bluuebunny/crossref_metadata_2025 huggingface dataset:
Quality of secondary prevention in centre-based cardiac rehabilitation: predictors and between-center variation
Authors: Novakovic M , Trsan J , Tasic J , Krevel B , Krunic B , Pusnik Vrckovnik M , Pagliaruzzi M , Cencic V , Ravnikar T , Lainscak M , Farkas Lainscak J , Fras Z , Jug B
Published: May 2023

Funding Acknowledgements

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

Background

Cardiac rehabilitation (CR) is a complex intervention, providing supervised exercise training, risk factor control, and secondary prevention. Centre-based outpatient CR provides the necessary structure to accomodate the delivery of several preventive interventions, but the quality of secondary prevention may vary. The present study sought to assess the impact of CR on the improvement and between-center variation of the quality of secondary prevention.

Methods

Data were extracted from the Slovenian National CR Registry for patients who completed CR between 2017 and 2020. A composite quality score (CQS) was calculated adjudicating one point for each of the following: non-smoking status, body mass index <25 kg/m2, systolic blood pressure <130 mmHg, low-density lipoprotein (LDL) cholesterol <1.4 mmol/L, antiplatelet therapy, and high-potency statin/combined lipid-lowering therapy. Predictors of CQS improvement were assessed using mixed-effects ordinal logistic regression model acknowledging the hierarchical nesting of patients within centres.

Results

A total of 1,952 patients from 5 centres were included (mean age 59.4±10.8 years; 22% women). Mean CQS improved from 3.16±1.11 to 3.53±1.21 (p<0.001), with CR associated with an OR 1.72 (95% confidence interval [CI] 1.49-2.00) for CQS improvement (Figure). Improvement of CQS was also positively associated with increasing number of sessions >12 (e.g., OR 6.06 [3.29-11.14] for 12-24 sessions) and total number of co-morbidities (OR 1.40 [95%CI 1.33-1.48]), and negatively associated with male sex (OR 0.78 [95%CI 0.65-0.92]), high cardiac risk (OR 0.83 [95%CI 0.68-0.99]), age >60 years (e.g., OR 0.62 [95% CI 0.41-0,94] for age group 60-69 years), and referral diagnosis other than STEMI (e.g., OR 0,56 [95%CI 0.39-0,72] for non-infarction coronary artery disease). Random-effects partitioning attributed 68.8% of variance to patient-level factors and 19.8% to between-center variability.

Conclusions

Centre-based CR is associated with improved quality of secondary prevention; factors affecting quality improvement range from patient-level (e.g., age and sex) to mode of provision (e.g., number of sessions). Up to one fifth of the variation, however, can be attributed to between-center variationm.
NT-ProBNP value to monitor the treatment with intropics of acute heart failure associated with acute coronary syndrome
Authors: Carias M , Almeida A , Paralta M , Claudio F , Rocha R , Bento A , Trinca M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

NT-proBNP is a cardiac biomarker with diagnostic and prognostic value. Assessment of NT-proBNP enables to determine, or exclude, cardiac cause of dyspnea, and variations in its levels are significantly related with prognosis, as higher values in heart failure have a significantly worse prognosis than those with reduction of its value.

Acute heart failure might be associated with acute coronary syndromes (ACS) and may require inotropic therapy to improve hemodynamic status and optimize cardiac output. Inotropes help improve cardiac contractility, therefore, increase stroke volume, cardiac output, and meliorating heart failure congestive or low perfusion symptoms and NT-proBNP value.

Purpose

This study aims to evaluate the effect of the use of Inotropes on the NT-proBNP value, comparing Levosimendan with Dobutamine, in patients hospitalized for acute heart failure associated with ACS.

Methods

We analyzed a retrospective, multicenter, observational cohort of 150 patients, admitted for ACS, with Killip 3 or 4 at presentation, requiring inotropic therapy. The population was divided into two groups: a group that used Levosimendan and a second group that used Dobutamine. The mean value of NT-proBNP, during hospitalization, was compared between both groups and compared with placebo.

Results

Levosimendan sample included 75 patients, of which 35,0% (n=26) were women, with a mean age of 82 ± 14.5 years old, while Dobutamine sample had 75 elements, of which 38% (n=28) were women with a mean age of 81.8 ± 12.9 years old. There was no statistically significant difference between both samples on age and sex distribution.

Levosimendan group had a mean NT-proBNP value of 8870±100 pg/mL, while Dobutamine group had a mean mean NT-proBNP value of 12454±984 pg/mL. There was no statically difference on mean NT-proBNP value comparing both inotropic therapy samples (p>0,05), however, there was a statistically significant difference, with a higher decrease in mean NT-proBNP value, in patients using Levosimendan, comparing with not using inotropes (1382 pg/mL vs 12329 pg/mL, p<0,01), not verified, with a not statistically significant difference comparing Dobutamine and no inotropic therapy.

Conclusion

Levosimendan is associated with a higher decrease in NT-proBNP value. As heart failure might complicate ACS episode, and might require inotropic therapy, we should be aware that the choice of using Levosimendan in these situations may confer a greater analytic benefit, associated with the higher decrease in NT-proBNP value, which might be associated with a better prognostic value. However, treatment guided by value of NT-proBNP is yet to be validaded.
Risk modification role of opportunistic screening of lipoprotein(a) at first acute coronary syndrome admission in patients under 65 years old
Authors: Fernandez Ruz L , Mora Robles J , Ceballos Gomez C , Sanchez Sanchez C , Urbano Carrillo C
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

There is a strong association between lipoprotein(a) (Lp(a)) and atherosclerotic cardiovascular disease (ASCVD). Recent guidelines recommend its measure once in each adults’ lifetime, but the moment remains undefined. Moreover, little is known about Lp(a) in the acute setting.

Purpose

To describe Lp(a) levels in young patients (under 65) affected by its first acute coronary syndrome (ACS) as part of the standard evaluation during hospitalization and how it can affect lipid residual risk stratification.

Methods

We conducted a descriptive and retrospective study involving 51 patients under 65 years old admitted to hospital between July 2022 and October 2022, for ACS, irrespective of the onset of symptoms (unstable angina, myocardial infarction with or without ST-segment elevation (STEMI, NSTEMI). We tested Lp(a), apolipoprotein B (ApoB), low and high-density lipoprotein cholesterol (LDLc, HDLc), triglycerides (TG) and glycated haemoglobin (HbA1c), in those patients.

Results

We included 51 patients in our study. 76,5% were male. Mean age was 56,1 years (± 7,34). The distribution of risk factors was: smoking 68,6%, hypertension 52,9%, diabetes 31,4%, dyslipidaemia 43,1%. 30 patients had STEMI (58,8%), 17 NSTEMI (33,3%); 4 unstable angina. Immediate percutaneous coronary intervention was made in 33 patients (64,7%). Mean LVEF was 55,19% (± 9,4). Mean high-sensivity troponin I (hsTnI) peak was 47648,14 ng/L (± 71365).

13 patients had Lp(a) >50 mg/dL (25,5%), including 2 patients with Lp(a) levels above 180 mg/dL. The rest of the lipid profile is shown in Table 1.

Conclusion

In our sample of young ACS patients, one of each four patients has Lp(a) levels above 50 mg/dL, which confers a higher risk for ASCVD. We consider screening for Lp(a) in ACS as an opportunity to redefine cardiovascular risk and intensify lipid lowering therapies during follow-up.
Did nocturia, in hypertension, correlate with dipping status?
Authors: Croce A , Parazzoli C , Pengo M , Rosa D , Bilo G , Chiodini I , Parati G F
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

The association between nocturia and hypertension has been widely reported yet remains poorly characterized, precluding a more refined understanding of blood pressure as it relates to the cardiovascular setting. Nocturia is associated with significant morbidity and mortality (1,2,3) which is thought to be mediated in large part by the fact that nocturia is a potential manifestation of systemic disease (4). Previous studies have reported that heart failure and uncontrolled hypertension were responsible for clinically significant nocturia (5,6). However, it remains unclear the relationship with any hypertension mechanism and the effect on circadian blood pressure rhythm.

Purpose

To investigate characteristics of hypertensive patients in who complain for nocturia.

Methods

We prospectively recruit 49 patients among outpatients attending the Hypertension Centre of Hospital San Luca, Istituto Auxologico Italiano. Physical examination, standard routine blood tests, urine analysis for microalbuminuria, 24-hour sodium excretion, 24-hour urinary cortisol levels, 24-hour urinary metanephrine/normetanephrine and a standard 24h ABPM has been performed. We asses in every patients the presence of nocturia (≥2 nightly voids) then we compare sub mentioned features between patients with nocturia or not.

Results

The population recruited demonstrate a mean age of 62 years old, it is made by a majority of men (M 61%, F 39%). We found nocturia in 13 patients on the 49 recruited. Demographic, anthropometrical and hematochemical features of the population recruited is described in Table 1. We compare patients who complain nocturia with patients with a normal number of nocturnal voids. Only height and hemoglobin demonstrate significative difference in the population. In a second analysis we compare ABPM results of patients with nocturia with patients who don’t have this symptom. The results are described in Table 2. Differently to what we expect no difference is demonstrated between the two group in dipping status, we found a significative difference in overall heart rate, this difference is evident only the day period but not in the night period.

Conclusion

These preliminary data suggest that patients with nocturia than patient with normal number of nocturnal voids i) have lower height and hemoglobin level, this in support to nocturia is a potential manifestation of systemic disease (4);) have both a lower overall and diurnal cardiac frequency. No dipping correlation have been found in our study, more study are needed to clarify a potential relationship with sleep disorder.
Hematological effects of Levosimendan therapy in patients with heart failure
Authors: Rocha De Almeida A , Carias De Sousa M , Congo K , Trinca M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Levosimendan is an inotropic drug, acting as calcium sensitizer, used in the management of acute heart failure. Despite its hemodynamic benefits, Levosimendan is associated with several adverse reactions, including hematological effects, with a hemoglobin value decrease, causing anemia.

Acute coronary syndromes (ACS) might be a precipitant of acute heart failure, in a substantial proportion of cases. These situations may require the use of inotropic drugs, such as Levosimendan. Antithrombotic therapy is the cornerstone therapy for management of acute coronary syndromes, and the decision of which strategy is determined by the balance of ischemic and hemorrhagic risks.

Therefore, in the management of acute heart failure, associated with ACS, the use of Levosimendan might be associated with the increase of hemorrhagic risk, due to hemoglobin decrease, influencing the antithrombotic therapy strategy choice.

Purpose

This study aims to evaluate the effect of the use of Levosimendan on the hemoglobin value, comparing with Dobutamine, in patients hospitalized for ACS.

Methods

We analyzed a retrospective, multicenter, observational cohort of 317 patients, admitted for ACS, requiring inotropic therapy. The population was divided into two groups: a group that used Levosimendan and a group that used Dobutamine. The mean decrease in hemoglobin value, and the minimum hemoglobin value, during hospitalization, was compared between both groups.

Results

Levosimendan sample included 39 patients, of which 40,1% (n=15) were women, with a mean age of 83±12,1 year old, while Dobutamine sample had 278 elements, of which 38% (n=105) were women with a mean age of 82±12,1. There was no statistically significant difference between both samples on age and sex distribution.

Levosimendan group had a mean minimum hemoglobin value of 10,7±2,2 g/dL and a mean decrease in hemoglobin value, during hospitalization, of 2,7±1,9 g/dL, while Dobutamine group had a mean minimum hemoglobin value of 10,7±2,2 g/dL and a decrease in hemoglobin value, during hospitalization, 2,1±1,9g/dL. There was no statically significant difference on mean minimum hemoglobin value on both samples (p>0,05), however, there was a statistically significant difference, with a higher decrease in mean hemoglobin value, during hospitalization in patients using Levosimendan, comparing with patients using Dobutamine (2,7±1,9g/dL vs 2,1±1,9g/dL, p=0,04).

Conclusion

Levosimendan is associated with a higher decrease in hemoglobin value. As heart failure might complicate ACS episode, and might require inotropic therapy, we should be aware that the choice of using Levosimendan in these situations may confer a greater risk of bleeding, associated with the higher decrease in hemoglobin value, in patients who need intense antithrombotic therapy.
Digital health nudging to increase physical activity and quality of life in pediatric patients with congenital heart disease: a randomized controlled trial
Authors: Willinger L , Oberhoffer-Fritz R , Ewert P , Mueller J
Published: May 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): This research was funded by an unrestricted grant from the “Stiftung KinderHerz Deutschland gGmbH.”

Background

Digital health nudging has been shown to be a compelling, age-appropriate, and modern e-health intervention to increase physical activity (PA) in healthy adolescents. However, such studies are lacking in adolescents with congenital heart disease (CHD), although activity promotion is particularly important in this vulnerable population.

Purpose

This randomized-controlled trail examines if digital health nudging via daily smartphone messages increases PA and health-related quality of life (HrQoL) in adolescents with CHD.

Methods

From May 2021 to April 2022, 97 patients (15.1 ± 2.0 years, 50% girls) with moderate or severe CHD were randomly allocated 1:1 to an intervention group (IG) or control group (CG). Daily PA was objectively assessed in minutes of moderate-to-vigorous PA (MVPA) by the wrist worn wearable "Garmin Vivofit jr." over the entire study period. HrQoL was assessed with the KINDL-questionnaire at baseline and after the intervention. The IG received daily, short and informative smartphone messages based on Bandura’s social cognitive theory on the subject of MVPA, thus nudging them to be more active in their everyday lives over a period of three month. Intention-to-treat analysis was performed based on multiple imputed data. To analyze the change of MVPA, the first two weeks of the intervention were compared to the last two weeks of the intervention with Mann-Whitney-U test. Results are expressed as median [25 quartile; 75 quartile].

Results

MVPA decreased from 78.1 [62.5; 86.5] to 71.4 [56.6; 75.2] min/day in the IC and from 80.2 [64.7; 102.9] to 76.0 [68.0; 94.0] min/day in the CG over the study period of three month. There was no significant change in MVPA when comparing the IG with the CG group (IG: Δ -6.4 [-18.6; 3.0] min/day vs. CG: -2.5 [-12.8; 8.5] min/day, p=0.199). Physical well-being significantly increased over the study period (IG: Δ1.60 [-0.24; 6.25] vs. CG: Δ0.00 [-12.5; 6.35], p=0.043), but not the total HrQoL score (p=0.518).

Conclusion

Three month of digital health nudging did not increase PA, but improved feelings of physical well-being in adolescents with CHD. Our results might indicate that although wearables and digital health nudging initially have a positive influence on physical activity, activity declines over time in both groups and digital health nudging apparently does not have the potential to stop or slow down this phenomenon.
Self-efficacy and barriers to exercise across the different stages of heart failure with a preserved ejection fraction
Authors: De Wilde C , Claes J , Bekhuis Y , Claessen G , Decorte E , Gevaert A , Falter M , Gojevic T , Hansen D , Kuznetsova T , Michielsen M , Van Craenenbroeck E , Cornelissen V
Published: May 2023

Funding Acknowledgements

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

Background

Exercise is a key therapy for patients across all the stages of heart failure with preserved ejection fraction (HFpEF). Despite being a class I recommendation, the EUROASPIRE registry showed that only a third of patients is sufficiently active, with numbers being even lower among patients with symptomatic HFpEF (stage C). Knowledge of barriers and confidence to exercise is needed to increase the uptake of exercise and a physically active lifestyle.

Objective

To assess barriers to exercise and self-efficacy in patients along the continuum of HFpEF and to detect possible differences between patients in different HFpEF stages.

Methods

The first 60 patients (n = 20 HFpEF stage A, 20 HFpEF stage B, 20 HFpEF stage C) from the PRIORITY randomized controlled trial (PeRsonalIzed remOtely guided preventive exeRcIse therapy for a healThY heart) were included. Barriers to exercise and self-efficacy were evaluated using the Exercise Barrier Questionnaire and the Exercise Self-Efficacy Scale.

Results

Patients with HFpEF stage C were older (72 ± 9.41 years), more likely to be female (70%) and were less physically fit (peak VO2 14.09 ± 2.58 ml/min/kg) compared to patients with HFpEF stage A (63.5 ± 9.10 years, 40% women and peak VO2 21.43 ± 4.94 ml/min/kg) and stage B (70.5 ± 5.25 years, 40% women and peak VO2 17.84 ± 5.15 ml/min/kg). As shown in Figure 1, patients with HFpEF stage C reported more barriers to exercise compared to patients with HFpEF stage A or HFpEF stage B. In particular, 50% of HFpEF stage C reported that they would not exercise when they perceived the exercise as boring (vs A:21%, B:22%), not fun (vs A: 21%, B:21%), if supervised by a bad instructor (vs A:32%, B:33%) or during holidays (vs A:26%, B:17%). Almost 40% of patients with HFpEF stage C reported that having to exercise alone would be a barrier for them (vs A:11%, B:22%). As shown in Figure 2, patients with HFpEF stage C were less confident that they 1) could overcome barriers to exercise by finding appropriate exercise resources (A:0%, B:6%, C:11%), 2) would exercise when feeling tired (A:5%, B:24%, C:28%), 3) would exercise without family support (A:5%, B:6%, C: 17%) or 4) without professional support (A:11%, B:18%, C:17%).

Conclusion

Barriers to exercise and self-efficacy were rated differently by the 3 stages of HFpEF. Patients with more advanced stages of HFpEF experienced more challenges to be physically active.
Burden of cardiometabolic diseases and life expectancy with and without atrial fibrillation among men and women
Authors: Lu Z , Aribas E , Tilly M , Geurts S , De Groot N , Kavousi M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial fibrillation is the most common cardiac arrhythmia worldwide, with significant sex differences in its epidemiology. Cardiometabolic diseases commonly coexist with atrial fibrillation and associate with a larger mortality risk. However, how increasing burden of cardiometabolic diseases affect life expectancy lived with atrial fibrillation remains largely unknown.

Purpose

To determine the impact of burden of cardiometabolic diseases on life expectancy lived with and without atrial fibrillation.

Methods

From the population-based Rotterdam Study, 4045 men and 5526 women (mean age 62 years) were included. Participants with cardiometabolic diseases, including diabetes, coronary heart disease, stroke, and heart failure, were divided into three groups according to the number of prevalent disorders (0, 1, and ≥2). A multistate life table was developed to calculate the life expectancy lived with and without atrial fibrillation according to the burden of cardiometabolic disease.

Results

Men aged 55 with no cardiometabolic disease had a life expectancy of 22.0 years and lived 5.9 years longer than men aged 55 with ≥2 cardiometabolic diseases (life expectancy 16.1 years). Of the total life expectancy at age 55, men with no cardiometabolic disease spent 29.1% (6.4 years) of their remaining years with atrial fibrillation, whereas men with ≥2 cardiometabolic diseases spent 36.0% (5.8 years) of their remaining years with atrial fibrillation. Women aged 55 with no cardiometabolic disease had a total life expectancy of 25.2 years, which was 8.1 years longer than women aged 55 with ≥2 cardiometabolic diseases (life expectancy 17.1 years). Of the total life expectancy at age 55, women with no cardiometabolic disease spent 25.4% (6.4 years) of their remaining years with atrial fibrillation, and those with ≥2 cardiometabolic diseases spent 29.8% (5.1 years) of their remaining years with AF.

Conclusions

The larger burden of cardiometabolic diseases was associated with a lower life expectancy among men and women, and a larger proportion of remaining years spent in atrial fibrillation. Findings suggest that larger proportion of time spent in AF translates to a lower quality of life and larger health care costs at population level.
Restarting statins in a specialist lipid clinic setting
Authors: Malone R , Kennedy C
Published: May 2023

Funding Acknowledgements

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

Background

Statin therapy remains a gold standard in the primary and secondary prevention of cardiovascular disease (CVD).[1] Poor statin compliance and discontinuation due to statin intolerance (SI) remains a pervasive clinical issue.[1] Research has demonstrated that the prevalence of SI is overestimated with most SI symptoms being nocebo.[2-3] Our practice involves a patient centred intervention to restart statins with four components: 1) careful exclusion of differential diagnoses 2) an in-person discussion regarding SI based on contemporary evidence 3) an incremental introduction of statins starting at the lowest dose 4) virtual follow up to ensure implementation of the therapeutic plan. The aim of this study was to assess the effectiveness of this intervention in terms of statin reintroduction and subsequent cholesterol levels.

Methods

An ethically approved retrospective chart review was performed of consecutive adult patients attending a specialist lipid clinic over a six-month period in 2021. Patient data recorded included demographics, clinical characteristics, treatment received and biochemical profiles. Statistical analysis was performed using the Student T-test.

Results

This study included 370 patients. SI prevalence was 25% with 10% referred explicitly for SI. Patients with SI were predominantly female (71%). Statin-associated muscle symptoms were the most common SI (62%). Statin therapy was restarted in 48% of patients [Rosuvastatin: (62%), Simvastatin: (16%), Atorvastatin: (13%), Pravastatin: (9%)]. Restarting a statin demonstrated significantly improved mean reductions in both total cholesterol (TC) (P = 0.007) and low-density lipoprotein C (LDL-C) (P< 0.001) levels versus management with or without alternative lipid-lowering agents [primarily ezetimibe (30%)]. Statin restart: (TC mean reduction: 3.17 ± 2.27 mmol/L, LDL-C mean reduction: 2.93 ± 1.77 mmol/L). Management with or without alternative lipid-lowering agents: [TC mean reduction: 1.61 ± 1.46 mmol/L, LDL-C: 1.35 ± 0.93 mmol/L].

Conclusion

This study highlights the prevalence of SI among patients attending a lipid clinic. Statins were successfully restarted in half of presenting cases and conferred significant improvement in both TC and LDL-C levels compared to management with or without alternative lipid-lowering agents. Interventions for SI are warranted given the high prevalence of nocebo effect and the undoubted benefits of statin treatment. Ideally such interventions should be replicated in a primary care setting.
Sport-related acute myocardial: occurrence of intraluminal thrombus could be associated with sport intensity
Authors: Kouame I , Chague F , Lhuillier I , Yao H , Bichat F , Maza M , Saint Jalmes M , Braghini N , Porot G , Zeller M , Cottin Y
Published: May 2023

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): Agence régionale de santé Société Française de Cardiologie.

Background

Contemporary data addressing coronary artery disease (CAD) characteristics of sport-related acute myocardial infarction (SR-AMI) are scarce and underlying mechanisms are poorly understood, in particular according to metabolic intensity.

Purpose

To identify coronary angiographic feature of patients with SR-AMI according to sport intensity.

Methods

From the RICO database, a large regional acute MI survey, all consecutive patients hospitalized in our University Hospital from 2010 to 2021 who underwent coronary angiography for SR-AMI were retrospectively analysed. SR-AMI was defined as MI occurring during sport activity or within the first hour of recovery. Patients were adjudicated according to Ainsworth classification, with a 7 METs (Metabolic Equivalents) cut-off.

Results

Among the 173 patients included, most were male (n=156(91%)). Median (IQR) age was 60 y (51-67), and had ST segment elevation MI (STEMI) (n= 112 (64%)). The main SR-AMI occurred while cycling (41%), jogging (23%), hiking (9%) or playing soccer (9%). Patients commonly experienced out -of-hospital sudden cardiac arrest (OHSCA) (17%). Atherothrombotic risk factors were dyslipidaemia (34%), current smoking (32%) or hypertension (31%) and history of coronary artery disease (10%). Most (n=156(91%)) had significant lesions, mainly treated by percutaneous coronary intervention (n=131(77%)) or coronary artery bypass grafting (n=11(6%)). In-hospital death occurred in 12 patients (7%), of whom 11 experienced OHSCA- and one was admitted with a cardiogenic shock during the Covid-19 pandemics lockdown. Main clinical and angiographic characteristics are summarized in table 1. Patients in the METs group ≥ 7 were younger, had lower diabetes rates, higher ST-segment elevation MI and had higher rate of intra-luminal thrombus.

Conclusion

In our large retrospective study, SR-AMI occurring during an elevated intensity exercise had specific angiographic features. Further studies are needed to explore underlying mechanisms of MI according to exercise intensity.
High sweet foods and low life satisfaction can act as risk factors for acute coronary syndrome through synergistic interaction
Authors: So J , Chung K , Seo J , Kim B , Chun H , Han S , Chung I
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea.

Background

Dietary and psychological factors contribute to development of coronary artery disease (CAD). However, contributing components of these lifestyle factors may vary depending on ethnic and cultural background, and secondary prevention programs dealing with these factors in specific population are not well established.

Aims

We aimed to analyze dietary and psychological characteristics and independent risk factors in Korean patients with acute coronary syndrome (ACS).

Methods

Ninety-two patients with ACS (29 acute myocardial infarction, 63 unstable angina) and 69 controls were subject to analysis of lifestyle factors focused on dietary and psychological status. Dietary intake was assessed by a food frequency questionnaire (FFQ) using the KoGES software and Can-Pro 4.0. Psychological depression and perceived stress were measured with the Patient Health Questionnaire 9 (PHQ-9) and the Korean version of Perceived Stress Scale (K-PSS), respectively. In additions, eight domains of life satisfaction was assessed with the Domain Satisfaction Questionnaire (DSQ).

Results

ACS group had more men (79% vs 61%) and was older (53 yr vs. 49 yr), less physically active, and higher waist circumference and BMI than controls. Dietary analyses showed that ACS group had more intakes of sweets and fish/seafood in both men and women compared to controls. Psychological analyses showed that ACS group had higher depressive symptom (5.4 vs. 4.2, p<0.05) and less total DSQ scores (average satisfaction scores across the 8 life domains: 4.2 vs. 4.7, p<0.001) along with the lower DSQ scores of all 8 individual domains (love relationship, leisure, standard of living, job, health, family life, sex life, and self). There was a modest but significant linear inverse correlation between daily sweet intakes and total DSQ score (r = -0.23, p=0.01). Sweets (OR: 4.57, 95% CI: 1.94-11.40) and total DSQ scores (OR: 0.34, 95% CI: 0.14-0.81) were identified, by multivariate logistic regression analysis, as independent risk factors that synergistically as well as individually contribute to development of ACS.

Conclusions

High sweet food intake and low life satisfaction can act as independent risk factors for ACS through interactive mechanism. These data also highlight the importance of the role of positive psychological factor in cardiovascular health.
Health-related quality of life in outpatients with coronary heart disease: impact of type D personality, depression, anxiety and insomnia
Authors: Frojd L A F , Munkhaugen J M , Papageorgiou C P , Sverre E S , Moum T M , Dammen T D
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Drammen hospital, Vestre Viken trust.

Background

Health-related quality of life (HRQoL) is an important treatment target in patients with coronary heart disease (CHD) and associated with impaired prognosis. Therefore, knowledge about correlates of HRQoL may be of clinical importance. However, there is limited knowledge about how a comprehensive set of psychosocial factors, including type D personality, depression, anxiety, and insomnia influence HRQoL in CHD outpatients.

Purpose

To determine the relative associations of clinical and psychosocial factors with mental and physical HRQoL in a sample of Norwegian CHD outpatients.

Methods

This cross-sectional study included 1017 patients 2-36 (mean 16) months after hospitalisation for a coronary heart disease event (80% myocardial infarction). Data on HRQoL, psychosocial factors, coronary risk factors, comorbidity, and demographics were collected from self-report questionnaires, clinical examination with blood samples and hospital medical records. HRQoL was assessed using the Short Form 12 (SF12), which is a 12-item questionnaire comprising two subscales: Mental Component Scale (MCS) and Physical Component Scale (PCS). Type D personality, depression and anxiety, and insomnia were measured using the type D Scale 14 (DS14), Hospital Anxiety and Depression Scale (HADS), and the Bergen Insomnia Scale (BIS), respectively. Crude and multi-adjusted linear regression analyses were used to investigate the association between covariates and MCS and PCS, respectively.

Results

Mean age was 61 (SD 10) years, 20% were females, 18% had type D personality, 20% depression, 14% anxiety and 45% insomnia. Mean scores for SF12 subscales were 47.1 (6.0) for MCS and 38.5 (4.8) for PCS. Type D personality, symptoms of depression, and insomnia, but not anxiety, were negatively associated with MCS, but not PCS in multi-adjusted analyses. (Table). Chronic kidney disease was associated with reduced MCS, whereas chronic obstructive pulmonary disease and low physical activity were all negatively associated with PCS. Younger age was associated with poor MCS, whereas older age was associated with poor PCS.

Conclusions

This study found that HRQoL was low among Norwegian CHD outpatients. Type D personality, depressive symptoms, insomnia, and chronic kidney disease were the strongest correlates of the mental component of HRQoL. However, these variables were not significantly associated with the physical subscale of the SF12. Assessing and managing type D personality, depression, and insomnia among these group of CHD outpatients may improve HRQoL.
Including coronary artery calcium scores to guide treatment in a specialist lipid clinic setting
Authors: Mays H , Malone R , Nasa A , Salama S , Hennessy M , O'connor P , Kennedy C
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The Multi-Ethnic Study of Atherosclerosis demonstrated that coronary artery calcium (CAC) scoring has proven to be an effective tool at guiding lipid lowering therapy in patients with dyslipidaemia who are at risk of atherosclerotic cardiovascular disease (ASCVD) in the setting of a cohort study. The 2019 joint ESC/EAS dyslipidaemia guidelines identify a number of risk modifiers to stratify ASCVD risk from low to very-high including Lipoprotein (a) [Lp(a)] and the identification of familial hypercholesterolaemia (FH) mutations.

Purpose

1) To determine whether CAC scoring can improve the risk assessment of ASCVD in a lipid clinic setting and therefore act as a more effective guide for clinicians when implementing lipid lowering therapy. 2) To compare CAC scores in patients grouped by Lp(a) levels and FH mutations.

Methods

A retrospective cohort analysis of patients attending a specialist lipid clinic from July to December 2021 in a tertiary referral centre. Data was collected in July/August 2022. Patients were divided into two groups, those with a CAC score of 0 and greater than 0. Data collected included patient risk factors and modifiers as described in the 2019 joint ESC/EAS dyslipidaemia guidelines, serum Lp(a) levels and FH mutation status. Statistical analysis with SPSS software applied the Mann-Whitney and Chi Squared test.

Results

49.4% patients (n=41) had a CAC score of greater than 0. Of the patients classified as very-high risk, 91.3% (n=21) had a CAC score of greater than 0. For those classified as high risk, 26.5% (n=9) had a CAC score greater than 0. The mean Lp(a) plasma level was 124nmol/L for a CAC score of 0, compared to 249nmol/L for a CAC score of greater than 0 (U=562,p=0.02). 23 patients had FH mutations, of which 47.8% (n=11) had CAC scores of greater than 0 (χ2 = 2.15, p= 0.340).

Conclusion

This initial analysis describes CAC scores in patients attending a specialist lipid clinic classified by ASCVD risk and risk modifiers. It suggests CAC scores have a role, either additional or confirmatory, in ASCVD risk assessment. Further analysis is required to include additional risk modifiers, expand the cohort and preform a more granular stratification of the group by CAC score.
Benefits of 4-tiered classification of exercise-induced left ventricular hypertrophy in adolescent athletes
Authors: Szabo D , Eklics K , Szokodi I , Cziraki A , Toth M , Sarszegi Z S
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Innovation and Technology Ministry Hungary - National Research, Development and Innovation Office (Innovációs és Technológiai Minisztérium - Nemzeti Kutatási, Fejlesztési és Innovációs Hivatal Hungary.

Introduction

Exercise-induced left ventricular hypertrophy (LVH) is widely investigated in adolescent athletes characterized by 2-tiered classification (2TC). Though, the differentiation of normal adaptive changes from pathological LVH can be challenging. 4-tiered classification (4TC) may discriminate better different forms of exercise-induced LVH providing three-dimensional information of the left ventricle (LV).

Purpose, methods

The main objective of our study was to distinguish alterations between 2TC and 4TC examining 121 adolescent athletes with echocardiography. Moreover, these results were also compared to the matched LV parameters of 114 adult athletes.

Results

Examining the 4TC allocation representing parameters (LV mass, LV mass/BSA, LV end-diastolic volume/BSA, concentricity) of the adolescent and adult athletes we identified significant differences (p< 0,05) between the different LVH groups and normal geometry, suggesting that the applied classification provides proper group distinguishing power. There were no significant differences between the cumulative training times of the different LVH groups (p >0,05). Furthermore, the BSA corrected LV parameters did not show any correlation with training time. Totally 25 athletes (22%) were reclassified in 4TC into completely different groups, highlighted the 6 athletes (5%) reclassified from normal geometry to concentric LVH and the 11 adolescent (9%) reclassified from normal to eccentric LVH. The reclassifications rate showed similar pattern in adult athletes.

Conclusion

Based on all these data we assume that training time has no significant impact on the classification. Cardiac remodeling develops already in young age, and further training time has less impact on the adaptive changes. We prefer to apply 4TC in the routine echocardiographic examination of endurance athletes to specify a more sensitive and distinct screening method.
Aortic root and left ventricular diameters ratio: a new tool to differentiate the athlete's heart from pathological aortic dilatation
Authors: Ragazzoni G L , Cavigli L , Quer L , Cangiano N , Santoro A , Mandoli G E , Pastore M C , Focardi M , Cameli M , Valente S , D'ascenzi F
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Training-induced cardiac remodelling is usually accompanied by a harmonic and symmetric adaptation of cardiac chambers. Mild aortic enlargement may be a consequence of intense training, although even the definition of aortic dilatation, particularly in athletes and tall athletes, is sometimes challenging. It is therefore essential to early identify competitive athletes with aortic dilatation to manage this condition appropriately.

Purpose

This study aimed to test a new parameter for the definition of aortic dilatation in competitive athletes, assessing the balancing cardiac remodelling in athletes through the ratio between the aortic diameter and left ventricular (LV) diameter.

Methods

Competitive athletes were compared with sedentary subjects and with patients with known aortic dilatation. 1901 subjects who underwent echocardiography from 2019 to 2022 were retrospectively enrolled: 993 athletes (74% males, mean age 26±7 years), 410 sedentary (74.1% males, mean age 29±11 years) and 498 patients with aortic dilatation (74.3% males, mean age 56±7 years).

Results

Patients with aortic dilatation had both an absolute (39.2±2.4 mm) and indexed (19.4±2.2 mm/m2) aortic diameter larger than athletes (30.6±3.2 mm; 16.1±1.5 mm/m2) and sedentary subjects ( 30.5±3.1 mm; 16.5±1.6 mm/m2), with no statistically significant differences between athletes and sedentary subjects. The ratio between the aortic diameter and LV end-diastolic diameter was lower in athletes (0.59 ± 0.06), compared to sedentary subjects (0.65 ± 0.05) and to patients with aortic dilatation (0.81 ± 0.06). The latter had a significantly higher value than the remaining groups (p <0.05). The analysis of the ROC curves highlighted that the cut-off of the ratio between the aortic root diameter and LV diastolic diameter was 0.71, with a 96% sensitivity and 99% specificity of detecting a pathological aortic dilatation.

Conclusions

This study tested a new echocardiographic parameter for the definition of an aortic dilatation in competitive athletes. The ratio between aortic diameter and LV end-diastolic diameter, with a cut off of 0.71, demonstrated a good sensitivity and specificity to differentiate between physiological and pathological remodelling of the aorta.
Proteomics and recurrence of atrial fibrillation: a pilot study nested in the PREDIMAR trial
Authors: Razquin C , Fernandez-Irigoyen J , Barrio-Lopez M T , Ramos P , Macias R , Ibanez-Criado A , Santamaria E , Goni L , Castellanos E , Ibanez-Criado J L , Tercedor L , Garcia-Bolao I , Martinez-Gonzalez M A , Almendral J , Ruiz-Canela M
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III (ISCIII): Fondo de Investigación Sanitaria y Fondo Europeo de Desarrollo Regional and Proteored Regional Government of Navarra.

Introduction

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia worldwide. Although catheter ablation is the most efficacious therapy to decrease AF recurrences, relapses occur in 30% of patients in the first year after ablation. Novel biomarkers of recurrence are needed for a better prediction and management of AF.

Purpose

In this pilot study we aimed to analyze the baseline proteome of subjects included in a case-control study nested within the PREDIMAR, a secondary prevention trial, to find differential proteins associated with AF recurrence.

Methods

We selected 18 cases defined as AF recurrence and 18 controls without AF recurrence matched by age. After QC process, baseline serum proteomics data (354 proteins) from 16 cases and 17 controls were obtained.

Results

Ten proteins were differentially represented in cases vs controls. keratin type I cytoskeletal 17 (K17) (FC=2.14; p=0.017) and endoplasmic bifunctional protein (GDH/6PGL) (FC=1.65; p=0.032). Eight proteins were underregulated among cases vs controls: c4b-binding protein alpha chain (C4bpA) (FC=0.64; p=0.006), coagulation factor XI (FXI) (FC=0.83; p=0.011), chloride intracellular channel protein 1 (CLIC1) (FC=0.62; p=0.017), haptoglobin (FC=0.37; p=0.021), immunoglobulin heavy constant alpha 2 (Ig alpha-2 chain C region) (FC=0.49; p=0.022), c4b-binding protein beta chain (C4bpB) (FC=0.73; p=0.028), N-acetylglucosamine-1-phosphotransferase subunit gamma (GlcNAc-1-phosphotransferase subunit gamma) (FC=0.61; p=0.033) and platelet glycoprotein Ib alpha chain (GP-Ib alpha) (FC=0.84; p=0.038).

In multivariate logistic models, we found that even after the adjustment for age, sex, BMI, T2D and hypertension the direct association between K17 and the inverse association between C4bpA, F11, CLIC1, IGHA2, GNPTG and GP1BA with AF recurrence maintained the statistical significance.

F11, C4bpA, C4bpB and CLIC1 have been previously associated with first arrhythmia or AF.

This pilot study suggests that the circulating proteome may serve as a predictor of AF recurrence after catheter ablation.
Analysis of long-term cardiovascular outcomes of COVID-19. Artificial Intelligence model for risk evaluation
Authors: Hovornyan A , Ilashchuk T O
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The COVID-19 pandemic has caused a serious worldwide health crisis with wide-reaching consequences. According to current studies, COVID-19 may contribute to the emergence of various problems, including cardiovascular disorders [1-3]. However, there are currently no strategies for predicting the cardiovascular post-acute COVID-19 consequences, nor is there any scientific examination of these effects [3]. This knowledge gap must be filled in order to improve post-acute COVID-19 care [4].

Purpose

To conduct a 12-month follow-up longitudinal observation study to explore potential long-term cardiovascular outcomes of COVID-19 and develop an AI-based model to predict them.

Methods

We included 328 COVID-19 patients who were admitted to the hospital between February and April 2021. The average age of the studied population was 56.1, while 51% of the population was male. Patients with severe comorbidities, major adverse cardiovascular events (MACE) in anamnesis, and intra-hospital mortality were not included. After discharge, patients were monitored for 12 months. The data were randomly divided into derivation (n=201), validation (n=81), and external cohort (n=47). The obtained data include clinical data, results of laboratory and instrumental investigations, and medical records during the 1-year period. Our AI model is a convolutional neural network (CNN) consisting of sigmoid-activation-function neurons, trained by using outcome results, received in follow-ups, and evaluated on the external cohort.

Results

Due to the analysis of clinical data, higher levels of C-reactive protein, D-dimer, neutrophil/lymphocyte ratio, and lower levels of thyrotropin were associated with a higher 12-month risk of cardiovascular consequences. The longitudinal study showed that 16.4% of patients experienced MACE (8.5% - myocardial infarction, 5.2% - cerebrovascular disorders, 2.7% - pulmonary embolism) leading to cardiovascular death in 2.4% of the studied population. The total count of cardiovascular complications was 25.9% including first-detected hypertension, arrhythmias, heart failure etc.

The derivation and validation datasets were used for the training of the CNN. The ROC analysis indicated that our AI model had a high predictive value for cardiovascular events during follow-up (AUC=0.891, 95% CI=0.869–0.913, p<0.001, sensitivity 92.4%, specificity 90.1%). The external cohort data analysis showed accurate results in 41/47 patients (87.2% accuracy), which significantly outperformed any other known methods of cardiovascular outcomes prediction during 12 months after COVID-19.

Conclusions

Cardiovascular health in COVID-19 survivors needs special attention since COVID-19 is linked to an elevated risk of post-acute cardiovascular consequences. Long-term outcomes for COVID-19 can be predicted using AI-driven models.