bluuebunny/crossref_metadata_2025 huggingface dataset:
Left bundle branch area pacing results in more physiological ventricular activation than biventricular pacing in patients with left bundle branch block heart failure
Authors: Sussenbek Ondrej , Rademakers Leonard , Waldauf Petr , Jurak Pavel , Smisek Radovan , Stros Petr , Poviser Lukas , Vesela Jana , Plesinger Filip , Halamek Josef , Leinveber Pavel , Herman Dalibor , Osmancik Pavel , Curila Karol
Published: May 2023

Biventricular pacing (Biv) and left bundle branch area pacing (LBBAP) are methods of cardiac resynchronization therapy (CRT). Currently, little is known about how they differ in terms of ventricular activation. This study compared ventricular activation patterns in left bundle branch block (LBBB) heart failure patients using an ultra-high-frequency electrocardiography (UHF-ECG). This was a retrospective analysis including 80 CRT patients from two centres. UHF-ECG data were obtained during LBBB, LBBAP, and Biv. Left bundle branch area pacing patients were divided into non-selective left bundle branch pacing (NSLBBP) or left ventricular septal pacing (LVSP) and into groups with V6 R-wave peak times (V6RWPT) < 90 ms and ≥ 90 ms. Calculated parameters were: e-DYS (time difference between the first and last activation in V1–V8 leads) and Vdmean (average of V1–V8 local depolarization durations). In LBBB patients (n = 80) indicated for CRT, spontaneous rhythms were compared with Biv (39) and LBBAP rhythms (64). Although both Biv and LBBAP significantly reduced QRS duration (QRSd) compared with LBBB (from 172 to 148 and 152 ms, respectively, both P < 0.001), the difference between them was not significant (P = 0.2). Left bundle branch area pacing led to shorter e-DYS (24 ms) than Biv (33 ms; P = 0.008) and shorter Vdmean (53 vs. 59 ms; P = 0.003). No differences in QRSd, e-DYS, or Vdmean were found between NSLBBP, LVSP, and LBBAP with paced V6RWPTs < 90 and ≥ 90 ms. Both Biv CRT and LBBAP significantly reduce ventricular dyssynchrony in CRT patients with LBBB. Left bundle branch area pacing is associated with more physiological ventricular activation.
Variables determining higher health care effectiveness in patients with cardiovascular disease
Authors: Kurpas D , Szlenk-Czyczerska E
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

The projected incidence of cardiovascular disease and the aging population (deaths from cardiovascular disease increase after age 50) are expected to increase in the coming years. It is therefore imperative to improve health care for patients with CVD in primary care.

Objective

The aim of this study was to analyze the variables that influence the efficiency of health care delivery, which is synonymous with high quality of life, intensification of health behaviors, and high satisfaction of needs in patients with chronic cardiovascular disease.

Methods

The study was conducted on 157 patients with chronic cardiovascular disease who came to a follow-up appointment with a general practitioner. The WHOQOL-BREF Quality of Life Questionnaire, the Health Behavior Inventory Questionnaire (HBI), the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS), and the Hospital Anxiety and Depression Scale-Modified Version (HADS-M) were used for the study. The Wilcoxon test and Fisher's exact test, as well as Spearman's rank correlation coefficient and logistic regression, were used for the analyzes.

Results

Analysis of patients revealed an association between home care effectiveness and the following variables (OR per unit): age (OR = 0.96, 95% CI: 0.92-0.99), educational level (OR = 1.45, 95% CI: 1.13-1.91), financial status (OR = 0.98, 95% CI: 0.20-0.89), assessment of physical well-being (OR = 2.60, 95% CI: 1.29-5.65), improvement in psychological well-being after a nurse visit (OR = 1.36, 95% CI: 0.00-0.17), and medication irregularity (OR = 0.30, 95% CI: 0.09-0.86). There was no association between effectiveness of care and duration of cardiovascular disease (p = 0.149), number of visits to a cardiology clinic (p = 0.414), number of visits to a PHC (p = 0.223), interventions by a family nurse practitioner (p = 0.075), and health care services provided by a physician such as ae.g., medical interview (p = 0.064), physical examination (p = 0.731), blood pressure measurement (p = 0.558).

Conclusions

Patients with CVD characterized by lower educational status, poorer financial status, poorer self-perception of physical well-being, expectation that the GP will provide information about disease progression, expectation that a social worker will provide information about the possibility of receiving social services, and the expectation that the family nurse would be more accessible when needed, as well as being characterized by irregular medication adherence and nonadherence to good eating habits, were much more likely to receive worse health care. Patients with cardiovascular disease can be well supported in primary care settings as long as the model of care is tailored to their specific needs. This includes care coordination within the health care team, home care, and support from general practice.
The kinocardiograph for assessment of fluid status in patients with acute decompensated heart failure
Authors: Herkert C , De Lathauwer I , Van Leunen M , Spee R F , Balali P , Migeotte P F , Hossein A , Yuan L , Kemps H M C
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Aims

To improve telemonitoring strategies in heart failure patients, there is a need for novel non-obtrusive sensors which monitor parameters closely related to intracardiac filling pressures. This proof-of-concept study aims to evaluate the responsiveness of cardiac kinetic energy (KE) measured with the Kinocardiograph (KCG), consisting of a seismocardiographic (SCG) sensor and a ballistocardiographic (BCG) sensor, during treatment of patients with acute decompensated heart failure (ADHF).

Methods

Eleven patients with ADHF who were hospitalized for treatment with intravenous diuretics, received daily KCG measurements. The KCG measurements were compared to the diameter of the inferior vena cava (IVC) and body weight. Follow-up stopped at discharge, i.e. in the recompensated state.

Results

Median (IQR) weight and IVC diameter decreased significantly after diuretic treatment (weight 74.5 (67.6–98.7) to 73.3 (66.7-95.6) kg, p=0.003; IVC diameter 2.47 (2.33–2.99) to 1.78 (1.65–2.47) cm, p=0.03). In contrast with BCG measurements, significant changes in median KE measured with SCG were observed during the passive filling phase of the diastole (0.48 (0.39–0.60) to 0.69 (0.56-0.84), p=0.026), the active filling phase of the diastole (0.38 (0.30–0.61) to 0.31 (0.09–0.47), p=0.016)) and the ratio between the passive and active filling phase (2.76 (1.68–5.30) to 5.02 (3.13–10.17), p=0.006). Systolic KE did not show significant changes.

Conclusion

KE measured with the KCG using SCG is highly responsive to changes in fluid status. Future research is needed to confirm its accuracy in a larger study population, and specifically its application for detection of clinical deterioration in the home-environment.
Variation in complexity weight values for heart failure admissions: the impact of COVID-19 situation
Authors: Del Castillo-Carnevali H , Sahuquillo A , Ripoll T , Torres J , Alvarez J , Cremer D , Coto B , Gamez J M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

COVID-19 outbreak nudged worldwide health systems to reallocate resources from from other areas to help fighting against this novel infectious disease. Consequently, accuracy and quality care of cardiovascular patients was partially compromised. Moreover, fear to get to hospital made patients to stay home despite the presence of symptoms that would have led them to search medical aid in other scenarios.

Aim

We aimed to demonstrate that heart failure admissions after the outbreak were more complex in term of coding compared to those previous to pandemic situation.

Methods

We analyzed complexity coding weight parameters (according to current Spanish Coding manual CIE-10)obtained from local healthcare authorities of 1479 admissions from Balearic Islands Region from January 2019 to December 2021. Admissions with higher coding value were considered more complex. We performed an interrupted time series using pre pandemic admissions as a control group.

Results

2020 showed a lower number of admissions (468), specially form March to June compared to 2019 (499) and 2021. Coding weight values, trend and comparison are showed in figures.

Conclusions

Number of heart failure admissions were reduced in 2020, being it complexity mildly higher compared to 2019 and 2021. Further analysis with data from other regions would be useful to confirm this trend in the whole country.
Maximal functional capacity in subjects with isolated left bundle branch block: a pilot study
Authors: Minguez S , Dominguez E , Mendez J , Iraola D , Albiach C , Gasull A , Lara R , Palau Sampio P
Published: May 2023

Funding Acknowledgements

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

Background

Left bundle branch block (LBBB) has been commonly associated with adverse cardiovascular (CV) events, but the effect of an isolated LBBB on maximal functional capacity is not well characterized.

Purpose

To evaluate maximal functional capacity in adults with isolated LBBB and compare it to healthy population-derived predicted values (adjusted for sex, age, weight, and height).

Methods

This descriptive pilot study included subjects with isolated LBBB derived from outpatient clinics of two academic hospitals. All subjects underwent maximal cardiopulmonary exercise testing (CPET) and a Global Physical Activity Questionnaire (GPAQ). The primary endpoint was to evaluate maximal functional capacity according to population-derived predicted values of peak oxygen consumption (peakVO2): pp-peakVO2. The secondary endpoint was to evaluate adverse CV events (CV deaths or hospitalizations) at follow-up.

Results

A total of 27 (18 women and 9 men) participants were included. The median (interquartile range) age of the sample and time to screening from the first LBBB diagnosis were 62 (51-71) and 3.4 (1.1-8.4) years, respectively. The results of the GPAQ score showed that 19 patients were highly active, and 8 were moderately active. The median of peakVO2 and pp-peakVO2 were 19.3 (15-22.5) mL/kg/min and 88 (79.3-104.4) %, respectively. There were no adverse CV events at a median follow-up after CPET of 3.1 (2.7-3.4) years.

Conclusion

In this pilot study, adults with isolated LBBB showed reduced maximal functional capacity, despite the absence of cardiac disease and a baseline moderate to highly active lifestyle.
Diagnostic yield in national team football players
Authors: Abela M , Mckean D , Micallef Stafrace K , Zammit Montebello J , Cremona C
Published: May 2023

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Malta Football Association.

Introduction

Sudden cardiac death (SCD) is an important cause of morbidity in competitive athletes. Pre-participation evaluation (PPE) is mandatory for most sporting organisations. The ECG plays a very important diagnostic role and is included in most screening algorithms. PPE for athletes ≥14 years registered with the National Football Association is now mandatory.

Study objectives: The objective of this study was to assess the diagnostic yield of PPE in a group of elite Maltese football players competing at national level.

Methodology

Players selected at national level (years 2020-2022) underwent PPE (history, physical examination, and resting ECG). Senior team players also underwent echocardiography (biannually) as per regulations. Data was tabulated and analyzed in Microsoft Excel.

Results

300 athletes (69% male) were selected in this timeframe. 10.6% (n=32) required referral for secondary evaluation, equating to 1 in 11 athletes screened. Referrals were more frequent in male vs female athletes (22.1% vs 10.2%, p=0.005). Most referrals were from the men’s senior’s squad (22.5%), followed by the men’s U17 squad (21.7%) and 20% of the men’s U15 team.

The ECG was the commonest reason for referral to a sports cardiologist (n=23, 71.8%). The commonest abnormal ECG patterns included anterior TWI (n=9, 3.0%), inferior/lateral TWI (n=6, 2.0%) and WPW (n=2, 0.7%).

108 (36.0%) had echocardiography as a first line screening modality. This was abnormal in a fifth of those referred (n=7, 21.9%), 4 of these had a normal ECG.

3 (1.0%) athletes were diagnosed with a condition linked to SCD (n=2 WPW, n=1 HCM). Another 5 (1.7%) athletes were diagnosed with a cardiac disorder (n=1 left ventricular outflow tract ectopy, n=1 dilated aortic root, n=1 aortic regurgitation, n=1 atrial septal defect, n=1 mitral regurgitation). Echocardiography doubled the diagnostic yield (1.3% vs 2.7%), with 3 athletes having otherwise a normal history, physical examination and ECG. 1 in 38 athletes (2.7%) were given a cardiac diagnosis, 1 in 100 athletes (1.0%) were labelled with a condition linked to SCD.

Conclusion

The referral rate is comparable to that reported in international screening programs, higher in males. The ECG was the commonest reason for referral. The overall diagnostic yield equates to 2.7%, while 1.0% were given a diagnosis linked to SCD. The higher diagnostic yield in this population highlights the importance of raising awareness about heart disease and PPE in young athletes.
Association between dietary phytochemical index and cardiometabolic risk factors
Authors: Gamba M , Roa Diaz Z M , Raguindin P F , Glisic M , Bano A , Muka T , Franco O H , Marques-Vidal P
Published: May 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Swiss National Science Foundation.

Background

Consuming plant-based diets have been associated with reduced cardiometabolic risk factors (CRFs), which might be partly mediated by their high phytochemical content and the synergistic action of these bioactive compounds. Nevertheless, dietary phytochemical content estimation is difficult. The dietary phytochemical index (DPI) has been proposed as a practical way to assess the total dietary phytochemical content from phytochemical-rich foods (PRFs).

Purpose

This study aimed to evaluate the association between DPI with CRFs.

Methods

Cross-sectional analysis within a population-based cohort study conducted between 2009-2012. The dietary intake was assessed via a validated food frequency questionnaire. DPI was calculated by dividing energy obtained from PRFs by total energy intake and multiplying by 100. Multivariable linear regressions were applied to establish the associations. CRFs included anthropometric measures, blood pressure, insulin resistance and diabetes markers, dyslipidemia markers, and cardiovascular/inflammatory markers.

Results

3879 participants (mean age 57.6±10.4 years, 53.5% women) were included. The median DPI value was 25.5 (interquartile range: 17.7–34.6). In multivariable-adjusted linear models, significant inverse associations were observed in the highest DPI quartile for body mass index -0.86 (-1.26,-0.46), waist circumference -2.91 (-3.99,-1.84), leptin -0.21 (-0.30,-0.12), insulin -0.09 (-0.14,-0.04), and high-sensitivity C-reactive protein -0.20 (-0.29,-0.11). No other associations were found CRFs.

Conclusions

A high DPI index representing a high intake of PRFs is associated with lower body mass index, waist circumference, leptin, insulin, and high-sensitivity C-reactive protein values.
Spatial analysis of 10-year predicted risk and incident cardiovascular atherosclerotic diseases in a swiss urban population
Authors: Jordan G , Ridder D , Guessous I , Joost S , Vollenweider P , Marques-Vidal P , Vaucher J
Published: May 2023

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Swiss National Science Foundation GlaxoSmithKline.

Introduction

Whether cardiovascular risk score geographically aggregates and informs on spatial development of atherosclerotic cardiovascular disease (ASCVD) remains unknown.

Aims

We first determined the spatial distribution of cardiovascular risk predicted in an urban population. Second, we compared risk maps with clustering of incident ASCVD over a 10-year follow-up. Sensitivity analyses were conducted to identify explanatory risk factors for both clusters of predicted risk and observed ASCVD.

Methods

Using data from a population-based cohort study, we computed the Systematic Coronary Risk Evaluation Score 2 (SCORE2 and SCORE2-OP) in participants free from ASCVD at baseline (2003-2006). Geographical distributions of predicted risk and incident ASCVD were determined using global and local spatial autocorrelation statistics. Different models were tested to identify explanatory variables (alcohol consumption, body mass index, socio-economic status, anxiety disorder, major depressive disorder, Mediterranean diet, sport activity, polygenic risk score, mean noise, concentration of PM2.5, normalized difference vegetation index, land surface temperature).

Results

6203 individuals (56% women, mean age 52.5 ± SD 10.7) with a median follow-up of 10 years (IQR, 6-10) were included in the analyses. Over the period, there was persistent geographical clustering of predicted risk and ASCVD (Figures 1 and 2). Predicted risk and incident ASCVD marginally overlapped spatially. Body-mass index (BMI) and alcohol consumption explained most of the spatial distribution of predicted risk, reducing high-risk clusters from 286 to 5 and low-risk clusters from 391 to 44. For ASCVD, high clusters either persisted or were reinforced depending upon locations, after adjustment for potential risk factors, with an increase from 100 to 118. Low clusters reduced from 293 to 76 after the adjustment. Incidence rate of ASCVD was 2.5% (IC95%, 3.7-2.4%]) in high-risk clusters compared to the rest of the population.

Conclusions

Using a population-based cohort, we showed that in an urban area there exists clusters of high and low incidence of ASCVD. Geographical distribution of clusters of high clinical risk score was not congruent with that of incident ASCVD, limiting the use of clinical risk scores in identifying areas where ASCVD may develop.
Interest of ergospirometry in the management of thoracic oncology surgery
Authors: Forton K , Lamotte M , Gillet A , Pennequin P , Vander Kuylen M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

A cardiopulmonary exercise testing (CPET) is recommended before a resection of a primary pulmonary nodule by surgical approach for patients at risk (with abnormal spirometry). The maximal oxygen consumption measurement (VO2max) evaluates the morbidity/mortality and allows to orient the surgical choice towards a lobectomy or a cuneiform resection. However, the VO2 max can be influenced by some parameters as patient’s motivation, overweight, ….

Purpose

The objective of this work is therefore to identify other complementary predictive factors of cardiopulmonary exercise test (CPET) in at-risk patients population with abnormal pulmonary function tests.

Methods

211 subjects who underwent thoracic surgery for non-small cell lung cancer (NSCLC) between 2016 and 2020 at Erasmus Hospital and performed a CPET were analyzed and divided into 2 groups (G1 At Risk: n = 159: 10 mL/min/kg < VO2max < 20 mL/min/kg; G2 Control: n = 52: VO2max ≥ 20 mL/min/kg). Anthropological, biometric, clinical, and intraoperative data were collected based on the medical record.

Results

The risk group (G1) had a reduced VO2max associated with a higher VE/VCO2 slope. However, the 30-day and 1-year mortality as well as the number of minor and major complications were comparable to the control group (G2) because of the screening and the operative choices.

All groups combined, VO2max was predictive of major complications (OR = 0.98, p = 0.04) and VE/VCO2 slope emerged as a predictor of total and minor postoperative complications (OR = 1.07, p = 0.0054 and respectively OR = 1.05, p = 0.046). Patients with a slope ≥ 34.5 had a higher incidence of total complications (OR = 3.16, p = 0.0004).

In a subgroup with medium operative risk (VO2max between 15 and 20 mL/min/kg), VE/VCO2 slope was predictive of total complications (OR = 1.09, p = 0.02) whereas VO2max was predictive of major complications (OR = 0.97, p = 0.04).
Aspirin and statin use in primary prevention after coronary artery calcium score
Authors: Parada Barcia J , Manuel Barreiro Perez M B P , Pablo Pazos Lopez P P L , Tatiana Matajira Chia T M C , Maria Sol Bravo Amaro M B A , Francisco Calvo Iglesias F C I , Inmaculada Gonzalez Bermudez I G B , Luis Dominguez Rodriguez L D R , Pablo Dominguez Erquicia P D E , Andrea Lizancos Castro A L C , Andres Iniguez Romo A I R
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

A coronary artery calcium (CAC) score of more than 100 places the 10-year cardiovascular risk above 7.5%, justifying the initiation of pharmacological measures in primary prevention.

Purpose

The present study explores the level of implementation of a primary prevention strategy after CAC score in patients without obstructive coronary disease.

Methods

The study cohort included all patients from the health area of our city (Galicia, Spain) who underwent a coronary computed tomography (CT) scan between July 2021 and February 2022. Subjects with obstructive coronary disease (CADRADS 3 or higher), atrial fibrillation patients and inconclusive studies were excluded. The final population of the study consisted of 209 patients. The sample was classified according to Agatston Score into three groups: no calcification (CAC=0), non-significant (CAC 1-100), and significant calcification (CAC >101). Multinomial and binomial logistic regression were performed to identify the predictors associated with the prescription of statin and aspirin, respectively.

Results

41 patients (19.62%) had significant calcification (CAC >101). Of those, 16 (39.02%) started aspirin and 21 (51.22%) started statin (Figure 1). The CAC score allowed to increase the percentage of patients who benefited from lipid-lowering treatment, from 31.70% to 82.92% (Figure 2). Significant differences were observed in the proportion of patients who initiated aspirin and statins according to the degree of coronary calcification (Chi2 18.76; p=0.000), (Chi2 48.42; p=0.000) respectively. After multivariate adjustment, a CAC score >100 (OR 5.88 (2.29-15.07; p=0.000) and the presence of vulnerable plaque (OR 6.78 (1.01-47.46; p=0.050) were the only predictos which led clinicians to start antiplatelet therapy. Neither age, nor SIS (segment involvement score) were associated. Regarding to lipid-lowering therapy, CAC score 1-100 (OR 5.87 (1.68-20.51; p=0.006) and CAC score >100 (OR 30.78 (5.08-186.47; p=0.000) were independently associated with statin prescription.

Conclusions

The use of coronary CT allows optimization of the therapeutic strategy in primary prevention, increasing the percentage of patients who may benefit from statins. In this setting, aspirin is little established in our cohort. Therefore, we should transmit to the clinician the possibility of starting antiplatelet therapy, individualizing the indication.
Evaluation of the eye findings of young male patients diagnosed with acute coronary syndrome compared to healthy individuals by optical coherence tomography angiography
Authors: Sahin A , Sertdemir A L , Icli A , Baloglu R , Satirtav Akdeniz G , Kesriklioglu S
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

It was aimed to evaluate retinal microvascular functions in optic coherence tomography - angiography (OCT-A) as a marker of atherosclerotic risk in young male patients followed up with Acute Coronary Syndrome (ACS).

Methods

This is a prospective study conducted in patients followed in our clinic with the diagnosis of ACS. Thirty male patients diagnosed with ACS and 30 healthy controls were included in the study. The patients in the ACS group underwent eye examination within the first 72 hours and selected parameters of the macular and circumpapillary vasculature, including macular vessel densities, foveal avascular zone, optic disc, were measured using OCT-A. The same measurements were made for those included in the similar age group in the control group and analyzed.

Results

In OCT-A measurements, the superficial and deep capillary plexus densities were found to be low in the ACS group, and the low superficial capillary plexus (SCP) density, especially in the perifoveal region, was noted (49.9-52.2, p:0.008). In addition, the foveal avascular zone was found to be higher in the ACS group (0.27-0.24, p:0.039). As expected, HDL values were lower and WBC and neutrophil values were higher in ACS patients (p<0.001). In addition, left ventricular ejection fraction (LVEF) was significantly lower in the ACS group compared to the control group (LVEF: 49.7%-63.1%, p<0.001, respectively).

Conclusions

Our results support the negative effects of atherosclerosis on retinal microvasculature in the newly diagnosed ACS group without known comorbidity and eye problems. Based on these findings, it was thought that the use of OCT-A in ophthalmic screening may be useful in predicting the atherosclerotic process.
Predictors of success of elective electrical cardioversion in patients with atrial fibrillation and atrial flutter
Authors: Aguila Gordo D , Piqueras Flores J , Martinez Del Rio J , Negreira Caamano M , Mateo Gomez C , Soto Perez M , Cubides Novoa A F , Jimenez Diaz J , Moron Alguacil A , Andres Sierra M , Concepcion Suarez R , Freites Esteves A , Jimenez Rubio B , Blanco Lopez E , Soto Martin P
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Electrical cardioversion is an effective therapy for the restoration of sinus rhythm. The success of cardioversion has been related to different clinical and echocardiographic variables, although the available evidence is scarce and heterogeneous.

Methods

Ambispective, observational, single-center registry that consecutively included 271 patients scheduled for elective electrical cardioversion (ECV) on the inpatient ward for atrial fibrilation (AF) or flutter fibrilation (AFL) >48 hours of onset during the years 2018-2021. All patients scheduled for CVE that were ultimately discontinued on the day of the procedure were excluded, finally analyzing 244 patients.

Results

The baseline characteristics are shown in Picture 1. No statistically significant differences were observed in the main comorbidities, cardiovascular risk factors, CHAD2S2-VASc scale, the position of the paddles, or days to ECV between patients with successful ECV and those with a failed procedure. Neither were they observed in terms of pharmacological treatment, including the presence of previous antiarrhythmic treatment as part of a facilitated ECV strategy (Picture 2). Moderately-severely depressed systolic function and the presence of moderate-severe mitral regurgitation were associated with a higher rate of cardioversion failure (3% vs 2.6% p= 0.002; 3.3% vs 1.3% p=0.001), higher number of biphasic electric shocks (1.3 vs 1.6 p<0.001; 1.2 vs 1.6 p<0.001) and higher total voltage received (245J vs 310J p=0.32; 229J vs 325J p<0.001). Moderate-severe tricuspid regurgitation was also associated with lower cardioversion success rate (96.7% vs 85% p=0.02) although no differences were seen with respect to the number of shocks or energy received. On the other hand, severe left atrial dilatation, although it had a neutral impact on the success of ECV, was associated with greater immediate recurrence (<5 minutes after ECV) (4.2% vs 50% p<0.001).

Conclusion

Patients with moderate-severe systolic dysfunction and significant mitral and tricuspid regurgitation have a lower success rate of ECV. Previous antiarrhythmic therapy presents a neutral effect on sinus rhythm restoration and immediate recurrence.
Trends in glycemic, blood pressure, and lipid control in adults with diabetes in Switzerland
Authors: Alkandari A , Marques-Vidal P
Published: May 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Swiss National Science Foundation, GlaxoSmithKline, Faculty of Biology and Medicine of Lausanne.

Introduction

Good glycemic, blood pressure and lipid control in adults with diabetes reduces complications and improves health outcomes, particularly when achieved simultaneously. Therefore, regular monitoring and successfully achieving control targets are essential in diabetes management.

Purpose

To assess the 15-year trends in the level of glycemic, blood pressure and cholesterol control in adults with diabetes in Switzerland.

Methods

Data from a population-based cohort study of 6,733 adults aged 35-75 years in Switzerland was analyzed. Baseline recruitment in 2003-2006 was followed by three subsequent follow-ups between 2009-2012, 2014-2017 and 2018-2021. In adults with diabetes, glycemic control was defined as fasting plasma glucose <7 mmol/L, blood pressure control as systolic and diastolic pressures of <140/90 mmHg, and non-HDL cholesterol control <3.4 mmol/L.

Results

Rates of glycemic control improved from 23.2% (95% CI, 19.5-27.3) in 2003-2006 to 32.8% (95% CI, 28.1-37.8) in 2018-2021. Blood pressure control also improved, from 51.5% at baseline (95% CI, 46.8-56.2) to 63.3% (95% CI, 58.2-68.1) 15 years later. The largest improvement was in non-HDL cholesterol control, from 29.1% (95% CI, 25.1-33.6) in 2003-2006 to 56.3% (95% CI, 51.1-61.4) in 2018-2021. Overall, simultaneous control of all three improved from 5.5% (95% CI, 3.7-8.1) at baseline to 17.2% (95% CI, 13.7-21.5) 15 years later. Improvements in risk factor control was accompanied by increases in the use of glucose-lowering agents, blood pressure-lowering medication and statins. Men were less likely to achieve blood pressure control but were more likely to achieve non-HDL cholesterol control. Caucasians were less likely to achieve simultaneous control than non-Caucasians.

Conclusion

Risk factor control in Swiss diabetes patients has improved in the last 15 years.
Lipoprotein (a) cholesterol burden predicts atherosclerotic risk in patients with elevated lipoprotein a
Authors: Vanderboom P , Baudhuin L M , Spears G M , Hartman S J , Somers V K , Berger P B , Mcconnell J P , Jaffe A S , Vasile V C
Published: May 2023

Funding Acknowledgements

Type of funding sources: Private hospital(s). Main funding source(s): Mayo Clinic Department of Laboratory Medicine and Pathology.

Background

Elevated lipoprotein(a) [Lp(a)] is associated with increased risk for atherosclerotic cardiovascular disease (ASCVD). Treatment of patients with elevated Lp(a) usually includes marked reduction in low density lipoprotein cholesterol (LDL-C). However, there are uncertainties about whether all increases in Lp(a) are equivalent in there risk relationship.

Purpose

The aim of this investigation was to risk stratify patients with elevated Lp(a) mass [Lp(a)-M] based on Lp(a) cholesterol (Lp(a)-C) measurements. We assessed coronary artery disease (CAD) by coronary angiogram and major adverse cardiac events (MACE) in a cohort of patients with elevated Lp(a) mass (≥30mg/dL) over a 15 year followup.

Methods

Electrophoretic and immunologic assays were used to measure Lp(a)-C and Lp(a)-M, respectively. Univariate and multivariate logistic regression analysis was employed to test for association between Lp(a) and CAD in a cohort patients with elevated Lp(a)-M (≥30mg/dL). The relationship between Lp(a) and time to major cardiac events was evaluated using cox regression analysis. Receiver operator curve (ROC) analyses were used to identify optimal cutoff values for Lp(a)-M and C for predicting CAD in our model.

Results

We analyzed 179 patients with elevated Lp(a)-M. Cutoff values of 3.3mg/dL for Lp(a)-C and 42.1mg/dL for Lp(a)-M optimally predicted CAD in an ROC analysis. Of these patients, 84 were found to have Lp(a)-C < 3.3mg/dL (low Lp(a)-C), while 95 patients had Lp(a)-C levels ≥ 3.3mg/dL (high Lp(a)-C). High Lp(a)-C was associated with CAD identified on coronary angiography in univariate (OR = 2.17, 95% CI = 1.18 – 4.00, p = 0.013) and multivariate (OR = 3.36, 95% CI = 1.64 – 6.89, p < 0.001) models controlling for traditional risk factors. In univariate analyses high Lp(a)-C was also associated with MACE (HR = 2.38, 95% CI = 1.19 – 4.75, p = 0.01) while Lp(a)-M ≥ 42.1mg/dL (high Lp(a)-M) was not (HR = 1.68, 95% CI = 0.82 – 3.44, p = 0.15) (Table 1, Figure 1). Lp(a)-C remained significantly correlated with MACE after adjusting for traditional risk factors. When included in a model together, Lp(a)-C maintained its significance while Lp(a)-M failed to predict MACE, indicating that Lp(a)-C is a stronger predictor of MACE than Lp(a)-M.

Conclusion

This study demonstrates that patients with elevated Lp(a)-M and high Lp(a)-C are approximately 2.5 times more likely to encounter MACE over time when compared to patients with elevated Lp(a)-M and low Lp(a)-C. Our investigation suggests that Lp(a)-C can be used to risk stratify patients with elevated Lp(a)-M and identify those at higher risk.
History of heart failure in patients with acute coronary syndrome: population characterization and impact on prognosis
Authors: Carias M , Paralta M , Almeida A , Claudio F , Rocha R , Picarra B , Bento A , Trinca M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Patients with Heart Failure (HF) usually have multiple co-morbidities, so their approach in the context of Acute Coronary Syndrome (ACS) could be an important challenge.

Purpose

To characterize patients with ACS and previous HF and evaluate its impact on the therapeutic approach, complications and in-hospital mortality.

Methods

We studied 745 patients admitted to a Cardiac Intensive Care Unit with a diagnosis of ACS. We considered 2 groups: patients with previous HF and patients without a previous history of HF. Age, gender, personal history, clinical and electrocardiographic presentation of the ACS, treatment at admission, left ventricular ejection fraction (EFj), coronary angiography and angioplasty were recorded. The following in-hospital complications were defined: heart failure, cardiogenic shock, need for invasive mechanical ventilation (IMV), re-infarction, mechanical complications, sudden aborted death, stroke and major hemorrhage. In-hospital mortality was compared between both groups.

Results

Patients with previous HF constituted 7.1% (53 patients) of the population studied. These were older (77.3 ± 8.9 vs 66.6 ± 13.6, p<0.001), a higher prevalence of arterial hypertension (88.7% vs 76.2%; p=0.03), of myocardial infarction (50.9% vs 24.3%, p<0.001), coronary artery bypass graft surgery (18.9% vs 5.2%, p<0.001), valvular disease 22.6% vs 1, 4%, p<0.001), peripheral arterial disease 22.6% vs 5.1%, p<0.001), chronic renal failure (41.5% vs 10.1%, p<0.001), chronic lung disease 22.6% vs 4.2%, p<0.001 and hemorrhage (9.6% vs 1.8%, p<0.001). Patients with HF presented more frequently with AMI without ST elevation (62.3% vs 45.7%; p<0.001) and infarction of undetermined location (26.4% vs 4.6%, p=0 .02) and Killip-Kimbal class ≥ 2 (64.2% vs 16.8%, p<0.001) and less with ST-elevation AMI (5.7% vs 42.5%, p<0.001) and pain (58.5% vs 87.7%, p<0.001). On admission, patients with previous HF underwent fewer coronary angiograms (56.6% vs 86.7%, p<0.001) and via the radial approach (53.6% vs 79.0%, p=0.001)5.7%, p<0.001), and less angioplasties (32.1% vs 68.7%, p<0.001). The presence of HF was associated with lower EFj (40.9 ± 10.4% vs 48.2 ± 9.9%, p=0.004), with greater development of HF during hospitalization (47.2% vs 12, 4%, p<0.001), greater need for non-invasive ventilation (17.0% vs 2.2%, p<0.001) and higher in-hospital mortality (13.7% vs 4.8%, p=0.008).

Conclusion

The previous presence of HF seems to condition the clinical and electrocardiographic presentation of the ACS and is associated with greater development of HF and in-hospital mortality.
Effect of adjuvant trastuzumab for HER2 positive breast cancer combined with radiation therapy and anthracyclines on left ventricular function
Authors: Krstic I , Deljanin Ilic M , Pejcic I , Vrbic S , Marinkovic D , Stojanovic M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Although trastuzumab has benefits in treatment of HER2 positive breast cancer, its use is associated with an increased risk of cardiotoxicity.

Purpose

To assess the effect of adjuvant trastuzumab in HER2 positive breast cancer pts, in addition to prior radiation and antracyclines therapy, on left ventricular function.

Methods

Fifty HER2 positive female breast cancer patients (mean age, 59.57±9.6 years) were enrolled in the study. In all patients (pts) left ventricular left ventricular ejection fraction-LVEF(%) and left ventricular mass – LVM (g) were assesed at the beginning and after the therapy with trastuzumab. All pts were on sequential therapy with anthracyclines (IV cycles) within the FAC regimen (fluorouracil 500 mg/m2, doxorubicin 50 mg/m2, cyclophosphamide 500 mg/m2) on day 21, and after that followed with trastuzumab (6 mg/kg of body weight on day 21) for the period of one year. The pts are divided in two groups: the group of patients (N=32 pts) who had prior radiation therapy (25 daily sessions of 2 Gy dose each, up to the total dose of 50 Gy) and group without radiation therapy (N=18).

Results

After completion of trastuzumab therapy pts who underwent radiation therapy, reduced LVEF by 2.24 % (from 66.58 ± 5.36 % to 64.34±7.34 %; p=0.048) and increased LVM by 17.95 g (from 160.38 ± 46.21 g to 178.33 ± 53.14 g; p=0.018) . The group of pts without radiation therapy, reduced LVEF by 0,72 % (from 63.33±7.60 % to 62.61±6.92 %; p=0.979) and increased LVM 23.34 g (from 141.98±35.82 g to 165.32±47.45 g; p=0.062).

Conclusion

The results of the study showed that the decline of LVEF and increase of LVM after completion of adjuvant trastuzumab therapy for HER2 positive breast cancer iz related with previous prior radiation administration. The pts with radiation had greater reduction of LVEF and increase of LVM than those without radiation.
Impact of cardiac rehabilitation programme in patients older than 65 and 75 y.o
Authors: Coto Morales B , Delgado Cavia F A , Basabe Velasco M E , Gomez Sanchez M I , De Juan Bitria C , Marschal A F , Duarte Torres J , Biscotti Rodil M B , Marti Sanchez D , Fuertes Pereira J , Casanova Lopez M P , Molinos A C , Rodriguez Biedma M F , Rodriguez Gamero M A , Alvarez Anton S A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Initially cardiac rehabilitation programmes excluded the eldery, but over the time it has been shown that the benefitial effects are maintained regardlees of age. However, many programmes still exclude older patients. Our objetive is to characterize and evaluate the impact of our cardiac rehabilitation programme on patients older than 65 and 75 y.o.

Method

Prospective observational study of all consecutive patients during the 2021 period who entered the Cardiac rehabilitation Programme of our centre. Inclusion criteria: 1- > 65 y.o. 2-Informed consent signed 3- Adecuate ergometer/cicloergometer adaptability. We evaluated the impact before and after the programme perfoming analysis by age subgroup (65-74 and >75). Statistical analysis was performed for cuatitative variables and paired samplesusing the Wilcoxon test. For cualitative variables, Fisher´s test / Chi-square test and Student´s T-test for age subgroups.

Results

During 2021 140 patients were included incardiac rehabilitation programa, 70 (50%) of the older than 65 y.o. The main results of this 70 patients are pressented in Table 1. The main age of the group was 75 /- 5 y, only 22% were women. High prevalence of risk factors (77%HTA, 63% dyslipemia, 36% diabetes). The main reason for incusion is ischemic cardiomiopaty. The main parameters of improvement after the intervention were: functional capacity (measured int METS), minutes of exercise on ergometer test and LDL control, wich was maintained after analysis by age subgroup (65-74 and >75).

Conclusions

Cardiac rehabilitation brings improvement to patients older than 65y.o y and older than 75 y.o., without differences in the improvement between both age groups.

It is necessary to increase efforts to indicate cardiac rehabilitation programs to older adults to favor their self-care capacity and adherence to healthy life styles, in addition to improving exercise capacity and quality of life.
Eicosapentaenoic acid (EPA) treatment increased the ratio to arachidonic (EPA/AA) and reduced adhesion molecule expression in vascular endothelium during inflammation
Authors: Sherratt S C R , Libby P , Bhatt D L , Mason P
Published: May 2023

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Amarin Pharmaceutical, Inc. Elucida Research LLC.

Background

Omega-3 fatty acid (n3-FA) treatment reduces cardiovascular (CV) risk in relation to circulating EPA/AA ratios. Treatment with icosapent ethyl (IPE), a highly purified EPA formulation, increased the EPA/AA ratio in treated patients (MARINE, ANCHOR). Unlike mixed n3-FA formulations, IPE reduced a composite of CV events in high-risk patients (REDUCE-IT) in relation to on-treatment EPA levels. These benefits of EPA may result in part from effects on vascular endothelial function and fatty acid content during inflammation.

Purpose

We measured the effect of EPA on human endothelial cells (HUVECs) during inflammatory activation, monitoring the release of soluble intercellular adhesion molecule-1 (sICAM-1) and changes in fatty acid content.

Methods

HUVECs were challenged with IL-6 (12 ng/mL) for 2 hours and then treated with EPA (40 µM) or vehicle for 24 hours. Total protein content was measured in cell lysates. Total fatty acids were extracted and derivatized using methanol containing 14% boron trifluoride to form fatty acid methyl esters (FAME). Gas chromatography measured total fatty acid content from C14-C24 and normalized to total protein. Levels of sICAM-1 were measured in cell supernatant using immunochemistry.

Results

EPA treatment increased the EPA/AA ratio by >20-fold compared to IL-6 treatment alone (1.55 ± 0.11 vs. 0.07 ± 0.003, p<0.001). The increased EPA/AA ratio correlated with EPA and docosapentaenoic acid (DPA) levels in lysates, which increased by 19-fold (26.71 ± 1.28 vs. 1.28 ± 0.05 mg/g protein, p<0.001) and 4-fold (29.42 ± 1.91 vs. 6.17 ± 0.36 mg/g protein, p<0.001), respectively, compared to IL-6. While IL-6 treatment increased sICAM-1 release (83%, p<0.001), subsequent treatment with EPA reduced sICAM-1 release by 39% (p<0.001).

Conclusion

In human ECs, EPA increased the EPA/AA ratio along with other n3-FAs under conditions of inflammation. Changes in the EPA/AA ratio correlated with reductions in sICAM-1 release with IL-6 exposure. As on-treatment EPA levels predict reduced CV risk, these direct vascular benefits of EPA may contribute to reduced CV risk observed in outcome trials.
Physical activity levels and sedentary behaviour pattern in cardiovascular disease patients attending a community-based phase III CR program
Authors: Ribeiro M , Sa G , Borges M , Pires M , Pinto F , Abreu A , Pinto R
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

Cardiovascular rehabilitation (CR) programs are an effective component of recovery from cardiac events or revascularization procedures. The CR recommendations advise that cardiovascular disease (CVD) patients must be encouraged to improve their physical activity (PA) levels to meet the current guidelines. However, the sedentary behaviour (SB) in this population remains high during and following standard CR programs. Furthermore, SB targets and recommendations are still lacking and undefined.

Purpose

To characterize the pattern of SB and PA levels in CVD patients admitted to a community-based phase III CR program and after 12 months.

Methods

This retrospective cohort study included a total of 124 CVD patients admitted to a community-based phase III CR program (3 supervised exercise sessions/week). PA and SB were measured using accelerometers at baseline (M0) and after 12 months (M1). Outcome measures were minutes spent in light PA, moderate PA, vigorous PA, moderate to vigorous PA (MVPA) and SB, where the number of breaks/day was assessed (interruption in sedentary time of at least 1 minute).

Results

Eighty CVD patients (62±9 years; 83.8% male; 89% with coronary artery disease) completed all assessments. After one year intervention, minutes of MVPA decreased from 51±28 mins/day to 45±25 mins/day (p=0.021), despite the majority of patients (80%) targeting PA recommendations and 46.3% reaching more than 300 mins/week of MVPA. Light PA did not change from 3.0±0.8 hours/day to 2.8±0.9 hours/day (p=0.058) and SB remained high (M0: 11.1±1.3 hours/day vs M1: 11.0±1.4 hours/day, p=0.674). Our results showed that SB time was less fragmented in terms of number of breaks after one year (M0: 107±64 breaks/day vs M1: 92±29 breaks/day, p=0.030) and the difference in these SB periods did not change (p=0.201).

Conclusion(s)

Patients attending a CR long-term program kept their PA levels on target after one year intervention. The SB time remained high and there was a decline in number of breaks per day. Despite the aim to improve PA behaviour, our findings highlight the need to additionally address personalized interventions focused on changing the amount and distribution of SB.
Effects of the 2019 guideline-update on lipid therapy in patients with acute coronary syndromes
Authors: Galli L , Schrutka L , Haider P , Distelmaier K , Wojta J , Hengstenberg C , Krychtiuk K , Speidl W
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): 2 Ludwig Boltzmann Institute for Cardiovascular Research.

Background

The European Society of Cardiology regularly updates its clinical practice guidelines. However, it is not well established whether guideline-changes have significant effects on actual clinical practice. Therefore, we retrospectively analyzed lipid therapy at discharge after acute coronary syndrome (ACS) in a one-year period until 3 months before and a one-year period starting 6 months after publication of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias, respectively.

Methods and Results

In total we included 702 patients that were discharged alive after treatment for ACS. 360 patients were treated in the period before and 342 were treated in the period after guideline change. 67.7 % of patients were male and 59.1% were treated for ST-elevation myocardial infarction (STEMI). After guideline change the proportion of patients that were discharged on high dose statin was significantly higher as compared to the period before the new guidelines were published (89.2 % vs 79.2 %; p=0.001). Ezetimibe was prescribed more often after the new guidelines (15.0 % vs 3.0 %; p<0.00001). Whereas proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) were not prescribed at discharge in the earlier period, five patients were discharged on PCSK9i in the later period. The higher proportion of ezetimibe use and the introduction of PCSK9i resulted in an increased number of patients on high intensity treatment (high dose statin or moderate dose plus ezetimibe or PCSK9i: 92.4 % vs. 79.7 %; p<0.0001) in the period after the new guidelines. In 32.3 % of patients, cholesterol levels were available for the time period between one month and one year after discharge. Median on treatment LDL was significantly higher in the period before (64.4 IQR 47.4 – 94.2 mg/dL) than after the publication of the 2019 guidelines (46.2 IQR 33.8 – 61.8 mg/dl; p<0.00001).

Conclusions

The update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias was associated with a significant improve in the proportion of high dose statin and ezetimibe treatment in patients after ACS resulting in a significant lower LDL plasma level in a subgroup of patients. The change of these guidelines rapidly translated into clinical practice resulting in improved risk factor control in high-risk patients.