bluuebunny/crossref_metadata_2025 huggingface dataset:
Frailty trajectories in three longitudinal studies of aging: Is the level or the rate of change more predictive of mortality?
Authors: Bai Ge , Szwajda Agnieszka , Wang Yunzhang , Li Xia , Bower Hannah , Karlsson Ida K , Johansson Boo , Dahl Aslan Anna K , Pedersen Nancy L , Hägg Sara , Jylhävä Juulia
Published: May 2021

Background

frailty shows an upward trajectory with age, and higher levels increase the risk of mortality. However, it is less known whether the shape of frailty trajectories differs by age at death or whether the rate of change in frailty is associated with mortality.

Objectives

to assess population frailty trajectories by age at death and to analyse whether the current level of the frailty index (FI) i.e. the most recent measurement or the person-specific rate of change is more predictive of mortality.

Methods

3,689 individuals from three population-based cohorts with up to 15 repeated measurements of the Rockwood frailty index were analysed. The FI trajectories were assessed by stratifying the sample into four age-at-death groups: <70, 70–80, 80–90 and >90 years. Generalised survival models were used in the survival analysis.

Results

the FI trajectories by age at death showed that those who died at <70 years had a steadily increasing trajectory throughout the 40 years before death, whereas those who died at the oldest ages only accrued deficits from age ~75 onwards. Higher level of FI was independently associated with increased risk of mortality (hazard ratio 1.68, 95% confidence interval 1.47–1.91), whereas the rate of change was no longer significant after accounting for the current FI level. The effect of the FI level did not weaken with time elapsed since the last measurement.

Conclusions

Frailty trajectories differ as a function of age-at-death category. The current level of FI is a stronger marker for risk stratification than the rate of change.
Efficacy of exercise-based interventions in preventing falls among community-dwelling older persons with cognitive impairment: is there enough evidence? An updated systematic review and meta-analysis
Authors: Li Fuzhong , Harmer Peter , Eckstrom Elizabeth , Ainsworth Barbara E , Fitzgerald Kathleen , Voit Jan , Chou Li-Shan , Welker Fei Li , Needham Shana
Published: May 2021

Objective

Exercise prevents falls in the general older population, but evidence is inconclusive for older adults living with cognitive impairment. We performed an updated systematic review and meta-analysis to assess the potential effectiveness of interventions for reducing falls in older persons with cognitive impairment.

Methods

PubMed, EMBASE, CINAHL, Scopus, CENTRAL and PEDro were searched from inception to 10 November 2020. We included randomised controlled trials (RCTs) that evaluated the effects of physical training compared to a control condition (usual care, waitlist, education, placebo control) on reducing falls among community-dwelling older adults with cognitive impairment (i.e. any stage of Alzheimer’s disease and related dementias, mild cognitive impairment).

Results

We identified and meta-analysed nine studies, published between 2013 and 2020, that included 12 comparisons (N = 1,411; mean age = 78 years; 56% women). Overall, in comparison to control, interventions produced a statistically significant reduction of approximately 30% in the rate of falls (incidence rate ratio = 0.70; 95% CI, 0.52-0.95). There was significant between-trial heterogeneity (I2 = 74%), with most trials (n = 6 studies [eight comparisons]) showing no reductions on fall rates. Subgroup analyses showed no differences in the fall rates by trial-level characteristics. Exercise-based interventions had no impact on reducing the number of fallers (relative risk = 1.01; 95% CI, 0.90–1.14). Concerns about risk of bias in these RCTs were noted, and the quality of evidence was rated as low.

Conclusions

The positive statistical findings on reducing fall rate in this meta-analysis were driven by a few studies. Therefore, current evidence is insufficient to inform evidence-based recommendations or treatment decisions for clinical practice.

PROSPERO Registration number: CRD42020202094.
The definition of sexual selection
Authors: Shuker David M , Kvarnemo Charlotta
Published: May 2021

Sexual selection is a key component of evolutionary biology. However, from the very formulation of sexual selection by Darwin, the nature and extent of sexual selection have been controversial. Recently, such controversy has led back to the fundamental question of just what sexual selection is. This has included how we incorporate female-female reproductive competition into sexual or natural selection. In this review, we do four things. First, we examine what we want a definition to do. Second, we define sexual selection: sexual selection is any selection that arises from fitness differences associated with nonrandom success in the competition for access to gametes for fertilization. An important outcome of this is that as mates often also offer access to resources, when those resources are the targets of the competition, rather than their gametes, the process should be considered natural rather than sexual selection. We believe this definition encapsulates both much of Darwin’s original thinking about sexual selection, and much of how contemporary biologists use the concept of sexual selection. Third, we address alternative definitions, focusing in some detail on the role of female reproductive competition. Fourth, we challenge our definition with a number of scenarios, for instance where natural and sexual selection may align (as in some forms of endurance rivalry), or where differential allocation means teasing apart how fecundity and access to gametes influence fitness. In conclusion, we emphasize that whilst the ecological realities of sexual selection are likely to be complex, the definition of sexual selection is rather simple.
DetectIS: a pipeline to rapidly detect exogenous DNA integration sites using DNA or RNA paired-end sequencing data
Authors: Grassi Luigi , Harris Claire , Zhu Jie , Hardman Colin , Hatton Diane
Published: May 2021

Motivation

Recombinant DNA technology is widely used for different applications in biology, medicine and bio-technology. Viral transduction and plasmid transfection are among the most frequently used techniques to generate recombinant cell lines. Many of these methods result in the random integration of the plasmid into the host genome. Rapid identification of the integration sites is highly desirable in order to characterize these engineered cell lines.

Results

We developed detectIS: a pipeline specifically designed to identify genomic integration sites of exogenous DNA, either a plasmid containing one or more transgenes or a virus. The pipeline is based on a Nextflow workflow combined with a Singularity image containing all the necessary software, ensuring high reproducibility and scalability of the analysis. We tested it on simulated datasets and RNA-seq data from a human sample infected with Hepatitis B virus. Comparisons with other state of the art tools show that our method can identify the integration site in different recombinant cell lines, with accurate results, lower computational demand and shorter execution times.

Availability and implementation

The Nextflow workflow, the Singularity image and a test dataset are available at https://github.com/AstraZeneca/detectIS.

Supplementary information

Supplementary data are available at Bioinformatics online.
‘All Watched Over by Machines of Loving Grace’1? Information technology, in-person relationships and normative regulation in an ‘integral cooperative’
Authors: Esteves Ana Margarida
Published: May 2021

On his study of the counterculture of the ‘60's and ’70's, Fred Turner argues that the application of systems-thinking and cybernetics to community-led initiatives (CLIs) makes them particularly vulnerable to internal factionalism and conflict, resulting from social and material pressures leading to the reproduction of mainstream norms and practices. Through the case study analysis of Cooperativa Integral Catalana (CIC) an “integral cooperative” for regional-level community development, this article explores how a governance strategy, combining online platforms for whole-system  regulation and local nodes based on in-person relationships, promotes forms of normative regulation that contain factionalism and centrifugal tendencies in community-led initiatives (CLIs). Fieldwork evidence indicates that the use of online platforms and alternative currencies for overall network regulation does not prevent the accumulation of power by a core group of “professionalized activists”. The lack of processes of socialization aimed at building a common “habitus” among members of the cooperative with distinct identities, backgrounds and motivations creates difficulties to the development of relationships based on trust, as well as obstacles to the overall management of the cooperative. However, the in-person relationships of proximity build in regional-level nodes created “micro-public spheres” of praxis-based, co-constructed normative regulation that prevented the escalation of internal conflicts to reach a point of rupture. Such relationships provided a “cushion” of resilience that allowed CIC to begin, at the time of fieldwork, a process of decentralization and simplification of its structure.
Direct Interhemispheric Cortical Communication via Thalamic Commissures: A New White-Matter Pathway in the Rodent Brain
Authors: Szczupak Diego , Iack Pamela Meneses , Liu Cirong ,   IRC5 Consortium, Tovar-Moll Fernanda , Lent Roberto , Silva Afonso C
Published: May 2021

The corpus callosum (CC), the anterior (AC), and the posterior (PC) commissures are the principal axonal fiber bundle pathways that allow bidirectional communication between the brain hemispheres. Here, we used the Allen mouse brain connectivity atlas and high-resolution diffusion-weighted MRI (DWI) to investigate interhemispheric fiber bundles in C57bl6/J mice, the most commonly used wild-type mouse model in biomedical research. We identified 1) commissural projections from the primary motor area through the AC to the contralateral hemisphere; and 2) intrathalamic interhemispheric fiber bundles from multiple regions in the frontal cortex to the contralateral thalamus. This is the first description of direct interhemispheric corticothalamic connectivity from the orbital cortex. We named these newly identified crossing points thalamic commissures. We also analyzed interhemispheric connectivity in the Balb/c mouse model of dysgenesis of the corpus callosum (CCD). Relative to C57bl6/J, Balb/c presented an atypical and smaller AC and weaker interhemispheric corticothalamic communication. These results redefine our understanding of interhemispheric brain communication. Specifically, they establish the thalamus as a regular hub for interhemispheric connectivity and encourage us to reinterpret brain plasticity in CCD as an altered balance between axonal reinforcement and pruning.
The SWEDEHEART secondary prevention and cardiac rehabilitation registry (SWEDEHEART CR registry)
Authors: Bäck Maria , Leosdottir Margret , Hagström Emil , Norhammar Anna , Hag Emma , Jernberg Tomas , Wallentin Lars , Lindahl Bertil , Hambraeus Kristina ,   for the SWEDEHEART study group
Published: May 2021

Aims

The quality registry SWEDEHEART covers data across the patient pathway after an acute myocardial infarction (MI), from hospital care to secondary prevention. Although cardiac rehabilitation (CR) is strongly recommended after an MI, there is still heterogeneity regarding standards, uptake, and adherence rates. The aim of the SWEDEHEART-CR registry is to provide continuous information on secondary prevention and CR performance to support the audit and development of evidence-based practice. To facilitate quality improvement and research initiatives, a description of the characteristics and development of the SWEDEHEART-CR registry is needed.

Methods and results

The SWEDEHEART-CR registry starts with data obtained during hospital care and then collects data at out-patient visits 2 months and 1-year after discharge, and at start and end of an exercise-based CR programme. The registry data covers comorbidities, biochemistry, blood pressure, anthropometric variables, medication, psychosocial- and lifestyle variables, readmissions, patient-reported outcome measures, attendance in CR-related programmes, and physical fitness variables. Over 100 000 patients with MI have been included in the SWEDEHEART-CR registry since its start in 2005. From initially covering 35 centres (47%) and 2200 patients annually (27%), SWEDEHEART-CR has developed to a nation-wide registry with 75 centres (100%) and 8800 patients annually (80%) in 2020.

Conclusion

The SWEDEHEART-CR registry includes a high proportion of the national MI population entering a CR programme and is a powerful tool for quality audit, improvement, and research. The registry provides insights into the characteristics, treatment, and outcomes of evidence-based secondary preventive practice, ultimately leading to better cardiovascular health.
Comparison and risk stratification of patients presenting with syncope in emergency department
Authors: Maqsood H , Younus S , Qazi S , Mazhar S , Ghaffar U , Basit A
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction :

Syncope is the sudden loss of consciousness, associated with an inability to maintain postural tone, with immediate and spontaneous recovery without requiring electrical or chemical cardioversion. It is a common condition associated with frequent hospitalization or visits to the emergency department. It has a prevalence of 40%, considering a lifetime of 70 years and an annual incidence of 6%. The prognosis after syncope ranges from relatively benign for vasovagal to poor for ventricular tachyarrhythmia, but invariably creates anxiety and potentially life-changing disruption demanding timely resolution Overall, morbidity and mortality in syncope patients are low, but 1-year mortality can reach significantly higher in certain subgroups.

Purpose :

To compare the mortality rates in men and women so that management of the disease and comorbidities can be done accordingly.

Methods :

Anyone who presented to the ED with transient loss of consciousness (TLOC) between 2015 and 2018 (n = 11,718) underwent evaluation for syncope. Initial evaluation included history, physical exam, orthostatic blood pressure, heart rate measurement and a 12-lead ECG with or without echocardiogram. All patients were followed up from their initial ED visit until either April 30, 2019, or death, whichever occurred first.

Results :

Among the patients who presented to the ED, 1,011 (8.62%) females and 1,391 (11.87%) males were admitted to inpatient facilities. The median age of females at the time of diagnosis was 49 years as compared to 54 years for males. Moreover, females had fewer comorbidities (67.9% with Charlson/Deyo comorbidity score of 0) as compared to males (61.8% with Charlson/Deyo comorbidity score of 0). At 30 days, among those admitted, females had a mortality rate of 2.2% vs. 5.1% for males, and among those discharged, females had a mortality rate of 0.1% vs. 0.6% for males (P < .001 for both). At 1 year, among those admitted, females had a mortality rate of 10.9% vs. 15.6% for males, and among those discharged, females had a mortality rate of 1.8% vs. 3.2% for males (P < .001 for both). All data were analyzed on SPSS version 20 and it was found that males had a 1.2 fold greater risk for death at 1 year compared to females.

Conclusion : By comparing the mortality rates of males and females presenting in the emergency department with syncope, we concluded that the mortality rate is higher in males. This finding will help us to manage the high-risk patients of syncope accordingly.
ECG markers of malignant arrhythmias risk in patients with arterial hypertension hospitalized for COVID-19 pneumonia
Authors: Novitskiy A , Popov K , Smirnova A , Shvarts Y
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction. Changes in the myocardium in patients with arterial hypertension (AH) can cause fatal arrhythmias. The effects of inflammation and drugs on the heart in COVID-19 pneumonia can also increase the risk of sudden arrhythmic death.

The aim of the paper is to study interrelationship of ECG markers of malignant arrhythmias and clinical and laboratory findings in patients with AH and COVID-19 pneumonia.

Methods. 48 patients with AH hospitalized for COVID-19 pneumonia (32 women aged 34 to 83, 16 men aged 48-80) were included in the study in October-November 2020. Exclusion criteria: congestive heart failure, previous myocardial infarction, reduced ejection fraction, valvular disease, life-threatening COVID-19 and other serious diseases. Main clinical characteristics and recommended laboratory findings were taken into account. Corrected QT and Tpeak-Tend were analyzed.

Results. The QTc fluctuations were from 353 ms to 494 ms. The QTc values were higher than normal in 28%. The QTc duration correlated with C-reactive protein level (Kendall R = 0.59) and NYHA class (Gamma = 0.48). The Tpeak-Tend value correlated with coronary heart disease (Gamma 0.65), C-reactive protein (Kendall R = 0.57) and taking dexamethasone (Gamma 0.44) and fluoroquinolones (Gamma 0.58). Multivariate analysis has showed that high level of C-reactive protein (Wald = 7.4) and the presence of heart failure (Wald = 5.2) were independent predictors of QTc increase. Coronary heart disease (Wald = 4,8) and taking respiratory fluoroquinolones (Wald= 3.7) were independent predictors of Tpeak-Tend increase. Age, SatO2, taking betablockers and other analyzed indicators were not significantly related to QTc and Tpeak-Tend.

Conclusion. Systemic inflammatory response, heart diseases and taking respiratory fluoroquinolones can adversely affect the myocardial repolarization indicators associated with the risk of sudden death in patients with AH hospitalized for COVID-19 pneumonia.
Sleep disorders in patients with overweight and acute and exacerbated chronic heart failure
Authors: Kalidjiev PK , Kinova E , Somleva D , Goudev A
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Medical University - Sofia University Hospital "Tsaritsa Yoanna – ISUL”

Background

 Often accompanying comorbidity in patients with heart failure and overweight is sleep disorders. Detection and treatment of sleep apnea will be helpful in these patients. 

Purpose

 To determine the phenotypic characteristics of sleep apnea in these patients. To determine whether there is a link between forms of sleep apnea and type of heart failure. 

Methods

Hospitalized 46 patients with acute and exacerbate heart failure. Measuring of NT proBNP. Sleep apnea screening with ApneaLink™. Echocardiographic assessment of left ventricular ejection fraction (LVEF) and the E/e‘ ratio. Statistical methods to compare independent samples and correlation analysis for linear dependence. 

Results

Of the 46 overweight patients with acute and exacerbated chronic heart failure, sleep apnea was diagnosed in 36 patients (78.2%). Of these, 83.3% (n = 30) have оbstructive sleep apnea (OSA) and 16.7% (n = 6) have central sleep apnea (CSA). There was a statistically significant difference in LVEF for the group with CSA (n = 6) vs group with OSA (n = 30) (41.67 ± 13.88 vs. 50.57 ± 8.16, p = 0.038). For diastolic function didn"t reach statistical significance for E/e" ratio (20,33 ± 5,00 vs. 17,06 ± 4,02, p = 0,089). Regarding NTproBNP, there is no significant difference between the groups with OSA and those with CSA (2978.5 ± 2664.1 vs. 2063.36 ± 1877.27 pg/ml, p = 0.316). There is a moderate negative correlation with LVEF and number of central sleep apnea events (r=-0,334, p = 0,047).

Conclusions

With greater frequency occurs obstructive sleep apnea. Left ventricular systolic function is lower in patients with central sleep apnea. There is a reverse correlation between ejection fraction and number of central apnea.
Impact of a cardiovascular rehabilitation program on frailty indicators in elderly patients with heart disease
Authors: Fonteles Ritt L , Matos E Oliveira F , Santos Pereira Ramos JV , Braga Linhares De Albuquerque R , Borges De Oliveira Q , Amoedo Da Costa Pinto D , Costa Claro T , Miura Feitosa C , Santos Gramacho M , Freitas Feitosa G , Sahade Darze E
Published: May 2021

Funding Acknowledgements

Type of funding sources: Private hospital(s). Main funding source(s): Hospital Cardio Pulmonar

INTRODUCTION

Frailty has been considered an important predictor of morbidity and mortality in elderly patients with cardiovascular disease. Cardiovascular Rehabilitation (CVR) has a direct and unequivocal effect on improving functional capacity in patients with heart disease, however, the effect of CVR on frailty indicators has not yet been well established. PURPOSE: To evaluate the association of the CVR program with frailty indicators in elderly patients with heart disease referred to a cardiovascular rehabilitation program and to identify possible predictors of improvement in frailty in this population. METHODS: Retrospective cohort with patients over 65 years old referred to an CVR program in Salvador-BA, Brazil from August / 2017 to March / 2020. Frailty was assessed using the Edmonton Frail Scale (EFS) at baseline and at least 3 months after the start of the program. Student"s t and Chi-square tests were used to compare continuous and categorical variables, respectively, logistic regression to analyze independent predictors of improvement in frailty and p <0.05 adopted as statistically significant. RESULTS: 51 patients were included, with a mean age of 75 ± 6 years, 65% men, 39 (77%) with coronary artery disease, 23 (50%) with heart failure, 21 (41%) with diabetes, 34 (67%) with hypertension and 41 (80%) dyslipidemia. According to the American Heart Association (AHA) risk stratification for exercise, 21 (49%) were risk B and 22 (51%) risk C. Regarding functional capacity, 12 (31%) were class I, 21 (41%) class II, 5 (13%) class III and 1 (3%) class IV according to the New York Heart Association (NYHA). The average initial ejection fraction was 53 ± 16%. The mean time between the two assessments was 5 ± 2 months and the improvement observed in maximum oxygen consumption (VO2 max) was from 15 ± 4 to 16 ± 4 mL.Kg-1.min-1 (p = 0.001). Regarding frailty, there was an improvement from 5.4 ± 2.0 to 4.8 ± 1.9 in the average of the EFS score (p = 0.034), with 25 patients (49%) being considered responders. This group was predominantly formed by men, non-diabetics, using statins, at risk B (AHA) and with a higher score on the quality of life score and on the EFS. However, in the multivariate analysis, only the highest score on the EFS (OR 1.8 CI 95% 1.06-3.3; p <0.05) and the lowest risk on the AHA scale (OR 0.18 CI 95% 0.03-0.97; p <0.05) remained as independent predictors of response. CONCLUSIONS: There was a significant improvement in the frailty of elderly patients referred for CVR, the higher the baseline frailty score, the greater the chance of response.
Frailty impairs the endothelial function of elderly with chronic heart failure
Authors: Karsten M , Rech DA , Silveira LS , Martins EM , Mortimer FM , Roque ABAO , Althoff A , Vieira AM
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Frailty has a high prevalence of heart failure (HF). It is believed that existing circulatory disturbance increase oxidative stress and chronic inflammation, predisposing to anabolic-catabolic imbalance. Thus, there is impairment of the efficient use of oxygen by skeletal muscles, limiting the physical-functional performance in these individuals. However, little is known about the influence of frailty on endothelial function in the elderly.

Purpose

To analyze the influence of frailty on endothelial function in the elderly with and without HF.

Methods

This was a descriptive cross-sectional study, which included individuals aged ≥60 years, with or without HF, who did not have diabetes, anemia, peripheral obstructive arterial disease and/or congenital heart disease. The Cardiovascular Health Study (CHS) frailty scale criteria were used to assess frailty (phenotype). Endothelial function at rest was evaluated by near-infrared spectroscopy ([NIRS]; slope 1, lowest tissue oxygen saturation [StO2], area under the curve [AUC] of StO2, slope 2, StO2 peak, overshoot, ΔStO2nadir_peak and Δtime nadir_peak) during arterial occlusion maneuver on the forearm. Results were grouped according to the frailty phenotype: robust, pre-frail and frail. Shapiro-Wilk test was used to assess the normality of data. Quantitative data were compared using a two-way analysis of variance plus Bonferroni post hoc test to determine the influence of the frailty or HF on endothelial function variables. A p-value <0.05 was considered statistically significant.

Results

Fifty-two elderly people (61% women) participated in the study, with a mean age of 70.3 ± 7.1 years. Of these, 52% (n = 27) had a diagnosis of HF. Among the sample, 35% (n = 18) were robust, 45% (n = 23) pre-frail, and 20% (n = 11) frail. Endothelial function analysis identified that there was an influence of frailty on reperfusion rate (slope 2 and ΔStO2 nadir-peak; p < 0.05) and desaturation during arterial occlusion (AUC StO2; p < 0.05) only in the HF group.

Conclusion

The coexistence of frailty and HF seems to impair endothelial function since frail elderly with HF had lower reperfusion rate and higher desaturation during the arterial occlusion test.

Abstract Figure. Endothelial function assessment by NIRS
Predictors of all-cause mortality within and beyond 1 year after an acute coronary syndrome
Authors: Zafeiropoulos S , Farmakis IT , Kartas A , Psarakis G , Kourti O , Tsolakidis C , Konstantas O , Touriki A , Baroutidou A , Vrana E , Graidis S , Psathas T , Miyara SJ , Karvounis H , Giannakoulas G
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Patients discharged after an acute coronary syndrome (ACS) have substantial mortality risk, especially during the first year.

Purpose

To determine differences between first year and long-term all-cause mortality of patients after an ACS and identify its risk predictors.

Methods

This is a post-hoc analysis of the baseline data from 360 patients after ACS with a median follow up 3.2 years (IQR: 2.5-3.8) that enrolled in a prospective randomized controlled trial. Mortality rates with 95% confidence intervals (CIs) were estimated by Kaplan–Meier method. Multivariate Cox proportional hazards regression analyses of clinical parameters and cardiac biomarkers were performed to identify predictors for all-cause mortality within first year and thereafter.

Results

In our cohort, all-cause mortality incidence per 100 person-years at risk within and after first year was 4.9 and 2.1, respectively (RR = 2.3, p < 0.001). Notably, 83% of the deaths during the first year were attributed to any cardiovascular cause, dropped to 50% after the first year. Baseline NT-proBNP value and prior myocardial infarction were the main independent predictors of all-cause mortality for both first year and beyond time periods (Table 1). Οn the contrary, severe chronic kidney disease lost predictive power after 1 year.

Conclusion

We observed higher all-cause mortality rate during the first year, mainly driven by cardiovascular death. History of myocardial infarction and baseline NT-proBNP levels outperformed any other clinical variable or biomarker for long-term all-cause mortality in  post-ACS patients.

Predictors of long-term all-cause death Variables Univariate analysis Multivariate analysis HR (95% CI) P-value HR (95% CI) P-value Age per 1-year increase 1.06 (1.03 - 1.10) <0.001 1.02 (0.99 - 1.06) 0.11 Female 1.07 (0.79 - 3.71) 0.17 HTN 2.52 (1.14 - 5.63) 0.02 Diabetes 2.06 (1.03 - 4.15) 0.04 CKD IV or V 9.01 (3.89 - 20.86) <0.001 0.88 (0.26 - 2.95) 0.83 History of MI 0.55 (0.26 - 1.17) 0.001 3.28 (1.05 - 7.17) 0.002 HFrEF 1.25 (0.51 - 3.04) 0.62 Family history of CAD 0.55 (0.26 - 1.17) 0.12 NT-proBNP* 1.92 (1.46 - 2.51) <0.001 1.70 (1.22 - 2.36) 0.001 hs-cTnT* 1.15 (0.91 - 1.44) 0.27 LDL-C 0.99 (0.98 - 1.00) 0.22 *Natural logarithms

Abstract Figure. Kaplan-Meier for all-cause mortality
Gender differences in patients presenting with NSTEMI in the STAR registry
Authors: Meer A , Kinsara A
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

 In most acute coronary artery (ACS) related literature, the female gender constitutes a smaller proportion compared to the male gender. The presentation of ACS in females is frequently atypical, causing a delay in diagnosis and management. This study is based on gender-specific data in the Saudi Acute Myocardial Infarction Registry Program (STARS-1 Program).

Methods

 A prospective multicenter study, conducted with patients diagnosed with ACS in 50 participating hospitals.

Results

 In total, 762 (34.12%) patients were diagnosed with Non ST segment Elevation Myocardial infarction Of this group, only 164 (21.52%) were women. The mean age of the female group (64.52 ± 12.56 years) was older and the mean body mass index (BMI) was higher (30.58 ± 6.23) than the male group. A significantly higher proportion of the female group was diabetic or hypertensive, however, a smaller proportion was smoking. Hyperlipidemia was not significant between the two groups, although present in almost half (48%) of the female group. The history of angina/MI/stroke and revascularization was similar, except for renal impairment. The presentation was atypical compared to the male group as only 70% presented with chest pain, and the rest with shortness of breath or epigastric pain. At presentation, the female group were more tachycardiac, had higher blood pressure, and a higher incidence of being in class 11-111 Killip heart failure. Only 32% had a normal systolic function, and the majority had either mild or moderate systolic dysfunction.

Guideline directed medical therapy were not different between the two groups, except for the initiation of a beta-blocker on admission. In particular, the rate of percutaneous coronary intervention (PCI) was similar. Overall, the in-hospital mortality was similar (5%), with more women diagnosed with atrial fibrillation and heart failure at follow-up. Conclusion: Women had a higher prevalence of risk factors affecting the presentation and morbidity but not mortality. Improving these risk factors and the lifestyle is a priority to improve the outcome and decrease morbidity.
Cardiovascular risk factors as predictors of heart failure during hospitalization for Acute Coronary Syndromes
Authors: Santos H , Santos M , Almeida I , Miranda H , Sa C , Chin J , Almeida S , Sousa C , Almeida L
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

Portuguese Registry of Acute Coronary Syndromes

Background

Cardiovascular risk factors (CVRF) are a growing health problem in developed countries. These patients have a higher prevalence of acute coronary syndromes (ACS) and as a consequence ACS complication, like heart failure (HF). HF after an ACS is a common complication and CVFR can influence its manifestation.

Objective

Evaluate the impact of the CVRF in HF during the hospitalization for ACS.

Methods

Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Patients were divided in two groups: A – without new onset of HF during the hospitalization for ACS and B – with new onset of HF during the hospitalization for ACS. CVFR was defined by body mass index, diabetes, arterial hypertension, smoking, neoplasia, dyslipidemia, coronary artery disease, chronic kidney disease and peripheral arterial disease. Logistic regression was performed to assess predictors of new onset HF in these patients.

Results

14717 patients were included, 2287 in group B (15.5%). Both groups were similar regarding body mass index (27.5 ± 4.3 vs 27.2 ± 4.4, p = 0.254). Curiously the group A exhibited higher prevalence of smoking status (29.8 vs 16.6%, p < 0.001). On the other hand, group B presented more females (25.0 vs 35.7%, p < 0.001), arterial hypertension (68.7 vs 78.2%, p < 0.001), diabetes mellitus (28.5 vs 43.1%, p < 0.001), dyslipidemia (62.2 vs 64.3%, p = 0.023), coronary artery disease (19.6 vs 25.6%, p < 0.001), neoplasia (4.4 vs 7.0%, p < 0.001), peripheral arterial disease (5.2 vs 15.8%, p < 0.001) and chronic kidney disease (4.6 vs 10.0%, p < 0.001). Logistic regression revealed that body mass index, diabetes, arterial hypertension, neoplasia and dyslipidemia were not predictors of HF during the hospitalization for ACS. Nevertheless, female gender (odds ratio (OR) 1.37, p < 0.001, confidence interval (CI) 1.22-1.54), chronic kidney disease (OR 1.59, p < 0.001, CI 1.33-1.90) and peripheral arterial disease (OR 1.54, p < 0.001, CI 1.27-1.86) were predictors of new onset of HF during hospitalization for ACS. Curiously, smoking seems to have a protective effect (OR 0.68, p < 0.001, CI 0.59-0.78) in new onset HF in ACS patients.

Conclusions

Chronic kidney disease and peripheral arterial disease were predictors of new onset of HF in during hospitalization for ACS.
Heart failure in patients with non ST elevation acute coronary syndromes: clinical landscape, predictors and in-hospital outcomes
Authors: Dakhil ZA , Farhan HASAN
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Heart failure(HF) in patients with NSTE-ACS is associated with high mortality and morbidity, it is needed to identify patients who are at risk for developing this complication to guide the management strategy. Little is known about patientsꞌ baseline characteristics and predictors of HF complicating NSTE-ACS particularly in Middle East.

Purpose

To determine the prevalence of heart failure in NSTE-ACs and to study its predictors and in-hospital outcomes.

Methods

The study prospectively included admitted patients with NSTE-ACS and identified those who developed HF during index hospitalization. HF is defined in this study as either clinical HF (KILLIP class≥2) or by echocardiographic evidence of left ventricular dysfunction (EF < 50%). Patients data were collected including demographics and investigation results. Predictors of clinical HF during hospitalization were evaluated using multivariate regression analysis. Besides HF; other In- hospital outcomes including death or stroke were recorded.

Results

A total of 280 patients with NSTE-ACS were enrolled in the study, among whom 96 patients (34.28%) had evidence of HF during hospitalization (either clinical or echocardiographic), clinical HF (KILLIP class≥2) was evident in 55 patients (56.25%). Baseline characteristics of patients with HF were as following: males (78.2%) and females (21.8%), they had HT, IHD, DM and smoking in 67.77%, 65.56%, 56.2% and 27% respectively, history of prior revascularization (PCI or CABG) reported in 21.8%. At presentation: Dyspnoea reported in 56.25%, mean HR was 89.3 ± 22.6, mean SBP was 135.78 ± 25.05. Serum troponin was positive in 56.25%, mean EF was 40.64 ± 6.9, preserved EF with clinical evidence of HF recorded in 7.29%. Main predictors of clinical HF (KILLIP class≥2) during index hospitalization were dyspnoea at presentation, EF < 50%, high GRACE risk score >140. Main arrhythmia reported in HF patients were AF in 10.4%, frequent PVCs in 7.29%, VT/VF in 4.16% CHB in 1.04%. In-hospital mortality of HF patients was 4.16% and stroke developed in 2.08% of patients.

Conclusion

Heart failure in the context of NSTE-ACS tend to occur in patients with other comorbidities like hypertension and prior IHD and in those with higher risk class at presentation. Looking forward; particularly in emerging countries; further researches are crucial to provide predictors for early recognition of those at higher risk for this complication and to guide therapy plan accordingly in order to optimise patientsꞌ outcomes.

Abstract Figure.
Impact of morphine use on mortality in STEMI patients treated with primary PCI - preliminary data from a new registry
Authors: Szabo D , Szabo A , Edes IF , Becker D , Merkely B , Hizoh I
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Opioids decrease the effect of P2Y12 receptor inhibitors in vitro and observational reports suggest that morphine use is associated with larger infarct size. Our research group presented previously, using a prospective single-center registry, that periprocedural morphine use may have no impact on long-term mortality in STEMI patients treated with primary PCI and clopidogrel.

Purpose

Our purpose is to check this interaction using a new registry of patients treated according to the current guidelines, including novel antiplatelet agents.

Methods

From May until November 2020, we collected 196 STEMI patients treated with primary PCI. 88 (44.9%) of them got morphine during the prehospital and periprocedural care. Baseline demographic, anamnestic, procedural, and laboratory data were collected. Survival data were analysed using Kaplan-Meier survival curves and the log-rank test. To adjust for confounding, a 1:1 propensity score-matching analysis was performed using 114 cases.

Results

An adequate balance on baseline covariates was achieved during propensity score-matching. Kaplan-Meier analysis showed no difference in 30-days mortality of the patients treated with or without morphine neither in the original nor in the propensity score-matched population (p = 0.094 and p = 0.309, respectively).

Conclusion

Our preliminary data suggest that morphine may have no impact on mortality in STEMI patients treated with primary PCI and medical therapy according to the current guidelines including novel P2Y12 antagonists.

Abstract Figure. Kaplan-Meier curves
Rehabilitation after myocardial infarction by using of biofeedback training, controlled by capnometry
Authors: Leonova I , Yarmosh I , Boldueva S , Suvorov N , Sergeev T
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

The increasing activity of the sympathetic nervous system was shown during myocardial infarction (MI). There are data that bio management application increases the vagal influences on a heart rate for patients with chronic coronary artery disease.

 The purpose of this study was the assessment of changes of vegetative regulation of heart rate in patients with MI, receiving along with standard methods of treatment and rehabilitation sessions of cardiorespiratory training (KRT).

 48 patients with IM in an early period of disease at the age from 40 till 70 years were surveyed. The main group was created from 29 people by whom KRT (5–10 sessions) was carried out. The assessment of efficiency and safety of KRT was carried out on a clinical picture and parameters of heart rate variability (HRV) before, after, and during KRT. The Control group consisted of 19 patients receiving only standard treatment. To exclude hyperventilation syndrome, capnometry was performed before the start of the KRT session to determine the FetCO2 individual norm for the certain patient to control the training process in a particular session. After each active sample, the concentration of carbon dioxide in the air exhaled by the patient was measured, and when it decreased below 95% of the initial value, the depth of breathing was adjusted. The use of capnometry in the study avoided adverse events during the sessions.

 During carrying out of KRT, and after KRT worsening of the clinical picture at patients of the main group was not observed. HRV analysis at patients of the main group showed that after the end of KRT decrease in an index of tension (p < 0,05), an increase in an indicator of the general dispersion of heart rate (p < 0,05), and also a tendency to increase of vagal part of total power during spectral analysis (р=0,05) was observed. Normalization of heart rate and arterial pressure, growth of cardiorespiratory index, and index of a variation took place, cardiorespiratory synchronization was restored. Persons from the control group had no such changes.

 Thus, the application of KRT realizing a mode of functional bio management of heart rate, as the instrument of psychophysiological support of standard medicament therapy showed the efficiency of its use in the program of rehabilitation of patients with myocardial infarction. The result of a comprehensive approach is the reduction of sympathetic and increase of vagal influences on heart rate, normalization of the main indicators of the cardiovascular system.
Efficacy and safety of doxycycline for the management of small abdominal aortic aneurysms- a meta analysis
Authors: Abdul Razzack A , Rocha Castellanos D , Lopez Mendez A , Fernando Perez Paz M , Pothuru S , Pusa M , Patel V , Sattar Y
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background- Patients with small Abdominal Aortic Aneurysms are managed with surveillance as there is currently insufficient evidence to recommend surgical aneurysm repair. Hence, there is a dire need and interest in pharmacotherapy like tetracycline antibiotics to reduce the need for aneurysm repair.

Purpose- To determine the efficacy and safety of doxycycline in the management of small abdominal aortic aneurysms.

Methods- Electronic databases (PubMed, Scopus, Embase, Cochrane) were searched until 25th November 2020.The primary outcomes were the mean difference (MD) in aneurysm diameter and the odds ratio (OR) calculated to compare the number of individuals referred to Abdominal aortic aneurysm repair in each group.

Results- A total of three studies with 572 participants (Doxycycline = 290; Placebo = 282 ) were included in our analysis. Average follow up was a period of 18 months. For AAA expansion, the combined results demonstrated a statistically significant mean difference in expansion rates favoring the placebo groups over the intervention (WMD-0.75, 95%CI 0.12-1.38; p = 0.02;I2 = 0%) There was no statistically significant difference in the efficacy and safety of doxycycline as opposed to placebo groups for referral to AAA surgery (OR 1.01, 95%CI 0.61-1.69; p = 0.96, I2 = 0%) and all-cause mortality(OR 0.51; 95%CI 0.18-1.43; p = 0.20, I2 =0%)

Conclusion- Amongst patients with small abdominal aortic aneurysms, doxycycline did not significantly reduce aneurysm growth.

Abstract Figure. A) AAA expansion B)Surgery C)Mortality
The use of Near-Infrared Spectroscopy to evaluate the effect of exercise on peripheral muscle oxygenation in patients with lower-extremity artery disease: a systematic review
Authors: Cornelis N , Chatzinikolaou P , Buys R , Fourneau I , Claes J , Cornelissen V
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Near-Infrared Spectroscopy (NIRS) has been suggested as a new diagnostic tool in patients with lower-extremity artery disease (LEAD). The aim of this systematic review was i) to summarize the impact of exercise therapy on lower-limb muscle oxygenation, evaluated by means of NIRS, in patients with LEAD and ii) to give an overview on NIRS instruments and methodology.

Methods

A systematic search was conducted in MEDLINE and Embase, from the earliest date available until 16th of March 2020, to identify peer-reviewed studies involving the use of NIRS in the evaluation of exercise training on muscle oxygenation in patients with LEAD. Primary outcomes were NIRS-derived variables. Effect sizes were calculated as standardized mean differences. Assessment of methodological quality was done using a combined checklist from the Cochrane bias and the quality assessment tool for before-after studies without control group.

Results

Eleven original trials were included involving 16 exercise groups and 4 control groups. Tissue saturation index (TSI) at rest remained unchanged following the exercise interventions. Yet, exercise training increased time-to-minimum TSI during exercise (range effect sizes: +0.172 to +0.927). In addition, exercise training led to a faster recovery to half and full TSI rest values in most intervention groups (range effect sizes: -0.046 to -0.558 and -0.269 to -0.665 respectively). Finally, NIRS data reproducibility and analytic methods were underreported in the included studies. To illustrate, only four studies reported appropriate measures to ensure repeated reproducible probe positioning. The use of raw or filtered data for analysis was reported in none of the included articles.

Conclusion

The available NIRS data suggest that exercise training improves deoxygenation and reoxygenation patterns in patients with LEAD. Whereas NIRS is a promising tool in the evaluation of LEAD, the low number of RCT’s as well as large heterogeneity in NIRS assessment methods, outcome measures and instrumentation, warrants more research to better understand the role of muscle oxygenation associated with exercise-induced improvements in walking capacity. In particular the role of NIRS to study underlying mechanisms and determinants related to exercise progression in LEAD patients is appealing.

Abstract Figure. NIRS during treadmill test
Identification, risk stratification and prognostication of stroke by detection of intra-carotid plaque hemorrhage
Authors: Maqsood H , Younus S , Saim M , Qazi S , Basit A , Shakeel HA
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Atherosclerotic stenosis of the internal carotid artery is present in 1% to 2% of the adult population and is the cause of  10% to 15% of ischemic strokes. Intra-plaque hemorrhage (IPH) in carotid stenosis increases the risk of cerebrovascular events. Magnetic resonance imaging can be used to detect pathologies like IPH and necrosis in carotid stenosis.

Purpose :

This study sought to compare the risk of stroke between patients with carotid artery disease with and without the presence of intraplaque hemorrhage (IPH) on magnetic resonance imaging.

Methods :

In this meta-analysis we gathered the data from 10 original cohort studies including 631 patients with symptomatic carotid stenosis and 157 patients with asymptomatic carotid stenosis. Primary outcome was the hazards of ipsilateral ischemic stroke which were compared between patients with and without IPH.

Results :

IPH was present in 57.1% of patients with symptomatic carotid stenosis and 24.7% of patients with asymptomatic carotid stenosis. During 1,334 observed person-years, 74 ipsilateral strokes occurred. Presence of IPH at baseline increased the risk of ipsilateral stroke both in symptomatic (hazard ratio [HR]: 11.7; 95% confidence interval [CI]: 4.7 to 22.8) and asymptomatic (HR: 6.8; 95% CI: 0.9 to 45.4) patients. Multivariate analysis identified IPH (HR: 11.7; 95% CI: 5.3 to 26.4) and severe degree of stenosis (HR: 3.8; 95% CI: 02 to 8.2) as independent predictors of ipsilateral stroke.

Conclusion : Our study concludes that IPH is common in patients with carotid artery stenosis and is a stronger predictor of stroke. Magnetic resonance imaging is the modality that can help in identification of patients with carotid disease who would benefit from revascularization.