Kayak, 9 long-distance swimming, 3 pentathlon. Athletes were submitted to clinical, anthropometric evaluation, cardio-pulmonary exercise stress test (CPET) and transthoracic echocardiogram (TTE), divided according to ejection fraction (EF) in those with lower EF (<55%) and normal EF (³55%). Strain rate and myocardial work index was performed and the following parameters collected: global longitudinal strain (GLS), global myocardial work index (GWI), constructive myocardial work (CMW), wasted myocardial work (WMW) and global cardiac work efficiency (GWE).

Results

Ten athletes had EF <55%, prevalently male (90% vs. 63%, p=0.086) and older (30±4.9 vs. 26.9±6.7 years, p=0.169) compared to normal EF. At CPET, in those with lower EF, lower HR (47.5±10.1 vs. 54.3±11 bpm, p=0.112), higher watts (374.±72.9 vs. 336.6±91.7, p=0.269), higher VO2\mL/min/Kg (54.8±12.8 vs. 50.9±8.4, p=0.246) and higher O2 pulse, mL/bpm (27.8±4.6 vs. 25±5, p=0.130) were found. At TTE, athletes with EF <55% presented morphological changes characterized by higher left ventricle end-systolic diameter and volume indexed (respectively 19.7±2.4 vs. 17.8±2.2 mm/m2, p=0.013 and 40.2±10.1 vs. 28.1±6.4 mL/m2, p<0.0001) and larger left atrium volume (p=0.007). No differences were found in GLS (-19.1±1.8 vs. -20±4.7%, p=0.579), GWI (1807.6±342.4 vs. 1886.5±262.6 mmHg, p=0.394), GCW (2178.3±431.8 vs. 2253.3±302.3 mmHg, p=0.488), GWW (90.2±32.6 vs. 94±52.3 mmHg, p=0.824) or GWE (95.4±1.3 vs. 95.5±2.1%, p=0.848).

Conclusions

Lower EF in endurance athletes can be considered as an adaptive mechanism according to better functional parameters and similar MWI. MWI can be used as additive echocardiographic tool in differential diagnosis between athlete’s heart and early stage dilated cardiomyopathy. Clinical parameter comparison.  Echocardiographic differences.
Estimating uncertainty when providing individual cardiovascular risk predictions: A Bayesian survival analysis
Authors: Hageman S H J , Post R A J , Visseren F L F , Mcevoy J W , Jukema J W , Smulders Y , Van Smeden M , Dorresteijn J A N
Published: June 2024

Background

Cardiovascular disease (CVD) risk scores provide point estimates of individual risk without uncertainty quantification. The objective of the current study was to demonstrate the feasibility and clinical utility of calculating uncertainty surrounding individual CVD-risk predictions using Bayesian methods.

Methods and Results

Individuals with established atherosclerotic CVD were included from the Utrecht Cardiovascular Cohort - Secondary Manifestations of ARTerial disease (UCC-SMART). In 8,355 individuals, followed for median of 8.2 years (IQR 4.2-12.5), a Bayesian Weibull model was derived to predict the 10-year risk of recurrent CVD events. Model coefficients and individual predictions were very similar to that of a traditional (‘frequentist’) model but the Bayesian model also predicted 95% credible intervals (CIs) surrounding individual risk estimates. The median width of the individual 95%CrI was 5.3% (IQR 3.6-6.5) and 17% of the population had a 95%CrI width of 10% or greater. An individual example is shown in Figure 1, for a 70-year old women with coronary artery disease. She has a predicted risk of 17.8%, and her individual 95%CrI was 15.1-21.0% based on the 2.5th and 97.5th quantile from the distribution of individual predicted risks. The figure also shows the possibilities of these methods to quantify the certainty of a patient having a risk higher than a certain treatment target. Figure 2 shows that the uncertainty decreased with increasing sample size used for derivation of the model. Combining the Bayesian Weibull model with sampled hazard ratios based on trial reports may be used to estimate individual absolute risk reduction with uncertainty measures and the probability that a treatment option will result in a clinically relevant risk reduction.

Interpretation

Estimating uncertainty surrounding individual CVD risk predictions using Bayesian methods is feasible. The uncertainty regarding individual risk predictions could have several applications in clinical practice, like the comparison of different treatment options or by calculating the probability of the individual risk being below a certain treatment threshold. However, as the individual uncertainty measures only reflect sampling error and no potential biases in risk prediction, physicians should be familiar with the interpretation before widespread clinical adaption.  Figure 2
Trends in burden of atrial fibrillation overthree decades: a population-based study
Authors: Yang S , De Kruijf N L M , Van Oortmerssen J A E , Kavousi M
Published: June 2024

Background

Atrial fibrillation (AF) is the most common sustained arrhythmia, increasing with age. Comprehensive population-based long-term data on AF trends and the associated comorbidities in men and women are scarce.

Purpose

To assess sex-specific trends in AF prevalence and incidence, as well as the impact of AF-associated comorbidities in three epochs.

Methods

We used data from a well-defined ongoing population-based cohort. The number of participants of three consecutive cohorts were 7750, 7675, and 7121, spanning three epochs (epoch 1990s: 1989 - 1993, epoch 2000s: 1997 - 2001, and epoch 2010s: 2008 - 2014) , respectively. We estimated the sex-specific AF prevalence and incidence. For AF-associated comorbidities, we calculated the hazards ratio (HR) (95% confidence intervals – CI), using Cox proportional hazard regression models, and the population attributable fractions (PAFs) .

Results

The mean (standard deviation - SD) age in three epochs were 70.3 (9.6), 70.0 (8.7), and 70.4 (9.8). The 5-year incidence rates for AF in three epochs were 31.4, 22.9, and 44.1 per 1000 person-years for women and 45.0, 34.7, and 65.6 per 1000 person-years for men, respectively. There was no significant trend observed across the three epochs. Hypertension was the only significant comorbidity consistently associated with incident AF over the three epochs; HRs (95% CI) were 2.17 (1.35-3.48) for women and 1.42 (0.94-2.13) for men for epoch 1990s, 1.82 (1.05-3.16) for women and 1.55 (0.93-2.56) for men for epoch 2000s, and 2.95 (1.64-5.30) for women and 1.21 (0.78-1.88) for men for epoch 2010s. Hypertension contributed most to incident AF; PAFs (95% CI) were 46.60 (24.00-68.30), 38.60 (11.90-68.90), and 59.90 (40.50-82.50) in women and 20.70 (-4.54-44.80), 31.70 (11.60-58.90), and 11.90 (-21.80-47.90), in men for the 3 epochs respectively.

Conclusion

The burden of AF has been increasing during the past three decades in the general population. Despite increasing recognition and management of hypertension, it is still an essential AF-associated comorbidity, especially in women. Tailored hypertension management strategies will insert a favorable impact on AF management. Figure 1
No association between increased high-density lipoprotein cholesterol and progressive cardiac damage in 1595 adolescents: a 7-year longitudinal study
Authors: Agbaje A O
Published: June 2024

Background

The inverse relationships between high-density lipoprotein cholesterol (HDL-c) and subclinical atherosclerosis are well documented in the general population. However, recent studies among adults have reported paradoxical relationships in which high HDL-c levels were associated with cardiovascular morbidities and mortality.

Purpose

To investigate the longitudinal association of changes in HDL-c with progressive structural and functional cardiac damage in youth.

Methods

From the Avon Longitudinal Study of Parents and Children (ALSPAC), UK birth cohort, 1595 adolescents aged 17 years who had fasting plasma HDL-c measured at 17- and 24-year clinic visits were included. Repeated echocardiography measured LVM indexed for height2.7 (LVMI2.7), relative wall thickness (RWT), LV diastolic function from mitral E/A ratio (LVDF), and LV filling pressure from E/e´ ratio (LVFP) were available at baseline and follow-up. LVMI2.7 ≥51g/m2.7, RWT ≥0.44, LVDF <1.5, and LVFP ≥8 were categorised as LV hypertrophy, high RWT, LVD dysfunction, and high LVFP, respectively. Multivariable adjusted associations were examined using generalized linear mixed-effect models and generalized logit mixed-effect models and adjusted for sex, and time-varying covariates measured at both baseline and follow-up such as age, insulin, high-sensitivity C-reactive protein, heart rate, systolic blood pressure, glucose, fat mass, lean mass, smoking status, family history of hypertension/diabetes/high cholesterol/vascular disease, socioeconomic status, sedentary time, light physical activity, moderate-to-vigorous physical activity, low-density lipoprotein cholesterol, and triglyceride.

Results

Among 1595 adolescents (mean [SD] age at baseline, 17.74 [0.38] years; 955 [59.8%] females]) HDL-c increased in males from 1.21 mmol/L to 1.42 mmol/L and in females from 1.38 mmol/L to 1.69 mmol/L, over 7 years. The prevalence of LVH increased in males from 3.6% to 11.9% and in females from 1.6% to 4% over 7 years. The prevalence of LVD dysfunction increased in males from 7.8% to 16.6% and in females from 10.3% to 15.4%. In the fully adjusted model, a 1-mmol/L increase in HDL-c was not significantly associated with higher odds of LVH progression (odds ratio, 1.14; [95% CI, 0.97 – 1.33]), high RWT (0.99; [0.84 – 1.16]), LVD dysfunction (1.02 [0.86 – 1.20]), and high LVFP (1.08; [0.97 – 1.21]) over 7 years. Among males, a 1-mmol/L increase in HDL-c was associated with 1.15g/m2.7 [0.45 – 1.85], p=0.001) increase in LVMI and 0.008 cm [0.002 – 0.013], p=0.006) increase in RWT but not in females, after full adjustments. In both males and females, increased HDL-c was not significantly associated with changes in cardiac function.

Conclusion

Increased HDL-c had no association with cardiac structural and functional damage during growth from adolescence through young adulthood but was paradoxically associated with progressive LV structural remodelling in males.