bluuebunny/crossref_metadata_2025 huggingface dataset:
Lifetime versus 10-year risk of recurrent events in patients with cardiovascular disease: impact of age
Authors: Van Trier T , Snaterse M , Hageman SHJ , Hoeve N , Sunamura M , Moll Van Charante EP , Galenkamp H , Deckers JW , Visseren FLJ , Scholte Op Reimer WJM , Peters RJG , Jorstad HT
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Most risk models for patients with established atherosclerotic cardiovascular disease (ASCVD) calculate short-term risk of recurrent events and death, typically for a duration of 10 years. However, lifetime risk estimates may better support the healthcare professional in selecting patients for intensified preventive treatment (1). Also, a cross-sectional study suggested that communicating lifetime risk to ASCVD patients enhances risk perception and willingness for therapy (2). In the new ESC prevention guideline, however, 10-year risk estimates remain standard for ASCVD patients but the additional use of lifetime risk is recommended for communication in the shared decision-making process (3).

Purpose

We therefore aimed to compare estimates of 10-year with lifetime risk of recurrent ASCVD events or death, stratified by age.

Methods

We pooled individual-level data on risk factors from six large, recent prospective studies (RESPONSE 1 and 2, OPTICARE, EUROASPIRE IV and V and HELIUS). We included Dutch patients aged ≥45 years with a follow-up of ≥6 months after acute coronary syndrome or revascularisation. The SMART-REACH models were used to estimate the difference between 10-year and lifetime risk of recurrent myocardial infarction, stroke, or cardiovascular death, stratified by age (<55, 55-65, 65-75, ≥75 years).

Results

In 3,230 ASCVD patients (24% women), mean age 61±8 years, at median follow-up 1.1 (IQR 1.0-1.8) years after index event, SMART-REACH 10-year risk was 23±11% versus lifetime 56±11%. (Figure 1) We found a considerable difference between 10-year and lifetime risk in patients aged 45-55 years (18±8% vs. 61±10%). Discrepancies decreased with increasing age, with similar estimates in the highest (75-85) age group. (Figure 2).

Conclusion

Lifetime risk of a limited set of cardiovascular outcomes rather than 10-year risk may provide a more complete estimate of future ASCVD disease burden, as especially in younger patients 10-year risk is usually low, even in the presence of risk factors.
Atrial fibrillation and 13-year risk of CVD mortality in Russian population cohort
Authors: Shapkina M , Ryabikov A , Mazdorova E , Titarenko A , Avdeeva E , Scherbakova L , Pikhart H , Bobak M , Malyutina S
Published: May 2022

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): The study was supported by RFBR #20-313-90015, RAS # АААА-А17-117112850280-2

Introduction

Given the worldwide increase in life expectancy, ageing-related conditions are becoming increasingly important. Atrial fibrillation (AF) is the most common arrhythmia and a serious predictor of the progression of heart failure and thromboembolic events (largely, stroke). Thus, the study of AF impact on cardiovascular (CVD) mortality is of particular relevance.

Objectives

We aimed to analyze the impact of AF on the 13-year risk of CVD mortality in the Russian population sample of elderly age.

Methods

A random population sample (n=9360, age 45-69 years) was examined at baseline in 2003-2005 in the Russian arm of the HAPIEE project. The cohort was re-examined twice and was followed up for end points up to end of 2017 (12.7 years on the average). Fatal end-points were ascertained by local mortality register; the current study focused on CVD deaths. Baseline AF was defined by rest ECG with evaluation by the Minnesota code (MC 8-3-1, 8-3-2; 6-8 with "fibrillation" for atrium). Those with prevalent CVD at baseline and with inadequate ECGs were excluded from analysis; Cox-regression age- and multivariable-adjusted models were estimated.

Results

In total, data on 8565 persons aged 45-69 years at baseline were analyzed. Among those, 145 (1.6%) subjects had AF at baseline and of those 100 subjects had no existing CVD. During the 13-year follow-up, there were 431 cases of CVD death (10.9%) in the cohort, among them 63% (n=272) were fatal coronary heart disease (CHD) and 23% (n=101) were fatal stroke (2.5%). In age-adjusted models, men with baseline AF had increased risk of CVD death (HR=5.76; 95%CI 3.88-8.55), fatal stroke (HR=6.26; 95%CI 2.96-13.22), and fatal CHD (HR=5.86; 95%CI 3.58-9.59). After adjusting for other risk factors, the increased risk remained for all CVD outcomes: 4.49 (95%CI 2.84-7.09) for CVD death, 3.62 (95%CI 1.46-8.96) for fatal stroke, and 4.95 (95%CI 2.81-8.70) for fatal CHD. In women, the age-adjusted HR for CVD death in women with baseline AF was 3.92 (95%CI 1.60-9.62) but in fully-adjusted models the HR was attenuated (HR=2.22; 95%CI 0.87-5.70). The numbers of deaths from CHD and stroke in women were too small for meaningful analyses.

Conclusion

In this urban population-based cohort of subjects free from CVD at baseline, 11% of participants died from CVD death during 13 years follow-up. Men and women with baseline AF had approximately 4-fold increase in CVD mortality risk. The estimated CVD excess mortality risk associated with AF in this Russian cohort is consistent with findings from Western European and North American populations.
Systemic inflammatory indices derived from complete blood count in assessment of future cardiovascular risk in preeclampsia
Authors: Pereira Da Silva Oliveira A , Andreea Rechitean AR , Ana Carolina Santos MSC , Andreia Matos MSC , Ana Portelinha PHD , Maria Jose Areias MD , Manuel Bicho MDPHD , Irene Rebelo PHD , Maria Clara Bicho MDPHD
Published: May 2022

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): FCT, Portugal

Systemic inflammatory parameters derived from complete blood count (CBC) might present a good potential and a cheap method in assessment the risk for the development of cardiovascular related diseases.

The aim of this research is to retrospectively evaluate the interplay of CBC derived indexes with other inflammatory parameters in women with arterial hypertension after a history of preeclampsia.

Clinical and laboratory data were collected and analysed in 170 previously pregnant women (n=170) with a mean age of 35 years (s= 5.477 years) and the average BMI value equal to 26.4 kg/m2 (s= 4.57 kg/m2), and the follow-up period was 10 years after pregnancy.

The majority of women who currently present hypertension (52.9%), were diagnosed previously with preeclampsia (97.8%, p=0.000). Compared to the non preeclamptic population, theese women present differences in BMI (p=0.002), waist circumference (p=0.000), hip circumference (p=0.045, M. Whitney), waist /hip ratio (p=0.001), granulocyte (p=0.037), Granulocyte X platelet/lymphocyte ratio (p=0.034), neutrophil/lymphocyte ratio (p=0.034, M. Whitney), ApoB (p=0.023) and NOX concentration (p= 0.033).

Prior preeclamptic women were associated with a higher risk of developing hypertension. Anthropometric data suggests that BMI, waist circumference, hip/waist ratio and CBC derived inflammatory indeces are parameters that can aid in prognosis of future hypertension in women.
Cardiac telerrehabilitation: a safe and effective alternative in patients with coronary artery disease
Authors: Calvo-Lopez M , Arranz R , Marin J , Gruosso D , Falces-Salvador C , Roque M , Andrea R , Vidal B , Sitges M , Sanz-De La Garza M
Published: May 2022

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): Ferrer Internaciona Groupl, S.A

Background

Center-based cardiac rehabilitation programs (CRP) have shown to reduce morbidity and mortality after an ischemic cardiac event, but their vastly underutilized. Home-based CRP seems to improve patient’s adherence, but there is still scarce evidence, especially in elderly patients and women.

Purpose

To develop a holistic home-based CRP for ischemic heart disease patients and evaluate its safety and impact on functional capacity, adherence to a heart-healthy lifestyle and quality of life.

Methods

The 8-week home-based CRP will include 60 patients (50% women) with no age limit who have suffered an acute myocardial infarction in the previous 3 months, with LVEF ≥40% and a tablet/mobile device. The CRP (Picture 1) includes 3 weekly exercise sessions combining tailored aerobic and strength training and 1 weekly educational session focused on lifestyle habits, therapeutic adherence, and patient empowerment.

Results

Between January and October 2021, 56 patients were included: 2 were rejected for presenting ventricular arrhythmias in the initial stress test and 4 due to technological barrier; 14 patients are currently performing the CRP. The preliminary results from the 36 patients who have completed the CRP show a significant increase in functional capacity, muscle strength, weekly training volume, adherence to Mediterranean diet, emotional state (anxiety) and quality of life (Picture 2). There have been no complications and patient’s adherence has been excellent for both exercise (85%) and educational (80%) sessions.

Conclusion

A holistic telematic CRP dedicated to patients after an ischemic cardiac event, including patients of both gender and of no age-limit, seems to be a feasible, safe and effective in improving maximal aerobic capacity, weekly training volume, muscle strength, quality of life, compliance with the Mediterranean diet and emotional state.
Gender differences in hemostatic potential in coronary artery disease
Authors: Hojker M , Kosuta D , Bozic Mijovski M , Jug B , Novakovic M
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Clinical presentation and contribution of different risk factors in coronary artery disease (CAD) vary between genders. Women are known to be generally older, have more comorbidities and are more likely to present with atypical symptoms. Previous research suggests there are important gender differences in the pathophysiology of CAD. One of the important mechanisms for atherothrombotic events seems to be increased coagulation, for which differences in presentation between genders is not yet fully documented.

Purpose

Our aim was to investigate a possible correlation between gender and coagulation appraised by overall hemostatic, coagulation and fibrinolytic potentials (OHP, OCP and OFP) in patients with CAD.

Methods

Consecutive patients after a recent acute myocardial infarction (within 90 days from inclusion) had fasting blood samples withdrawn. OHP, OCP and OFP were determined using thrombin and recombinant tissue-type plasminogen activator by absorbance measurements at 405 nm in 1-minute intervals for 40 minutes. Areas under the curve were constructed for OCP and OHP with the obtained measurements, OFP was calculated as the difference between the two areas: OFP = [(OHP – OCP) / OCP] x 100 (%). Baseline data and cardiovascular risk factors profiles were collected.

Proportions were compared using χ2 test, means were compared using t-test, medians were compared using Mann-Whitney U test, linear regression models were constructed for the multivariate analysis.

Results

We included 117 patients (mean age 56 ± 10 years), 23 (20%) were women. Arterial hypertension was present in 86 (73.5%), diabetes mellitus in 10 (8.5%), dyslipidemia in 75 (64.1%), family history in 46 (39.3%) patients, 54 (46.2%) were active smokers (within 2 years). There were no significant differences in mean age and risk factors presence between genders. Median OCP and median OHP were significantly higher in women (25.1 (interquartile range [IQR] 5.8) vs 21.8 (IQR 5.7), p=0.035; and 9.5 (IQR 4.3) vs 7.8 (IQR 3.1), p=0.032, respectively) while median OFP were similar.

Female gender retained its significant predictive value after multivariate adjustment for age and traditional risk factors for OCP (R2 0.25; ANOVA for regression p<0.001; Beta 2.96 [0.61-5.31], p=0.014) and OHP (R2 0.24; ANOVA for regression p<0.001; Beta 2.04 [0.76-3.32], p=0.002).

Conclusion

In patients after acute myocardial infarction women seem to have a higher procoagulant state, as determined by OCP and OHP. Our findings suggest different pathophysiology of CAD in women, further research is needed to fully understand and address gender differences in CAD.
Anticoagulation use in the setting of atrial fibrillation in a typical outpatient cardiology population
Authors: Mustafa M , Sanmugathas N , Mcintosh K , Angaran P
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

The risk of cerebrovascular events has been greatly reduced with the guideline recommendation of anticoagulation in the presence of atrial fibrillation (AF). Based on current epidemiological evidence, over ⅓ of patients with known AF who are eligible for anticoagulation, do not receive them. The elderly population are especially susceptible to this disparity. The CHA2DS2-VASC score is currently being used to assess for need for anticoagulation in patients with AF. More recently, the HAS-BLED score has been developed to assess for bleeding risk. Weighing the bleeding risk using HAS-BLED score with stroke risk using CHA2DS2-VASC score, we assessed if a segment of the Canadian population with AF were appropriately anti-coagulated.

Purpose

Assess the concordance of one outpatient cardiology practice with anticoagulation guidelines for atrial fibrillation.

Materials & Methods

Patients were randomly selected from a single centre outpatient Cardiology practice between January and May 2021. The patients were selected by 1 researcher. The patients selected must have been diagnosed with atrial fibrillation by ECG and Holter analysis. The HAS-BLED and CHA2DS2-VASC scores were calculated for each individual.

Results

101 patients were selected for this study. 66 were male and 35 were female with ages ranging from 33 to 91 years old. Patients with a CHA2DS2-VASC score greater than 1, were anti-coagulated with direct oral anticoagulation (DOAC) unless they were in severe renal failure (creatinine clearance <30ml/min) in which case Warfarin was used. In the age group of 65 and under, 12 patients had a CHA2DS2-VASC score greater than 1 and were anti-coagulated. In the age group 65 and over, 72 had a CHA2DS2-VASC score greater than 1. Of the 72 individuals, 71 were appropriately anti-coagulated. In the age group 80 and over, 29 individuals had a CHA2DS2-VASC score greater than 1 and were anti-coagulated. For the individuals on anticoagulants, the HAS-BLED score was less than or equal to the CHA2DS2-VASC score. Only one of the patients in the study with a CHA2DS2-VASC score greater than 1, was not anti-coagulated. There were no reported major bleeding risks in the patients reviewed.

Conclusion

In a sample of the typical Canadian population, based on risk factor assessments using both the CHA2DS2-VASC and HAS-BLED scores, 99% of patients were appropriately anti-coagulated in the presence of AF. This shows a significant increase in appropriate management of AF patients compared to the current national and global averages. There were no major bleeding events reported in any of the patients receiving full anticoagulation. This supports the recommendation that the benefit of anticoagulation in stroke reduction from thromboembolism outweighs the risk of major bleeding events.
Diabetes mellitus in coronary artery disease
Authors: Diakonikolaou S , Styliou T , Christou V , Eid O , Eid R , Karataraki F , Abdelrahman R , Moutiris J
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Morbidity and mortality are increased in patients with myocardial infarction that also have co-existing diabetes mellitus (DM) making it an important risk factor for coronary artery disease (CAD). Overall, diabetes mellitus worsens the prognosis in CAD patients.

Purpose

This paper was done from a study, that enabled us to measure the prevalence of diabetes mellitus in patients with coronary artery disease, in relevance to other CAD risk factors (age, gender, systolic blood pressure, LDL-C and smoking). These results would give us the ability to compare it with the outcomes of the EUROSPIRE IV study published in 2015 (1).

Methods

Retrospective observational study of consecutive patients from the Registry of Cyprus Heart Survey, examined in the Cardiology Clinic of Nicosia General Hospital, between the years 2011-14. The total number of patients was 371 (11.5% females and 88.4% males). These patients had a history of myocardial infarction and underwent either a PCI or a CABG.

Results

From the total amount of patients, 36.9% had history of diabetes mellitus. The percentage adjusted to gender shows that 44% of females and 35.6% of males included in the study had diabetes. The mean age of people that had diabetes and coronary artery disease was 68.65 (CI: 67.18, 70.12). The prevalence of diabetics with hypertension and coronary artery disease was 75.91% while the average systolic blood pressure (SBP) was 138 mmHg (CI: 135.33, 140.67). The systolic blood pressure was ≥140 mmHg in half of the diabetic individuals. Smoking was also assessed as a risk factor in patients with diabetes and CAD. The prevalence of ex-smokers was 28.46%, of smokers 18.24% and of non-smokers 53.28%. Finally, values of low density lipoprotein cholesterol (LDL-C) were measured in 90.5% of diabetic patients, 88.7% of them had an LDL-C ≥1.8 mmol/L (≥70mg/dL) and 53.22% had an LDL-C ≥2.5 mmol/L (≥100mg/dL). The average LDL-C value was 109.19 mg/dL.

Conclusions

The outcome of the study revealed that a substantial number of patients with CAD suffer from diabetes. Therefore, diabetes was verified as a major risk factor in patients with CAD and the development of acute coronary syndrome. Regarding those patients, other risk factors proved to have a negative impact on their cardiovascular health. Moreover, the risk factors in patients with DM and CAD of this study were compared with the well known study, EUROASPIRE IV (1). The prevalence of diabetes in the present study was 36.9%, compared to 26.8% in EUROASPIRE IV, indicating a higher prevalence in our study. We concluded that marked reduction in the events of myocardial infarction can be seen if we reduce the prevalence of uncontrolled diabetes mellitus occurrences with medication or better control of the risk factors of CAD early in the diagnosis to reduce complications.
Role of serum n-6 polyunsaturated fatty acids in the development of acute coronary syndromes
Authors: Inoue N , Morikawa S
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background and Aims

n-3 polyunsaturated fatty acids (PUFAs) have an inhibitory effect against the development of coronary artery disease (CAD). However, whether n-6 PUFAs, dihomo-gamma-linolenic acid (DGLA), and arachidonic acid (AA) play a role in the development of CAD remains unclear. This study investigated the association between PUFAs and the risk of developing acute coronary syndrome (ACS) using the lipid and PUFAs data of patients who received percutaneous coronary intervention (PCI) for either non-emergent conditions (staged group) or ACS (ACS group).

Methods

We retrospectively evaluated 433 patients who underwent PCI between 2014 and 2021. The patients were divided into the ACS group (n = 18) and the staged group (n = 132). The lipid and PUFAs values of each patient between the two groups were compared. Moreover, to investigate the correlation between n-6 PUFAs levels and ACS, the effects of confounding factors such as use of strong statins and low-density cholesterol (LDL-C) levels were adjusted.

Results

The ACS group had higher n-6 PUFAs levels than the staged group (DGLA: 36.8 ug/mL vs. 29.6 ug/mL; AA: 203.3 ug/mL vs. 145.8 ug/mL). Furthermore, the analysis of covariance adjusted for LDL-C levels showed a significant difference between the two groups in terms of DGLA and AA levels.

Conclusions

The n-3 PUFAs levels did not significantly differ between the staged and ACS groups. Moreover, the ACS group had higher DGLA and AA levels and lower n-3 PUFAs/AA ratios than the staged group. Therefore, excess n-6 PUFAs may be a risk factor for ACS.
Familial hypercholesterolemia in community-based KHDC Nepal program-baseline data
Authors: Sharma S K , Adhikari S , Shah N , Aebischer Perone S , Lab B , Heller O , Chappuis F
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): HUG and Republic and Canton of Geneva – Service de solidarité internationaleBP Koirala Institute of Health Sciences

Familial hypercholesterolemia (FH) is either underdiagnosed or diagnosed after primary coronary events. Although homozygous variant of FH is considered rare, heterozygous FH is estimated to occur in about 1 in 200 to 300 individuals. There is no study pertaining to prevalence of FH in Nepal which could be a factor influencing cardiovascular morbidity and mortality.

We present a baseline data of FH in an ongoing in participants of community-based cardiovascular and kidney diseases preventive (KHDC Nepal) program in Mechinagar municipality in Eastern Nepal.

KHDC is a program to collaborate among health post, primary health center or equivalent, and local government along with community representatives created to educate, screen, and intervene for selective NCDs. This program is in alignment with the World Health Organization’s Package of Essential Noncommunicable (WHO PEN) disease interventions for primary health care in low-resource settings. General health status and lifestyle habits, physical examination, and blood pressure were assessed. Blood tests done included fasting lipid profile, serum creatinine, FBS, and HbA1c. A mechanism was developed to follow-up screened positive persons in the primary health centers. Referrals were made to the tertiary care center as needed.

We analyzed initial 7289 participants, 20 years or above, who were enrolled in KHDC program in the year 2020. We assessed for FH using Dutch Lipid Clinic Network(DLCN), Simon Broome and AHA criteria. Participants were categorized as definite, probable, possible, or no FH based on the scores of DLCN criteria; as definite and probable based on Simon Broome criteria and as clinically diagnosed FH based on AHA criteria.

The median age of the patient was 54 years, the majority being females (62.7%). A total of 70(0.96%) of the participants had elevated LDL-C levels of more than 190mg/dl detected during the screening and had no secondary cause for hyperlipidemia. According to DLCN criteria, 65(0.89%) participants were grouped under possible FH, 5(0.06%) were grouped under probable FH while none of them could be delineated as definite FH. According to Simon Broome criteria, 14(0.2%) participants were grouped under probable and none of them could be delineated as definite. According to AHA criteria, 10 (0.13%) participants were categorized as clinically diagnosed FH. DNA analysis was not available in our setup. Clinically manifested atherosclerotic disease was recorded in 5 participants. None of the participants were aware of the FH.

This community-based program of the adult population help create baseline data of FH in Nepal. Larger study with genetic analysis is likely to reveal true prevalence of FH in Nepal.
The most important safety risk of fish oil from the latest meta-analysis?
Authors: Yan J , Liu M , Yang D , Zhang Y , An F
Published: May 2022

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): This project was supported by the National Natural Science Foundation of China (No. 81670325 and No. 81370325).

Background

Fish oil supplements are popular worldwide, and many people believe that fish oil supplements are beneficial to their health. However, there is still controversy about whether Omega-3 fatty acids can reduce the cardiovascular risk of users. In recent years, the publication of several large randomized controlled trials has pointed out the direction for us to use fish oil supplements.

Purpose

We conducted a meta-analysis of recently released large randomized controlled trials to evaluate the clinical value of fish oil supplements.

Methods

Five latest large randomized controlled trials on Omega-3 fatty acids were included, including the ASCEND study, VITAL study, REDUCE-IT study, STRENGTH study and OMEMI Study. We analyzed the effects of fish oil supplements on the incidence of major cardiovascular events, myocardial infarction, stroke, atrial fibrillation, death from cardiovascular cause and death from all-cause.

Results

Fish oil supplements can significantly reduce the risk of myocardial infarction in users (RR 0.85, 95%CI 0.72- 0.99; P = 0.04), however, significantly increase the risk of atrial fibrillation (RR 1.32 95%CI 1.11-1.58; P=0.002). The use of fish oil supplements had no effect on the incidence of major cardiovascular events (RR 0.93, 95%CI 0.84-1.04; p=0.23) and stroke (RR 0.99, 95%CI 0.84-1.17; P = 0.93). Similarly, there was no effect on death from cardiovascular cause (RR 0.91, 95%CI 0.79-1.05; P = 0.20) and death from all-cause (RR 0.99, 95%CI 0.92-1.07; P = 0.79).

Conclusion

The results of this meta-analysis showed that fish oil supplements can reduce the incidence of myocardial infarction, but significantly increase the risk of atrial fibrillation. We should reconsider the role of fish oil supplements in preventing cardiovascular disease. We also need some large randomized controlled trials to verify the risk of atrial fibrillation caused by the use of fish oil supplements.
Tailor-made cardiac rehabilitation for patients with obesity: results of the OPTICARE-XL randomized controlled trial
Authors: Ter Hoeve N , Den Uijl I , Sunamura M , Stam HJ , Boersma H , Lenzen MJ , Brouwers RWM , Tenbult-Van Limpt NCCW , Kemps HMC , Van Den Berg-Emons HJG
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Dutch Organisation for Health Research and Development (ZonMW) and Capri Cardiac Rehabilitation

Background

More than a third of the patients referred to cardiac rehabilitation (CR) suffers from obesity, and this number is growing. However, in patients with obesity, standard CR is not effective in achieving the recommended physical activity levels and results achieved in weight loss and health related quality of life (HRQOL) are unsatisfactory.

Purpose

To describe the effectiveness of a new state of the art CR program designed for patients with obesity, OPTICARE XL, on weight, physical activity and HRQOL.

Methods

A total of 201 patients that were referred to CR after a diagnosis of coronary artery disease (CAD) or atrial fibrillation (AF) and a BMI≥30 were randomized to standard CR (n=99) or OPTICARE XL CR (n=102). Standard CR consists of a 6 till 12 week aerobic exercise program, supplemented with cardiovascular lifestyle education. OPTICARE XL CR is a one-year intervention including aerobic and strength exercise, behavioral coaching on diet and physical activity and an after-care program. Weight was measured with a calibrated weight scale, physical activity (steps/day) was measured with an Actigraph GT3X+, and HRQOL with the MacNew questionnaire. Data was analyzed by means of linear mixed-effect models.

Results

Included patients had a mean age of 59 years, were predominantly male (73%) and the majority was referred to CR after a CAD (66% CAD, 34% AF). Patients in the OPTICARE XL group showed on average greater weight loss three months after the start of CR (mean change -3.6 kg vs -1.8 kg, respectively, p=0.002). Six months post CR, changes in body weight were equal between groups (-2.5 kg in both groups, p=0.959). No significant between-group differences were seen in improvements in physical activity both three months after the start of CR (+880 steps/day for OPTICARE XL vs +481 steps/day for standard CR, p=0.169) and six months post CR (+331 steps/ day vs +283 steps/day, p=0.919). With regard to HRQOL score, also no significant between groups differences in improvements were seen both three months after the start of CR (+0.6 for OPTICARE XL vs +0.5 for standard CR, p=0.169) and six months post CR (+0.5 for both groups, p=0.907).

Conclusion

OPTICARE XL had added value on the short-term, but this did not sustain on the long-term. We suggest to re-evaluate the OPTICARE XL program to expand short-term effects.
Leveraging cluster analysis of weather and pollution features to predict acute cardiac or cerebrovascular events
Authors: Testa A , Anticoli S , Pezzella FR , Mangiardi M , Di Giosa A , Marchegiani G , Frati G , Sciarretta S , Peruzzi M , Cavarretta E , Gaspardone A , Mariano E , Versaci B , Versaci F , Biondi-Zoccai G
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

Despite mounting evidence, the impact of the interplay between weather and pollution features on the risk of acute cardiac and cerebrovascular events has not been entirely appraised.

Purpose

We aimed to perform a comprehensive cluster analysis of weather and pollution features in a large metropolitan area, and their association with acute cardiac and cerebrovascular events.

Methods

Anonymized data on acute myocardial infarction (AMI) and acute cerebrovascular events were obtained from 3 tertiary care center from a single large metropolitan area. Weather and pollution data were obtained averaging measurements from several city measurement stations managed by the competent regional agency for enviromental protection, and from the Metereologic Center of Italian Military Aviation. Unsupervised machine learning was performed with hierarchical clustering to identify specific days with distinct weather and pollution features. Clusters were then compared for rate of acute cardiac and cerebrovascular events with Poisson models.

Results

As expected, significant pairwise correlations were found between weather and pollution features. Building upon these correlations, hierarchical clustering, from a total of 1169 days, generated 4 separate clusters: mostly winter days with low temperatures and high ozone concentrations (cluster 1, n=60, 5.1%), days with moderately high temperatures and low pollutants concentrations (cluster 2, n=419, 35.8%), mostly summer and spring days with high temperatures and high ozone concentrations (cluster 3, n=673, 57.6%), and mostly winter days with low temperatures and low ozone concentrations (cluster 4, n=17, 1.5%). Overall cluster-wise comparisons showed significant overall differences in adverse cardiac and cerebrovascular events (p<0.001), as well as in cerebrovascular events (p<0.001) and strokes (p=0.001). Between-cluster comparisons showed that Cluster 1 was associated with an increased risk of any event, cerebrovascular events, and strokes in comparison to Cluster 2, Cluster 3 and Cluster 4 (all p<0.05), as well as AMI in comparison to Cluster 3 (p=0.047). In addition, Cluster 2 was associated with a higher risk of strokes in comparison to Cluster 4 (p=0.030). Analysis adjusting for season confirmed the increased risk of any event, cerebrovascular events and strokes for Cluster 1 and Cluster 2.

Conclusions

Unsupervised machine learning can be leveraged to identify specific days with a unique clustering of adverse weather and pollution features which are associated with an increases risk of acute cardiovascular events, especially cerebrovascular events. These findings may improve collective and individual risk prediction and prevention.
Independent and additional value of cardiopulmonary exercise test to the new york heart association classification in heart failure
Authors: Moraes Alves De Souza I , Donelli Da Silveira A , Stein R , Santos Pereira Ramos JV , Sadigursky Ribeiro R , Meira Pazelli A , Borges De Oliveira Q , Sahade Darze E , Fonteles Ritt LE
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

The Cardiopulmonary Exercise Test (CPET) is the gold standard test for functional assessment in Heart Failure (HF), but it has not been adequately evaluated on top of the New York Heart Association (NYHA) class.

Purpose

We aimed to assess the independent and additional value of CPET to NYHA class in patients with HF and ejection fraction (EF) <50%. Our secondary purpose is to assess the performance of CPET variables in patients with better (NYHA I or II) and worse (NYHA III or IV) functional class.

Methods

Patients with HF and reduced or mid range ejection fraction (EF) who underwent CPET were followed for the occurrence of the primary end point of death, heart transplantation and left ventricular assist device (LVAD) implant. Cox regression analysis and ROC curve analysis were used to determine independent predictors for the primary outcome and the additional CPET value, respectively. Kaplan–Meier failure curves were created to illustrate time to primary end point. A value of p <0.05 was considered statistically significant.

Results

613 patients were followed for a mean of 30 ± 22 months. Mean age was 56 ± 12 years, 64% were male, mean EF was 30 ± 8%. NYHA as follows: NYHA I 32%, NYHA II 41%, NYHA III 24% and NYHA IV 2.8%. The rate of primary outcomes was 13%. Death occurred in 8.7%, heart transplantation in 4.4% and there were no cases of LVAD´s implantation. Independent predictors of the primary outcome were: EF (HR 0.946; 95% CI 0.918-0.976; p<0.001), NYHA (HR 2.1; 95% CI 1.55-2.73; p<0.001). When peak VO2 was added to the model, it was maintained as an independent predictor (HR 0.90; 95% CI 0.85-0.96; p 0.001), as was the percentage of predicted peak VO2 (HR 0.03; 95% CI 0.007-0.147; p<0.001), VE/VCO2 slope (HR 1.02; 95% CI 1.01-1.04; p 0.011) and CPET score (HR 1.16; 95% CI 1.06-1.27; p<0.001). ROC curve of the predictor model with only NYHA and ROC curves of the models adding the other CPET variables are shown in Figure 1. There was no significant difference between the curves of the model containing only NYHA and the models with the CPET parameters or the CPET score (Table 1). VO2 peak and VE/VCO2 slope were able to discern survival in functional classes I and II (log rank p < 0.001), but were not clearly in classes III and IV (log rank p = 0.113 and p = 0.124 respectively). CPET score was able to discern survival in both groups, in those with the best and worst functional class (log rank p < 0.05).

Conclusion

CPET variables were independent predictors of prognosis in HF, even when controlled by NYHA class. Although they have independent value, their additional value was modest and not statistically significant.
Cardiopulmonary exercise testing in post-COVID-19 patients: Where does exercise intolerance come from?
Authors: Milani M , Milani JGPO , Cipriano GFB , Cahalin LP , Stein R , Cipriano Junior G
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES). Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq).

Background

Post-COVID-19 persistent symptoms and exercise intolerance are poorly understood. Cardiopulmonary exercise testing (CPET) assessment is important to address the sources of the underlying symptoms and limitations.

Purpose

To evaluate the source and magnitude of exercise intolerance in post-COVID-19 subjects via CPET.

Methods

This cohort study assessed subjects with different SARS-CoV-2 illness severities. The propensity score matching method was used to select the control group. Patients with available CPET prior to SARS-CoV-2 infection were compared before and after COVID-19.

Results

288 subjects (144 post-COVID-19 and 144 matched-controls) were assessed. The median age was 43.0 years, and 57% were male, with different illness severity (60.4% mild, 20.8% moderate, 18.8% severe). Residual symptoms were reported in 41% of the sample. CPET was performed 14.4±9.4 weeks after disease onset, with exercise limitations being attributed to the peripheral muscle (91.7%), pulmonary (6.3%), and cardiovascular (2.1%) systems. Lower median percent-predicted peak oxygen consumption was observed in the severe subgroup (72.2%) compared to both mild (98.5%) and control subgroups (91.6%). Peak oxygen consumption (peakVO2), VO2 at the ventilatory thresholds (VO2 at VT), and heart rate differed among illnesses, severities, and controls. Conversely, ventilatory equivalents, oxygen uptake efficiency slope, and peak oxygen pulse were similar (Figure 1). Additional subgroup analysis of 42 subjects with prior CPET revealed changes only on peak treadmill speed in the mild subgroup and additional reductions on peakVO2 and VO2 at VT in the moderate/severe subgroup (Figure 2), while ventilatory equivalents, oxygen uptake efficiency slope, and peak oxygen pulse remained unchanged.

Conclusions

Peripheral muscle fatigue was the most common etiology of exercise limitation in post-COVID-19 patients regardless of the SARS-CoV-2 illness severity. Our data suggest that treatment should emphasize comprehensive rehabilitation programs, including aerobic and muscle strengthening components.
Assessment of cardiorespiratory fitness and physiological responses with different ergometers in people with bipolar disorder: data from the FINEXT-BD study
Authors: Gorostegi-Anduaga I , Etxaniz-Oses J , Maldonado-Martin S , Garcia-Corres E , Gonzalez-Pinto A
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III

Background

Bipolar disorder (BD) is a mental illness in which manic and depressive episodes are combined. People with BD are associated with an unhealthy lifestyle. Assessment of cardiorespiratory fitness (CRF) indicates the overall health of the person and is essential for the design of the exercise intensity ranges in an individualized way. The assessment of CRF can be performed with different ergometers (treadmill, T vs. cycloergometer, C) and the results may differ.

Purpose

To analyze and compare the CRF and physiological responses of two peak, progressive and ramped protocols on different ergometers (T and C) in people with BD.

Methods

Physiological variables (peak blood pressure, test duration, ventilatory threshold, peak heart rate, peak oxygen uptake [VO2peak], peak metabolic equivalent) assessed by cardiopulmonary exercise tests (T and C) were measured in participants (n=28, 67.8% women, 45.9±12.5 yr old) with BD.

Results

Differences were found in peak systolic blood pressure (T=148±29.5 vs. C=184±32.7 mmHg, P<0.001, Cohen's d=1.14), peak diastolic blood pressure (T=79±10.7 vs. v=88±17.1 mmHg, P<0.01, Cohen's d=0.72) and test duration (C=9.4±3.6 vs. T=11.3±4.9 min, P<0.01, Cohen's d=0.43) with higher values in C (24.5%, 12.4% and 19.6%, respectively). No other statistically significant (P>0.05) between ergometers-differences were found in the rest of studied variables, including VO2peak as the gold standard of CRF assessment (T=23.8±7.6 vs. C=24.6±7.7 mL·kg-1·min-1).

Conclusions

The no differences between ergometers (T vs. C) when assessing CRF and physiological responses in people with BD indicate that both modes of assessment could be used interchangeably. The increased blood pressure response in C compared to T could be due to unfamiliarity with the ergometer and the physiological factors that determine blood pressure.
Feasibility and preliminary effects of technology-assisted interventions in hybrid cardiac rehabilitation (TecHCR): A pilot randomised controlled trial
Authors: Chong M S , Sit JWH , Choi KC , Suhaimi A , Chair SY
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

As COVID-19 pandemic continues, using technologies within cardiac rehabilitation facilitates access to care and reduces the frequency of direct contact with vulnerable cardiac patients. We aimed to assess the feasibility of technology-assisted interventions in hybrid cardiac rehabilitation (TecHCR) and preliminarily evaluate its effects on patients with coronary heart disease (CHD).

Methods

Between February 2021 to May 2021, a total of 28 patients with CHD were recruited and randomised to receive a 12-week TecHCR programme (n = 14) or a 12-week conventional, centre-based programme (n = 14). The TecHCR group received three center-based, supervised exercise training sessions. Participants were instructed to wear a fitness tracker watch for exercise self-monitoring at home environment, and the exercise data were shared through a web-based application for remote monitoring by the intervener. Participants received six audio-visual educational videos via a messaging application and a weekly video/telephone call follow-up. Self- Efficacy for Exercise (ESE), Health Promoting Lifestyle Profile II (HPLP II), Hospital Anxiety and Depression Scale (HADS), exercise capacity and cardiovascular health outcomes were assessed at baseline and at 12th week on completion of the programme. Generalised estimating equations analysis was conducted to compare the outcomes between groups.

Results

Out of 28 participants (56.46±12.98 years old; 1 female), 67.9% had percutaneous coronary intervention and 28.6% had coronary bypass grafting surgery. Among 14 participants in the TecHCR group, three dropped out due to: 1) fear to attend face-to-face supervised exercise training during high daily COVID-19 cases; 2) infected with COVID-19 and 3) found a job in overseas. Eleven participants in the TecHCR group attended all video/telephone call sessions, nine participants completed 3 supervised exercise training sessions and nine participants adhered to the weekly exercise recommendations. No treatment-related adverse events were reported. TecHCR was non-inferior to conventional, centre-based program on exercise self-efficacy, exercise capacity and cardiovascular health outcomes. TecHCR group showed significantly greater improvement in health-promoting behavior when compared with the control group (p =0.013) at post-intervention.

Conclusion

This pilot study demonstrated the feasibility in recruitment and implementation of TecHCR as an alternative delivery mode and could enhance health-promoting behavior among patients with CHD.

Implications

The TecHCR program provides accessible interventions to patients without frequent visits to the outpatient centre. A full-scale randomised controlled trial is needed to confirm the effectiveness of TecHCR.
The validity and reliability of the 6 minute stepper test in patients with systemic hypertension
Authors: Karaduz B , Ozcan EB , Sener YZ , Calik Kutukcu E , Jabrayilov J , Saglam M , Vardar Yagli N , Inal Ince D , Yildirim T , Tokgozoglu L
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction and Background

6 Minute Stepper Test (6MST) is a valid, reliable and practical field test that evaluates exercise capacity in chronic conditions. There is a need for evaluating the validity and reliability of 6MST in for using evaluation during cardiac rehabilitation.

Purpose

The aim of this study was to evaluate the validity and reliability of 6MST test in patients with systemic hypertension.

Methods

Forty hypertensive individuals (mean age: 47.55 ± 6.55 years, female/male: 24/16) were included in the study. Demographic and clinical characteristics of patients were recorded and echocardiography was conducted. Functional exercise capacity was evaluated with 6MST and step number during 6MST was recorded. Exercise capacity was tested with the six minutes walk test (6MWT) and used for validity.

Results

Clinical and demographic status of patients were presented in Table-1. According to the test-retest ICC (Intraclass correlation coefficient) analysis for the reliability of 6MST test in hypertensive patients; 6MST test score has very good reliability for single measurements (ICC value = 0.896, p <0.001) and mean measurements (ICC value = 0.945, p <0.001). According to the results of pearson correlation analysis to evaluate the criterion validity of 6MST test; 6MST test score showed a high relationship with 6MWT distance as the criterion test (r = 0.689, p<0.001) in patients with systemic hypertension.

Conclusions

6MST can be used as a valid and reliable test to evaluate exercise capacity in patients with hypertension. Because it is practical, tolerable and safe so it may be a new valid field test in cardiac rehabilitation.
Motivational aspects of the cardiac rehabilitation programme
Authors: Coto Morales B , Del Castillo Carnevalli HA , Marti Sanchez D , Gomez Sanchez MI , Basabe Velasco ME , Rodriguez Biedma MF , Molinos AC , Fuentes Pereiro J , Casanova Lopez MP , Marschall AF , Duarte Torres J , Biscotti Rodil MB , Rodriguez Gamero MA , Rodriguez Torres DJ , Alvarez Anton SA
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction/Background

Cardiac rehabilitation programmes have proven to be effective in many ways in patients with cardiovascular disease. In fact, its implementation has acquired a relevant role in the European Clínical Practice Guidelines. The reasons why the programmes are successful are diverse, including motivating patients to improve their lifestyle. But, what specific aspects keep the patient motivated in the cardiac rehabilitation programme?

Method

An anonymous survey was administered to patients who completed cardiac rehabilitation programme and who were considered by their physicians as successul in terms of lifestyle changes. A 13-question questionnaire was distributes (Table 1) including baseline characteristics. Patients were asked to rate from 1 to 5 (being 5 the highets rating) how important each of thes items had been in terms of motivation.

Results

83 questionnaires correct completed were analyzed. Mean age was 66+/- 12 y.o. and 21 women (25%). The mode of studies level was primary school. Mean Value of Question (Q) 5: 4,56, Q6: 4,07 Q7: 4,55 Q8: 4,64, Q9:4,43 Q10: 3,93 Q11:3,96 Q12: 4,34 Q13:4,16.

Conclusions

Although many items were valued similarly, the most popular items were the trust in the information given by healthcare professionals( Q5) and the importance of feeling better and improving self-esteem (Q8), being scored over 4,5. On the other hand, the last popular items were the posibility of having a relapse (Q11) and the impact on social life (Q10). The population who fulfilled the survey considered the programme as valuable in terms of makin them improve their lifestyle, being Q13 scored over 4 (4,16).