bluuebunny/crossref_metadata_2025 huggingface dataset:
The Revival of Animism in the 21st Century
Authors: von Stuckrad Kocku
Published: May 2023

The academic concept of “animism” has a long and complicated history. Born from a colonial setting around 1900, it was used to identify premodern or “primitive” understandings of certain nonhuman entities or objects as being alive, ensouled, and agentic. Because of its European depiction as a “failed ontology,” and the heavy colonial baggage this depiction entails, the concept was criticized and went almost out of use in mainstream anthropology and the academic study of religion. Around the turn of the 21st century, however, a different interpretation of animism was (re)introduced, which focused on animism as a relational approach to the world rather than as ontological claims about nonhuman entities. Many scholars in the emerging field of “new animism” base their considerations on spiritual practices in Europe and North America that use the concept of animism in a positive way. This is true for many forms of paganism, nature-based spiritualities, and environmental activism. In a parallel, and in fact intertwined, movement, academic theories have been developed across disciplines and intellectual traditions that conceptualize relationality, nonhuman agency, and entanglements of life forms in a way that strives to overcome influential binaries such as subject–object, nature–culture, mind–matter, or human–nonhuman. These theories, in turn, materialize in literature and art, and they influence political and spiritual practice in many ways. In what can be called animism’s double-bind, new animism is a mode of critique of exactly those binary constructions that originate in European hegemonic thinking. While the idea of animism, due to its colonial legacy, should no longer be applied as a generic concept to a particular “type” of religion, its revival in Euro-American discourse at the turn of the 21st century can, ironically, be interpreted as a subversive attempt to decolonize the hegemonic tradition that constructed European (white, male) humans as detached from the rest of planetary life and as the pinnacle of evolution and creation.
Ellipsis in the Romance Languages
Authors: Brucart José M. , Gallego Ángel J. , Fernández-Sánchez Javier
Published: May 2023

Linguistic expressions are complex objects that consist of sound and meaning. However, it is well known that certain linguistic expressions that convey meaning may lack sound, given the appropriate context. Consider the string John a book: Without a previous context, the sequence cannot be interpreted as propositional; however, when such string constitutes the second conjunct in a coordination structure as in Mary read a paper and John a book, it then receives full propositional content. More specifically, the second conjunct is unequivocally interpreted as John read a book, not as John wrote a book or John will read a book, for example.

These phenomena, which involve meaning without sound, fall within the domain of ellipsis. Ellipsis is pervasive across languages, although its existence poses an obvious challenge to the dual nature of linguistic expressions as pairs of sound and meaning (note that, in a sense, ellipsis phenomena are the flipside of expletive elements like the pronoun it in it snows, which involve sound without meaning). Precisely because of its theoretical relevance, it has always occupied a privileged position in the linguistic literature. Although English has played a crucial role in the inquiry on ellipsis, more languages, including Romance languages, have been increasingly considered to strengthen the empirical validity of the various theories available. The goal of this article is twofold: first, to show how Romance languages can contribute to our theoretical understanding of ellipsis and, second, to discuss the various issues regarding parametric variation within Romance in the domain of nominal, verbal, and clausal ellipsis.
Invited Commentary: The Winding Road to Identifying the Annual Rate of Tuberculosis Infection
Authors: Horsburgh, Jr. C Robert
Published: May 2023

Many persons with immunological tests indicating Mycobacterium tuberculosis infection, such as tuberculin skin tests or interferon-γ release assays, are at risk of progression to tuberculosis disease. Persons whose tests revert to negative may no longer be at such risk. Therefore, identifying the rate of test reversion, potentially indicating cure of M. tuberculosis infection, is an important area of investigation. In their accompanying article (Am J Epidemiol. 2023;192(12):1937–1943), Schwalb et al. extract data on test reversion from prechemotherapy literature and construct a model to predict the rate of reversion, and thus the likely cure of infection. Unfortunately, the incompleteness of the historical data and the use of imprecise definitions of test positivity and reversion lead to substantial misclassification and limit the usefulness of the model. Better definitions and improved tests will be needed in order to develop a clear picture of this aspect of the natural history of tuberculosis.
‘I Laid Earl and Clementine on a Chair and Whipped Them’: Child Murder and Criminal Justice in the Jim Crow South
Authors: Adler Jeffrey S
Published: May 2023

This article explores a horrific 1945 child murder in New Orleans and argues that the case revealed broader developments in Southern criminal justice in the age of Jim Crow. Ernestine Bonneval tied her young children to an ironing board and lashed them, killing her 7-year-old daughter. The murder generated outrage, with residents demanding severe punishment, even the gallows, for the brutal crime. After a jury returned a guilty verdict, the judge sentenced the killer to one year in the state penitentiary. New Orleanians initially expressed fury at the lenient punishment but quickly conveyed sympathy for the murdering mother and perceived her as the victim of a failed legal system. The shift reflected four wider changes in white sensibilities about the role of the state. First, New Deal programs establishing a safety net during the Great Depression transformed white attitudes toward government authority. Second, Clementine Bonneval’s death became tethered to a national panic over juvenile delinquency, even though the victim was only 7. Third, gender ideals influenced perceptions of women who engaged in criminal violence. Fourth, and most important, Southern whites increasingly encoded violence as an African American behavior. As a consequence, white killers became hapless victims of circumstances beyond their control. The Bonneval murder was reinterpreted within a racialized construction of crime and criminal culpability that produced more aggressive policing and more draconian punishment for African American suspects and fewer arrests, indictments, convictions, and long prison sentences for white killers. Jim Crow, in short, shaped the modernization of Southern criminal justice.
Mutate and observe: utilizing deep neural networks to investigate the impact of mutations on translation initiation
Authors: Ozbulak Utku , Lee Hyun Jung , Zuallaert Jasper , De Neve Wesley , Depuydt Stephen , Vankerschaver Joris
Published: May 2023

Motivation

The primary regulatory step for protein synthesis is translation initiation, which makes it one of the fundamental steps in the central dogma of molecular biology. In recent years, a number of approaches relying on deep neural networks (DNNs) have demonstrated superb results for predicting translation initiation sites. These state-of-the art results indicate that DNNs are indeed capable of learning complex features that are relevant to the process of translation. Unfortunately, most of those research efforts that employ DNNs only provide shallow insights into the decision-making processes of the trained models and lack highly sought-after novel biologically relevant observations.

Results

By improving upon the state-of-the-art DNNs and large-scale human genomic datasets in the area of translation initiation, we propose an innovative computational methodology to get neural networks to explain what was learned from data. Our methodology, which relies on in silico point mutations, reveals that DNNs trained for translation initiation site detection correctly identify well-established biological signals relevant to translation, including (i) the importance of the Kozak sequence, (ii) the damaging consequences of ATG mutations in the 5′-untranslated region, (iii) the detrimental effect of premature stop codons in the coding region, and (iv) the relative insignificance of cytosine mutations for translation. Furthermore, we delve deeper into the Beta-globin gene and investigate various mutations that lead to the Beta thalassemia disorder. Finally, we conclude our work by laying out a number of novel observations regarding mutations and translation initiation.

Availability and implementation

For data, models, and code, visit github.com/utkuozbulak/mutate-and-observe.
The human person, the human social individual and community interactions
Authors: Lawson Tony
Published: May 2023

An account of the nature of human community organising structures has been systemised as social positioning theory. Here I explore the sorts of human entities that are able successfully to draw on and make use of community structures of the form portrayed in the theory, focussing especially on the sorts of human community interactions that are facilitated.
Transcatheter aortic valve implantation improves endothelial and autonomic function
Authors: Vitez L , Starc V , Jug B , Bunc M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Degenerative aortic stenosis is the leading native valve pathology in developed countries. Its degeneration process is affected by aging, common cardiovascular risk factors and an atherosclerotic-like process preceded by endothelial and autonomic dysfunction. With the increasing integration of transcatheter aortic valve implantation (TAVI) in the treatment of aortic stenosis in the elderly, research is being intensively oriented into its beneficial effect on the cardiovascular system. Measurements of vascular function with flow mediated dilatation (FMD) and autonomic cardiac function using heart rate variability parameters represent a validated method for treatment evaluation at different time-points.

Purpose

The purpose of our study was to assess whether haemodynamic and structural changes after TAVI will have a positive impact on endothelial and autonomic cardiac function on early and late follow-up.

Methods

50 patients with severe aortic stenosis destinated to TAVI were prospectively included. Data was collected at baseline (24 hours before the procedure), on early follow-up (48 hours after the procedure) and on late follow-up (6 months after the procedure). While different heart rate variability parameters were obtained using a high-resolution electrocardiogram, FMD was assessed using a standardized ultrasound-based process with induced forearm hyperaemia.

Results

43 patients completed the study (mean age 81 (75-85); 60% women). FMD measurements significantly changed from baseline to early follow-up (2.8 ± 1.5 % to 4.7 ± 2.7 %, p < 0.001). Improvement was persistent on late follow up (4.8 ± 2.7 %, p = 0.936). Moreover, heart rate variability parameters remained unchanged on early follow-up and improved 6 months after. Late follow-up statistical significance was reached by HF, a frequency-domain parameter (5231 ± 1783 to 6507 ± 1789 ms2; p = 0.029) and two Poincare diagram parameters: RR ecc (682 to 906 ms2; p < 0.001) and SDRR (9.6 to 23.9 ms; p = 0.001). Significant predictors of FMD change were as following: baseline maximal aortic valve velocity (R = 0.415; p = 0.011), mean aortic gradient (R = 0.373; p = 0.018), indexed stroke volume (R = 0.503; p = 0.006) and NT-proBNP (R = 0.491; p = 0.001).

Conclusions

Both endothelial and autonomic function improved after TAVI. While FMD seems to change early due to acute haemodynamic changes attributed to aortic valve stenosis resolution, autonomic cardiac functions remain stable and ameliorate late after procedure, likely reflecting left ventricular reverse remodelling.
Insomnia in patients with myocardial infarction with and without obstructive coronary arteries: prevalence and prognosis
Authors: Izquierdo Coronel B , Lopez Pais J , Martin Munoz M , Nieto Ibanez D , Olsen Rodriguez R , Abad Romero R , Perela Alvarez C , Alvarez Bello M , Galan Gil D , Espinosa Pascual M J , Ceballo Silva J F , Fraile Sanz A , Mata Caballero R , Awamleh Garcia P , Alonso Martin J J
Published: May 2023

Funding Acknowledgements

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

Introduction

Although some studies suggest a relationship between insomnia and cardiovascular disease, the initial approach of patients with myocardial infarction does not usually include the evaluation of sleep disorders as a contributing factor to cardiovascular disease.

This study aims to compare the prevalence of insomnia between patients with obstructive coronary artery disease (MICAD) and those without significant coronary obstruction (MINOCA) and its impact on prognosis.

Methods

During a five-year period (July 2017-July 2022), all consecutive patients with myocardial infarction and coronarography were included. This study was conducted in a university hospital which covers a population of 220,000 people.

Insomnia severity index (ISI) questionnaire was completed by each patient during admission. Follow-up analysis included major adverse cardiovascular events (MACE: cardiovascular readmission, myocardial reinfarction, stroke, and death from any cause).

Results

Among 533 patients, 56 had MINOCA, and 477 had MICAD. There were no significant differences in the prevalence of insomnia between both groups: insomnia median value (M) in MINOCA: M=7 (3-11) vs MICAD M=7 (3-12), p=0.95. Analysing it by sex, the score remained similar: MINOCA women M=9 (3.5-11.5) vs MICAD M=8.5 (3.2-15), p=0.6. MINOCA men M=5.5 (3-9.7) vs MICAD M=7 (3-11), p=0.77. (Figure 1)-

At the three-year follow-up, there was a relationship between the insomnia levels and survival (IC [1.1-6.6], p=0.03). When ISI score was over 7 points (subclinical insomnia, moderate insomnia, or severe insomnia) there was a relationship with more mortality: number of events under the median value =7; number of events over the median value =16; (IC [1.1-6.6], p=0.03); whereas MACE remained similar (IC [0.6-1.5], p=0.89).

Conclusions

In this study, the prevalence of insomnia was similar between MINOCA and MICAD patients. A higher score in the ISI questionnaire was related to a worse prognosis at the three-year follow-up.
Effect of a home-based inspiratory muscle training program on functional capacity in post-discharged patients with long COVID: The InsCOVID trial
Authors: Albiach C , Dominguez E , Lopez L , Sastre C , Minguez S , Nunez J , Palau Sampio P
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Sociedad Española de Cardiología.

Background

Fatigue and exercise intolerance are the most common symptoms in patients with long COVID.

Purpose

This study aimed to evaluate whether a home-based inspiratory muscle training (IMT) program improves maximal functional capacity in patients long COVID after a previous admission due to SARS-CoV-2 pneumonia.

Methods

This study was a single-centre, blinded assessor, randomised controlled trial. Twenty-six patients with long COVID and a previous admission due to SARS-CoV-2 pneumonia were randomly assigned to receive either a 12-week program of IMT or usual care alone. The physiotherapist and participants were not blinded. Patients allocated to the IMT arm were instructed to train at home twice daily using a threshold inspiratory muscle trainer and to maintain diaphragmatic breathing during the training session. The usual care arm received no intervention.

The primary endpoint was changes in peak oxygen consumption (peakVO2). Secondary endpoints were changes in quality of life (QoL), ventilatory efficiency and chronotropic response during exercise (evaluated by chronotropic index-CIx- formula). We used linear mixed regression analysis for evaluating changes in primary and secondary endpoints.

Results

The median (interquartile range) age of the sample and time to first visit after discharge were 52 (42-59) years and 405 (301-435) days, respectively. A total of 11 (42.3%) were female. At baseline, the median of peakVO2, ventilatory efficiency and CIx were 17.4 (15.6-21.1) mL/kg/min, 29 (24.5-33.3), and 0.64 (0.54-0.87), respectively. The IMT arm improved their peakVO2 significantly compared to usual care (+Δ 4.46 mL/kg/min, 95% CI 3.10 to 5.81; p<0.001). Similar positive findings were found when evaluating changes for CIx and some QoL dimensions. We did not find significant changes in ventilatory efficiency.

Conclusion

In long COVID patients with a previous admission due to SARS-CoV-2 pneumonia, IMT was associated with marked improvement in exercise capacity and QoL.
The incorporation of repeated measurements of risk factors at current and previous visits improves the accuracy of cardiovascular risk assessment: an analysis of the EXSCEL trial
Authors: Oulhaj A , Aziz F , Suliman A , Iqbal N , Coleman R L , Holman R R , Sourij H
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Risk prediction tools play an important role in cardiovascular risk stratification. One major limitation of most of these tools is their use of only single values of each risk factor, measured usually at a particular clinical visit, ignoring measurements made at previous visits.

Purpose

The aim of this study is to demonstrate the gain in predictive performance when CVD risk prediction tools incorporate repeated, rather than only single, measurements of risk factors.

Methods

We used data from the Exenatide Study of Cardiovascular Event Lowering (EXSCEL) randomized controlled trial to compare the quality of predictions of future major adverse cardiovascular events (MACE) in the Cox proportional hazards model that uses single values of risk factors, compared to the Bayesian joint model that uses repeated measures of risk factors. The risk of MACE was calculated in patients with type 2 diabetes with and without established CVD. We assessed the predictive ability of the following cardiovascular risk factors: glycated haemoglobin (HbA1c), high-density lipoprotein cholesterol (HDL-C), non-HDL-C, triglycerides, estimated glomerular filtration rate, low-density lipoprotein cholesterol (LDL-C), total cholesterol, and systolic blood pressure (SBP) using the time-dependent area under the receiver operating characteristic curve (aROC) for discrimination and the time-dependent Brier score for calibration.

Results

In participants without history of CVD, the aROC of systolic blood pressure increased from 0.62 to 0.69 when repeated, rather than only single, measurements of SBP were incorporated into the predictive model. Similarly, the aROC increased from 0.67 to 0.80 when repeated, rather than only single, measurements of both SBP and LDL-C were incorporated into the predictive model. For all other investigated cardiovascular risk factors, the measures of discrimination and calibration both improved when using the joint model as compared to the Cox proportional hazards model. The improvement was evident in participants with and without history of CVD but was more pronounced in the latter group.

Conclusion

This analysis demonstrates that the joint modeling approach, considering trajectories of cardiovascular risk factors, provides superior predictive performance of CVD risk stratification compared to standard risk prediction tools, using only a single time point.
Identification of ICD-code misclassifications in cardiac disease using natural language processing
Authors: Falter M , Godderis D , Scherrenberg M , Kizilkilic S E , Xu L , Tukanov E , Neven F , Dendale P
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): FWO - Flanders Research Foundation.

Background/Introduction

The international classification of disease (ICD) codes are used worldwide for classification of hospitalisations. The codes are used for administrative, financial and research purposes. It is known however that errors occur in the coding process.

Purpose

To investigate methods for automatic classification of disease in unstructured medical records using natural language processing (NLP) and to compare these to conventional ICD-10 coding.

Methods

Two datasets were used: the open-source Medical Information Mart for Intensive Care (MIMIC)-III dataset (n=40.000) for algorithm testing and a dataset from a hospital in Belgium (n = 8041). In the Belgian dataset automated pseudonymization was performed prior to further analysis. A training, validation and test set was used in all methods. Automated searches using NLP algorithms were performed for the diagnoses "atrial fibrillation" and "heart failure". The information extraction methods that were used were: rule-based search, logistic regression, term frequency-inverse document frequency (TF-IDF), XGBoost and bio-bidirectional encoder representations from transformers (BioBERT). All algorithms were tested on the MIMIC-III dataset. Precision (or positive predictive value), recall (or sensitivity) and accuracy were calculated for each model. The best performing algorithm was then deployed on the Belgian dataset.

Results and discussion

Results for the different NLP models are depicted in Table 1. Non-compatible results in NLP versus ICD-coding often indicated errors in ICD-coding. NLP algorithms could thus be used to improve the ICD-coding process in hospitals.

Conclusion

A high accuracy can be achieved when using NLP algorithms for diagnostic classification of patient records. Also, NLP algorithms can be used to identify ICD-coding errors and optimise the ICD-coding process.
ST-segment elevation is associated with a higher risk of cardiac arrest in patients with acute coronary syndromes
Authors: Paralta De Figueiredo M , Carias M , Picarra B , Rocha De Almeida A , Claudio F , Rocha R , Trinca M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiac arrest is a feared complication of cardiovascular disease, even in inpatient context, and requires swift and precise management to avoid increasing morbimortality. Identifying which patients are at greater risk could potentially improve outcomes.

Purpose

We aim to identify if ST-segment elevation is related with a higher incidence of intra-hospital cardiac arrest.

Methods

We analysed a population of 940 patients (C) admitted with ACS and divided them into two groups: those who had a myocardial infarction (MI) with ST-segment elevation on ECG (C1), and those who had no ST-segment elevation (C2), which included those with MI with no ST-segment elevation, undetermined location MI and unstable angina. We then compared the incidence of cardiac arrest between both groups. Age, sex, personal history of smoking, hypertension, dyslipidaemia, diabetes mellitus, and previous stroke/TIA and myocardial infarction were also documented.

Results

C1 was comprised of 379 patients (40,3% of the population). When comparing age, sex and prevalence of hypertension, dyslipidaemia, diabetes, and previous stroke/TIA or myocardial infarction between the groups, there were no relevant differences and no impact regarding risk of cardiac arrest was documented. Nonetheless, C1 had a significantly higher incidence of intra-hospital cardiac arrest (6,1% vs 0,5%, p=0,0001; odds ratio: 12,017, 95% CI [3,582;40,316]) than C2.

Conclusions

Patients with ST-segment elevation on admission have a 12-time higher risk of intra-hospital cardiac arrest than other ACS and thus may require more careful and regular monitoring.
Identifying predictors of coronary stent restenosis
Authors: Carias M , Paralta De Figueiredo M , Picarra B , Rocha De Almeida A , Claudio F , Rocha R , Trinca M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Despite advancements in stent technology, such as the appearance of the drug-eluting stents, stent restenosis remains a common post-procedure complication and is associated with a higher morbimortality. These patients frequently need repeat revascularisation and pose a therapeutic challenge.

Purpose

This study aims to characterise if it is possible to identify clinical predictors of stent restenosis.

Methods

We retrospectively observed a population of 9815 patients (D) admitted with acute coronary syndrome (ACS) and divided them into two groups: those who had stent restenosis (D1), and those who did not (D2). We then compared both groups regarding age, sex, personal history of smoking (both current or former smokers), hypertension, dyslipidaemia, diabetes mellitus, stroke/TIA, chronic kidney disease and stent location.

Results

D1 consisted of 2,9% of the population. Both groups had similar age (D1: 67,95±10,35 years vs. D2: 68,56±11,57years) and were predominantly of the male sex (75,9% vs. 73,3%). D1 had a significantly higher prevalence of diabetes (3,1% vs 2,7%, p=0,008; odds ratio: 1,183, 95% CI [1,044;1,340]); dyslipidaemia (72,4% vs 59,0%, p<0,001; odds ratio: 1,821, 95% CI [1,586;2,092]); hypertension (86,4% vs 80,8%, p<0,001; odds ratio: 1,507, 95% CI [1,259;1,805]); smoking (38,1% vs 33,6%, p=0,003; odds ratio: 1,215, 95% CI [1,069;1,381]); and chronic kidney disease (12,1% vs 10,0%, p=0,003; odds ratio 1,235, 95% CI [1,020;1,495]) than D2. When comparing stent location, restenosis was more frequently observed in the right coronary artery (4,5% vs 2,3%, p<0,001; odds ratio 2,016, 95% CI [1,775;2,289]), with no significant differences in relation to other segments. There were no statistically relevant differences regarding stroke/TIA between the groups.

Conclusions

In patients with ACS, stent restenosis seems to be associated with a significantly higher prevalence of diabetes, hypertension, dyslipidaemia, history of smoking and chronic kidney disease. Right coronary artery stenting also seems to be associated with a higher rate if restenosis when compared to other revascularised segments. These characteristics could help predict which patients are at a higher risk and need closer monitoring, potentially improving outcomes. Further developing a score with these predictors could be of interest.
Adherence to free and single-pill combination of rosuvastatin/ezetimibe: findings from a real-world analysis in italy
Authors: Zambon A , Liberopoulos E , Dovizio M , Veronesi C , Degli Esposti L , Perez De Isla L
Published: May 2023

Funding Acknowledgements

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

Background/Introduction

Several studies have shown that simplifying cardiovascular drug treatment by alleviating pill burden leads to better treatment adherence.

Purpose

This real-world analysis aimed to evaluate characteristics and change in adherence in patients treated with rosuvastatin and ezetimibe (ROS/EZE) as free combination who switched to ROS/EZE as single-pill combination, in Italy.

Methods

A retrospective analysis was performed using administrative databases covering approximately 7 million health-assisted Italian subjects. Adults prescribed with ROS/EZE as a single-pill from January 2010 up to June 2021, were selected. The index date corresponded to the first prescription date of ROS/EZE as single-pill combination; all patients with at least 1 year of data availability before and after the index date were selected. Among selected patients, users of ROS/EZE as a free combination during 1 year before the index date were included in this analysis (patients switching from free to single-pill combination). Baseline demographic and clinical characteristics of these patients were evaluated during the year before index date. Adherence to free or single-pill combination was evaluated as the proportion of days covered (PDC), during 12 months before and after index date (PDC<25% non-adherence; PDC=25-75% partial adherence; PDC>75% adherence).

Results

A total of 1,219 patients (61.1% male, mean age 66.2 ±10.4 years) met the inclusion criteria. Among them, 83.3% had cardiovascular (CV)-related comorbidities, 26.4% of patients had diabetes mellitus and 16.2% of patients presented a combination of CV disease and diabetes mellitus. A significantly higher percentage of patients were adherent to single-pill compared to free combination (75.2% vs 51.8%, p<0.001). Moreover, the proportion of partially adherent patients (16.4% vs 37.4%, p<0.001) and non-adherent patients (8.4% and 10.7%, p<0.05) was significantly lower with the single-pill combination compared to free combination.

Conclusions

This analysis provides real-world evidence on adherence of patients to ROS/EZE in free or in single-pill combination, suggesting that switching from multiple to single-pill combination could positively impact the level of adherence to lipid-lowering medications.
Impact of chronic obstructive pulmonary disease in patients with myocardial infarction
Authors: Paralta De Figueiredo M , Carias M , Picarra B , Rocha De Almeida A , Claudio F , Rocha R , Trinca M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Chronic obstructive pulmonary disease (CPOD) is a common comorbidity in patients admitted with myocardial infarction (MI) and needs to be considered since it can condition therapeutic approach and potentially negatively impact their prognosis.

Purpose

We aim to evaluate the impact of CPOD in therapeutic approach, clinical course and in-hospital mortality in patients admitted with MI.

Methods

We retrospectively analysed a population of 2797 patients admitted with MI (C). We divided them into two distinct groups: those with an established diagnosis of CPOD (C1) and those without it (C2). Age, sex, personal history, in-hospital therapeutic, left ventricular ejection fraction (LVEF), electrocardiographical presentation and angioplasty were documented. We defined the following as complications: heart failure (HF), need for invasive and non-invasive mechanical ventilation, reinfarction, newly onset atrial fibrillation, high-grade atrioventricular block and need for temporary cardiac pacing. Mortality, incidence of complications and a combined outcome of both mortality and any of the previous complications were compared between groups. We applied a multivariate analysis to adjust the effect of CPOD to the presence of other potential predictors.

Results

C1 consisted of 6,3% of the population (N=173). These patients were older (69,8±10,6 vs 65,5±13,5 years; p<0,001), had a higher prevalence of hypertension (76,3% vs 68,7%; p=0,036) and chronic kidney disease (13,7% vs 5,6%; p<0,001). They presented less frequently with ST-segment elevation MI (38,3 % vs 47,4%; p=0,019), but more often with depressed LVEF (57,9% vs 47,2%, p=0,008). They received less beta-blockers (63,4% vs 80,2%; p<0,001) and had fewer rates of drug-eluting stents application (63,4% vs 80,2%; p<0,001); on the other hand, they were more frequently medicated with calcium-channel blockers (16,7% vs 8,1%; p<0,001) and diuretics (50,0% vs 31,6%; p<0,001) and more bare-metal stents were utilised (52,8% vs 37,4%; p=0,002). The diagnosis of CPOD was not associated with higher mortality in patients with MI, however C1 presented with an increased incidence of complications (33,1% vs 26,0%; OR =1,413 [1,019-1,959]; p=0,037) and of the combined outcome (34,3% vs 26,5%; OR=1,447 [1,046-2,000]; p=0,02). Though multivariate analysis, CPOD tends to be an independent predictor of mortality and/or development of complications, although it narrowly misses to achieve statistical significance (p=0,056); only age, medication with beta-blockers and depressed LVEF were statistically independent predictors.

Conclusions

The comorbid diagnosis of CPOD conditions the choice of medication in patients with MI and tends to be an independent predictor of mortality and/or development of in-hospital complications.
Cardiac rehabilitation participation and risk of falls in older individuals with cardiovascular disease
Authors: Chacin-Suarez A , Zhang L , Medina Inojosa J R , Taylor J L , Fischer K , Manemann S M , Gomes P F , Bonikowske A R , Smith J R , Squires R W , Brenes Salazar J A , Terzic C M , Thomas R J
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Falls are the leading cause of injury-related morbidity and mortality among older adults in the United States, including those with cardiovascular disease. Cardiac rehabilitation (CR) helps to optimize functional capacity, strength, and balance in patients with cardiovascular disease and, in theory, may reduce the risk of falls. However, little evidence has been published in this regard.

Purpose

The purpose of this study was to assess the association between CR participation and risk of falls in a community-based sample of individuals 65 years of age and older with cardiovascular disease who were eligible for CR participation.

Methods

Individuals from Southeastern MN and Western WI, USA, 65 years of age and older who had experienced a cardiovascular event that qualified them for CR (MI, PCI, CABG, Valve Surgery, Transplant) between January 1, 2000, and December 31, 2018, were included in this study. Participation in CR (≥1 sessions, CR-group) and subsequent falls (moderate or severe, using the Campbell classification system) were ascertained using the Rochester Epidemiology Project records-linkage system. Logistic model to create propensity weighting were used to test the association between CR participation and falls after adjustment for potentially confounding factors.

Results

A total of 5004 individuals met inclusion criteria for the study, with 2183 (44%) included in the CR group and 2821 (56%) in the non-CR group (CR was indicated, but the individual did not participate). Overall, 1122 patients experienced a fall within the first 5 years (16% of those in the CR-group, 23% of those in the non-CR group). After adjustment, CR participation was not associated with falls, but older individuals, females, and those with a history of falls were more likely to have had a fall, compared to young individuals, males, and those without a history of a fall.

Conclusions

While CR is beneficial for patients with cardiovascular disease, our study did not find evidence of an association between CR participation and fall risk in individuals 65 years of age and older who have cardiovascular disease. Additional research is needed to evaluate the role of CR components that may potentially reduce modifiable risk factors for falls and thereby reduce the risk of falls.
Trends in diabetes mellitus among hospital hospitalizations in Switzerland
Authors: Marques-Vidal P , Abu Obaid H
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

In Switzerland, the prevalence of diabetes mellitus (DM) has increased in the general population, but little is known regarding DM-related hospitalizations and their impact on mortality and health costs.

Objective

To assess 1) the evolution of hospitalizations for DM as first diagnosis and as comorbidity; 2) the association of DM with ICU admission, length of stay (LOS), in-hospital mortality and costs.

Methods

Swiss hospital discharge data for period 2012-2020. Type 1 (T1DM), type 2 (T2DM) and other types (OTDM) of DM were considered. Costs were estimated using Swiss diagnosis related groups.

Results

Between 2012 and 2020, the number of hospitalizations (% total) increased from 4204 (0.27) to 4980 (0.45) for T2DM, 539 (0.05) to 854 (0.08) for T1DM and 221 (0.02) to 381 (0.03) or OTDM. Hospitalizations with DM as comorbidity increased from 89,752 (8.6) to 128,700 (11.7) for T2DM, 2934 (0.29) to 3536 (0.32) or T1DM and 5774 (0.58) to 9143 (0.83) for OTDM. Compared to non-DM hospitalizations, hospitalizations for T1DM had a higher likelihood of ICU admission: odds ratio and 95% CI: 3.49 (3.30-3.71), while T2DM had higher LOS: 6.0±1.0 vs. 5.1±1.0 days, and all DM types had a lower odd of in-hospital mortality. Patients with any type of DM as comorbidity had a longer LOS than patients without. Total cost of DM rose from CHF 42 million in 2012 to almost 100 million in 2019 and decreased afterwards.

Conclusion

DM represents an increasing health and economic burden in Switzerland.
Impact of lipid lowering therapies after an acute coronary syndrome, applied through telematic consultation, in a cohort of elderly patients
Authors: Jimenez Mendez C , Perez Asensio A , Mialdea Salmeron D , Puche Garcia J E , Silva E , Delgado Nava W , Bartolome D , Alarcon De La Lastra I , Lubian Esplugues J , Benjumea Rodriguez J , Heras Jimenez L , Grez Gutierrez T , Tey Aguilera M J , Gheorghe L , Vazquez Garcia R
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

After Covid-19 pandemic, telematic cardiology consultations are a reality in most developed countries. However, the impact and safety of telemedicine in the elderly population needs to be clarified. Elderly patients may need help to understand and use telemedicine effectively, being thus its benefits differential.

Objetives: To assess the impact of lipid lowering therapies, after an acute coronary syndrome (ACS), applied through telematic consultation, in a cohort of elderly patients (≥70 years).

Methods

We performed a prospective cohort study that consecutively recruited all patients admitted to our centre with an ACS from January 1, 2020 to December 31, 2020. All patients were discharged with high-intensity statins and other currently recommended cardiovascular drugs. Lipid profile was evaluated one month after discharge. Patients were then contacted by phone, treatment was confirmed, and their lipid- lowering therapy was adjusted according to the results of the blood test. This procedure was repeated every month until LDL-c target (≤ 55 mg/dl) was achieved in accordance with current European clinical practice guidelines.

Results

346 patients, 32% women, were included. Mean age was 67.3 ± 12.4 years, being 48% ≥ 70 years. Mean follow-up was 17.3 months. Patient’s main characteristics are summarized in Table 1. Comparing both subgroups, patients ≥ 70 years more frequently were women, and had past history of hypertension, diabetes, heart failure and myocardial infarction. There were no differences in clinical presentation at admission (predominantly non-ST elevation myocardial infarction). Patients ≥70 years reached the goal of LDL ≤55 mg/dl in a similar proportion to the younger subgroup (80.1% vs 82.8% p 0.051). There were no statistically significant differences in prescription between groups, with a tendency to a higher prescription of statins and ezetimibe in younger patients (62.8% vs 50.6%, p = 0.05). At follow-up, overall mortality was higher in the subgroup ≥70 years (7.8% vs 1.2%, p 0.026) at the expense of non-cardiovascular mortality (4.8% vs 0.6% p 0.013). There were no differences in cardiovascular mortality, stroke, non-fatal myocardial infarction, or non-urgent angioplasty.

Conclusion

Lipid lowering therapies applied through telematic consultation in a population ≥ 70 years old after an ACS is as effective and safe as in younger patients. There is however a higher mortality in this subgroup, predominantly because of non-cardiovascular causes.
Sudden cardiac arrest and role of sport preparticipation screening in children
Authors: Graziano F , Schiavon M , Cipriani A , Savalla F , De Gaspari M , Bauce B , Rizzo S , Calore C , Thiene G , Paiaro P , Corrado D , Basso C , Zorzi A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Competitive sports activity may increase the risk of life-threatening ventricular arrhythmias and sudden cardiac death (SCD) in athletes with underlying cardiovascular diseases (CVD). Preparticipation screening (PPS) offers the potential to early identify CVD and reduce this risk, but the optimal age of sport PPS start is not known.

Purpose

The aim of this study is to assess the burden of sudden cardiac arrest (SCA) and the diagnostic yield of PPS for CVD at risk of SCA in two different age groups: 8-11 year-old and 12-15 year-old.

Methods

Data on the incidence and causes of SCA from 2011 to 2020 were retrieved from the sudden death registry of our region, hospital records and local press. During the same period, we assessed 25,251 young competitive athletes aged 8-15 years who underwent 58,185 annual PPS (mean 2.3/athlete) including history, physical examination, ECG and exercise testing. Further tests were required in case of abnormalities at first-line screening.

Results

Over 10 years, 21 sudden deaths and 5 resuscitated SCA occurred: 6 in athletes (incidence 0.7/100.000/year) versus 20 in non-athletes (0.7/100.000/year). 67% athletes versus 5% non-athletes who suffered SCA were successfully resuscitated (aborted sudden cardiac death=aSCD), (results according to the age-group in Figure 1). Idiopathic ventricular fibrillation was the most common diagnosis accounting for 14/26 (54%) cases. The incidence of SCA was 0.2/100.000/year in the age group 8-11 year-old versus 1.3/100.000/year in the age group 12-15 year-old. By PPS, 26 (0.1%) athletes received a diagnosis of at-risk CVD, significantly more often in children ≥12 year-old (0.06%/evaluation) than <12 year-old (0.02%/evaluation, p=0.02), (Figure 2). During follow-up, 2 screened athletes suffered SCA due to idiopathic ventricular fibrillation, both ≥12 year-old at the time of PPS.

Conclusions

The incidence of SCA was 6 times higher in the age group 12-15 years compared with the 8-11 years group. Similarly, the diagnostic yield of PPS for at-risk CVD was significantly higher after 12 years of age. This suggests that systematic PPS may not be justified before 12 year-old.
Cardiac rehabilitation in women. Have we improved care in recent years?
Authors: Eliche Mozas P , Rus Mansilla C , Duran Torralba Mª C , Cortez Quiroga G , Cubillas Quero A , Cruz Romero L
Published: May 2023

Funding Acknowledgements

Type of funding sources: None. Main funding source(s): Ninguna.

Introduction

Cardiovascular disease is the main cause of morbidity and mortality worldwide, but there are inequalities in diagnosis and treatment between men and women. Although there is greater awareness of cardiovascular disease in women, diagnostic techniques are less used in women, they receive fewer pharmacological and invasive treatments, and have less access to cardiac rehabilitation.

Objective

To compare the assistance offered to men and women in our Cardiac Rehabilitation Unit up to 2018 with the assistance given from 2019 to 2022.

Methods

Patients treated in the Cardiac Rehabilitation Unit before 2018 (group 1) and from 2019 to 2022 (group 2) were analyzed, comparing the characteristics of male and female patients, as well as the attendance rate to Cardiac Rehabilitation and treatments indicated.

Results

In group 1, we analyzed the data of 399 patients, 19.8% women. In group 2, which included 167 patients, the rate of women rose to 26.3%, this difference being statistically significant (p<0. 05). Women were older than men in both groups (63 vs 59 years in group 1; 64 vs 59 years in group 2), less smokers (26.3% vs 57.3% in group 1; 25% vs 50.4% in group 2). The percentage of hypertensive patients was the same in both sexes in group 2. Until 2018, fewer coronary angiographies were performed on women (94% vs 99%, p<0.05); however, in the second period (group 2, 2019-2022), the percentage was similar in both sexes, (96% vs 98%, p= n.s.). Revascularization is less, possibly due to the characteristics of coronary disease in women (Table 1). Lipid-lowering treatments are used equally in both groups (Table 1).

Conclusion

In recent years, care for cardiovascular disease in women has been improving. The percentage of women who are included in Cardiac Rehabilitation program and who undergo coronary angiography has increased. The raising awareness that this disease has the same severity in both sexes has allowed the optimal medical treatment implemented to be similar.
The relationship between vitamin D and sarkopenia in patients with metabolic syndrome
Authors: Ulker Eksi B , Akinci B , Yigit S , Korkmaz Dayican D , Calikoglu B F , Yeldan Karagoz I , Satman I
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Backround: Vitamin D is essential for the optimal function of many bodily systems and it is associated with various types of metabolic illnesses such as obesity, diabetes mellitus, insulin resistance, and cardiovascular diseases including hypertension. Decreased absorption of vitamin D may pose a risk for sarcopenia by affecting the lipid profile responses in metabolic syndrome (MetS).

Purpose

Our aim is to examine the relationship between vitamin D level and selected sarkopenia parameters such as muscle and fat mass, muscle strength, body composition, and walking speed in patients with MetS.

Method

67 patients (mean age=50.3±7.69/years, F:51, M:16) aged 35-65 years and diagnosed with MetS (according to NCEP-ATP III criteria) were included in the study. Body mass index (BMI), muscle and fat mass of the participants were assessed using bioelectrical impedance analysis (TANITA). Waist and hip circumferences were measured. Right and left quadriceps muscle strength (J-Tech CommanderTM Muscle Tester) and grip strength (Jamar dynamometer) of the dominant hand (all patients were right dominant) were measured with dynamometer. Walking speed was calculated by dividing the distance walked by minutes in the 6-minute walking test.

Results

Of the patients, 9 (13.4%) were categorized as deficiency (<12 ng/mL), 10 (14.9%) had inadequacy (≥12 and <20 ng/mL) and 48 (71.6%) had sufficiency (≥ 20 ng/mL) level of vitamin D. There was a significant correlation between vitamin D level and body fat mass (r=-0.29, p=0.017), BMI (r=-0.29, p=0.014), hip circumference (r=-0.28, p=0.021) and left quadriceps muscle strength (r=-0.288, p=0.018). There was no correlation between vitamin D level, 6 minutes walking speed, body muscle mass, right quadriceps muscle strength and hand grip strength (p>0.05).

Conclusion

In this study, although vitamin D level was associated with left lower extremity muscle strength in patients with MetS, it was not associated with other sarcopenia parameters such as muscle mass, upper extremity muscle strength and walking speed. The relationship between vitamin D level, fat mass and body composition seen in our study may be due to altered lipid metabolism responses. We think that the effects of vitamin D on sarcopenia in MetS should be prospectively examined in a larger sample including elderly patients and considering the vitamin D intake.